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HomeMy WebLinkAboutMiscellaneous - 95 OLD FARM ROAD 4/30/2018I -V 01:. -(*':� - //' Date.......... ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING v This certifies that .............. 7- /7 ........ has permission to perform ........ ..... .. . .............. wiring in the building of ..... ....................................... at ...... 9� ... a,, .... North Andover, Mass. I- ............ 0) &ee ... ... Lic. No. -A ........... ELECTRICAL INSPECTORWJ Check # C'onwwnweaki. o f Maseaclwdaffi Official Use Only �p cc�� Ji'. 7 Permit No. 2eparfinent a/}ire �eruiced Occupancy and Fee Checked 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 Code ( ), 5F CMR 12.00 (PLF-4SE PRINT IN INK OR PE INFORAL4TION) Date: �' IV/ City or Town o 0 C% -, f. I ol, �' To the Inspector of Wires: By this application the undersigne gives notice,f his or her intent to perform th a ectrical work described below. Location (Street & Number) ,5 o Lf44- Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate ox) Purpose of Building S144 J.? -A-kvgi 14 Utility Authorization No. Existing Service _�W Amps ?.)l `71t/ oats 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, 4 j,-:, J J G (?4701G0 Completion of the folloivine tafile nray be waived by thg Inspector of 417res. No. of Recessed Luminaires No. of Ccil: Susp. (Paddle) Fans r o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above ❑ In- L1o. g nd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o erection andInitiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers p Heatpump Totals: umber ons K o. oSelf-Contained Detection/Alertingr Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ umecti ❑Other Connection Dryers No. of D Heating Appliances Key Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters. o. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP _ITclecomfDevictio r Wiring: No. of Devices or E uivalent OTHER: Attach additional detail tfdesired, oras required by the Itrspector of S. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the Iicensee provides proof of liability ins ce including `completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover is in force, and has exhibited proof of s e to the F it issuing o ce. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �L 1 Z I certify, tinder the paw ns attd penalties of perjury, that the information on t/ is application is true and contple FIRM NAME: ,.J �� n 1 C LIC. NO.: ��l .� Licensee: S i% UA Signature LIC. NO.: {If applicable, enter ' exein ^ " in the t'c nse rrurnber line I 11� Bus. Tel. No.; _ Address: .5 - u�� !1 Att. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security workJequires Department of Isub is Safety "S" License: Lic. 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 agent Owner/Agent PERMIT FEE: S Signature Telephone No. U J J �w L M V U CO 11 W �) #< UU :5U = J Z 2 S- Date...3 - I � - 0 ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .A L/,,,,, ...................................................................... ............... has permission to perform .................................... wiring in the building of . .......................................... at.q.\ ... . . ....... ........... . North Andover, Mass. Fee....:' ....... Lic. No....../ .. I.....E......................................... ELECTRICAL INSPECTOR Check # 89`x: Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. — S 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (ME,0WORK (PLEASE PRINT IN INK OR TYPE ALL INFORM1q TION) Date: City or Town of: NORTH ANDOVER To the By this application the undersigned gives notice of his or her intention to perf rm the el� electrical ��,)ector of �ies described below. Location (Street & Number) U� Owner or Tenant 1 ✓�rj Owner's Address Telephone No. 4�C Is this permit in conjunction with a buil permit? Yes Purpose of Building ltd S e 2 LJ NO (Check Appropriate Box) � !—'�) -- �y` Utility Authorization No. Existing Serviced Amps jig / U Volts Overhead ❑ _____�_Volts No. of Meters �_ New Service Amps / _Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity - Location and Nature of Proposed Electrical Work No. of Recessed Luminaires MPI eftonof the ollowin No. of Ceil.-Sus p. (Paddle) Fans table may be waived b the Inspector Of Wires. No. of 1 No. of Luminaire Outlets No. of Hot Tubs Transformers Total KVA No. of Luminaires Swimming pool Above ❑ In- ❑ Generators KVA o, o mergency ig g - - . No. of Receptacle Outletsd and No. of Oil Burners Batte Units No. of Switches FIRE ALAILMS No. ofWi7 � N No. of Gas Burners ofnes No..Detection and No. of RangesTotal No. of Air Cond. Initiating Devices No. of Waste Disposers Hp Pum Tons Number Tons KW No. of Alerting Deviceseat No. of Self -Contained No. of Dishwashers Space/Area Heating KW n/Al Deteetioertin Devices ❑ Municipal No. of Dryers HeatingA PPhances ICV' Connection 0 Other Security Systems:' No. of Water Heaters ' No. of No. of Devices or E uivalent Si s alo. Ballasts Data Wiring; No. Hydromassage Bathtubs No. of MotorsTota! HP No. of Devices or, E uivalent Telecommunications Wiring: OTHER: t Rcrc No. of Devices or E uivale ry �c< cam✓` c Dom: /� GG Attach additi nal detail if desired, or as required by the Inspect r of Wires, Estimated Value of Electrical Work: q00 �� Work to Start–r- D (When required by municipal policy.) nspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE GE: 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ,& BOND ❑ OTHER I certify, under the pains and enaltees o El (Specify:) ' p fpeJury, that t e information on this application is true and complete. FIRM NAM v t^ Ll – Cn d eca Licensee: LIC. NO.: %� r Sl (Ifapplica Signature + �5 kS LIC. NO.: ter ' exe t " in the license n tuber li e.J Address: . (�, a Orf S -Z% X 030 3 Bus. TeL No.:ia 3 as �4?z *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safe "S" License: fit' Tel. No.: OWNER'S INSURANCE WAIVER: I am ware that the Licensee does not have the liabilityLic. No. required bylaw. B si below, eby waive this requirement I am the (check one) 0 er coverage normally agent Owner/Age Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Dice of lnrestig ations 600 JMzykington Street Boston, M4 02111 l ' www rnass.gov/dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plambers licant_Information Name (Business/organization/Individual): Address: Z G , City/State/Zig: iU ,fel-A667D3 1 . ox.73 Phone #:_. CO3 9 31r" � Are you an employer? Check -the appropriate box: 1, Iz am a employer with 4. ❑ 1 am a general contractor and I L(full and/orpart-time).* 2. ❑ I am.a.sole proprietor or have hired the sub -contractors listed partner- ship and have no employees or>. the attached sheet t These sub -contactors have working for me in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. Q 1 am a homeowner doing officershave exercised their all work Myself [No•work=' ' comp. right of exemption per MGL a 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. Q Demolition 9. Q Building addition I 0 X Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑.Other `Airy applicant than checks bort #I must aiso fill out the section below Showing their workers' compensation policy ah0. �Cotttractors that check this box mart o t homeowners who submit this must t indicating they are doing all work and then hire outside can attached an additionaactors must submit a new affidavit indicating each. l sheer showing Litethname of the sub-contmetats and their workers' COMP. poriey inmmsation. ant an employer that is providcng:workers' compensation information. ursurawe for nF employee-; Below is the policy and job site Insurance Company Name: ' Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: j Attach a copy of the workers' compensation Policy declaration page (showincity/State/zip: t e p l�icynumber 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 �t 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 pains andpenalties of perjury that the information provided above is true and correct Si Lure: Date: Phone #: (Jficia! use ortfy. Do not write ut this area, to be completed by city or town. ofciaL City or Town; Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspectar 5. Plumbing Inspector 6.Other Contact Person: Phone #- a Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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, MOL chapter 152, §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-conizactWs) name(s), address(es) mind 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 cavy 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 entertheir self-insurance'Iieense number on the appropriateline. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departmew 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 vvilI 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 policyinformation (if necessary) and under "Job Site Address" the applicant should write "alt locations in (city or town)." A copy of the affidavit that has been officially starnped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fift a 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 bum 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 Departruent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-8.77-MASSAFB Revised 5-26-05 Fax # 617-727-774 www.raass.gov/dia C Location (-2- ~ �-�� / No. `7,,2,.s Date HO*T" TOWN OF NORTH ANDOVER Certificate of Occupancy $ `,SSACMUS �� Building/Frame Permit Fee $ l� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # i8y7'! Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT W_A11& RENOVATF,ORDEMOLISH A ONE OR TWO FAMILY DWELLING 'G. �; ri" Mme• .. .. BUELDING PERMIT NUMBER: V alp DATE ISSUED: - SIGNATURE: Building Commissioner/IngWor of Buildings Date 6.w SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number-,, 96' OI D 6zrm moa -� ORor.'o=oo :: PL04O� ? 4 l' , a3 zro �� . Map Number pQ 06to G Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts 8 1.6 BUR DING SETBACKS ft ' Front Yard Side Yard Rear Yard Requir6d Provide Required Provided Required Provided 1.7 Wats Supply M.G.L.C.40. 34) 13. Flood Zone Informdion: 1.t Sewecap Disposal System: Zone Oamide Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ ❑ Private ❑ PublicSECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 11:' [.0%i jt=L2ii8triCt: 16,23 2.1 Owner of Record k9C— -L.?Y TVU S T Name (Print) Address for Service Signature V Telephone 2.2 Owner of Record: r Name Print Address for Service: Si&nature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: A - _^ �' 03 License Number , ross d 3 ?- 7% 1 t� 3 Z 0 (p Expiration Date tgnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Dale Signature Telephone M SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 i 25c(6) , Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Pro sed Work check v a b4 New Construction ❑ Existing Building ❑ . Repair(s) Alterations(s) 0 Addition ❑ �-' '0 -*51!.,, ,, A, ,y Accessory' �i A .- mo Bldg. g 1 ❑ Delition 0 Other ❑ Specify ���;_ R A Brief Description of Proposed Work: -' :1:.r?`� f -a (� :�Y.% 2 -XS x �dti •=�:�,;,�'�I�er S U,vaie r '�c k or is w17n No r. SRrTION 6 - R.STTMATR.D V0NRT2TTVT1nN VnCTc item Estimated Cost (Dollar) to be Completed by permit applicant OFI+`ICIAL USE ONLY 1. Building U O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (,) x tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number ua.v a.- ... V Mr, <. VDitJUM Am" W t11 A OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ' i • ' . Y � a 4 ^ � .... ah a4 a f .. � ' . I• as Owner/Authorized Agent of subject property ` Hereby authoriz r � E ` •. to act on half, in all a relative ork authdffzed by this building permit application) Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATTON I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent _Date NO. OF STORIES , - SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2' 3Kv SPAN DIMENSIONS OF SILLS DRV ENSIONS OF POSTS DIMENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �Q z CL Q H Co W H oc W C3 COD I [r �S o m C • C �i O J C� Ci C C. co W O C :Z _O O � Ea +0.. C o a EC43 o o a$ 3 co mi • y C 5 E 3 = O � 60 •� s =CG - go Cc c c O :Em CLS CD goon a 'fl c :moa `TL= m' Zo :=moo c, 0. o, c • c S CL o w CL W C O v� O OfD C m � � oo=� O C36 m VJ s� CO zCf) 0z 0 �O z v) (%) �0 w U U O v O L Z O. O y � C cm C Q LA cD O �E m m CD CD Z O� 3� CD L M o a �a o =� C coO CL. 0,v a) C Z ts CL V y O C C ■� C c CL U) U) o� W W W U) a a a a v cn aG v U W. c� w w w c�4 k. W co o cn E cn z CL Q H Co W H oc W C3 COD I [r �S o m C • C �i O J C� Ci C C. co W O C :Z _O O � Ea +0.. C o a EC43 o o a$ 3 co mi • y C 5 E 3 = O � 60 •� s =CG - go Cc c c O :Em CLS CD goon a 'fl c :moa `TL= m' Zo :=moo c, 0. o, c • c S CL o w CL W C O v� O OfD C m � � oo=� O C36 m VJ s� CO zCf) 0z 0 �O z v) (%) �0 w U U O v O L Z O. O y � C cm C Q LA cD O �E m m CD CD Z O� 3� CD L M o a �a o =� C coO CL. 0,v a) C Z ts CL V y O C C ■� C c CL U) U) o� W W W U) 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 or requirements. APPLICANT FILLS OUT THIS SECTIO APPLICANT GOE + Pf A 7-7- e6"14LTY 7-4457— PHONE1c_ i� 95 # 7 LOCATION: Assessors Map Number -214-03S-0-01,7- 0000. o PARCEL SUBDIVISION F2 C: M C(f %$2 W LOT (S) STREET_ _9.5 OGS F,,' 4m ,e b ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: ADMINISTRATOR DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Rev+ad M97 jm -4-1 1,4 /I/L/ VA-) 7p,,C>y DE VELLI S CARPENTRY OUALITY WORKMANSHIP RESIDENTIAL - COMMERCIAL 13 7t .-L /y S <, + # 0- e �� BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR lj Numbe', CS1 005743 Birthdate:}03126/1954 %:. I,..er.i�..r:„� _ r•.c Expiresi 03/262006 Tr. no: 23554 Restrieted--00 DAVID J DEVELLIS 198 MAIN ST SANDOWN, NH 03873 " Acting C mts oner 00 - 35,000 cf enclosed space (MGL CA 12 S.60L) 1A - Masonry only 1 G -1 & 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code 1 is cause for revocation of this license. f I � DIG SAFE CALL CENTER: (888) 344-7233 Feb 7 2005 11:10 P.02 AC -0 -RD CERTIFICATE OIC LIABILITY INSURANCE FAX (603)382-2034 3)382 DATE(&Mmpfyy" ''Q� 160-4600 02/07/2005 Insurance Sol V4-46W Cor oration THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P. ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE PO'Box 1079 HOLDER, THIS CERTIFICA I t DOES NOT AMEND, EXTEND OR Atkinson, NH• 0.39,11 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dolores Magl is INSURERS AFFORDING COVERAGE I^IscIRED Davi d .Devei � s NAIC # 198 Main Street INSURER A: York Insurance Co. of Maiile Sandown, NH 03873 INSURER B: INSURER C; INSURER D: _ - INSURER I -- THE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THrz POLICY PERIOD -INDICATED. NOTWITHSTANDIN( ANY REQUIREMENT, TERM OR CONDITION, OP ANY CONTRACT OR OTHI=R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, bCCLUS)ONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI AIMS. SR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECj'IVE POLI7:�AED "E' MhAL LIABILITY UMITS YMIU73229 08/27/2004 08EACH OCCURRENCE s�( COMMERCIAL GENERAL LIABILITY DAMAGE TO RUrrED$�QCLAIMS MADE � OCCUR 300 00 A � �' (Any one pafBon) $ -------------- 4AUTOMOBILE GGREGATE I,JMIT APPLIE�7PER: LICY JET . LIAg1UTY YM1U73229 08/Z 7/2004 08/27/: ANY AUTO ALL OWNED AUTOS A SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS GARAGE LIABILITY 7 ANY AUTO - CKCESS/UMSRELLA LIAMILITY 7 OCCUR ❑ CLAIMS MADE DmUCTIBLE RETENTION---------------- $ , WORKERS COMPENSATION AND • EMPLOYERS, LIABILITY ' .ANY PROPRETOR/PIVE OFF.ICPP/Mr=MBER EXCLUDED? OTHER DESCRIPTION OF 0PERAYK3X3I LOCAT70N3! VEHICL)=S I EXCLUSIONS ADDED HY ENDORSEMFNT ISPECIAL PROVISIONS >PERATIONS: CARPENTRY 4CORD 25 (2001/08) PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OF AGG $ COMBINED SINGLE LIMIT I $ (FB aoddenp --- �,-Lu u 500,00 12000,00 1.000.00 500 (Per ILY p --n) i $ I BODILYINJURY I $ I PROPERTY DAMAGE (Per a�rldent) $ AUTO ONLY-EAACCIDENT $ OTHER THAN EA ACO AUTO ONLY: AGG S $ EACH OCCURRENCE $ ' AGGREGATr g S ' S ,E.L EACH ACCIDENTArlsE.L. DISEASE-EAE^MPLO.L i]15FgSE-POLICY LI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE RXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL IO. DAYS WRITTEN NOTICE TQ -T. ,KE CERTIFICATE ItQLDER NAMED TO THE L> PT, BUT FAILURE TO MAIL SUCH NOTICESHALL IMPOSE NO OBLJGATION OR LIABILITY OF ANY -KIND UPON THE INSURER, Ff•S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRMFNTATWE TION 1988 PROPOSALNO. ' SHEET NO. PROPOSAL SUBMITTED TO: _ WORK TO BE PERFORMED AT: DATE NAE ADDRESS 4t0E.S CITYSTATE TATE DATE ANS 3.03 7 HONEARCHITECT r We hereby propose to furnish the materials and perform the fabor necessary for the completion of _ 777�.• p- Q S _le P► " - tr i j �� _ _�� A r"— All material is guaranteed to be as specified, and the above work to be performed in accordance and specifications submitted for above work and completed In a substantial workmanlike manner for the sum ot: __— �_ _— ----------_---- Dollars with payments to be as follows Any 200.atlmn or d-labon 11, n Wov..p.Nfoktion. mtoaup erta LGSM Respectfully submitted wll• b..amond Wy upon wMd mdef, and wig iMCO" 44 OxbS VhW94 _*' ." ."_ tM "iNst". M �QrYMw�,it COnfinyMl Ugtn �tdkN, nddd.dl.. dewo bryond our nontmt. Note . This proposal may be withdrawn by us if not accepted within—___—_days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outfined above. SIGNATURE — _-- DATE______. SIGNATURE ___ Adarns 9450 Z CE.eT/FY ;-Cl T.f/E T/TGE /NSU•PO.P.400 Ta T,�/E' BAN,f' 7W47 T.yEOwEGG/N6 /S GOCATEO VV T//E 4oT AS C0.1/FGtPlw !Y/Tf1 rs�e-TUw� OFNo2"�� AN00.E'P2ovivG .eEG!/LAT/0.1/S REGA.PO/N6 SETBAC�t'S F�O.Sf ST.eEETS �` CDT G/NES. "' 1 FU.�>f/�".P LE.CT/FY T•S/i4T T///S O/�'ELL/N6 /-s' �t/OT GOGgTEO /it/ T.YE FEFpElCi4G�FCOOG f,'.9ZA.P0 A.PEf:. SHawN O/t/ FEMA""�'O..!NM: />Y,or.vGL 250098 5 G tr C�"lAQ OAze & 93) /N O/PA�it/ FO/P . _.--.._--._.......-...._..__..... l2oeERT �ltiTt4R Gf�1v"IM�T Tir//S PLAit/ N,. - - RUCPOSES - /vOT FO.P BO!/.vO.PY pETE•PiY//.t�AT/O.v_ Bo�,voA.es� iciFo.Q.ys- �E.P,P//�1.9G� E'•vGisiEE�P/.c�G SE.Pv/lES AT/O,l/ TA�E/(/:F,eoq� �Er�ST/.c/G Pe-coPvs. G� f'4/P,E� ST.PEET M- 55 ZS ft/vOOYE,P, /f7.4SS,4C/Y!/SETTS O/8/O Location ' r �tNo. Date TOWN OF NORTH ANDOVER 3 *... • 0 Certificate of Occupancy $ f ~ Building/Frame Permit Fee $ s�cMuse Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building inspector Div. Public Works PERMIT NO. ' APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. i /PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE RZ_I SUB DIV. LOT NO. — LOCATION G 0\4 \4 PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SI/Z[E OWNER'S ADDRESS / BASEMENT OR SLAB �— ARCHITECT'S NAME a arm SIZE OF FLOOR TIMBERS IST "JVr I X 2ND 3RD BUILDER'S NAME Ted r�S '7� , SPAN DISTANCE TO NEAREST BUILDING f } -- DIMENSIONS OF SILLS --- POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDESr7oREAR t /�O ! " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW v`) SIZE OF FOOTING 1v li x camX , M1bficd IS BUILDING ADDITIONr, /�--� MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND OL / WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /"--s 0 _] C IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 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 (T ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS r PLANS MUST BE FILED A �AP/PROVED BY BUILDIi/NGJNSPECTOR DATE FILED !3 �L SIGNATURE OF FEE 'A�A5". © 6 ZED PERMIT GRANTED -57ly-yW / t9 _ 7 13 OWNER TEL. # CONTR. TEL. #�e��Z6" CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST IVt` (<�, a" - EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM t ) SEPTIC PERMIT NO. PERMIT NO. A 4 BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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. ■ S�OkIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR 3 PINEHAR PLASTER DRY W L DRY WALL UNFIN. FINISH 1 _ 2 13 _ _ _ — _ CONCRETE CONCRETE BL K. BRICK OR STONE ---III PIERS _ 3 BASEMENT AREA FULL FIN. B M'T'.AREA 1/1 '/r FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ ill� 1 2 �_ 3 _ _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDIVJ'D ASBESTOS SIDING COMIACN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIO--yl ADEOUAATE I I NONE 10 PLUMBING 5 ROOF GABLE GAMBRELMANSARD I 11 HIP BATH (3 FIX.) TOILET RM. (2 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 PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 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 GAS OIL B'M'T 2nd _ la 13rd 11 ELECTRIC NO HEATING ■ n Q Ti z m I C C ?'� o = _ co r. - S. O CS y D C O C O 'D CO2==moo Co Cl) O H n CL m Z CD x'00 y '-° =gym o. card CD O CD y p O CD m - a .a p .00.E CC G _ O wo yO� .o CD CD n-0 Cfl O CD CD m � y `% O CA y V y CL �_ Q C a (^ IE CA VJ y ycd �CD � cd CD d CA CD CD 03 C 3 � . Er 0 C C', R, CD a� A C3 Wp.o� = cD d Cu a y O n > Cgs C/] O C/l ° M '17 z w 91 - Gid] X37 w p G') C17 � y G p X17 w (% fD ` �d G an 71 G PO 0 C"n G M O � d 'TI CO) Cl) O r CD n Z CO) CCD O 'O CL r c � � c v LV �o Mq o CD p CLCD O Q W CD n CCD O CD C) W t= CD a y, m �. O CD y ' O Cfl CD z � CO) p O � CD n Z a OCD m z O C D r CD I C C ?'� o = _ co r. - S. O CS y D C O C O 'D CO2==moo Co Cl) O H n CL m Z CD x'00 y '-° =gym o. card CD O CD y p O CD m - a .a p .00.E CC G _ O wo yO� .o CD CD n-0 Cfl O CD CD m � y `% O CA y V y CL �_ Q C a (^ IE CA VJ y ycd �CD � cd CD d CA CD CD 03 C 3 � . Er 0 C C', R, CD a� A C3 Wp.o� = cD d Cu a y O n > Cgs C/] O C/l ° M '17 A w 91 - Gid] X37 w 7� S. ,d 0r4 C17 � '17 w G p X17 w (% fD ` �d G an 71 G PO 0 C"n G M O Cn Pan C/) n 177 O x g O > v \/ E W v �O V H 0 9 0 c ARM__KOA D__.-- �'u��q CoR►►BR POSTS x to P. -r. ®16" oC, - 2x10 Na�b� L.or��edt -40 ex�s��� strcx�ti� "x ('11 P•T. GAS V IW 1Zt-1) t16ST BASE IZrrCd►�GRIrTE P1�[ 4 8" T'o G NPt b ►(o' x 12' t>eck ReAR r&VD _ . 2x2 ��gS 16 F - T 0) 0 C, �Z�Zti\0 PdST BASE Po kc -IA C9,'C�k4(4 SCwbhj i $GrCEh kol-) 41(xglf c4kuCk POITS - 1-1 .,-StuYL be<K 12'/CdQCR.JTE QIJEF 48" ro GLADE 3'1 zr J Date... t-............................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ' ' " has permission to perform..:: wiring in the building of ........... ' _ �,= - 11 ' f"- at ...................... ..... .. ..:...................... . North Andover, Mass. Fee . /,=''.............. Lic. No �". ` . .............. e........:.:'��..................... "ELECTRICALINSPECCOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer % (gommouu►eutt% of M000ar4uoetio Delxww nt of Pr4lir Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only �� Permit No.Y'� Oecupan y & Fee Checked 3/90 (leave blank} APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �— 0 22 —.0 City or Town of /V /p % ly A -AI M V f k �-=To—th►e Inspector of (Wires: The undersigned applies or a permit to perform the electrical work described below. Location (Street & Number) - l __02 4- D /C,4 R In Rf)1,+1) Owner or Tenant P_V e fie-- G RX:,yl M zm- Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building S 6 1, 4 in r 1,Y Utility Authorization No. _ ExIong Service Amps / Volts Overhead Undgrd❑ New Service .Amps / Volts Overhead n Undgrd ❑ NtAber of Feeders and Ampacity Location and Nature of Proposed Electrical Work_<A� = 2� L C�� $O L L. e� No. of Meters Nb. of Meters No. of Lighting Outlets No. of Not Tubs TOTAL No. of Transformers KVA No. of Li ting Fixtures Above In - Swimming g Pool rrid. ❑ md. ❑ Generators KVA No. of Receptacle Outlets No. of Oil BBurnerso. Burners of Emergency Lighting Batte Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones 'No. of Detection and Initiating Devices No. of Sounding Devices - No. of Self Contained Detection/Sounding Devices Murricipal Local❑, Connection ❑Other No. of Ranges Tota No. of Air ConditionersTons No. of Dis osais t feat Tota Tota No. of Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of D=rs Heating Devices KW No, of Water Heaters KW No. o No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs Na of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws 1 have a current Liability insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ! NO 0! have submitted valid proof of same to this office. YES V NO n If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE I N BOND ❑ OTHER❑ (Please Specify) Estimated value of Electrical Work $ 3 � • � . (Expiration Date) Work to Start ] __ Inspection Date Requested: Rough Final Signed under the penal s of erjury: FIRM NAMEV L R L M L -L cTt ,—o�,�" Gf L LIC, NO.,/4 J 5 !3 ,Licensee f'�i r - G Signature LIC, NO. Address./41 661> E'IS b 1�is�/ ��,cE= �, Mpg - O (�L i Bus. Tel. No7&3- -2 9 1 Alt. Tel. No. .OWNER'S INSURANCE WAIVER: t am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) DCo"IT CCC It