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HomeMy WebLinkAboutMiscellaneous - 95 HICKORY HILL ROAD 4/30/2018N ;❑2012 Massachusetts Electrical Code Amendments 527 CMR12.00 § Rule 8: In accordance-with the provisions of M.G.L. c.143, §. 3L, the ermit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed' on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shalLbe limited as to the time of ongoing construction. activity, and may be.deemed_bythelnsp'ector_of_Wires abandoned_and.invalid.if_he—.. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the_ permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits -and licenses concerning the use or development ofreal properly. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008.and extending'through August 15, 2012. X-Rqle 8—Permit/Date Closed: Note: Reapply for new permit ❑ Permit Extension. Act—Permit/Date Closed: 9bb5 Date ........ °.,•``° '• :"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... 4. has permission to perform ............i7Z;y�l�......!4,2 l wiring in the building of ............... h.,4W.... E ............................................ at ........� � C f� �t�l.�l�...t?D .....Z , North Andover, Mass. Fee .. �.5 Lic. No.. g�1D ........ /'��// •RiCAl.IN3PE R ' Check # ft 6+Urrllr1U11VVUa1&11 Un - Q., Permit No. Department of fore Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORIN! ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: % .r /4 6-2 ° / e City or Town of. NORTH ANDOVER To the .Inspector of Wires: By this application the undersigned gives nptiA of his or her irate d/o to perf rm.the electrical work described below. Location (Street & Number) Owner or Tenant , , r,+ G z Telephone No. Owner's Address 5; o Is this permit in conjunction with a building permit? Yes [q No F1 (Check Appropriate Box) Purpose of Building �j CLilj. /V-144 ly!' / Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f 1e -A -e /] Com letion of the following table may be waived by the Inspector of Wires. W' P No. of Total No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets �j' No. of Hot Tubs Generators KVA ; �- No. of Luminaires Above In- Swimming Pool rnd. El 'n- ❑ o. o raergency xg mg Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number To KW No. ofSelf-Contained No. of Waste Disposers P Totals: - Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local ❑ Connection No. of Dryers Heating Appliances KWSecurity Systems:* No. of Devices or E uivalent No. of WaterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of tres. Estimated Value of Electrical Work: 1 S d d (When required by municipal policy.) Work to Start: - / )6,/` t Inepections to be requested in accordance with NEC 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 undersigned certifies that such cis in*force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE over BOND ❑ OTHER ❑ (Specify:) I certify, under ilpepains andpenalties of �rjur ,Haat tl a in r ' tion on this a plication is true and complete. FIRM NAME: J7t,0 tj A191- �j �' r ��e� ti, _4r` LIC. NO.: ao © 4 Licensee: ,7 l� H'r'-di d Y Signatur i►� - LIC. NO.: � % a�, (If applicable, enter "exen pt' in the license number line.) Bus. Tel. No.: e > '' �� % Address: Alt. Tel. No.:97e 2 rl',Y— *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Owner/Agent PERMIT FEE: $ 771 Signature Telephone No. I A, The Commonwealth of Massachusetts Department of Industrial. Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print LeLyibl, Name (Business/Organization/Individual): d r t'1� �� Address: S ✓�n-� c��/ �7/ City/State/Zip:Q C`� l3y Phone #: 73o $117 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I emft oyees (full and/or part-time).* have hired the sub -contractors 2. 6, 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. workers' comp. insurance. [No workers' comp. insurance 5. [1 We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip:_ 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 the DIA for insurance coverage verification. I do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. c;,,,,�fi,�� it �-- L4,�' — + T)atP• C Phone #• -*' I 7k 5� _'3 c) 5-117 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 30 Date..���°.... HORTM O1 3: TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION This certifies that .. / f .�r ; r )� , y has permission for gas installation .... f`! .`?. �. e in the buildings of ...PA `!............................ . at .. ? ..� �t.� .i? :.::..� .�. �. .......o _Andover, Mass. Feel ?. �.: '`.. Lic. No. � ). � .r .�.. ! .� Ga i INSPECTOR Check # MASSACHUSETTS LTNIFOkVI APPLICATON FOR PERNIrr TO DO GAS FMING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's N; New ❑ Renovation ❑ Replacement 0 Plans Submitted n Permit # Amount $ So N A rint ameor type) /� 1 /� zze�r Check one: Certificate Installing Company Corp. ddress AV M Partner.. rsaness Te ephone — Firm/Co: Name of Licensed Plumber or Gas Fitter �L/ZL��4 17— Gx—e% INSURANCE COVERAGE Check one: I have a current liability Insurance p rcy or it's substantial equivalent. Yes No If you have checked �, please i icate the type coverage by checking the appropriate. box. Liability insurance policy Other type of indemnityBond Owner's Insurance Waiver: lam aware that the licensee does not have the Insurance coverage required by Chapter 1.1.2 of the :Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the• rest of nn knowledge and that all plumbing work and installations performed antler P�_r Isacd for this application wi in compliance with all pertinent provisions of the Nlassachus�s 11 t Viand ( a of the Gener s. By: Title Ci tyrTown APPROVED (OFFICE USE ONLY) Sign: re of Licensed Plumber Or Gas Fi ter P tuber as Fitter tc ensc 1 um er Master Journeyman x Cn C6 a 0 q rn F .y p zr~ � O � a H x C7 U ¢' T• W v0 rJ C4 Z' Gq 7a a CO)z a w d x E~ w H a (�H c a 4 z' o a "+ O Gay A U' U O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T II. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR N A rint ameor type) /� 1 /� zze�r Check one: Certificate Installing Company Corp. ddress AV M Partner.. rsaness Te ephone — Firm/Co: Name of Licensed Plumber or Gas Fitter �L/ZL��4 17— Gx—e% INSURANCE COVERAGE Check one: I have a current liability Insurance p rcy or it's substantial equivalent. Yes No If you have checked �, please i icate the type coverage by checking the appropriate. box. Liability insurance policy Other type of indemnityBond Owner's Insurance Waiver: lam aware that the licensee does not have the Insurance coverage required by Chapter 1.1.2 of the :Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the• rest of nn knowledge and that all plumbing work and installations performed antler P�_r Isacd for this application wi in compliance with all pertinent provisions of the Nlassachus�s 11 t Viand ( a of the Gener s. By: Title Ci tyrTown APPROVED (OFFICE USE ONLY) Sign: re of Licensed Plumber Or Gas Fi ter P tuber as Fitter tc ensc 1 um er Master Journeyman 9654 r 0 TOWN OF NORTH ANDOVER -7, c PERMIT FOR WIRING This certifies that ......Pt .,t, T5 ... Nog.r�l ...... ........ ........ . .. .......... 1714w,;.IX ....................... has permission to perform ...... f.l.z.0kA, Zee .................. wiring in the building of ........ 1)Q. Cru C-.% .................................................... .t ........... �6 ............... .. Northi"dover, Mass. Fee .... !;-0 .. Q00- .. Lic. No-?��ft04 ............. ...... ....... Check # /D 3 �N a,urrunw�wCanu vi rra��ac.uu�acw --- - --- - Permit No. Department of Fire Services Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MECI, X27 CMR 12.90 , (PLEASE PRINT - INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the nspector of Wires: By this application the undersigned gives notic f his or her int tion to erf the electrical work described below. Location (Street & Number) %GcR Owner or Tenant " ` Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:-�,"F�U j�fyVOK7 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets 3 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number .................................... Tons ............. KW .......... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ElMuniciPP' ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of WaterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No, of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value gof Electrical Work: �i J �! v (When required by municipal policy.) Work to Start: / -0 0/,0 Inspections to be requested in accordance with NEC 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 undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under theZqins and pe ties of perjury, that the information on this application is true and complete. FIRM NAME: ,;f_A17 S Meg %f LIC. NO.: Ry 71/0 Licensee: Signat . NO.:�tt6 (If applicable, enter "ex iptI in the license number line.) Bus. Tel. No.: 9 / [1 Address: 335- L tw i -v CR s'i_/nC� �S% 11 I'%� �� Alt. Tel. No.: r,7 *Per M.G.L c. 147, s. 57-61, security work requires Department df Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Owner/Agent PERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 4 z� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 1I Name (Business/Organization/Individual): 479 rs NOOK % l - Address: S3 5 J,4 "A vu 6/L S City/State/Zip: &heSfe Phone # Please Print Le xcf L /C OCST-19K M4 �7t - .3J`5 -I17 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I oyees (full and/or part-time).* have hired the sub -contractors 2.,K] I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ectrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #I 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 the DIA for insurance coverage verification. I do here"rti"derthepa�ss and 779- that the information provided above is true and correct. nnte. l — 9',— 6 % t) 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 #: Date. /`. �..... �'.: •� :'�o tI.- TOWN OF NORTH ANDOVER is �. ,� ... •. �t p PERMIT'FOR PLUMBING ••.,r.o .•` �5 'SSACIIUSfct This certifies that .`...►..... ..................... . has permission to perform ..... . S p. V/l ................. plumbing in the buildings of .. r. ............. at .. r../ ! c .b C. L�.'�!.............. %! .,, orth Andover, Mass. Fee. 3% Lic. No.. ! ? 3 J '. ......t-PILU .MBING INSPE TOR Check # ' 8G 96 FA t MASSACHUSETTS IJWORM .AppLICATION FOR PERIMT TO ]DO PLIJIYIBIlNG (Type or print) NORTHAND O/VER, MA%S�SACHUI1SETTS BuildingLocation Date Permit Amount 3,7 Of New Replacement Plans Submitted Yes ElNo� Renovation Y'LATIikiml Check one: Certificate (Print or type) 41 Installing CompanyN'ame �.' 11 Address /� Partner. 4 Firm/Co. Name of.Licensed Plumber: A le,! Insurance Coverage: Indicate th e of insu ce coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnity 0 ;Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one ofthe above three insurance rgnature' Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or enfered) in above application are.trae and accurate to the best of my1mowledge and that all plumbing work and installations performed der ermit Issued for this application will be in w;th all pertinent provisions oftheMassachuset�P��d Chat 2 ofthe General Laws. ITitle ;D (OFFICE USE ONLY 1 Tyne of lumbing License rcense umber Master Journeyman The Commonwealth ofAlassachusetts 1Dpartmeni o f£radusfrW _l cadent, Office of)5ivestiga2ions 600 Washinbpton Street Bostorz, I1 L4 02.711 www "lasagovIdia Workers' Compensation Insurance Affidavit: BnUders/Contractors/LZectrieiags/Plumbers alalicant•Tnformafaion c Pip�vo IDL 4_4-,r Name (Business/Oro nization/Individual): �n �f Address: ./. !-7 City/State/Zip: Phone #:—V-%��-- •Ar e you an employer? Check the appropriate box: 1. ❑ I a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).* � have hired the sub -contractors 2 I am a sole proprietor or partner- Misted on the attached sheet ship and have no employees These sub -contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.]officers 3. El am a homeowner doing work have exercised their all myself. [No workers' comp. right of exemption per MGL C. 152, § i (4), and we have insnrancerequired-) t no employees. [No*orkers' r.6mp. inst3xmct; reml,"A j Type of project (required): 6. ❑ Neer construction 7. [] Remodeling 8. ❑ Demolition 9. ❑ Btulding addition 10. F1 Electrical repairs or additions .I 1. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other �`n3"^a?fcrttha:c�� bo l •"•�° �,-� .^a'.:°t Seo fill ee!C fhe secem+ � Elazaeownera who suhmit•tHis affidavit indicatin th , arm ac' anomas er as coap�s?_on Y"" J aL.LLdiiv:L g e3 mg aU' 0,1 and thea hireoutside con1-etors 161kt ,u nit a new ifhdavit indicating such. +Contractors �t chegl; this box m; s; a�.ched an additional sheet showing the name -of the sub -contractors and their workers' comp, policy inform dML .I am an employer that is providing workers' compensation irzszcrance for my emproyees Below is the policy and job site inforrrzataon. Insurance Company Name: Policy # or Self -ins. Eic. #: a-piration Date: J'ob Site Address: %! t� o�/ l ••• City/state/Zip: Attach. a copy of the workers' compensation. policy declaration page (showing the policy ttumfiexpiration Failure to secure coverage as required under Section 25A ofMGL c. I52 can lead to the imposition of criminal penalises of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form o= a STOP WORK ORDER and a zine Of up to X250;00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office Investigations of the DIA for insurance coverage verification. ce of . Ido herehy cer7ifjv under th pains and 'es , perjury thrzz` a znformarian. providedabove zs true and co ect: Signature: Date,.._ . . _7 � � Official use only. Do not write in this area, to he completed ,hj= citp or town official City or Town: P'ermitUcense # h -'U n Authority (circle one): I_ Board of Health 2. TiillldIlLo Department 3. 0ty/T'own Clerk 4. Electrical Inspector 5. Plumbing, Inspector G. Other Contact Person: Phone'#: Town of North Andover Gerald Brown Inspector of Buildings Brian Leathe Local Building Inspector RE: 95 Hickory Hill Rd, N. Andover, MA September 16, 2010 This letter is to inform you that I have made the required site visit to inspect the installation of the steel beam located in the new Garage addition at the above mentioned address. The inspection was made on September, 16, 201.0. Based on my site visit, I found that the beam was the specifies size, and installed properly based on the drawings. The beam rested on a adequate bearing plate, welded to a 4x4 steel tube column, (4) bolts on each end fastened the beam to the column, which is more than adequate. An additional bottom bearing plated was installed the column placed properly over the foundation, transferring the loads correctly to the earth. Thank you, The site inspection was made by & reported to Ken Savoie by William Nolan — Designer Ken Savioe — Architect of Record p \�ED Ah�y�T�q®e c� No, 6056 cn O BOSTON, a MASS. �a LSF PG�J � �� q�TH of M�S�'�� Location No. -C Date V �A `c. ti TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �+ Foundation Permit.•Fee $ Other Permit Fee7 $ c� - Sewer Connection Fee $ 1J Water Connection Fee $ A TOTAL V ze, Building Inspector 6192 Div. Public Works Location No. - Date %-.) 21 NORTH Ot,t`•O 14,. Tb ffus ftT°i ANDOVER • ? �• , • IS < Building/Frame Permit Fee $ Foundfitiah'-Permit Fee SACHUS V-1�r— Other m Fe, Sewer Connectfon- Fee Water Connection Fee $ �� TOTAL r _ -. _- - Building Inspector i• Div. Public Works Location No. Date /a .� 7 NORTH TOWN OF NORTH ANDOVER Oft.a° ,a1ti O? •' a OOw Certificate of Occupancy $ • # • : Building/Frame Permit Fee $ r `L��FRoundation Permit Fee $ Other Permit Fee $ Np�TH R f Sewer Connection Fee $ r -7g9V ater Connection Fee $ < 6-1�7V- 6"0 SEC 2 ' TOTAL $ �U UG -o Building Inspector r (� Div. Public Works Location Ile No. Date ' % , - "° DT ;,ho TOWN OF NORTH ANDOVER F ; p Certificate of Occupancy $ � r� y -T" uilding/Frame Permit Fee $ � Foundation Permit Fee $ y ®�N Other Permit Fee $ —� p�,SSq wer Connection Fee $ To titer Connection Fee $ ipEC TOTAL $ Building Inspector Div. Public Works APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. fl AV 31 ��v I PAGE 1 MAP 4v0. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK '.PAGE ZONE SUB DIV. LOT NO. C-D.'j D 5 If q I 0�vjo--p4 11 LOCATIO C k V �1 cl . PURPOSE OF BUILDING ' e • I M 4 A OWNER'S NME OWNER'S ADDRESS 1 NO. OF STORIES �i SIZE ' %OO SZ BASEMENT OR SLAB -ba Set,Mp,/�- '21NLD vIST,* ARCHITECT'S NAME oMLS 7, OQUiko SIZE OF FLOOR TIMBERS 9 I11 . )l � y 3RD BUILDER'S NAME'JA SPAN lq { , II ftl /► I1 �`�•L� DISTANCE TO NEAREST BUILDING } 1 _�°S DIMENSIONS OF SILLS R DISTANCE FROM STREET �{' �O1 POSTS DISTANCE FROM LOT LINES - SIDES f+26)1 REAR I DDI } + GIRDERS q) a)( t FRONTAGE 1001 AREA OF LOT :303()( ��"�. HEIGHT OF FOUNDATION Is I THICKNESS DI IS BUILDING NEWvp .5 ,I••No SIZE OF FOOTING X O 1 IS BUILDING ADDITION MATERIAL OF CHIMNEY is IS BUILDING ALTERATION N 0 IS BUILDING ON SOLID OR FILLED LAND -g.0 I rcL WILL BUILDING CONFORM TO REQUIREMENTS OF CODE p t� IS BUILDING CONNECTED TO TOWN WATER C -s BOARD OF APPEALS ACTION, IF ANY N A �'1 IS BUILDING CONNECTED TO TOWN SEWERIs IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS /Yy- 6 SEE BOTH BIDES � y ,�^�" = FMi LEr,...1 r d PAGE 1 FILL OUT SECTIONS 1 - 3 IME i Flf ME U 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 ^AP%PR/OyVEED//B/Y BUILDING �ECTOR DATE FILED _ 1.2 / .,2 / �/ eel/ SIGIWATURE OF OWNER OR.ICOTHORIZED AGENT FEE e�/ /< VCJ PERMIT GRANTED i Sri_ OWNER TEL. #%9 CONTR: TEL. CONTR. LIC. #__ _L7 DEC Z .3 igg? AV -10 D 5, 3 PROPERTY INFORMATION LAND COST 65-1 O/y^t .00 EST. BLDG. COST 117.000-00 EST. BLDG. COST PER SQ. FT. 5,1019 G. COST PER ROOM I i M 00 SEPTIC PERMIT PERMIT NO�� 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN S ■WILime INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. Siam .4144 - Ilk � _ CONSTRUCTION 2 FOUNDATION I8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE HARDW D PLASTER _ DRY WALL UNFIN. PIERS 3 BASEMENT AREA FULL FIN. B M AREA '/. 1/1 1/. FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS 8 _ 1 2 �_ 3 _ _ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING 'CONCRETE EARTH HARD"V'D COMIAGN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME - BRICK ON MASUN ­RY BRICK ON FRAME ATTIC STRS. 8 FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I- I POOR _ ADEQUATE NONE 10 PLUMBING 5 OF GABLE GAMBREL I HIP BATH 13 FIX.) MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST V PIPELESS FURNACE FORCED HOT AIR FURN. ** TIMBE MS R COLS. STEAM STEEL d K&S3 HOT W'T'R OR VAPOR WOOD RAFTER= _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OAS il B'M'T 2nd ELECTRIC 1st 13rd NO HEATING Siam .4144 - Ilk � 1 W w � 1 0 c FORM U - LOT RELEASE 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***************** *********************Official Use Only************************ APPLICANT: _ I spas .V ,.1� �t0 Phone LOCATION: Assessor's Map Number 1) Parcel RICIA )) OCJI! Subdivision I ��� s f�► ( Lot(s) Street 14, l s ' ��i j I St. Number .L* - RECOM4ENDATIONS OF TOWN AGENTS: G�'`_ 1 Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments 1d1-2 Date Approved v L/ Health Agent �p Date Rejected Comments dC Public Works - sewer/water connections 10,Z4, -V/ �J 1 - driveway perm, t PL Qpor go IZIZ3 i2 13Kc. Fire Department ` Received by Building Inspector M 2.3 1992 Date ProPO.54 S iic Pl LOT 5 H CVO ry 411 1" _oto H�cYORY 0�LL_ RO'� J LA Be - - _ Y �W7 1 oto c 'tib 7 z I IM �4 IN to - 0 �2 r - \ co 0 5 o I r- � pQoPosfD ,� #A FDTO 3 1 OloZ `- 5 .Vr. U to It 0 d �o LoT 5 30,0c�2} sf. 0 �o 0 N 220 0 �YCc .S1S i� r - N (D o - J' �+ o\� N �r "A 205630 c~'i r'A.F�j.. � 2 ��U ! ,b CERTIFIED FOUNDA TION PLAN LOCATED /N GO RL 1.1 -DING DEPARTMEN? SCALE /= 4.0' DATE Scott L. Gi/es R. L. S. 50 Deer Meadow Road North Andover, Mass. N ic�o2y Ir - X4.438 40 -• ZZ .GG 0 20 -•tip'= -�L�. it 6 m Ns� F�+o. t r 0 IO' 4 � �o-r- 5 U► �ioG2 S.F.' - Q1 Q7 W W �A15fs ��u'f" . Q•� V+O f � i CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE OF HE OFFSETS OF THE BUIL DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE /S FOR THE W/TH THE ZON/NG DETERM/NAT/ON OF ZON/NG `' BY LAWS OF CONFORM/ T Y OR NON- COIVFORM/TY WHEN CONSTRUCTED.Ai t WHEN BUIL T 4-(2(a3 { P Opo aG o w co a cn Cd o w C � w rx v Uw" —,O4 o w w m w a U W W m w g � cn C w x p `� ono � aG ct w z w W °�' aq ° z cn i Q i cn r • C� iCD uml • �O CLz O� 0 Q VIC_! . VE ! � N 0- � C:, �' N N .,r>3 C/) cm C � m � N � C m �•O •� �` • !n•--� O N = C 1r✓1�'�11� Em loCLUL m r-4 44 c O CD m v N O O Z C0-3 Cf Q O ` m C •O F=- p d FpCD COD Cc CD LL N W O •C �. � r=... •� Co r •'NA "EL O C Z C.2 •m p O C N O' CD O � _ �oy•� O c. � m z o. v K# O O v CO) 03y CD L CLQ G O al 0 _Q CL CO2 O O Q LA) .Q CO2 G O Q m CO) rdolo 16- 0 O v CD Q CO2 G CO c, G Co o m m co �D CD 0 Q o CL d �a ate••• G O O J •0 02 Z Q O. CO) G J Q z z 0 Q W z C) U cc LU 0 - LU w LL' cc 0 L J LL Q Z LL cl LL < CD 5 z z Cl z u uu CL u c)1�1=1(a:tiO1�: (.'.()NSI- : I (VATION I I1:�\I:II I 11 "LANNIN( i DATE Town of, 1 IIS 1!;II IN ()I-' 1'l—ANN1NG & ("051AWNl'1'1' OCATION I s— /tG I:AI"I:Hl 1 I.I'. NI;I )N. I )IItI:(: I ( )It CIIIAINLY APPLICAIIOIJ ANO ITNA1II' I:'�Il,l,lill �Ili i•I I�I:Iti';,II 1111' i II', I I lit l 1LUNER'S NAME: )'UILOER'S NAME: ' ' ' �,e 7ct �\o QA V1C) ASON'S NAME: AAA IASON'S ADDRESS: J� , INW f4 AAA ASON' S TELEPHONE: ATERIAL OF CHIMNEY:_ NFERIOR CHIMNEY: )� LXILRIOIZ CIIIMAY: Ul,i6ER AND SIZE OF FLUES: r -y �Z /> ffICf;1JESS OF HEARTH: ' • iti ckii")tey an. 6i)Lepcnee eolt40,4111 to Vie. the euc/e and havc "ltl (.3 sulci eguiati.ow been neeeZveci: ��S-------------- ATE: —4/zl IGNATURE OF MASON: ERMIT GRANTED: FEL' oiS �O )CERT NICETTA JILDING INSPECTOR VSPECTEU: EI+dARKS: SOLID [CLUCK RI-;*UUlREU THIS PERMIT 1,IUSF GE UISPLAYLO 014 111E i'U1,11S( CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 568 (1992) Date JUNE 21, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 95 HICKORY HILL ROAD (Lot E ) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE IN ACCORDANCE & DECK WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Thomas D. Zahoruiko o ,..o ;•, ra P' ADDRESS 185 Hickory Hill Rd. sNortri Anlover _ ,3S'us� Bui ding Inspector e �l W r 1 I9 co ui L� z r -4 cm a col cc C � m cco y N tog .1."' O W i mWO) oScm y m cm C y O G3•�Z O O O r- Cf C3 p CLO C Q e y m C •O 0 y Rte m WLL •CAA dt OO LLI c Z c •E o c •y co C.7 CD _ COO CL. rA ` ce O �. Sam z 0 0 U 0 0 Cir W di i l �p UWA r. co cc o o cc Lau z Au � - -zz CDC v a o N V vJ c Q w Ll w° cn m C2 U w2 w\QO t� -a u w a 1 a: cn w co 7 ❑ v z C v 7 m cn cn I9 co ui L� z r -4 cm a col cc C � m cco y N tog .1."' O W i mWO) oScm y m cm C y O G3•�Z O O O r- Cf C3 p CLO C Q e y m C •O 0 y Rte m WLL •CAA dt OO LLI c Z c •E o c •y co C.7 CD _ COO CL. rA ` ce O �. Sam z 0 0 U 0 0 Cir W di CL co O co 0 M O Q CL CMCC C* O o � cc v J� C Z co 0 CL V y _ C O CA D i l CD z E�- co cc o o cc Lau z aQ - -zz CDC C w CO2> o_ c Q CD ' O '� m m w z > 03 O co CL co O co 0 M O Q CL CMCC C* O o � cc v J� C Z co 0 CL V y _ C O CA D Location No. Date 2596 TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ / Building/Frame Permit Fee $ �r .'Ss�cMus t� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL / $ G �, Building Inspector 3/% 12:39 91.00 PAID _ 95119 Div. Public Works PER -AIT NCS.' 0 y APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K,10. LOT NO. I 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. 'LOCATIONPUR �{ •� I t �Z ci POSE OF BUILDING • N►$I. I � q PP Rox x.7.5 1°S..—A,s E'n$ OWNER'S NAME j,f OWNER'S ADDRESS 1 / +' NO. OF STORIES SIZE BASEMENT OR SLAB ARCHITECT'S NAME —� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME V� SPAN - -- DISTANCE TO NEAREST BUILDING �— DIMENSIONS OF SILLS "" POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES — SIDES w PFAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION _ THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATIONr._ �; c1 �SC �t MT I•e ♦ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE t IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER • �•J IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 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 i DATE FILED Z �' % 3 1 SIGNATURE -OF OWNER 04 AL4HORIZED AGENT F E r -PERMIT GRANTED �% 3 PROPERTY INFORMATION LAND COST EST. BLDG. Cojlg)) [I 36 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. M �o�Z' I S v ,4 CONTR. TEL. # CONTR. LIC. N. H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 } SINGLE FAMILY S"ORIES THIS SECTION MUST SHOW EXACT, DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS 'OF,BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE HARDW D E 1 2 13 CONCRETE BL K. BRICK OR STONE PIERS PLASTER UNFIN. 3 BASEMENT AREA FULL FIN. B M T AREA _ V, 1/2 1/1 FIN. ATTIC AREA NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING HARD"J D ASBESTOS SIDING _ COMMON ASPH. TILE VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME I _ BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 GABLE MANSARD M. ( TOILET RFI 12 FIX.) — FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS._ STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OIL B'M'T 2nd ELECTRIC _ isr 13rd NO HEATING M uml 7O CL z =o O U Cci O N C O u r O O F- w C C O U m C w � ww O a LL V)t Z z —tc U :� Z z ,�..dMU N E C i i. Z .. U '� 7 ° G v V)w w G m c°' w C u u C;,)cn 4! O M uml 7O CL z E a N L y O i y C O7 W cm C C m `o cm c .0 O N m L 0 Z O a J 0 y coy .E C3 L CL co C 0 CD Q Q.. CO) C O Q. CO2 C O U O C R CO2 0 L O V CO CL y C =o mC Cci O N C r O vU C C m C : L O � O w y EQ N E C m :m 0 0 CO C m J: c y m 3 f' o' •C cc �� � C . y O v� m : CL C y m m C1 p C C Q N G C L CD o� ` � yZ o . L = m : m ++ N LJJ N Q2 ed � m LL. o •y m ACL � � C LLLJ E r V .0 V CD oCO coo = ca m cm :5 _ cc F- L •O., O.L... m E a N L y O i y C O7 W cm C C m `o cm c .0 O N m L 0 Z O a J 0 y coy .E C3 L CL co C 0 CD Q Q.. CO) C O Q. CO2 C O U O C R CO2 0 L O V CO CL y C x Q,M z m �ZE So; z ....Ln: ... i 0 L F It Q :L 3 R p HOME IMPROVEMENT CONTRACTOR RegistTation 108383 ' e Type - INDIVIDUAL Expiration 08/18/95 Kenneth B. Keen G��1 ieWitt Ave ADMINISTRATOR o. Andover MA 01845 +a . c f1„s,�,�l" '°�s Restricted �0' 00 ,,,,Wahlr �/ /r�rrr'rrr00� _ NORe pny t OF PUO�tC CloSAFLSE 1� _ hason�l µDees OEPAR`hCN� SOR 6irtbdate:. t h 1 Faet1Y =, CONS �QOC110µ SUPE Ex vts: p3'2g11913 j t 050145 CS Restricted 6 KEEN It 01,11 01L N 010 pN00VER, NA 4 i FnS Fgi{ofot�r �rF=''`�f!°v°VRSR 0hr La==m ui &;=== af �Vuhl.0 HOARD OF r1RE PRE/E1 104 REVIULA710S :-c C JR 12:10 office us. Cmy X Permit No. -(/ C=pancy & Fee Clocked 2 M (leave blank) APPLICATION FOR PERMIT TO PERFORN1 ELECTRICAL WORK All work to be performed in ac--rdance with the Massarnusetts E:ec*"cai Cade, 527 CN,1 12: 0 (PLEASE PRINT IN INK OR TYPE ALL INFORIMATICN) Date c yj or Town of NORTH d %1BOVER To the Inspe .or of Wires: The udersigned acciies 'or a permit to perform trse eiec•^cat icr described below. 1_c:cancn (Street 3 Number) ,�• ��ZL�y F'%7T__^9 /�L Cwr.er cr Tenant C.vr,er's Ad=ress Is ,"is permit in ccnjurctien with a ,uiicing ^errntt: Yes No _ (Check Apprcpnate Scx) Purccse cf Suiicir.c Utility Autncrization No. Existing SerAc Uff At'Cs �,S' y'3� `itis Cverne-a _ Uncg nit No. of Meters Nair @mice Arrtps `iCaS Cverre_c r No. cf Meters -Num=er „t=•aecers arc Arrrcac:,y -- c.... ar.z `la:.._ _. r ..ccsec=.__..._�. .:crx �dC�r� `•Zi 0IVZ—X Q� ��1 �+e. -. _.gr.m; ...:ea -. -_. �=s Nc. _. 'anstormers C.A No. :r _.gnt:ng = xvares uanera:cls ��%• No. cr Emergency L:gnitng Nc. :r - ...ac:e Cut:ets ` `1C. _. ::1 ._.r.ers =--erf Units No. _. =w,ccr Curvets No. c. Sas ?_.-_._ I =.-._ AL.4RMS No. cf Zor.es ' {_:a. i No. o. ct == -=:cn arc 1 Nc. _. ranges Nc. =r a'r ==. _. :cs I ir.,:iating'Cavicas NC. _t ::iScC5a13 -ea: _:a, --,a, NC.:: ��-.s -:rs No. o. =curcing Cev,ces No. cr zed Centa,nec No. cr Cisnwasners Scace.Area-__..r- C:r I Cetea:cniscunetng Cev,ces Mun,e:=at No. ct Crvers jea=ny Cevcas Klw _=car ' Connec•:on _Otnar -a%v •rc,tage i No. cr •Nater mKinn^ eavers }CN ::c -s °-aass _ No. -•.c:o l.tassace lits Nc.:. . c.c._ ...s. -- c iNSL;skANc= cc:vE=AGE. ?t;rsuant :o :no reca:terrents =. .: assac-_sa-s ;er.erai Laws I rave a current L4=iiry Insurance ?clic-/ nrx:rg Cor C=era:cns Ctverage cr as sucsranaal ecuiva,ent. YES = NO = nave suem,ree vane c cot et same :o :re Cr'ica. YES NC t ycu nave cnecxec Y_= ;,ease inciCatili me ryFe f gcverage :+ -necx,ng :re ycc^.rate oox. INSUPANCZBONO = CTI -!EP = (Please Sect+t ,,(/ a,ranan Oa:e, =s::matec value of c er- y warx s 0.6', �� C/`%t L rat ��rL/� •Ncrx :o Scar. ins=e^on Casa =rc_rs:ac- -=ug' , S:caee uncer •tie Perai-os of ;eflury: =,.P%I NAME %7Oseop fiiVy4s n uC. NO. _cense• S:y-a._� ii..y�,�i_t �7�icr - :C. NC.F�.S'Z7� Actress Bus. :at. No. Alt. :al. No. CwNEP-S INSUPANCc WAIVER: I am awa" ural Se L'Cettsee :cA pct wave :no ,nsurarce coverage or its suostanual eeutvolent as re- etureo oy Massacnusem General Laws. ane __%at .-y s S -a _re cn == =er-:t accitcatron watves mts reeutrernent. Owner Agent tP'eass cn�cx one( `l 'etecncre No. PERMIT P_= S (� �( �� isignature or Owner =r .+Send -" ., ... � .- . y _ . ...i--^l�,z.-.. �. .. ,. •. ,. r.y1L-��.—;��"':.�-rvA:..t_r Y.: �-_•r s`. t.J "�'� Date ....�.g`..//. �..../...f�. 2836 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... -f.v.!'........ ..................................... has permission to perform ....... ......... wrong in the building of ........ .. ct..!ti ........../.... ............. at ....... c �. ......� �rLsk.�`<.../1 `( North Andov r Mass. Fee ...... �:. r� ... Lic. No./ , �r� ,%.,��. ................ ................... ................... E CTRICALINSPE,CT0R -�' 02/21/% 09:49 40,00 PAID L2 WHITE: Applicant CANARY:Dept. P :Treasurer OLD: File ••••• ,••• •••,••.. I V vrs�rvrlM Mt'r'L,/tvI\I Iuf�1 f VI"1 f Ci'1M11 u uv f'i.u�Yr�7��.v Flint a Type) NORTH ANDOVER Mass. Oahe / ,10 Buildingi -7/ Pannit LocatloName f New Ld' Renovatlon Q Replacement Q Plans Submitted: Yes(3 No. Q FIXTURES .. Check one: Instilling Comps n Name _ / ,� ,� �� Q Corp. Address - v .. / ❑ Partnership Business Telephone (Q Flo —d 0 Name of Licensed Plumber� S' �� 1 have •current 11abA Insurance utecx one RY policy or its substantial equivalent • Yes E -- - No Q If you have checked ygj, please Indicate the type coverage by checking the appropriate box ;I Ilablil ® I_ --- Certificate Y insurance policy Other typed Indemnity t7 Bond O OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the Insurance coverage required by Chapter 142 d the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: are of Owner or Owners en Owner Q Agent Q hereby CW* that AN at the details and Information 1 have tubnM d tot entered) inare bus and ate to the best of my notwled a and that sN plumbing work and insidatlons pedwnwd under the penrA I thl pertinent provisions of a Massachusetts State Pli mbkq Codd th Code std 142 tion wiM ootnp with sit slilhatur"nicensed // er Zn License Number CD jhl"OVED (OFFICE USE ONLY) Type of Knbing License: Master 0' Journeyman Q Fill 11-11/111/���������������/1111111 Check one: Instilling Comps n Name _ / ,� ,� �� Q Corp. Address - v .. / ❑ Partnership Business Telephone (Q Flo —d 0 Name of Licensed Plumber� S' �� 1 have •current 11abA Insurance utecx one RY policy or its substantial equivalent • Yes E -- - No Q If you have checked ygj, please Indicate the type coverage by checking the appropriate box ;I Ilablil ® I_ --- Certificate Y insurance policy Other typed Indemnity t7 Bond O OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the Insurance coverage required by Chapter 142 d the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: are of Owner or Owners en Owner Q Agent Q hereby CW* that AN at the details and Information 1 have tubnM d tot entered) inare bus and ate to the best of my notwled a and that sN plumbing work and insidatlons pedwnwd under the penrA I thl pertinent provisions of a Massachusetts State Pli mbkq Codd th Code std 142 tion wiM ootnp with sit slilhatur"nicensed // er Zn License Number CD jhl"OVED (OFFICE USE ONLY) Type of Knbing License: Master 0' Journeyman Q 3376 ._ Date.. "1.�.% ..9/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING N,SSACMov 4o,��� This certifies that ...9 ... ......... . . has permission to perform ..... �% plumbing in the buil ings of . . . .. .......... at. . % �.. ....... North Andover, Mass. 7 Fee�.S. ,-... Lic. No.. .. . . ............................. . 3b PLUMBING INSPECTOR 8- 06/18/97 11:35 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer