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Miscellaneous - 96 RUSSETT LANE 4/30/2018
J �1 N° ,I v6L Date.....4:� .J.�./ s s TOWN OF NORTH ANDOVER A PERMIT FOR WIRING 8 14 This certifies that .!..............�. �.!...`: P e L .............. ................................................... Ica has permission to perform ........ .. . .."..'' .........�.-r%.%.�.`.. t- .............. wiring in the building of ...... P. -01..k..?.,. ....................................... R c ,c c f f .... .................................... . North Andover, Mas Fee..... .,�....v Lic. No. �. J�l................................................................ ELECTRICAL INSPECTOR C�L`��3 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ------------ ff �y ° ul�e �>lrrmuttur�ttlt of a- ' '`ttttrllu5rtt I Oftice Use Only 01!Parttnent Of PLIbliC=+ttfrttt I Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR Occupancy & Fee Checked APPLICATION FOR pER1V11 12:00 ; 3,90 (leave blank) All work to be T —i performed in accordance with � PERFORM ELECTRICAL (PLEASE PRINT IN INK OR TYPE ALL INF Massachusetts Electrical Code, 527 CMR City or Town of RMATION) CMR 12:00 The udersigned a Date .� applies for a permit to - To the Ins Location perf rm the electrica work described below, pector of Wires: (Street & Number) Owner or Tenant 14 Owner's Address Is this permit in conjun tion with a buildin permit:;�-- Purpose of Building Yes ❑ No ` /�. (Check Appropriate Box) Existing Service Utility Authorization No. Amps ____Volts _ New Service Overhead ❑ Undgrnd --� Amps — No. of Meters Number of Feeders and Am —Volts Overhead ❑ pacity Undgrnd No- of Meters Location and Nature of Proposed Electrical Work t No. of Lighting outlets �-------- No. of Hot Tubs i No. of LightingI No. of Transformers Total Fixtures Swimming Pool Above In- KVA No. of Receptacle Outlets 9rnd' ❑ grnd. ❑ I Generators No. of Oil Burners No. of Emergency KVA No. of Switch Outlets Batte 9 Y Lighting No. of Gas Burners rY Units No. of Ranges FIRE ALARMS No. of Air Cond. Total No. of Zonos No. of Disposalstons No. of Detection and No.of Total Heat Total Initiating Devices Pumps Tons KW No. of Dishwashers I No• of Sounding Devices No. of Dryers Space/Area Heating KW No. of Self Contained Heating Devices Detection/Sounding Devices KWM unicipal No. of Water Heaters KIN I No. of Local No. of Connection ❑ Other ----- Signs Ballasts Low Voltage No. H� Massage Tubs I wiring --- ---- No. of Motors Total HP OTHER: i INSURANCE COVERAGE: I have E: Pursuant to the requirements current Liability Insurance Policy quirng Co of Massachusetts have submitted valid he including Completed O general Laws checkingProof of same to the Office. Y Operations Covera the EIPP opriate box. ES NO 9e or its substantial equivalent. INSURANCE qi' BOND - L- If You have checked Y ndicYES - NO 'v , OTHER ES. Please indicate the type (Please Specify) YP - of coverage by Estimated Value of Electrical Work $ Work to Start Signed undertf�e Penalties of d Inspection Date Re Ex'i n Date) Perjury. monogQ $ . R _ FIRM NAME _ - nal Licensee "Imm HOME SE(r+(j�j 166 WEST.ET� 8VIT$ 6 Address _ ON}A LIC. N OWNER'S INSURANCE WAIVER: I am aware thatOFFICE- ther{� 08 • - LIC. NO. --- —_:___ 657.0443 us• el. No. quired by Massachusetts General Laws,t� - AltvTel. No. not have t ------ (Please - check one) and that my signature on th,� he insur n Covera e Permit application waives thg requirement. Owner (Signature of -----_ Agent _ Owner or Agent) ------ Telephone No. _- ----_ .�------- PERMIT FEE $ x-6565 14 Date ... ...... �.j ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING his certifies that ....................... .... ................................................... has permission to perform ................................................................................. wiring in the building of .... .......... ;:,.; ......... ........................................... 1* 1 , 1 '7 - I at .............. ............................................................. . North Andover, Mos. Fee.& ..... ........... Lic. No; ...... z.' K.). ELECTRICAL INSPECTOR Check # / <<74,1 THE COMMONWEALTH OFMASS4CHUSE77S Office Use only DEPARTARATOFPUBIICS4FETY V Permit No. BOARD OFFIREPREVEW0NREGUZA770NS527CW 12 00 ���� � Occupancy & Fees Checked Id' APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 2 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wire; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) r Ue- i— Owner or Tenant Owner's Addressy S SG (ill Is this permit in conjunction with a building permit: Yes [D' No [:3 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ED Underground No. of Meters New Service Amps / Volts Overhead r--1 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work —421 /1 U 0CV, c. 1///1 i No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No_ of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP rA OTHER - 4 hlsltta =Covutage. RIISIIaiYtol1le18C]ILIEtT]elY50fM Ri9eU5GQlP1il1I�1WS Ihawaaruertliabj}ityhowancePt>licyincLxlQtgCorrl Covgageoritsabstmialegaivalat YES � NO IhavesttbtniWdvandp o4ofsametodrOffim YES ED ifyfluhavec ndodYES,pleaseir"catmhetypeofcovaageby aWp Esrt "DdValwofFLaricalWotk $ WotktoStatt IrWetxionDaleRegttesqpd Rao Final Signedundatrieftnahesofpajtuy % FIRMNAME �I �P-(J �n � (tX e Liomm Ice, o (n /, 46A man SigwWre OWNER'SINSURANCEWAIVER;Iamawat dmtftLmwdoesnothaX and thatmy sigaahunem thispermitappficatim waivusthis tequitemem (Please check one) Owner Agent Igna ure o . wner or Agent _ LicroseNo. 2 LicemNo BusitmTel. No. L i ' 7 v © AIL Tel No. wbstmtolegttivablasoWredbyM<•> whuscMGeneralLaws Telephone No. PERMIT FEE,$ ` " The Commonwealth of Massachusetts Department of industrial Accidents Office of investigations Boston, Mass. 02919 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. Policv # Company name: r Address Ci!y Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonments weU_as_civil.penatties)n thelorm-dA-STOP VAKM ORDFRind_a.fine._ai..(,$1 DDM)-arJay.against,nw- I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. n / do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date ,i Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept E]Check if immediate response is required .0 Licensing Board Ei Selectman's office Contact person: Phone #: Ei Health Department Ei Other N° 9 6 9 2 Date. «•° TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING NSSACMUSe II ! This certifies that. i ..,.!... � 17' ............. . has permission to perform . E&-Cj4.- ................ ✓ plumbin in theJbuildingso{f ...? .�� ...................... at ..... i. /.... -Lt 671I.e A .. �'F3 , , , .. , North Andover, Mass. �.. t. Fee ... Lic. Nt—L ... MI> ......................... � (� � �� PLUMBING INSPECTOR Check # " WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY" MA DATE !� /� (PERMIT # JOBSITE ADDRESS IL.S� �� OWNER'S NAME[,j� t�a POWNER ADDRESS (_ _- — —__ -_ - _._._I TEL;OC' v it FAX TYPE OR OCCUPANCY TYPE COMMERCIAL [_7 EDUCATIONAL [- RESIDENTIAL PRINT CLEARLY _ NEW: jRENOVATION: - ` REPLACEMENT: ( 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM + - •_._._(! _ _ -_._- ___ !i I `.._.___._..._.__............__ ....-___._.._. ____.... _.___._. DEDICATED WATER RECYCLE SYSTEM i I -----„ --- ._..._.___..._ _.____._............... ' DISHWASHER .... _. _ - - --- --- -- - _ ..............._._...._... .. DRINKING FOUNTAINi FOOD DISPOSER ,__...__�. _-- _----__...... }s 1, FLOOR /AREA DRAIN - -- - - -- -'-- - - INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ------------ i ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET - - - - - -- - - - ---- - - -- - - - URINAL_ -- WASHING MACHINE CONNECTION WATER HEATER ALL TYPES -' WATER PIPING OTHER _I i 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES j NO [? IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ;!,I OTHER TYPE OF INDEMNITY (� BOND rI 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,= i AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provisi n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME , MICHAEL HOUSE i LICENSE # 17173 A MPj �.. JPCORPORATION:. j#3377 C (PARTNERSHIP[#( i LLC. i#' -�- COMPANY NAME MERRIMACK VALLEY CORPORATION ; ADDRESSLl 5 AEGEAN DRIVE, UNIT#3 I CITY I METHUEN ; STAE ZIP ; 4 I -�---"-~"-- -_- T(_MA 0184 TEL __--= L_-- ----- 978689-0224 ' FAX 978-689-2206 , CELL ! 978-815-4523 EMAIL I LLITTLE@MVALLEYCORP.COM W F O z z 0 U W a z r Q z r oo z a �❑ z O � w w Z a w z U = � ~ � W O > � z 3 N a J � W Q � U J 0. a � a � w s w � LL W H O z z 0 F U W a r V 'Q1 J LL V O x • 0 sus, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers A Iicant Information Name (Business/organization/Individual) : City/State/Zip: Phone#:_ %9 A�� Areyou an employer? Check the ropriate box: 1 I am an employer with 7 � 4. p employees (full and/or part I am a general contractor and I have have hired the sub -contractors 2.0 1 am a sole proprietor or partner_ ship and have no employees- listed on the attached sheet. working for me m any capacity. [No workers' comp. insurance sub-contractorshave employees and have workers' required] 3.11 comp. insurance. $ 5.0 We are a corporation and its 1 am a homeowner doing all workmyself o workers' com comp. officers have exercised their insurance required] t right of exemption perm MGL c. 15Z § 1(4), and we have no employees. [no workers' comp. insurance required.] Print Type of project (required): 6.0 New construction 7. 0 Remodeling 8. f J Demolition 9.12 Building addition 10. 0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12. G Roof rel 13.� .7 "Any apPI1;li!ant that checks box #1 mast also Lip ont the seefion bek►w tHomeownen who submit this affidavit indica showing then workers' ooapeaaation Po Y information. ;Contactors that check t' they are doing aH work and then hire outside contractors most submit a new affidavit indicating such. this box mnst attach an additional sheet showing the name of the subcontractors and state whether or not those entities have the sub -contractors have em ees, theyconst Provide their workers' Cl I am an number. �Ployees if employer that is praf�ia9ttg workers' compensation insurance or information, ,/ f my employees; Below is the policy and job site Insurance Company Name: VIIIA , ,& , a / , J_ , r- . I _ Policy # or Self -ins. Lic. ' " on Date: 44o i� 3 Expiration Job Site Address: S' ANLp Attach a copy of the City/State✓Zip: W, workers' compensation policy declaration a (showing the 11 number and expiration (date), Pug ( g policy Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal up to $1,500.00 and/or one year imprisonment as well as civilorm Penalties ofa fine ER and a fine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded toof a oth Office of IP WORK an estigations of the DIA for coverage verification. I do herby ce fy underhep � f perju tPat the information provided above is true and correct Si re: Pe l',l�1•,e'//�L/tJ� �a— Date: // I Print Nome; Phone #: Officud use only Do not write in this area to be completed b3' city or town official City or Town: Permit/Ilcease #• Issuing Authority (circle one): 1.Board of Beath 2. Building Department 3. City/Town Clerk 4. Electrical Ins 6. Other pector 5. Plumbing Inspector Contact person: Phone #• May 07 12 02:27p Mid e• House 2079658719 p•1 -.e .. M.M.3 .::'.� '•:nom ' '.. , _ v.: M -4- 4vito V rn -.Q •_ 4' ni1•_=a� - - � �. _• �` a ''� mus+'�- D n tz ..: . T ♦Q�`�' w WWn N . 2079658719 p•1 This certifies that. e- has permission for gas i stallationa in the buildings of , ` t at .... ...SSP . �rr :..... ,North Andover, N..-, Fee ...... Lic. No. GASINSPECTOR Check # r5b O 8 8476 C c C', MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ✓ l r rdoo— r MA DATE /��9 ���PERMIT # JOBSITE ADDRESS q6P RV,5Sa - Lao OWNER'S NAME W[a- r+e l t OWNER ADDRESS TEL SSS- 331-2— FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALX' CLEARLY NEW: RENOVATION: REPLACEMENTT PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS— BSM7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND 1 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. C SIGNATURE OF OWNER OR AGENT HECK ONE ONLY: OWNER AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com liance with all Pertinent pr visi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME. MICHAEL H HOUSE LICENSE # 7173 SIGN T RE - 1 MP , MGF JP JGF LPGI CORPORATION # 3377 C PARTNERSHIP # LLC # COMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS 15 AEGEAN DRIVE, UNIT #3 CITY METHUEN STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-884-3427 EMAIL Ilittle@mvalleycorp.com or srutter@mvalleycorp.com • r� U • W F O 7 z 0 U W 0. N z a z c � z z O W }� � ~ W O W O F a Z N N d > z ¢ N W � O GL W a Gti N .a U O a Q U x a F a N til 2 W H W N W F 0 z F W a z a v x v o x • r� U • The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: uilders/Contractors/Electricians/Plumber Applicant Information s Name Are ou an employer? Check VY -1 ppppropriate 1 AI am an employer with --.�+Ls-' 4. C employees (full and/or part time).* 2.0 I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp, insurance required] ' 5.0 3. D I am a homeowner doing all work myself [No workers' comp. insurance required] t .sem Phone#:_ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' COMP. insurance. # We are a corporation and its officers have exercised their right of exemption perm MGL c. 152, § 1(4), and we have no employees. [no workers' COMP. insurance required,] nn. T_ a aysa la. i 1 M& Type of project (requi 6. 0 New construction 7. 0 Remodeling 8. U Demolition 9. C] Building addition 10. 0 Electrical repairs or additions 11. 0 Plumbing repairs or additions 12. G Roof 13.� "Any applicant ffiat checks box #1 mast also fin tont the section below sh tHomeowners who submit this affidavit in owing their workers compensation policy mformation #Contactors that check indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such. this box mast attach an additional sheet showing the name of the sub -contractors and state the sob -contractors have em ees, they must rovide their workers' co whether or not those entities have employees I am an number. employer that is providing workers' 1-1 compensation Insurance or informadon. f my employees. Below is the policy' and, job site Insurance Company Name:_Wrfe < ---7,r.�i� Policy # or Self -ins. Lic. #: Job Site Expiration City/state/Zip A�,,�L,9,—- 1,44 , 'Gf� 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 152 can lead to the imposition of criminal up to $1,500.00 and/or one year imprisonment as well as civilorm a STOP WORK InPR penalties a of fina fine $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of of the DIA for coverage verification r ' May; 07 12 02:27p Mike House 2079658719 p.1 ti m:M 3 =.i.: 3.o.n. A:." '. Nom•`;=``._ CA CA o . mrp w; C� ca f :• • n _ Y: fir. 2079658719 p.1 No l !.1 n. Date...`.....: ......... ........ kj TOWN OF NORTH ANDOVER ~ PERMIT FOR WIRING This certifies that . -............✓.1s :' 'r �--4� .............................. has permission to perform ......//-.r.............................................................. wiring in the building of �Yyllr.......................................... J � ` at . North Andover Mass. a Fet .-......:"`... Lic. No.-�.... .............. �J % - ELECTRICAL INSPECTOR Check # 1/ D WHITE: Applicant CANARY: Building Dept. PINK: Treasurer No 4 T1 3 4. Date. . - .,-:7 :.... - i TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... rr ;f * has permission to perform ..'.................? ................... . plumbing in the buildings of ..... r. ................... C ......... , North Andover, Mass. Fee ' ...... Lic. No.. A.4. ............ . j PLUMBINGINSPECTOR Check # '�� WHITE: Applicant CANARY. Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO OO PLUM13ING a� OMM or Typo %.O r . Mass. oat p Bulldk►p Location .owners 0r5 O d Type of Ooatrpwvcy rSt 5 17 E ev 7i A L -._.._ New p R«wvatkm ❑ Repisewnwrt Be' Pm= SuNiMed: Yes 0 NO 0 FIXTURES BUS Aess Name Of Ucensed Plwnbw Che* ate: 13 Corpormam ❑ pwbwre* INSURANCE COVERAGE: 1 have a cuff Mt I kwu mos poft or its as l eqthraWt vridd e11Mts the requkwwft of MGL CA. 142. Yes No ❑ • If yOu NM chodml3, pens Wdinho Vo Mm ar4ssW by dwddM the gXxopt s boot .A IWAIty hsurance oaffey Ld1"1 Omw typo of kwWmN r ❑ Band O OWNER'S INSURANCE WAIVER: l am aware that the Newo a dams not have the bm anee covwMP requked by i;hpter 142 Of the Mass. General Lswe. and OW my WWwhm on this perntit applicaUm nr &n this requkemant. C21sok One. Owner O A4" 0 I hereby Derby that d of to details ane Ioban fmowlseps ane Mat d phrfnbirrp worm stye ko pertinMrt pra+a,ora of Me Mm k&mn bi efts. TitN om USE own I own I haw srAnritls - for wttsreel in above appicabon we bus and accents to tfte best of my rasI Fig wood underby psrrr* for #" sppfKation vA be in aompherm with al Mo N W NW CtlaoW W d Lms. g----st— Type of IJOerrae: JoumrAl b 0 l =nm Plurnb.r V < = M 119.. o _~ tz O S tl d a Op e= a e s`- O w w 29 w IL z I- e rsu o W m 's =< a c s L o ~ v s o= r a pbo = s M a O • .ei � a: e < a! .� A O-- J O wO O < 3 e a0 sua—as�T. •ASRUENT 1!T FLOOR 2ND FLOOR 3NO FLOOR 4TH FLOOR STH FLOOR 4TH FLOOR Mit PLOOR STH FLOOR BUS Aess Name Of Ucensed Plwnbw Che* ate: 13 Corpormam ❑ pwbwre* INSURANCE COVERAGE: 1 have a cuff Mt I kwu mos poft or its as l eqthraWt vridd e11Mts the requkwwft of MGL CA. 142. Yes No ❑ • If yOu NM chodml3, pens Wdinho Vo Mm ar4ssW by dwddM the gXxopt s boot .A IWAIty hsurance oaffey Ld1"1 Omw typo of kwWmN r ❑ Band O OWNER'S INSURANCE WAIVER: l am aware that the Newo a dams not have the bm anee covwMP requked by i;hpter 142 Of the Mass. General Lswe. and OW my WWwhm on this perntit applicaUm nr &n this requkemant. C21sok One. Owner O A4" 0 I hereby Derby that d of to details ane Ioban fmowlseps ane Mat d phrfnbirrp worm stye ko pertinMrt pra+a,ora of Me Mm k&mn bi efts. TitN om USE own I own I haw srAnritls - for wttsreel in above appicabon we bus and accents to tfte best of my rasI Fig wood underby psrrr* for #" sppfKation vA be in aompherm with al Mo N W NW CtlaoW W d Lms. g----st— Type of IJOerrae: JoumrAl b 0 l =nm Plurnb.r r i� ♦, THE09MM0NWE4L7H0FMASS4CHLS= Office Use only DEPARTAfiD%TOFPUXJCS9FE7Y Permit No. �. BOARD OFMEPREVE7M0NREGMT10AN-WCMR 120 C 9A4 Occupancy&Fees Checked PPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �V Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) v-ssE711 k.- 3-,Q, Owner or Tenant Owner's Address S s Is this permit in conjunction with a building permit: Yes ® No F1 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead D Underground 1:3 No. of Meters New Service Amps / Volts Overhead r --J Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (,C],777 77-7 77>J�� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above BelowGenerators 1-1 KVA ground M ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal r7 Other No. of Dryers Heating Devices KW a Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Instra =Caerage: Psis miDthem*metnatsofNbsmdusmCci®ILaws Iha%eaaxre tL bhyhmm=PohymdxkECanpkt CoArJWcrgssti>satWet}rivala:; YES � NO Iha%esi.dm advalidptoofofsartetotheOffmYES IfyuimedtadWYFS,pleaseedi¢*ftrAeafwAr.Wbyd=kirgthe -'�'IINSJRANCE r71/ BOND r --J OTHER egmY) .! �' � Es�IedVaiuectlt7tartticalWCdc$ ,S`�% � WCIkIDSlatf litspedmD*Re*jaWd Ra*Frtal SigteduldeM ofpDaMty. FIRM NAM�E— LioenseNa Lioatsae (/% Sigtaane Idoa>9eNo °Z�d 9 Bt&mTel.Na _ AICTeINa OWNER'SINS[JRANCEWAIV ;lammmdr,tt cLi mwdo t thems m=aasaWa-ossbsbr>balet}uwlartaStt *mudbyMamadiEmCavraILaws andthatmysigttaaseatthspemrtappiica6mv i%esd isIugtmonem (Please check one) Owner Q Agent ✓ Telephone No. PERMIT FEE $— r� Location / 4 TUUS—Seh' /+AN e - No. !t/ Y� Date hC1 TOWN OF NORTH ANDOVER Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 1 J J � Z � ' i�lllSlEhhh�.?;; = ;.,•,., . 33r:6��:.. IIMU_ 4_ a Div. Public Works Certificate of Occupancy $ Building/Frame Permit Fee $ Eck' sAGMUs Foundation Permit Fee $ Other Permit Fee P=." . _ $ .fib Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 1 J J � Z � ' i�lllSlEhhh�.?;; = ;.,•,., . 33r:6��:.. IIMU_ 4_ a Div. Public Works 1 � r+ (n O+ O N G N z � � � U (IJ � CA VI G W J \ � N C M _ W _ N z � � � U (IJ � CA G W J \ � N C M _ W _ z V p IV ra on 00 1 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 SECTION APPLICANT c��etit C�,.� t� VI G� PHONESJZ� LOCATION: Assess_:�s Map Number_A� /4— PARCEL Ty SUBDIVISION LOT (S) y� b— a% /�Q ST. NUMBER S TP E. T �l/ ii CCQ �� OLS-= OFFICIAL USE ONLY U/A -t h e , MMENDATIONS OF TOWN AGENTS: _ i9�33' n - CO SE; VATION ADMINIS T RA TOR OMMENTS T PLANNER tJ COMMENTS DATE APPROVED DATE -REJECTED DATE APPROVED DATE REJECTED l FOOD INSPECTOR -HEALTH DATE APPROVED _ DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED .4. PUBLIC WORKS - SEWER/WATER CONNECTIONS DFJVE'NAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING INSPECTOR DATE • Ilr -JRTGAGE INSPECTIC :.) - BAY STATE SURVEYING ASSOCIATES INC. 100 CUMMINGS CENTER, SUITE # 316J, BEVERLY,MA., 01915 �c3cXF,MA NOTM' 73,89 LOCATION :.!v�./aN0ovE2 """""""""••••••'••"f .............. / 1) This Is a mortgage inspection survey and not an /O -S- 9$ instrument Bey, therefore this plot plan Is for SCALE: 1" SO DATE ...................................... mortgage Inspection purposes only. 2) This survey is based on survey marks of others. .... ............... REFERENCE: B.K'Yg� Ef.SE ' 3) �1es, vYubs, fences and tree lines do not K : ..... yc^�E5$E'k n10. g........ 1......: Indicate lines. iy property ........ .................... 4) V1lhowww an offset [all +-or lees, an instrument ..................................................... surrey Is recommended to determine property MO GAC- F NC IAL S64VICES �*'and 'm possible ancroactsnents. TO:..._......�......... _....._i/U14 f) Offsets shown we approximate, and are to be The location of the building(s) as shown, either used only for the deteneimstion of zoning, Not to complied with the local zoning setbacks at the time of be used to establish property Ones. construction or Is exempt from violation enforcement action 6). In my professional opinion the building(s) are not under Mass. G.L Title VII Chapter 40A Section 7 located In the speda flood hazard zone, as defined by H.U.D. MAPS ZS-C�ocj T 41219.3 13 -51f Sz.oS�j Lai ' �.o---7- 01M� N Kc O z W cd O A v 8 U4 v v cn O U z A o w oc w U w 0 u ot a o u: c W. 04 O U W a r2 chi G w z 0 � `° w W Q rA cin v) ui om a 01, 0 co Q E co O v Z CD CL O y � C GD pm p.— Q H O 0 �E m CID co 0 CD CD Q � ; CD 0 Q L CL cn Q C* C 00 C !D A2 'fl CL Q CODCL Z � V CO) O C CL COD Q — 0 W _M U) uj irW w W C/) .5 0 y_' o c s O ` ' C H O 2� ;o ' wv :ac ea ev `. : m c L I� Lmc m 2: 0 C " E5 � �: •: a�- m c • N � m CO) CO) C C ' N A m o : :av` N m m -CO3 ..� Na acr of m o� v c0 O. O H m�y m c :d .y O.t O c LU •E ���cm m .5 O � 2 !O0 H �O �a�m a 01, 0 co Q E co O v Z CD CL O y � C GD pm p.— Q H O 0 �E m CID co 0 CD CD Q � ; CD 0 Q L CL cn Q C* C 00 C !D A2 'fl CL Q CODCL Z � V CO) O C CL COD Q — 0 W _M U) uj irW w W C/) 16717 1111Ay([,- Building Inspector �t�s (AJ Location % 5 No. I Ci D Date C�- /7i' U 3 &Opt, TOWN OF NORTH ANDOVER f w + ; , Certificate of Occupancy $ swcHus Building/Frame Permit Fee $ S a ♦ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /S Check # 16717 1111Ay([,- Building Inspector - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: " l Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: T Z, 1.2 Assessors Map and Parcel Number: /" y 40 Map Number f Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Require Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record L- IS 112ke, Name (Print) Address for Service -3 12 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: V4,/ t J . L,- N -?,A- Licen:ted Construction Supervisor: 3 k 47 / ' /� Add • sLZI 4( :�� !f 7 — ��� - y7 ?i% SignatureTelephone Not Applicable ❑ o g Q g License Number Expiration Date 3.2 Registered Home Improvement Contractor "/� W%ZN� G�g� /J C s �o•�-z ,�% si��v Not Applicable ❑ / L/ 7 Company Name L� S % Registration Number ^� Add ess a/ Expiration Date Si nature Telephone H"Q LO SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 § 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 .......0 No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: /y ZC X/ 6,X yy�T� /C�: v!' C. /Z 1'h / /lK % ti✓! /�! dWs l ev /f )CIS T ! ova WtN Oo w G P00V i1yC SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building /.14 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ,2 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owned et�.nf subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, Y'Q-L 1 41 ?- as Own Authorized A nt subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge andelief iey V A- L T Print N e SignattTre of 6 r/ ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIv1BERS 1 s 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE HT1. ����lr�✓� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 102467 Expiration: 7/2/2004 Type: Private Corporation NEW ENGLAND CUSTOM DESIG Val'"Lanza 226 LOWELL ST. WILMINGTON, MA 01887'!``' Administrator License or registration valid for individul use only before•the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid ithout s re ✓iie TOomrinwvuueau�z a�✓ac�ivaeit6 'r`=r BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ry,x Number: CS 008828 „z B irth date: .04/20/1951 Expires: 04/20/2004 Tr. no: 20132 f Restricted: 00 VAL J LANZA � 34 BIXBY ST C.i.» REVERE, MA 02151 Administrator License or registration valid for individul use only before•the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid ithout s re The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Ti? l .e A J-79Ans7/GL/ i Location: / 4 %Z U S S r-77- L AW City &, A mod, zz2n_ Phone # 9 71 L 9 5' 33 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: /£ M� Ld ,V, f C U S 7,:;-/-1,7 0- Address Z Q wr ZZ sT k" Company name: , 7g-e5Y-a CttY. Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the and/or one � imposition of criminal Patties of,a fine up to $1,500.00 and/or years''mprisonrnent_aswas_ciA4:k �naLes-nlhe.lam-f-aBTDP]AK)W-ORMRand_afine9(A$ljao_DD)_ajdayagainstm-- I understand that a copy of this statement may be forwarded to the office of Imrestigations of the DIA for coverage verification / do hereby eerfoy under Use pains and penalties of perjury that the information provided above is &w and coned. r � Print name 1/A� Z_A-A/2, Official use only do not write in this area to be completed by city or town official - City or Town Perm4n ;--ensi El Building Dept ❑Check if immediate response is required [j L icensirig Board E] Selectman's Office Contact person. Phone # E] Health Department r-1 Other 0,e North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A.. The debris will be disposed of in: 1 _/2. h- N S Jt Lyx,-L CO L Vlyl l 7-S 7 c t�r-► 9_n A/L c/ 4_ . (Location of Facility) Sigi4 iure rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector This Agreement is made on 20 03 by and between New England Custom Design, Inc. "Contractor") and owner _ t,f (hereinafter, "Ov City /'Town .r, %y r c `v, State j?/pct- Zip HPhonea- Job Address "The Premises") , i✓ ( ') � � ,i{' iJ _• %% �7�y �-t`' WPhone New England Custom Design, Inc. Salesperson Roofing will be applied only on slope roof surfaces below, over present roofing shingles unless specified under REMARKS. MATERIAL ............................. �-. w z :� ..................... Color ........................................ pMain Roof ......................... �..; Bay Windows .......................... Extensions -....................................................................................... Cn O Porches: Front ....... ......... Side ................................... Rear�.................................... Other Roofs ................................ NOTE: Roof b d Replacement Cost per foot OR per 4 x 8 sheet of inch CDX Plywooc 3 a o I We will cover the low slope roofs specified here with ........................... Roofs to be covered I ' ..................................................................... ......... Color .............................................. Cn �O Siding will be applied only on, outside perpendicular w lls where specified below. MATERIAL .......(T .`�rJ '.fl �.......,W'd� —/. MATERIAL CU QUnderlay ....�;r7v.. Color........C. a...... ...... ............ Color .............................. Underlay ...... ............................... ................... ......�r. v� Apply where ..I. I�%..C'.t::�J:� v.r... ��'%::�....1.—`2 ..... ......... Apply where .......................... .................................................. Enclosed porch: House wall? ................................ Porch Bulkhead: Inside? ...................... Are window casings to be covered with siding ?...... ::..................................................................... jo A with aluminum trim. Z /-7 � - ^�d.;� Color .......................... Sills only: Number .......................... Color ..................... 0o trim specs to 1 will be covered Window casings: Num ert/c1��. ��.h z Door casings. Number .../f.......,r.f...C.......... Color .....� f�::. r -fir.... C u✓t.I ............... ......................................................... jSoffit and facia: Color..&A!t.:1� s...Gl;�rc �.. Facia only: Color...... fir. ::. z:ie...... _:✓..t?;........................................................ QOther and where......'? �'...... !............................................................................................................................... .Vrl:...... .:%.� 1^ ....: 'E'.....f.' � .. ... 4.3C.r...j`. C'f%Y:s:......... �cY..Y.v.r...7f_,t�....f.:�4'+f�;, ........................ a� 3 mber....Doors: Nu ......... ....... Type ::...................................Stle......................................... Color ........................................ O Window: Number ca ............................. Type:i'ui.`C...Sf,y/r...Style...%%#/r:�.............. Color...,,�::h�z�`C:.................... ............................................................................ Shutters: Number PRY ....................... Color....25-.....?`�-xzltr..d:...... Style.. '................ Where .................. .............:...............:............ .....::..........._.............,.......................... ...... ....----------------. ._ .r.....�s.,n...�s......%!..`.r�%.......lc�.f�.......l�s..�::r:: �'J......::..`.`:.................................................. The Contractor agrees to perform in a good and workmanlike manner all work detailed above. CASH PRICE $.....1..�:`.....!?�G................... . . NOTE: All Roofing Customers DOWNPAYMENT $ ............... ' '%!.:..f.` ...................... New England Custom Design, Inc. will not be held PAYABLE ON START OF WORK $ ...... -:. .............................. responsible for dust and debris falling in attic area PAYABLE ON COMPLETION$......,�/G`.f-:.:................................ during roof installation. Please remove or cover valuables. DATE: ................:..................................................... 20 .............. RIGHT TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be h main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See attached Noti( of Cancellation. A cancellation fee representing 30% of the contract price will be in effect if cancellation is requested after the legally allotte time has elapsed. The Owner hereby certifies that he has read this Agreement, that the terms and conditions and the meaning thereof have been explained to hi and that he Hilly understands them and that there is no understanding between the parties, verbal or otherwise, than that which is contained it this Agreement, and agrees that the said Contractor is not responsible nor bound by any representations not contained in this Agreement, ma by any of its agents, unless the same be reduced to writing and signed by the Contractor. ATTENTION HOMEOWNER- DO NOT SIGN THIS CONTRAC"IF HERE.ARE NX BLANK SPACES. tom; ---� ` � ' �,f `i�,•.= � ,�' .� � � � - /: � Owner'- Si<Jnature Date New England Custom Design, Inc. 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