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HomeMy WebLinkAboutMiscellaneous - 94 SHERWOOD DRIVE 4/30/2018N O CD cn � A CT 2 n m o 0 0 v 0 0 0 ;a 0 < O m Date ... .��...�..�!- ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING JR $4C1US�S4 Thiscertifies V v z!^ V �� that ....... ................................. . ... .................................................................... has permission to perform .... .... ,ie �'Q.Q. ........................................................ ..... plumbing in the buildings of ....... )Q ........................................................................ at.........`..��..................................................................................... North Andover, Mass. Fee.( -,,X).'..22 .... Lic. No. �..�.?.�..�.�.. �......................................................................:... t PLUMBING INSPECTOR Check # . iIs� 411 t A�1- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK VCITY _ I) t� MA DATE %/ / / PERMIT # JOBSITE ADDRESS LeVUOWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL Q RESIDENTIAL IZ PRINT CLEARLY NEW: © RENOVATION: 9 REPLACEMENT: E] PLANS SUBMITTED: YES[] NO® FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM ®� DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL ,SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER J INSURANCE COVERAGE: I have a current liabilit.v insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [3 OTHER TYPE OF INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER[_—] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application . true and accurate to the best of my knowledge and that all plumbing work and installations perfom5ed under the permit issued for this application will be in c p igippe with al Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Nicholas Sawas LICENSE # 15234-M ' -SIXATUKE MPEJ JP® CORPORATION#®PARTNERSHIP®#®LLC [I# COMPANY NAME I Nicholas Sawas ADDRESS 11A Ma Jo Lane CITY De STATE NH ZIP 103038 TEL 9788043303 FAX CELL 978803303 EMAIL 1clearwaternsavigmail.com CE r O z z 0 H ti o El z z E] o � w �D W O W aLU z w Q W W O a a O L LU O zz a W t- � a U J CL CL Q v' U w x w w W E•+ O z z O H U W A4 z oa a Cx7 O The Commonwealth of Massachusetts q� Department of Industrial Accidents s Office of Investigations ri 1 Congress Street, Suite 10d Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nicholas Sawas Address: 11A Mary Jo Lane Derry, NH 03038 Phone #:9788043303 Are you an employer? Check the appropriate box: 1. FNI I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions I I.X Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Hartford Policy # or Self -ins. Lic. #: 76 WEG GD3975 Expiration Date: 2/15 Job Site Address: 7 y ,4'X�)W, City/State/Zip:XkA A, "/ ac, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of Investigations of thADIA for insurance coverage verification. Ido hereby c fy Aider the pains and penalties of perjury that the information provided above is true and correct. Si ature: �1// �C-�%9/% Date: l/ //�('/ t ty Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 1.52, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be. sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit' -indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: _ The Commonwealth of Massachusetts , Department of Industrial. Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877'-MASSAFE Fax # 617-727-7749 Revised 7-2013 www.mass.gov/da �' r t i Date.... . .... 1................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................................ ............................................ t has permission to perform .......�.�.'..M ...... 0 ........ wiring in the building of—..44.c�.. ................................................................................ at-, . ...... .... Ve..k .............. 49orth Andover, M ss. . I � 60 Fee.... ,4 P .............. Lic. No. . 1..... ....... ......... L .... .......... h, ELECTRICAL NSP CTO Check # lMorunoturt� o rt3e& Official Use Only 2eparz`isw9o15hre Serulcea Permit No. _ 17j�7,1 J. BOARD OF FIRE PREVENTION REGULA i IONSo71 v 10and Fee Checked (leave blanc:) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WA ORK All %vorl, to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 �PASPRrvTf OR T.FE� NFOxn"MA9 Date. 6ld01 y City or 'down of _,V0� t/P/ To the I7spectof- of Wires: By this application the undersigned gives notice 6fhis or her intentio to perform the electrical work descnbed below. Location (Street & Numb,er) 9 c /C�/rit/� 77 Owner or 'Tenant Owner's Address Is this permit in c Purpose of Buildh Existing Service Amps I Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undggd ❑ Number of Feeders and Ampacity No. of dieters No. of i Zeters Location and Mature of Proposed EIectricai Worls: �j �y� (� 'Vtll �r;�g j- g__ �q No. of Recessed Luminaires I {6{{Vl{ V {.{c u{unvttr No. of Cell.-Susp. (Paddle) a ars more mau oe wanrea v , fire !n ector of 1f'ires Of Total Transformers I£VA No. of Luminaire outlets No. of Hot rubs Generators WIA No. of Luminaires swian g 6T01 •above I]: -- Q 1itl. moi' id. o. o mergency ._ Its tang 3atte 'units ` No. of Receptacle Outlets No. of Oil Burners FIRE ALAR VIS Into. of Zones No. of Switches No. of Gas Burners 14M. of Detection and InitiatingDevices No. of Ranges No. of lair Cond. Tot, �No. of Alerting Devices No. of Waste (Disposers heat Ptiiaap Totals: Iumber Tons _ No. of Self -Contained Detection/4lertin Devices No. of (Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other i Cotnnecta©n No. of Dryers heating Appl?ances 7CW ecurity Systems:* No. of Henters No. of No. of Devices or Equivalent �V Si a Signs DBallasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Voters Total HP Telecommunications �Wirting:ent NO. of Devices or EQ uival OTHER: �"loa� +-- .v1�,�-- res �-r n..uur UUUMUeieu Guru" J aesrrea, OrOS required kit the Inspector oflf'fres. Estimated Value of Electrical Work: J�.Q0 (When required by municipal policy.) Work t, (Start: & o k ( Inspections to be requested in accordance with 1v1EC Rule 10, and upon completion. INSURANCE COVERAGE- -. Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The underslgied certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I cet�i, jy, under the pauis and penalfies of pet', jug, that Lite bIrormailon Oft this appllcaflon is true and completes FIRIMNAME: -,C'h C_ LIC. NO.- 41 ?/'3 Licensee: v •� U'7 Signa`fire -- ,' LHC. filo.: (((applicable, e r "erre pt" in fire license number 1' e.} Bus. Tel. Ptlo.: Address: _-moo 7ak. 7 �! r� ��� ,;: o/ fY9 us9_4 70 . Tel. No.: 97X -9-,f.2^ J -Z;.7/ *Per iVi.G.L. c. 147, s, 57-61, security work requires Department of Public Safety "S" License: Lic. No. GQ OWNER'S INSURANCE W411+IER: I am aware that the Licensee does nor have the liability insurance coverage normally required by Iaw. By my signature below, I hereby waive this requirement. 1 am the (check one) Elowner ❑ owner's agent. Owner/Agent Signature n elepaone No. �� WT F,..E. S (a() . ��`�-e-19 I The Commonwealth of Massachusetts Print Form T =Departinent of Indushial Accidents s`=+� Office of Investigations { I Congress Street, Suite 100 Boston, MA 02114-2017 w -t www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le>Jiibly Name (Business/Organization/Individual): Address: /::�,y /,-;0 )( /)C7 City/State/Zip: i`1 i 10014-%^l Alf- &iYhone #: Are you an employer? Check the appropriate box: Type of project (required): 1. 0_1 am a employer with J— 4. ❑ 1 am a general contractor and I 6. [3 New construction employees (full and/or part-time). * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance required.] comp. insurance.+ 5. [] We are a corporation and its 10 JX Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance reQuired.l ,*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. L Insurance Company Name: Policy # or Self -ins. Lic. #: Qg (/i�G �'� %�7�p Expiration Date: ��da / ��!•�� Job Site Address: �% 7 r R/�/yfl City/State/Zip: /047 me yJ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of.MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of . Iltvestigafions of the DIA for insurance coverage verification. :do hereby certify 9derO pa' nd penalties ofpedury that the information provided above is true and correct //// Hml Phone #: Q 2 L 6 F247-70 Oficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: e CERTIFICATE OF USE &OCCUPANCY (� Town of North Andover Building Permit Number 1 3 S (7 Date I I j 1 111 & THIS CERTIFIES THT THE BUILDING LOCATED ON Lf+— 9 & I q1 56mooJ. D MAY BE OCCUPIED AS g� N.i ice. �A w►� �� Rft4"N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 1 gORTN 1 CERTIFICATE ISSUED TO I I I I aM81%rftiff OI� _� ADDRESS ,'SAC Building Inspector GN C\ r--4 2 uj LIM m o 1,5 0 z 0 Cl) 1.4 Ow v cw Ja- a 'Its rDcl v Li. ......... W4 uj LIM m o 1,5 wnm is - Location s No. Date t►GRTIy - -TOWN OF NORTH ANDOVER o?o.t...o .•,hoop Certificate of Occupancy ' $ Building/Frame Permit Fee $ 4 c►+ us C'°'tt�' Foundation Permit Fee $ s� .'Other Permit Fee $ Sewer Connection Fee d•, 0 . Water Connection Fee $ 7 f. TOTAL $ 14 9 3 tv r � - ildi , Ins actor 04/03/97 3. 2 082 x Tt i -: 9H6 �. Div.Pua(c Works Location C? t� No. .� 4 Date TOWN OF NORTH ANDOVER Certificate Certificate of Occupancy $ Building/Frame-Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ '�TV ©4/0S � 7 3 / Building InslActor �O. iii PAID Div. Public Works PEA31iI NO: " / ` APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAG MAP 4-40. 1�J�L+ LOT NO. 14— 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE p l SUB DIV. LOT NO. � t� Tln 0 QjU1l��P �� / _ 1 `!/ 13zsq 9(.P LOCATION 4 Shc��_,.x-ogZ2�uF PURPOSE OF BUILDING R �S OWNER'S NAME T"1mc�E��,.A��E�__ NO. OF STORIES Z SIZE 6 C/ OWNER'S ADDRESST . �`�C'�X_ "lC�`�) N• i�►Jpo�. BASEMENOR SLAB QWS_E_�MEdJT ARCHITECT'S NAME SL��L2 XAOmFS SIZE OF FLOOR TIMBERS ISTAx\,U. 2ND AXkO 3RD BUILDER'S NAME ��U�i�a��(`�'♦J� �LAG{.� SPAN 1-A---'Ptr DISTANCE TO NEAREST BUILDING 24/ DIMENSIONS OF SILLS XR' --- •' POSTS DISTANCE FROM STREET �^ DISTANCE FROM LOT LINES — SIDES 4% / REAR 1 � �I GIRDERS 4^ x 1�S o•cr AREA OF LOT A a/1 A A_ 1-1 FRONTAGE ,bQ HEIGHT OF FOUNDATION C9 f6- THICKNESS O IS BUILDING NEW 7 SIZE OF FOOTING 2 �( X 12 IS BUILDING ADDITION , ` AJ. MATERIAL OF CHIMNEY IS BUILDING ALTERATION \ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y 7 IS BUILDING CONNECTED TO TOWN WATER / BOARD OF APPEALS ACTION. IF ANY , ` IV IS BUILDING CONNECTED TO TOWN SEWER 10 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED Iq Q SIGNATURE OF OWNER OR AUTH6RIZED AGENT r PERMIT GRANTED /ice • .t `J - rim mvJaz . MAR 2 5 1997 3 PROPERTY INFORMATION LAND COST \ !'OK EST. BLDG. COST a oal& EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR 0 OWNER TEL. J/ CONTR. TEL. # ' A3Z— 01 v / CONTR. LIC. # H.I.C. # �lyfb l0 -2'73" .-_- �f:L �; z 1 OCCUPANCY SINGLE FAMILY �- ��_ �.•ii �""'� F6flilO �i SUPERIOR I� POOR ADEQUATE NONE STORIES MULTI. FAMILY 10 PLUMBING GABLE GAMBRELMANSARD FLAT _ OFFICES APARTMENTS BATH (3 FIX.) _ STEAM CONSTRUCTION 2 FOUNDATION SHED I 8 INTERIOR FINISH CONCRETE ` 3 1 2 I3 CONCRETE BL'K. KITCHEN SINK PINE SLATE NO PLUMBING BRICK OR STONE TAR & GRAVEL NO HEATING HARDW D _ ROLL ROOFING _ PIERS _ PLASTER TILE FLOOR TILE DADO _ DRY WALL _ _ _ UNFIN. K 3 BASEMENT AREA"II E 1/1 '/FIN IC AREA/1 FIN. ATTIC A HEAD ROOM _II MODERN KITCHEN_JY, 4 WALLS 1i 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCR)C �ETE _ WOOD SHINGLES EARTH ASPHALT SIDING HARD\!J'D _ ASBESTOS SIDING COMMCN 77X _ VERT. SIDING ASPH. TILE �J�= STUCCO ON MASONRY ---Ill STUCCO ON FRAME WIRING STONE ON FRAME I 1 1 HEATING �- ��_ �.•ii �""'� F6flilO �i SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD FLAT I 11 HIP BATH (3 FIX.) Z STEAM TOILET RM. (2 FIX.) STEEL BMS. & COLS. SHED HOT W'T'R OR VAPOR WATER CLOSET _ ASPHALT SHINGLES AIR CONDITIONING LAVATORY 7 NO. OF ROOMS WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL NO HEATING STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6 FRAMING I 1 1 HEATING �- ��_ �.•ii �""'� F6flilO �i WOOD JOIST PIPELESS FURNACE'Y FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING JL 7 NO. OF ROOMS RADIANT H'T'G UNIT HEATERS GAS- OILj ELECTRIC B'M'T 2nd 1st J 13rd I NO HEATING �.' c Ya _v, y One. _. CA CM) 10 0 CD a z y CD CL o CO), O CL = y a� 0 d o v CD d� O c=r %NC d CD CD o CD C O re CD CO y Co CD a v y O 'CD CD z O � • CD O CCD b ni I ac woo= o Swami, _ r ECSO .O CA m�aca m CA o ci Z ?lo Ni ? 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O ` 0 p 0 z " � >' - r m N m m N m 7 H> N C C C C A O= z Z 0 L O 14A p O O O O > -q i N +1 m Z i • m a a a a O o� Z a r 8 � O a w 0 0 0 0 2 i� z c A b c 0 Z Z Z O 3 O21 > A JAI r ;• C i O 0 O i O A < Z N N n ,t 1 N p p i 0 0 0- q A > 0 0 r I�+ b iI� rnn m Z Z A r A A s IY, ; r m " =N�, Z �° G� Z x V N Q W N � � A 0 111 m D V 9 l7` 1�sQ c�-� 1 m� h ee� i Hi<S :V ML) - .FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner.from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number.- Parcel Subdivision Lot(s) r% Street CJ+ Sh U-DOcJ 19- St. Number q4- ************************Official Use Only************************ RECOM EN ATI S OF OWN} AGENTS: . Date Approved _3110 77 Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Ins -ctor-Health Date Rejected Date Approved c Inspector -Health Date Rejected Comments ublic Works - sewer/water connections �� 3 -f 9-c/% driveway permits Fire.Department Received by Building Inspector MAR 2 5 1997 Date 7 7 v cf. Rio Ui4id VOW josipa L CCARR "no yAt t DISKS, XF, 03038 MR 2 5 1,997 P.O. BOX 907 TIMBERLAND BUILDERS NORTH ANDOVER MA. 01845 STEPHEN R. KARETA TO THE BUILDING INSPECTOR, DUE TO RECENT CHANGES IN OUR ORGANIZATION WE WOULD LIKE TO CHANGE ALL OF THE BUILDING PERMITS CURRENTLY OUT WITH TIMBERLAND BUILDERS TO REFLECT THAT ROBERT INNIS IS THE CONSTRUCTION SUPERVISOR ON ALL OF OUR PERMITS AND WORK SITES. ROBERT INNIS HAS A MASSACHUSETTS CONSTRUCTION SUPERVISORS LICENSE # vb$�339 THE PROPERTIES AFFECTED ARE: 158 FOREST ST. PERMIT NO# 604 10 JERAD PLACE LOT15A PERMIT NO# 444 44 SHERWOOD AVE LOT 2 PERMIT NO# 560 9.k,*-SHF,RWO033 A -VE �LOT-7, _--_ - PERMIT=NO#=P .xrnrNr; 93 SHERWOOD AVE LOT 13 PERMIT NO# 90 67 SHERWOOD AVE LOT 16 PERMIT NO# 603 IF YOU HAVE ANY QUESTIONS OR COMMENTS PLEASE DO NOT HESITATE TO CONTACT ME AT 508-557-5531 ' ••`°.`�r.• •���+ + �v vaear%inm MrrL.At•AjgUte r1JM 1'CttM11 lu uv rL_wavruus.. NORTH ANDOVER, Mase. Date BuQdlnpPenta= s�eRw 5. toeaifon_ o o Owners Name -T43e4 (ND Svc' 1 D e(I -3 New 1p_ Renovation ❑ Replacement ❑ Pians Submitted: YesO No .: F1XTi1AE$ ......_. bPony Name i biz IZO) vonecx one: ❑ cow ❑ Partnership Certmeate ❑ Firm/Co. busthesi Telephone .Pz '1%ffto of Llcehtied Plumber Fr- .17d-h�e�i/`�l ,L)NSURAYA,NCE COVERAGE: CnecX ori .have a current liability Insurance policy or Ra eubatantW equlvalerd. - Yea ❑ No ❑ L you have Checked yg�, please Indicate the type coverage by checking the appropriate box. )INV in$ to Polity [ - Oilier typed indemnity ❑ gond ❑ O WNER`S INSURANCE WAIVER: I am aware that the licensee dose not have the Insurance coverage required by ii,t*apler 142 of the Mass. General -laws, and that my signature on this permit application waives this requlroment. IA'S'4 Check one: :�■��e"or urmsr or sr's m Owner Q Apert tNrsbti oxllfy that all of Ilia details and Information i have submitted Ion entereo in above application ars Irue and aoourate to Ilia boil o(my F„{inoyAad a and that alp1un61rq wok and Inalalatlona performed undK the Issued for thio ap Uon w(1 d. �erlinon�Provision of the Massaehuutts Slate t�lurn p. Pka In compoance with an :.:. _ �g Code and Maptet 11 2 al tM (iarreral r na e 4 ' Uosnse Plumber ii'ewn , Type Of M mWg License: Master ❑ 'P11dVE0 (Offte USE OKY) v. Journeyman NONE MEMMUNKINKNOM bPony Name i biz IZO) vonecx one: ❑ cow ❑ Partnership Certmeate ❑ Firm/Co. busthesi Telephone .Pz '1%ffto of Llcehtied Plumber Fr- .17d-h�e�i/`�l ,L)NSURAYA,NCE COVERAGE: CnecX ori .have a current liability Insurance policy or Ra eubatantW equlvalerd. - Yea ❑ No ❑ L you have Checked yg�, please Indicate the type coverage by checking the appropriate box. )INV in$ to Polity [ - Oilier typed indemnity ❑ gond ❑ O WNER`S INSURANCE WAIVER: I am aware that the licensee dose not have the Insurance coverage required by ii,t*apler 142 of the Mass. General -laws, and that my signature on this permit application waives this requlroment. IA'S'4 Check one: :�■��e"or urmsr or sr's m Owner Q Apert tNrsbti oxllfy that all of Ilia details and Information i have submitted Ion entereo in above application ars Irue and aoourate to Ilia boil o(my F„{inoyAad a and that alp1un61rq wok and Inalalatlona performed undK the Issued for thio ap Uon w(1 d. �erlinon�Provision of the Massaehuutts Slate t�lurn p. Pka In compoance with an :.:. _ �g Code and Maptet 11 2 al tM (iarreral r na e 4 ' Uosnse Plumber ii'ewn , Type Of M mWg License: Master ❑ 'P11dVE0 (Offte USE OKY) v. Journeyman G Date.9. . rk4f�' 3359 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . LX,.4ek,, . . . . DcX r(;.1E . ..... ?�'. .... . . has permission to perform.. :e: ................. plumbing in the buildings of ./. S! ............ . at ...`� ? ...�/�.w. �...� ............. North Andover, Mass. Fee. . �?... _.. Lic. . ....... ...... . "PLUMBING INSPECTOR 06/10/97 16:21 390.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TQ DO GASFITTINIG (Print or Type) t NORTH ANDOVER Mass. Date tuilding Location Permit # 2-) 6o " Li Owners Name-17/'�6pc> Y New Y -.Renovation Replacement II Plans Submitted D (Print or Type) Check one: Certificate Installing Company Name '11f # 1�b ]] P ro Corp. Address �� - / Partner. Att/�16*61 MA Firm/Co. Business Telephone:7� Name of Licensed .Plumber or ,Cas . Insurance Coverage. lndica:e ::�a :ype of insurance coverage by checking the a� Liability._,.insurance...polic.y. �Ot^er Lupe of indemnit Bord -., Insurance Waiver: 1, the urdersicne-d, have been made aware -that..Ahe-licensee. of this application. does not have .any one of the above .three insurance coverages,_.-.__ Signature of owner/agent of property Owner -A ent I he:eby certiry that all or the deuds and information. t flare submitted (or entercd) in above appfieation are true and accurate to the best of mY iraoWcdge and tlut atl plumbing Wort; and fnaud4uoss -,=for-. 4d ural=-ft-rmit i=uzd ro: this aprdcxt:ea rill be En wmpFiance with aU VcrtEaat provisions or tlta WA& aG4uactta State Gat Cade and tlapter I<Z c. =.a Gcic-i L wz_ c m o t4 - to c7 I .= I O V t' = [- 2 v, _ - m r< c a Q �. � { : to ul .LA ty H T 02 tu _ o _.v - o, - < c c n to > to c7 ►�-. W u, O U -r - LU -4 ham- w - - - e LUt- y. to c c'= Ottu--- SJi3-3S;.1T. �....I _4 . _I I I I I r I { aasEMExT It I{{'._I .._-I I -1ST FLOOR I _.:1 : I ._:I` L ) • ...I = :` I ( I I I I 1 I 17. .:..I _ . . ._.I.'_ I 't. 4�+ f X0 FLOOR ZOR -I f I I! E I I! I I I� I I- I: � .-_[ -. j 3RQ FLOOR ! ( -I '-I I - I ! I I ( I I ..I ._Ir- _ It.._ I .-I.-- _ -_..I•-- - STH FLOOR `I L ._..� r.. L .. 1.. I I I I I -. ..I _._,. { -.I 5TH FLOOR I II I I I Itt tI I 1 I ! I I I`` tC. I 1`` 6Ti FLOOR M I i ` i jI t I (I I I +( f ITT 7TH FLOOR BTFt FLOOR _. (Print or Type) Check one: Certificate Installing Company Name '11f # 1�b ]] P ro Corp. Address �� - / Partner. Att/�16*61 MA Firm/Co. Business Telephone:7� Name of Licensed .Plumber or ,Cas . Insurance Coverage. lndica:e ::�a :ype of insurance coverage by checking the appropriate box: Liability._,.insurance...polic.y. �Ot^er Lupe of indemnit Bord -., Insurance Waiver: 1, the urdersicne-d, have been made aware -that..Ahe-licensee. of this application. does not have .any one of the above .three insurance coverages,_.-.__ Signature of owner/agent of property Owner -A ent I he:eby certiry that all or the deuds and information. t flare submitted (or entercd) in above appfieation are true and accurate to the best of mY iraoWcdge and tlut atl plumbing Wort; and fnaud4uoss -,=for-. 4d ural=-ft-rmit i=uzd ro: this aprdcxt:ea rill be En wmpFiance with aU VcrtEaat provisions or tlta WA& aG4uactta State Gat Cade and tlapter I<Z c. =.a Gcic-i L wz_ By Ti_l e C=tr/Tcwn: APPROVI=D (OFFICE usE ONLY] Plu.Ttber .' l Gassitter Signature of License- I ;easter Plumber or�Gasfitter � Journeyman ad C- License (lumber . a ti Dat �' e. 25 30 . . HORT., TOWN OF NORTH ANDOVER a. OE .ao e gti0 .. or • �� PERMIT FOR GAS INSTALLATION.' ♦ o �a . �9SSACeHUSS This certifies that WG'A'{,..... 1 - C" has permission for gas installation ...:.......... in the buildings of..... ...: at . �-� .. � f u: 0.0 Cl ... . No Andover, Mass. Fee.. �.%Q..` . Lic. No..). (uv.tf." ...... GAS INSPECTO J WHITE: Applicant CANARY:, Building Dept.- PINK: Treasurer GOLD: File rwE o; x4s-swe+7455775 vo-& e 14 P-1&4 s4a# BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No_ (1 7 Occupancy & Fee Checkedyp a -v APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the (Please Print in ink or type all information) Town of North Andover Massachusetts Electrical Code 527 CMR 12:00 Date _ To the Inspecior of ares: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number o I _2 / / I "- �_ `�_ Owner or Tenant Co L 0 ki c m 1 l 1-L—ft £Y(__ Owners Address ( � 1� JQA/®l ( Is this permit in conjunction with a building permit Yes a No ❑ (Check Appropriate Box) Purpose of Building JJ /kA ct C—A-M / 4:�K OU4 L C - N Utility Authorization No. Existing Service q Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service C7 ob Amps_Ly Volts a. Y6 Overhead ❑ Undgmd X No. of Meters Number of Feeders and Ampacity, ' dd Location and Nature of Proposed Electrical Work ( O M P C if,'- j lJ i 2 N� Lf% C�i Nb G rAA f L,-1 OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES,6_NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of pe rjury. FIRM NAME �'f/ n6 j �T G �— LIC. NO. % �('� I_Ir_wnsne I (Y -01��. ��Tfi Slanature 4—�� I LIC: NO. t y i► / .� ! �1 /� /� ! Bus. Tel No. Address t� W A L C d / / b /tea IMIcjJ�L f✓ Alt Tel. No. —O 7 Z OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance cdvirag4 o ifs substantial equivalent as required by massachussM General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE S� — (Signature of Owner or Agent) Total No. of Lightfing Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ , No. of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Soace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heatinq Devices KW Local • Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES,6_NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of pe rjury. FIRM NAME �'f/ n6 j �T G �— LIC. NO. % �('� I_Ir_wnsne I (Y -01��. ��Tfi Slanature 4—�� I LIC: NO. t y i► / .� ! �1 /� /� ! Bus. Tel No. Address t� W A L C d / / b /tea IMIcjJ�L f✓ Alt Tel. No. —O 7 Z OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance cdvirag4 o ifs substantial equivalent as required by massachussM General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE S� — (Signature of Owner or Agent) 2 N 11809 Date ... 15 A ................ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING /7-/ C � This certifies that ........ n)m ....... ......... j� ....... .......... has permission to perform ...... wiring in the building of ..... ...... A, A 01, ACV ell� at.... . .................... qvNorth Aldo,%�qj-,Wass. FeA10-d ....... Lic. No. 0.- ....................... .............. ELECTRICAL INS R C (r, -4 / ;rpm WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only 943 01 4t Lfsmmuniur# of :,7(itt0,9ar4u9eft9 Permit No. U� ihpartmeat of Vublic 26afitg Occupancy & Fee Checked �7 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3190 (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - ,f (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a�rpermit to perform the electrical work described below. Location (Street & Number) _I Y s9E_P-L-� CD DQ Owner or Tenant t (v\ j3 E a LA 1 QQ EU Owner's Address P.6.MX q97 A(\)00Q!E R II Y tft 0 �g���- ...... . �` Is this permit in con unction with a building permit: Yes fi-I No ❑ (Check Appropriate Box) Purpose of Building Fal Q E 14lc Utility Authorization o. -7 0,3 T5 / Existing Service Amps _J Volts Overhead ❑ Undgrnd New Service Q00 Amps 1_,aJQ_s2L1-Volts Overhead ❑ Undgrnd CK No. of Meters —�— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 03EIZ� ug�,MV OTHER: UV INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES i 9 NO I have submitted valid proof of same to the Office. YES yet NO _ If you have checked YES, please indicate the typ of coverage by checking the appropriate box. INSURANCE A BOND —_ OTHER —_ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S _ Work to Start Signed under the Penalties of perjury: FIRM NAME Inspection Date Requested: Rough ignature - �us. Tel. No. v N t+ 0 30 3� BAlt. Tel. No. Final LIC. NO. ,�/ LIC. NO. Y �L�2 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) X-6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures I Above In Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices Heat Total Total No. of Disposals No.of Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Other Local ❑ Connection IMunicipal No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts I Wiring No. Hydro Massage Tubs I No. of Motors Total HP . n I OTHER: UV INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES i 9 NO I have submitted valid proof of same to the Office. YES yet NO _ If you have checked YES, please indicate the typ of coverage by checking the appropriate box. INSURANCE A BOND —_ OTHER —_ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S _ Work to Start Signed under the Penalties of perjury: FIRM NAME Inspection Date Requested: Rough ignature - �us. Tel. No. v N t+ 0 30 3� BAlt. Tel. No. Final LIC. NO. ,�/ LIC. NO. Y �L�2 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) X-6565 Date... 943 k r TOWN OF NORTH ANDOVER a p PERMIT FOR WIRING.- rz"' ' h �,SSACNUSE� .R This certifies that ............... .................. ................................ ........,.....:.........:;. has permission to perform ........... �/� 1F . .1.. ,•1 r4 . -:P... s` wiring in the buildin of....qtf a North Andover at ...... c3.......... . ll.. ., .Mass. . ................ W Fee' 1. :..... Lic: No.. . ............ ..................................... :.. ...... s ECTRICAL.INSPECTOR WRITE: Applicant CANARY:. Building Dept. PINK: Treasurer .