HomeMy WebLinkAboutMiscellaneous - 97 MIFFLIN DRIVE 4/30/20181
Location
No. Date -�
4
,&ORTol TOWN OF NORTH ANDOVER
►. 9
`Certificate of Occupancy $
•
��SSACMUst<� Building/Frame Permit Fee $ `1
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
T . Building Inspectof
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT MPAWMVA Oft DIMOLISH A ONE OR TWO FAMILY DWELL94G
BUILDING PERMIT NUMBER: l'J DATE ISSUED: f ��
SIGNATURE: v�
Buikfing CwMisSia!ffqnWMr of Buildia Date
SECTION 1- SITE INFORMATION
1=1 Property Address: ,
1.2 Assam Map and Parol Number:
U 319-- oa��
Map Number Pared Number
l.] ZonMInformetion:
1.4 PropertyDiaaensimr:
Zan' — Use
Ler Ara Fiesta n
1.6 BUILDING SETRACKS 00
Front Ywd Side Yard Rear Yard
Provide Providixl rad Provided
U
1.7 WtlQ�9° [�i[t LC en. !e) IJ. FindPdft 7aes feTarmrtiae !.f S Qi�posd speeor
Zak 000* Fba ?aero 0 S)*w 0
E' Priv.ae 0
S$CTION 2 - PROPIRTY OWNERSEUPIAUTBORIM AGR" ' UIS ! Ct, Yes —No
2-1 Owner of Record
" i �;tf F IN �Z A(&► AMM, Alf-O' C'M ys–
Name (Print Address 2or Service
Si cure Tdcpbonc
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
13.1 Licensed Construction Supervior
Not Applicable 11
3
iLrconaod construction supervisor.
O� j Y
License Number
Expiratwn Date
Si a Te1q►haae
3.2 Registered Home Improvement Corahalor
Not Appbcable ❑
Ar? �s ��Ea(r(IT4 r
�Y S—(�,/8
Company Nana
—Registration Numbs
/ G u z4z—
Address
gi Takyborle
Mv
M
z
0
0
Z
M
0
Mn
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C
M
w
z
0
cvtlnnM 1- WORIMRS COMPENSATION (MG.L C 152 9 25d6l
Wortms Compensation Inswawe affidavit roust be eompMW nerd submitted with this appliostioa. Failure to provide this ■davit will result
in the denial of the issuance of the buildinit Lortrut.
Sileld affidavit Attached Ya .......0 No...... ❑
SECTIONS Desert ithm of PnMied WorkcLoct
bls
New Construction 0
Existing Building V
Rapair(a) [
Altcrations(s) 0
Addition
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Worse
MDI'Nl• frZPyQ JA -9,H k0inb" Cly t% 19664cwt Z
APO L4]6 Ut Agg,17 - ?"Y14,0M Ove -t dgtL-r-i A4,!-
4,! -SECTION
SECTION6 - BSTI ATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Comleted b t applicant
OFFICIAL USE ONLY
i. Building
(a) Building Permit Fee
Multiplier
2 Electrical �s O -
(b) Estimated Total Coat of
Construction
ZYZ/ 30"-) i—
3 Plumb' c G -
Building Permit fee I&) : nl
�' D
4 Mechanical HVAC '6- S C) 6,'
5 Fire Protection
6 Total 1+2+3+4+5 3 o_ , -
Check Number
sizcnON 7a OWNER AUTHORIZATION TO 1311: COMPLETED WHEN
OW��Njj ERS�A�GEN�1T OR CONTRACTOR APPLIES FOR BUILDING PIRMT
as Owner/Authorized Agent of subject property
Hereby authorize �'/ vi u 13 /G L"n� �'--fig �w to act on
My a 1 ma re e m w k antho�z by this building pemtit application
/ty or
S e of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
t A( Maflgt w r ,us Owner/Authorized Agent of subject
Property
Hereby declare that the statements and information on the foregoing application are sue and accurate. to the best of my knowledge
and belief
41 c� t
Prin
j/ZY(0J
Si a of Owner/Agent Late
NO. OF STORIES SIZE
BASEMENT OR SLAB ,v p
SIZE OF FLOOR TIMBERS VT
SPAN
DIMENSIONS OF SILLS N p
DDAENSIONS OF POSTS -7,1
DB ENSIGNS OF GIRDERS Hl*
}(EIGHT OF FOUNDATION ,•144 THICKNESS 161,
SIZE OF FOOTING N a X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FRIM LAND so
IS BUILDING CONNECTED.TO NATURAL GAS LINE
IFnnIA R002I OHS 00S0VLV9L6T %V3 9C:CT f1H.L SO/LT/CO
CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE.40' DATE.4/4/2005
Scott L. Giles R. P. L. S.
Frank. S. Giles R. P. L. S.
50 Deer Meadow Road
North Andover, Mass.
imw
I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE �t�A of
THE OFFSETS
OF THE BUILDING INSPECTOR ONLY S
SHOWN COMPLY a H
AND SUCH USE IS FOR THE 8
WITH THE ZONING 0.13972 0
DETERMINATION OF ZONING ss`iST
NORTH ANDO VER EREO���
BYLAWS CONFORMITY OR NON -CONFORMITY °a�L LAS 5
WHEN BUILT WHEN CONSTRUCTED. d ¢ zeww
North Andover Building Department
Tel: 97MBS-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:
0
(STA -T,-- ssOrc Dl,- cf g
(Location of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
F
cIRte Corrcmonwea£th ofX=achuse=
I Depamnertt eIndustrialrAxidents
Off= oflnvestigatiu
600 Washington Street
Boston, WA 02111
Workers' Compensation Insurance Afndavit
APPLICANT FORMATION Please PRINT Le?ibly
Nam,: 41 M4+4tvt
Location: q7
City' l�4 %f�vrl✓� A44IJ • Oily( Telephone#:
❑ I am a homeowner performing all work myself.
❑ I am sole proprietor and have no one working in my capacity
❑ I am an employer providing workers' compensation for my employees wonting on this job
Company Name:_�/GV
w
Address:
City: %far e t,
-e a 114
Telephone #:
'7.F- % i G _z f f
Insurance Company:
77f-
❑ I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed below who have the following.
workers' compensation policies:
Company Name:
Address:
City:
Telephone #:
Insurance Company: Policy #:
Company Name:_
Address:
City:
Insurance Company;
Telephone #:
Policy #:
Attach additional sheet if necessary
raiiure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORT: ORDER and a f nt of $100.00 a day against me. I
understand that .a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify nde pains an enalties of perjury that the information above is true and correct
Signature: Date: si i
Phone#
Print Name: > K
Official Use ONLY - Do not write in this area
o Building Department
Permit/License #: o Licensing Board
City or Town: o Selectmen's Office
❑ Health Department
0 Check If immediate response is required o Other
INp'ORMAnON & INS7C ucnONS
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation
for their employees. As quoted from the "law" 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 denned 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 section 25 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, 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 beenpresented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the.box that applies to your situation
and supplying company names, address and phone numbers as all affidavits may be submitted to the
Department of Industrial Accidents for.confumation 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.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the
bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding
the applicant. Please -.be sure to fill in the permit/license number which will be used as a reference number. The
affidavits may be returned to the Department by mail or F AX unless other arrangements have been made.
The Office of Investigations would like.to thank you in advance for your cooperation and should you have any
questions, please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street.
Boston, MA 02111
Fax 4 (617) 727-7749
Telephone # (617) 727-4900 ext. 406, 409, or 375
Mar 25 05 07:24a
Ray Gauthier
'
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 069439
Birthdate: 05/23/1965
Expires: 05/2312006 Tr. no; 9360.0
Restricted: 00
JAMES FERGUSON
108 CONCORD RD
CHELMSFORD, MA 01824
Commissioner
Board of Building Regulations and Stundards
HOME IMPROVEMENT CONTRACTOR
...7! Registration:
145618
FKPIr2tion: 2/15/2007
Type: Individual
JAMES FERGOSON
JAMES FERGUSON
108 CONCORD RD
CHELMSFORD, MA 01824
Administrator
978-470-2844
F.1
Form A155 CONTRACTOR AGREEMENT
THIS AGREEMENT made the c da of Mee c
Y l, 3-a i
calS` (year) by and between
called
the
� j3 /d f- Ce;z r hereinafter called the Contractor and'D A „, � � A /o i 1 hereinafter
Owner. ..
Witnesseth, that the Contractor and the Owner for the considerations named agree as follows:
Article 1. Scope of the Work
The Contractor shall furnish all of the materials and perform all of the work shown on the Drawings and/or
described in the Specifications entitled Exhibit A, as annexed hereto as it pertains to work to be performed on
property at 9 7 M, '1/. A
Article 2. Time of Completion
The work to be performed under this Contract shall be commenced on or before 4p a Zac r(year)
and shall be substantially completed on or before T �y / , a,-cS—(year). Time is of the essence. The following
constitutes substantial commencement of work pursuant to this proposal and contract:
(Specify) 0 b7 --,'v -r P u r -m % r
Article 6. Additional Terms
Name and Registration No. of any Salesperson who solicited or negotiated this contract:
Signed this day of
Signed in the presence of:
Witness
G "elw
Name of Owne
By
ign e
(year).
Witness
Name of ntra 7x
r
By. Signa
re-,
Street Address
AA( a/Ye K 147 0��/�
City/State/Zip
Telephone No.
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° <�``° '• "� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
i � " i
'phis certifies that4.. r C = ..::...- ......... ....�' :...'f ........
has permission to perform
wiring in the building of�l .................... ....................................
,,�- , North Andover, Mass.
at............:..:.i..............:...............................
Fee G.-
Lic. No D../�: .r�.' . ,.%..... /.:;�.................
ELECTRICAL INSP'
Check # "J / i 6/
C 'mmonweaR o f Maijachaeelle Orficial Use Only
_ cc�� �]] Pernut No. Z,f
1J¢Rarl»renl o`J`ire �ervic¢e 0-r/Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIO [Rev. 11/99] leave blank)
APPLICATION FOR PERMIT TOP FORM ELECTRICAL WORK
All work to be pedbrined in accordance with the Massachuseus Electrical Code (iNIEC), 55,27 CN7 12.00
(PLEASE PRINTININK OR'1'Y1'E.,lLL1NI'OR;t•L177ON) Date:
City or !'own of: l/ < w! l�i�e[/' To the InspectorofJV(Fes:
By this application the undersigned glues notice ofhis or her intention to erform the electrical work des gibed below.
Location (Street R Number) % N11, % t t� 'UV ✓-� /�t t (j�/ P,l/j`
4
Owner or Tenant - - Van, , �- U4,09- 9- � p 1 r>j S - Telephone No. X117 GTI-
Owner's
TI-.
Owner's Address 1� ) /14 t; /1 ---
Is
Is this permit in conjunction with n building permit? Yes ❑ No 9 (Check Appropriate Bos)
Purpose of Building es , Utility Authorization No.
Existing Service An+ps / Volts Overhead ❑ Uudgrd ❑ No. oCtlIeters _
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Nleters _
Number of Feeders and Ampacily
Location and Nature of Proposed Electrical Work: ZOU",
Corn letion o(the olluuinQ table may be waived by the his cctor o(1Vims.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
Total
Trans No. of formers Tota
No. of Lighting Outlets
No. of blot Tubs
Generators KVA
No. of Lighting Fixtures
Above El 111-
S��imming Pool -r d. rnd. 1:1Batte
o. o Emergency Lighting
• Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARDIS
No. of Zones
No. of lleand
n
No. of Switches
No. of Gas Burners
InitiatingDevices
No. of Ranges
Tot
No. of Air Cond. Tons
No. of Alerting Devices
Heat rump
Number
"Tons
KW
No. of Self -Contained
No. of Waste llis users
p
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Cunnnectineen l El Other
Coon
No. of Dryers
Y
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of \VaterKWNo.
of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassaoe Bathtubs
b
No. of illotors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
:attach additional detail irdesired, or as required by the Inspector of !Vires.
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 cov rage is in force, and has exhibited proof of s �e to the permit issuing office.
CHECI:ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) i _ A/ Ot'P
(Expi do Oate)
Estimated Value ofEle-trical tiVork:' It COb (When required by municipal policy.)
Work to Start / D /;2, o �- Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
I certify, carder the i it - arrd penalties of etjujy, that the wf nation on this application is true and complete. i
1,1101 NAME: � � � SNL LIC. NO.: t(021 �
Licensees •(AiSpr�. _ +at ire LIC. NO.:
(If applicable, enter "c.rcu�! in the licep.,re lice.,nwnber r �� .) 13us. Tel. No. ` yiPcl
Address: lv� �/�/"Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not h tie the liability insurance coverage normally
required by lave. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Anent I'L'RAUT FEL: S
Sianatun e Telephone No.
><i�tia-Lril:�.yl�l
U)
W
Z
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FE
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J
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2
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Commonwea& of MijachwelLt
2eparinrenl o`3ire Serviced
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
cjOccupancy and Fee Checked
[Rev. 11/99] (leave blank) '
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perlornied in accordance with the Massochuseus Electrical Code (10EC), 527 CNI 12.00
(PLE:I.SE PRINT IN iNK OR TYPE :ILL INT -MAL I T iON) Date: j cv � 61
City or "1'owtt of: �, t�i;ZL To the Inspector of JV res:
By this application the undersigned ewes notice of los or her intention to perform the electrical work des gibed below.
Location (Street R Number) t j- (i t �� t ✓ Gc1 ��/' /'.
Owner or Tenant
Owner's Address
I-
0— V) t] ' Telephone No.1111 j 07
r't--,-(- _ Al �IGIrX�i��v'
Is this permit in conjunction with a building permit' Yes ❑ No 9 (Check Appropriate Box)
Purpose of Building ej , Utility Authorization No.
Existing Service Anrps / Volts Overhead ❑ Undgrd ❑ No. oftlleters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity rt
Location and Nature of Proposed Electrical Work:
Completion o%the following table pray be waived by the lnspcctor of IVires.
No. of Recessed Fixtures
No. of Ceii: Susp. (Paddle) Faits
No. of Total
Trans[ormers KVA
No. of Lighting Outlets
No. of 1lot Tubs
Generators KVA
No. of Lighting Fixtures
Above.
Swimming Pool rnd. El d. El
o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zoites
rNt
No. of Gas Burners
o. of Detection and
. o. Twitches
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
Hcat Yump
umber
To
KW
No. of Self -Contained
No. of Waste Disposers
P
Totats:
.i
Y
Detection/Alerting Devices
No. of Dishisashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances Kll:
Security Systems:
No. of Devices or Equivalent
No. of Nater
KW
No. of No. of
Dula Wiring:
Heaters
Sions Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
b
No. of illotors Total HP
"Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
1NSURA.NCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work niay 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 s to to the permit issuing ofFce.
CHECK ONE: INSUIL\NCE BOND ❑ OTHER ❑ (Specify:) �� /ZylaJ ��j/Da�te) (Expi do
Estimated Value of Ele •lrical Work: it 006 (When required by municipal policy.)
Work to Start: / D /,2 O S— Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certifj,, under the / ii and persalttes *of erimy, that the in. nation on this application is true and complete.
F1101 NAME:t l rr T �-.� L LIC. NO.: r C�z
Licensee, r tbfrata ! LIC. NO.: Z`f -7
(If applicable, enter ..e.ecrr "in the lice . nunrbe�r .) in .�1 •t�wgi
Bus. Tel. No.:
Address: 7 Ct v v` c1 `:'%FYI/� e ' / Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not h ire the liability insurance coverage normally
required by law. By nny signature below, I hereby Nvaive this requirement. I am the (check one) ❑ o%vocr ❑ ov,-ner's agent.
Owner/A-enl E1)1;RiWTT-EE: S
Signature 'telephone No.
Date./")... v ........ ':S....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............................................. ....................
has permission to performm—rJ1 ........... I
.....
wiring in the building of .
....................................r............................
at..North Andover, Mass.
.................................. ......
FeeAl�� ............ Lic. . ...........
ELECTRICAL INSPECTOR
Check #
DEFARnWENT0FPtfflWMFW pormitNm
BQARDOFFREPREvzvnOrNRFGUlA1M527adR ao
� tkcupaary az Fees Checked
J
APPUCA71ONFOR PERMUTO PERFORM ELE CAL WORK
All, WORK To BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS E XCrR1CAL CODE, S CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL II�iFORMAMON) Da
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street d
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes No [Z] (Check Appropriate Box)
Purpose of Building / rC ,� ��/ 7y
s'rz4, 4,a/ Utility Authorization No.
Existing Service Amps —�/14a Volta OverheadRde[gtOund
New Stsivic� Amps �2 Volts Overhead nderground
Number of Feeders and Ampacity
Location and Nature of Proposed Mt
No. of Meter
No. of Meters k
Na of Ualifing Ou"
Na of Hat Tubi
No. offm iamaa
TOW
KVA
Na of UabtiN Film"
Swi mlq Pod Above
Baker rl
Oatnmm
KVA
Na of Receptacle OudNa,
0
No. d OU Burn=
No. of Emerpaq UaMlna Battery Univ
Na of Switch Outleu
No. of Oae Banrara
FME ALARMS Na of Zona
No. of Rartaaa j
Na of Air Cad. Told .
TOaa
No. of Ddecdoo and
No. of Dtepaale
No. of Haat Told Total
100me
Ton
KW
reitie ft Devks
Na of soundirta Devices
No. of Dishwasher
Spatx Ansa Hwdna Kw
/
Na of self Comahbd
DefectiDevicas
L d �moWcipd
O
No. d Dryer /
Hoeft Devices Kw
No. of Water Hater / KW
Na of Naof
I
311100
Beflub
Na Hydro Manse Tabes
No. of moon
TWA HP
lhWsift it dvddpvdc( =1odreafflM YM r
Gun 1:3
WadruSott ly/��US impediorrDnePM] d
-i13Wc 'JI►lL�l11�G/iiWl
I<yotthitetieded
l��� ,✓r//��tii dVa1zdnscftWb& s
Find Z114�j
Unwi4a � 5-6,22 L
_ UUMM
BW=Td?k
fa dl r,o--
At IN No
V2 8' -�2 �<— 9�1 Fy
6a2 Xrg 08'73
aWMrSIIV:AntANXWAMRIamawaelhetdrelj=wd=w1 eineuameana arissubdarridegiivaimtasrec}aedbyMas®der�GmsalLauts
ardthtrrp��r�mdibpenriappic�mwei�esfiueQifsmt
(Please check one) Owner CM Agent
Telephone No. FEE
Signum or Ow or Agent
DEPARIIAVPO IZIUMUTti'lY Perndt Na
B04JtDOFFDfEPRCYF11t1110 VRDQ1[A?710V 527(21aiM
Occupancy & FM Checked
APPUCA71ONFOR PERMITTO PERFORM ELECAL WORK
f ALL WORK To BE PERFORMED IN ACCORDANCE WLrH THE MASSACHUSSTS ELE( MICAL CODE, S CMR 12:00
(PLEASE PRD T IN INK OR TYPE ALL OffORMAMON) Da
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street d
Owner or Tenant
Owner's Address f�-,&e
Is this permit in conjunction with a budding pemrit: Yes No [n (Check Appropriate Box)
purpose of Building yl[�,f", - ,, /Yt/ f" 711 1 Utility Authorization No.
Existing Service ';� Ampsi �� olta Overhead Undergound C3
New Serv�c� - APs � ' Vola Overhead n&wound C3
Number of Feeden and AmpadtyLeyn,�'le- c
Location and Nature of Proposed Electrical Work
No. of Meters
No. of Meters
NM of Lighting Oaten
Na of Hot Tube
No. dTarrtlM=I
Totd
KVA
Na of Llgbtirtg Pbttaea
Swimming Pod Above
I ow
Below
Clpterabtta
KVA
No. of Reaeptscb Oudbtt . 6)
No. of On Bnman
Na of EtnKgeoey Lighdng Battery Univ
No, of Switch Outbu
No. doss Banners
FME ALARMS
No. of Zones
No. of Rang i
No• of Air Conti .S Tod �.
Tom
Na of Dabcdoe ad
No. of Dlsposde
No. of Haat Tool Tod
Pangs
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Na d Dadcn
No. of Diahwuhen
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Na of SON Conwh"
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No. d DrMs ;
ting
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No. of Water Heaven / Kw
Na. Of No.ofC��n
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No. Hydro Musge Tabe
Na Of Mown
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(Please check one) Owner ASM
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ....... .......................
has permission to perform ... /J. .......................
plumbing in the buildings of . . . . ?.,. K,1. .,. '. . w� ...............
at ............... North Andover, Mass.
Fee. Lic. No. . ........ 1\
,/PLUMBING INSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
Owners Name
of
New rf Renovation Replacement
/^--d 0 1:1
FIXTURES
Date t' s! ° e
fw -� Permit #
Amount
Plans Submitted YesNo
(Print or type) J Check one: Certificate
Installing Company Name l (i` 4' Vl Corp.
Address partner.
Business Telephone ORMI/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy I XI Other type of indemnity Bond
0 El
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature ,, ner ❑
I hereby certify that all of the details and info a on I
best of my knowledge and that all plumbing w r and i
compliance with all pertinent provisions cftthe cl
y:
VED (OFFICE USE ONLY
of
0
application are true and accurate to the
Issued for this application will be in
ipter 142 of the General Laws.
Master P Journeyman ❑
Location i ` + ` IN
^�
No. Date
Nom,. TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame /Frame Permit
9
Fee $
<�
Foundation Permit Fee
$
CMUs
Other Permit Fee
$
�l
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
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Building Inspe r
`' -08114!99 14:43
60.00 PAID
Div. Public Works
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING
(Print or Type)
,jZ ANDOVER Mass. Date
Y'iuilding Location /�/llT�,�t �r, Pe/rmit
Ow rs Name
.New '1 Renovation �J Replacement Plans Submitted 0
FIXTUP.E1z
!Q.
(Print or Type) /
Installing Company Name dovtr
Address <r--% r
� Check one: Certificate
E (Corp.
.S� = Partner.
Firm/Co.
Business Telephone:
e; O J��3 K-27)
Name of Licensed Plumber
or Gas Fitter
�
Indicate th type of insurance coverage
by checking the
appropriate box:
Liability insurance policy Other type of indemnity
0 Bond
Insurance Waiver: I,
the undersigned, have been made
aware
that the licensee of
this application does
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coverages.
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SUB—asmT.
BASEMENT
I ST FLOOR '
2NO FLOOR
3RD FLOOR
4THFLOOR
f
STH FLOOR
6TH FLOOR
TTR FLOOR
STH FLOOR
(Print or Type) /
Installing Company Name dovtr
Address <r--% r
� Check one: Certificate
E (Corp.
.S� = Partner.
Signature of owner/agent of property Owner 17 Agent 11
I hereby certify lhat all of the dctails and information I have submitted (or entercd) in above application are true and accurate to the best of my
knowledge and tlui all plumbing work and InstxLLatioas puformed under Permit issued for this appliay14&'V<
mplranoa with allPertinent
of the Massachusetts State Cas Code and Qupter 141 of the General Laws.
By PE LICENSE: —
Plumber
Title sfitter- Sigfiature of Licensed
City/Town: -.aster Plumber o�Gasfitter
ou
Jrneyman
APPROVED (OFFICE USE ONLY) License Number
Firm/Co.
Business Telephone:
e; O J��3 K-27)
Name of Licensed Plumber
or Gas Fitter
Insurance Coverage:
Indicate th type of insurance coverage
by checking the
appropriate box:
Liability insurance policy Other type of indemnity
0 Bond
Insurance Waiver: I,
the undersigned, have been made
aware
that the licensee of
this application does
not have any one of the above three insurance
coverages.
Signature of owner/agent of property Owner 17 Agent 11
I hereby certify lhat all of the dctails and information I have submitted (or entercd) in above application are true and accurate to the best of my
knowledge and tlui all plumbing work and InstxLLatioas puformed under Permit issued for this appliay14&'V<
mplranoa with allPertinent
of the Massachusetts State Cas Code and Qupter 141 of the General Laws.
By PE LICENSE: —
Plumber
Title sfitter- Sigfiature of Licensed
City/Town: -.aster Plumber o�Gasfitter
ou
Jrneyman
APPROVED (OFFICE USE ONLY) License Number
LL Date .....................
Q; ,
ORTH TOWN OF NORTH ANDOVER
` N.to ,eti O
p PERMIT FOR GAS INSTALLATION
This certifies that . ..........................................
has permission for gas installation ............................
in the buildings of ..............:...........................
at ..................... .'.............. North Andover, Mass.
Fee......... Lic. No..:........ ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File