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Miscellaneous - 97 WINDKIST FARM ROAD 4/30/2018 (2)
Date ... 4�.�.5 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that '�.j 6 �� .. r � (�-A qt�t) I � ................................. ................................ ........... �z . I .......... has permission for ga stallation . t:7r� .............. in the buildings of ..... ......................... .......... at............t I ..... O.A.S.I.J\ .'tl . . ................... North Andover, Mass. Fee.� .... ... I.j. S/ ......... ..................................................................... .. 7 ...... Lic. No . .. .... ..... GASINSPECTOR Check #06) L ;" 5 1 .� / �GIC,?G ,vim 51 0 1 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER - MA DATEAPRIL 22, 2015 PERMIT # JOBSITE ADDRESS I 97 WINDKIST FARM RD. OWNER'S NAME I JOAN PENNACE GOWNER ADDRESS JOAN PENNACE TE 978-273-0902 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL F1 EDUCATIONAL F -,j RESIDENTIAL El PRINT CLEARLY NEW:O RENOVATION:E] REPLACEMENT: ® PLANS SUBMITTED: YESE] NO® APPLIANCES -1 FLOORS- BSM 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN M POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT - - - - — - - - — TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER CWHER I INSTALL A GAS LINE AND 1 CONNECT A GENERATOR INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [:1] NO D I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Z] OTHER TYPE INDEMNITY Ej BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru nd accurate to the best of nowledge and that all plumbing work and installations performed under the permit issued for this application will bei c m fiance with all Pe 'dent Prov' ion f th I Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JOHN MARSHALL LICENSE # 778 ; SIGNATURE MPEJ MGF ® JP [:1 JGF [—] LPGI E] CORPORATION Q# PARTNERSHIP EI# LLC D# COMPANY NAME:j EASTERN PROPANE GAS ADDRESS 131 WATER ST. CITY DANVERS STATE = ZIP 01923 _ TEL 1-800-322-6628 FAX CELL EMAIL 0 1 1 Workers' Compensation InsuranceAffida%'it: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Eastern Propane Gas, Inc Address: 131 Water Street City/State/Zip: Danvers, MA 01923 Phone #: 978-750-6500 Are you an employer? Check the appropriate box: 1.70 I am a employer with 45 employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]** 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] Business Type (required): 5. ❑ Retail 6. ❑ RestaurantBar/EatinQ Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10.❑ Manufacturing 11.❑ Health Care 12.❑■ Other Gas Fitting, Equipment Installation & Fuel Supply *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box # 1. 1 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: HDI -Gerling America Insurance Insurer's Address: G&A Insurance, Inc. 34 Dover Point Road City/State/Zip: Dover, NH 03820 Policy # or Self -ins. Lic. # EWGCD000080615 Expiration Date: 03/15/2016 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct. Signature: (jarred, (� 5" Date: 03/16/2015 #:978-75 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/dia The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 4 Boston, MA 02114-2017 wwminass.aov/dia Workers' Compensation InsuranceAffida%'it: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Eastern Propane Gas, Inc Address: 131 Water Street City/State/Zip: Danvers, MA 01923 Phone #: 978-750-6500 Are you an employer? Check the appropriate box: 1.70 I am a employer with 45 employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]** 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] Business Type (required): 5. ❑ Retail 6. ❑ RestaurantBar/EatinQ Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10.❑ Manufacturing 11.❑ Health Care 12.❑■ Other Gas Fitting, Equipment Installation & Fuel Supply *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box # 1. 1 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: HDI -Gerling America Insurance Insurer's Address: G&A Insurance, Inc. 34 Dover Point Road City/State/Zip: Dover, NH 03820 Policy # or Self -ins. Lic. # EWGCD000080615 Expiration Date: 03/15/2016 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct. Signature: (jarred, (� 5" Date: 03/16/2015 #:978-75 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/dia ,i Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD OF PLUMBERS AND GASFITTERS ISSUES.:THE FOLLOWING LICENSE LICENSED AS AN LP.GAS JNSTALLER z JOHN:F MARSHALL W, 47 HOBART STREET.; JJ DANVERS.., MA 01923-1.943 moi I--, Date .... .. ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that O.Alr�.l .. U42 ......... 4: ........... has permission to perform .... ..... ....... . . ......................................................... wiring in the building of ...... 7ro.. ...... oo� ...................................... at North Andover, M. ass. Fee .. .... Lic. No. . . . ......... . . .. ............ E PE�C41CALL INSP TOR Check # 0. Commonwealth of Massachusetts Official Use Only / Permit No.�? Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. iml (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT INNK OR TYPE ALL INFORNATION) City or Town oh NORTH ANDOVER By this application the undersigned gives notice of his or Yer inten 'o. Location (Street & Number) ,j7 /`, f Owner or Tenant �i ,4-h A10 Date: _ To the Inspector of Wires: to perform the electrical work described below. Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: 20 Completion ofthe_following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- ❑ rnd. rnd. o. 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 No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number " Tons ' "'" ""' "' ' KW ' ' ' "'' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: f� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 9f 0 (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 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 [1.90ND ❑ OTHER ❑ (Specify:) Icertify, under thepains an penalties ofperjury, hat the information on this application is true and complete. FIRM NAME:. / cez /c, LTC. NO.: Licensee: 4 luvAr 1 o 4i k gZ Signature 40,,L LTC. NO.: / g� / ��• (If applicable, enter "exempt" in the licens number line.) Bus. Tel. No.-fo 9y.3 -2%7j `E Address: P..0.4,x ZXO j , — K -V .tt H 030(p I' Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public 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 ❑ o er's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the.provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comme �l Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: P,d l36>! 2- 6 k C, City/State/Zip: Phone Are you an employer? Check the appropriate box: 1. ❑ I am ployer with employees (full and/or part-time).* 2. am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ 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. insuranceJ 6.❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] gV3_247 Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.0 Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P.e e ✓ L-5 /,�, S — Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. 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 atypenalties of perjury that the information provided above is1rue and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # r�7V /-r Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed. legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia GENERATOR APPLICATION DATE: q 17 1, LOCATION: OWNERS NAME: GENERATOR kw "2D NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: V44v.5c,�,--e z. -E�, Jc- PHONE NUMBER: ELECTRICAL RESIDENTIAL ml COMMERCIAL TEMPORARY LOCATION OF GENERATOR: L�.e.� Yid' -j *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL cV�t HP Officejet Pro 8600 N911 g Series Fax Log for Generator Power Solutions 6037181820 Feb 06 201511:26AM Last Transaction Date Time Type Station ID Duration Pages Result Digital Fax v Feb 6 11:24AM Fax Sent 6036933008 2:02 4 OK N/A b/N NO I• 6£:0 800££69£09 xeJ lei! tlnsa�j s96ed uogein(] (]I uol;ets INdZ9: 6 6 5 6OZ 90 qa-4 OZ81,86LE09 suoltnloS JOmOd JoteMOO Jo} Bol xed tueS xe j INV 65:6 6 9 qaj ads jL auall ate(] uol10esueJl Isel SOPS 6 6 WN 0098 oJd te(aoi O dH • w icn s cJ � z " cn _ ' rn m Z cl) N V Z o 2 rr n rn O} N Z T n .\w m O 3r� »ern o nog-, w -n l0 - m Co r) r 1L m n Z = Ln Zm LICENSEE SiGNATURp :: 0L910 s113snHOvssdw 'a3noaNv 133a1S A21Vd 99 SMA213S 9N1833NI9N3 NOVWI2RI3W OZl 09 N 0 t00Z L[ J,Vvl :3lda 09 L QV02I I^I2Id3 ,LSI}I(INIM 46 R3NVNNSd NVOf �8 SVWOH,L 2l3NM0 2l0J 432JHd3bd ssdW `�ISnoQNV H,r,NoN xr NOI,LF7QNf10J A NVrld ,LO'I °I)a<-y Z,,L-W � 0/'?)/- -� - e� a_,6 IL 101 '£t dVNI M3NM30H V003H V SVWOHL munnmv in muni 1< 14 Location 90 w aa/sf FA P10 P69 4 No. 5 7 � Date NORTH TOWN OF NORTH ANDOVER •. L 9 Certificate of Occupancy $ ° y '�s •"'°'''�� Building/Frame Permit Fee $ s�CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '5d0 � Check # 6-391 17138 11,44 ,o 16 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING l for �_. BUILDING PERMIT NUMBER:�,5_41/ DATE ISSUED: c3—/g'—ado 3 SIGNATURE: L� Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: U✓I�,�x� S� �2, �• 1.2 Assessors Map and Parcel Number: 1067 Map Number Parcel Number 1.3 Zoning Information: R- k T's"J e, f Zonin District Pr osed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqLfired Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes __,..No 1 Owner of Record Name (Print) Address for Service : C,42 q Signa/ Telephone 2.2 Owner of Record: Name Print Address for Service: Si re Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: L __-) 4 e -I L' nsed Construction Supervisor: 3 y2 Address'— l , 6217. Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Regi ered Home Improvement Contractor Not Applicable ❑ Compan4j Name Registration Number Address Expiration Date Signature Telephone Ma M Z O v n m I N O Z M 90 O Mn r v M r r Z 0 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check aRapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ('dwS fuciao'oZQ UJ 4 A 7 :I'o ( ( %dVt^ 1X_ A 44, L v. `f —M r v� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction c , 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total .(1+2+,3+4+5) '' • ` 'tl - �+ - ~ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner/Authorized Agent of subject property Hereby authorize to act oii y behalf, in all matters relative to work authorized by this building permit application. i nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 ST 2 ND3 RD SPAN DIN ENSIONS OF SILLS DIlvIENSIONS OF POSTS D ENSIONS OF GIRDERS lfr'IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 FlyUT THIS SECTION*******-**** APPLICANT_ _ h,��w r, v �i� -�� _ PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) n STREET i D KI �'� �ct ST. NUMBER. ` ***************OFFICIAL USE TOWN AGENTS: -�. CON ERVATION ADM t STRATOR DATE APPROVED p DATE REJECTED COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH S SEPTIC INSPECTOR -HEALTH ij � COMMENTS to t"+' J DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED _ DATE REJECTED -,q Ft/1vl�fiiol�i � S t,tN.Cc..ep'�, 11 5 - 54J0we. X v IVL6 V-r-VuAGf PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised Revised 9197 jm TE Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUR -DING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. Date ..... �f:. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... .`......... s- ...:...:^ ?.....'':............................................ has permission to perform ........ <- ::.w -::A. Q .................................... i. wiring in the building of .................................................. at .. n.........r ..... North Andover, Mass. Fee .. .......... Lic. No. /ZA? .... am ........................ �1 -,ELECTRICAL INSPECTOR Check # _, (1.7 THE COMMONWFALTHOFMASSACHUSETTS Office Use only DEPARTMFV!'0FPUMJCS4MY1 Permit No. -.636 BOARDOFFIREPREVEMONREGULWONS527QNR12 Gb Occupancy &Fees Checked APPLICARONFOR PERMIT TO P ORM ELECMCALWORTz ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA SSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 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) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes [21 No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps /� &I 2Volts Overhead 1:3 Underground rM No. of Meters New Service Amps Volts Overhead =1 Underground M No. of Meters Number of Feeders and Ampacity /yjQp .s„�t�i t'KI�?if✓V /��� A BAA2 Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures -a Pool Above Below Generators KVA -7 -Swimming ro 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 _ Othe No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- ,htsttrataeCDmnge. Ptsmt>athetegtmmim so usZCalaalLaws ltmea=utLAkh nm=R)licyin ixlffgComplMt DwWori mbst@tMgxvaiat YES NO �IhaveaibnidladvaTdVoofofsww1D hetes YES rT Ifyouhavedred(odYES,pleMgdcatt re WofmNeWby dtad�rgthe box 11���J POItANMYZ BOND r7 OTHER (PleaseSpeciiy) EVimfm D& EsftIn*dValxofE4e0"Wc& $ Wolklosm htspectimD*Reguesldd Rough Final SigtedurxiArPtnaitiesof pp PIRMNAME lie lio Li=wNa Licensee Si uto LicffwNo BusirressTelNo. 178-�i3�•� aG � A pO �e e �I9 o/,➢f/li AXTeiNcx OWNER'SINSURANCEWAMT,IamawaethattheLicarsedotsrothalvetheirtstrmwoDverageoritsabsuntmlequvalatasmgmedbyNt% dmsomCentalLaws and thatmysigrlureonthispetmMappkahc twaivesthisIegmanalt (Please check one) Owner M Agent Signature or Owner or Agent Telephone No. PERMIT FEE $ 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: Jew, (Location of Facility) Signature of Pe Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Name V -2 - city - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afdavit Please Print City A be V e, Phone #q7,? 05 7 h lz� 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: Address Gity: Phone* Failureto, secure coverage as required: under Section 25A or MGL 152 can lead tat* anpasism of criminal = of.a'fihe up to S'f.SOC and/or one years' imprismmentas wdLas-ad penaMmloshelmn-dA STQP rmict_(31 W)_ajdWAga�me 1 understand that a copy of this statement may be forwarded to the Office of Investigation of the DIA for �� coverage verificatioir. /do hereby certify d/er pains �dp[e/nailties ofperjury that the inronnaffw pirovvied above is true and correct_ Signature �dace 2a 7 l Print name^.Nip l vK-'iG41 PhoneA-�—'2, 1 / Official use only do not write in this area to be completed by city or town offidar City or Town 0 BU17dtlFlg Dept [Check if immediate response is required L ice nQ B08R se/ectmn's. (on Contact person: Phone #. E] Head Departm D Other k BOARD OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR Number: C$ 045638 Birthdate: 11/2211943 Expires: 11/22/2004 Tr. no: 3721 estricted: 1 G DANIEL P KILEY 111 342 N MAIN ST ANDOVER, MA 01810 Administrator This is to certify that twenty (20) days hava! elapsed from date of dedalW, IM without filing of an appeal. Oats .7 ao JOY08 A. Bradshaw Town of North Andover Office of the Zoning Board of Appeals r�wn ��'�` 6 Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Any appeal shall be filed within (20) days atter the date of filing of this notice in the office of the Town Clerk. NAME: Thomas & .Ioan Pennace ADDRESS: 97 Windkist Farm Road North Andover, MA 0184 Notice of Decision Year 2003 P, f 0ORrF, o "OLD 12/ t C usE� Telephone (978) 688-9541 Fax (978) 688-9542 at: 97 Windkist Farm Road BEARING— ( -S)-2003 PETITION; TYPING DATE March 11 & April I6, 2003-011 The North Andover Board of Appeals held a public hearing at its r - 7:30 PM upon the application of Thomas & Joan Pennace, 97 Wegulart meeting N ay, at requesting a Variance from Section 7 Ple 2 for Andover order to construct a 2nd story addition to a currently conforming struct ure and lot. 1Thside d Premise affected is property with frontage on the West side of Windkist Farm Road within the R-2 zoning e district. The following members were present: Waiter F. Soule, Robert P. Ford, John M Pallone, Ellen P McIntyre, and Joseph D. LaGrasse. Upon a motion made by John M. Pallone and 2nd by Joseph D. LaGrasse, the Board voted to GRANT the request of a dimensional Variance from Section 7 Para the right side setback in order to construct a 2°d story Z�Ph 7.3 and Table 2, for 4.7' relief from shown on the Plan of Land in North Andover Mass addition to the existing single &mily dwelling as Pennance, 97 Windkist Farm Road, North Andover, amazed far owner/applipnt Thomas 8c 3oan Merrimack Engineering Services, 66 Park Street, Andover, MbY tassa h ephen E Stapinski RL.S., #29876, Voting in favor: Robert P. Ford, John M, Pallone, Ellen P. McIntyre, 01810, dated 2/04/03.. tyre, and Joseph D. LaGrasse. The Board finds that the applicant has satisfied the provisions of Section 10.4, Para bylaw and that such change, extension or alteration shall not be su Paragraph of the zoning existing structure to the neighborhood. bstantially more detrimental than the Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the S substantial use or construction has commen s Special Permit was granted unless notice, and a new hearing, it .hall lapse and may be was only after ATTEST, A True Copy Town Clerk Decision 2003-011 Town of North Andover Board oof' AAppeals, Walter F, Soule, Vice Chairman JUN 2'03 PMI:20 Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-Cmo;z: nj -+ < Z �O a 01 � . z p — Jo 0 icu rn fD c -0 ? -0 D N A f t 0 0 a M0 fD 0ri c _7 O c ;ma CL 0) m (A. In 0 Eo 0 0 0 0 a H ro O� 0 O IM I3 2.n 0. �p �� 0 C 7 O =r 0 0. o �,'D � % m Or1 <D 0 d W X3:0 a 1 aas a ;» l w in c O =dip Q_ m o Co !:C p :� c�c 0 E O C c 'w O * TOw _ coo 3 0 �z 01) ti HIM X OU3 aj D •, > O E (D m O mz a. -- 3 a n: f Z C F _ m O 0 0 I x mn Cc m `C i�� %^ u 0 V' i z� YID v o y ~ m :a C �d a o- CD O 0 � y Z m m X m N m N mm _v, F 'L7 C � — d 10 O CD 0 Z co) CLO . Cly _� O � � C CL y o v CD CD o CL Cr d CD Er T CD O CD C co CO) av y �■ O CD I S- CA O � Z CD � O CCD O CCD I n O z cn �z CC?� O d = CM= y O Q y _gOy Cl) Cos e',ac 3 m y o �7 =ro wad o CO) O y ..� m 0 MIM m = > > oo O m �, o t m 0 c vi n . W • O c X co 0 CD m mom io 0 CO) � �46 p O1 y H CLpat Q 44 CA C ` N r C40) Cm • CA �� O O m m m -4b CA 'VCDWQ#; O A ..« CD (dd a -o 0 )Mq 0 9 0 00 CA F- r ,� M 8 o 0 4 J I 6-a Am HORTM of 14, � a i� +a ,SSACHUS� This certifies that Date.' �. i. - 0. `. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .................. has permission to perform ... ............... plumbing in the buildings of . .. ...:.`- .................... . at .. e??..1�. ! �. ��.'.' . ��.. 17i.? r^. ,,,., -North . Andover, Mass. Fee. .4./..... Lu. No..�. �! ..... .... �...... . PLUMBING INSPECTOR Check # / 1 � 6�, U-8 PIP' A z0 �6 J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIlV (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location . /� Owners;la e Permit # �21� o Amount Type of 0c1u anc New Renovation rl Replacement [j Plans Submitted Yes No ❑ FIXTURES (Print or type) Installing Company Name Name of Licensed Plumber: Insurance Coverage: India Liability insurance policy Insurance Waiver: I, three insurance Chec one: ertificate ol Corp. Partner. ElFirm/Co. of insurance coverage by checking the appropriate box: Other type of indemnity ❑ Bond have been made aware that the licensee of this application does not have any one of the above Signature Owner El Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installa '- performed under Pe it Issued for this application will be in compliance with all pertinent provisions of the M ach to Plumbing 9 d er 14201 General Laws. OVER (OFFICE USE ONLY Type of Plumbing Licefise icenseINum er Master 11 Journeyman Date ... . .1 ...G.`./ .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. rl.n. x, r:".r.4 :.,............ has permission for gas installation .. r' ........ in the buildings of .A4..` . . ............................ at ......... North Andover, Mass, Fee. 2 ..... .�S INSPECTOR Check # / 2 ) - o ? 4782 MASSACHUSEIIS UNIFORMAPPUCATONFOR PERM TODO GAS FfrnNG (Type or print) s pate NORTH ANDOVER, MASSACHUSETTS Building Locations ' Permit # zt-e ? �' Amount $ L Owner's Name New Renovation Replacement Plans Submitted El B -BASEM ENT ASEMENT AT. FLOOR D. rT4T FLOOR D. FLOOR � W � 6TH. FLOOR I5TH.FLOOR 7TH. W 8TH. FLOOR a U x � W Q Ea>4 GC F x cn zz o w x z o ° z H w� a o x a 0 H zE~t�- z w w we H a W -t 5 0 0 B -BASEM ENT ASEMENT AT. FLOOR D. rT4T FLOOR D. FLOOR H.. FLOOR 6TH. FLOOR I5TH.FLOOR 7TH. FLOOR 8TH. FLOOR (Print or ty)10 e one: Certific e /s a g Company Name Et Corp. Address, Partner. Business Telep one Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Chcck one. I have a current liability Insurance olicy or it's substantial equivalent. Yes No Q If you have checked Vis, ase - icate the type coverage by checking the appropriate x. Liability insurance policy Other type of indemnity 0 Bond Owner's Insurance Wai er: I am aware'that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information 1 have submtttea (or enterea) to aoov)/d non are true ano accurate to the best of my knowledge and that all plumbing work and installatio performed under Pernnort ' application will be in compliance with all pertinent provisions of the Ma achusetts tat Code and Ch�ptee G eral Laws. Y: City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed ® Plumber ® Gas Fitter 7 Master Journeyman DOMENIC J. SCALISE, ESQ. 89 Main Street North Andover, MA 01845 (978) 682-4153 FAX: (978) 794-2088 R UNDO WN AND RECORDING SHEET SELLERS: I v BUYERS: PROPERTY: 91-1 Cf//��,Jf AQa? Rundown Dates: to Date I Book/Page I Action Fed. Tax Liens State Tax Liens RECORDING INFORMATION Date of Recording: 6 /,,--/o 3 Document Document No. Time Cert. Copy -2- e-) Special Instructions: Recording Fees - Check No. 3 Z/ 9 Tax Stamps - Check No. $ Recorded I C-1 S- Plan Review Narrative The following narrative is proviQed tG further explain the reasons for DENIAL. for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Police Conservation Plannin Other Health uepartment of Public Works Historical Commission Buildina Dennrfmon+ n�RTk °4 "`°'`�� Zoning Bylaw Review Form s�� PcA� Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 Street: 9 r,7 W/A..)KS 7- Map/Lot: Map/Lot: / D q -5- Applicant: Ap licant: m w% z s -4. To d N e N ry A N C A Request: ao' rA4A Date: Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zonina The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. a -?-c,3 �`/O -D 3 ilding Department Official Signalu� Application Received Application Denied Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting e s 2 Frontage Complies y S 3 Lot Area Complies 1 e S 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed s G Contiguous Building. Area 2 Not Allowed 1 rti � Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient `-1 e S 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information e S 5 Rear Insufficient Building Coverage 6 Preexisting setback(s)N�a 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed y e S 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94A 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required q 1 /V � More Parking Required 2 Not in district `'t e S 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 1 Pre-existing Parking Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review S ecial Permit C - Setback Variance Access other than Fronto e S ecial Permit Parking Variance Frontage Exception Lot special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Si n Continuing Care Retirement Special Permit special Permits Zoning Board Independent Elderl Housin S ecial Permit Large Estate Condo Special Permit Special Permit Non-Conformin Use ZBA Planned Developmnt Di estrict Special Permit Earth Removal Special Permit ZETA Planned Residential Special Permit Special Permit Use not Listed but Similar R-6 Density Special Permit Special Permit for Si n Special permit for preexisting Watershed Special Permit nonconformin The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. a -?-c,3 �`/O -D 3 ilding Department Official Signalu� Application Received Application Denied Tummmealt of Massuc*fm lepton trnt of public %frtq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only LO /` Permit No. U Ompancy A Fee Checked fe 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM9 12:90 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date IF or lbws Of NORTH _ANDOVER To the Inspector of Wires: T61 idbralgned applies for a permit to perform the electrical work described below. Loe;atibn (Streit A Number) fib` 7 #adjZ 07 Gi)1,✓Vet 7- �i4 M OWnet or tertint Owner's Address /b �&,�.fi�L Is this permit in conjunction with al building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpo 04! Building Utility Authorization No. 76 y- 7 95 Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service JQt_ Amps 190J.J!� Volts Overhead Undgrnd No. of Meters Number of Feeders and Ampacity �. t Location and Nature of Proposed Electrical Work ;jL�3rA-&/-S,pgoldeY c7 Gt1/6f OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I homes a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES _4 NO = I Have submitted valid proof of same to the, Office. YES Z NO Z: If you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE SON G OTtijA/"i✓ (Please Specify) (Expiration Date) L6111Aated Value Of Electrical Work S Work to start Inspection Oats Requested: Rough Final Sighed under the Penelope of perjury: (� . FIRM NAME � 9 yl fe, 2 G Z1( LIC. NO. 'Licenep Signature 60f LIC. NO. azeilq =_�-�L_ ... _lhyis any �1' sus. Tel. No. Address All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or Its $615stantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent k one) d 1 (Phan check LJ Telephone No. _. PERMIT FEE $ (Signature of Owner or Agent) X-6565 No. of Lighting Outlets No. of Hot ?ribs No. of ltansformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. gmd. Generators KVA No. Adbi"fi No. of Emergency Lighting of Outlets , No, of Oil Burners Battery Unita No. of Switol( Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of As" i' NO. of Air Cond. Tbtal tons Initiating Devices No. of DisposalsMost . No.of Total Total pumps Tons KW No. of Sounding Devices No. of Self Contained No. 61 Olefmwashars Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑ Other ❑ No. of Drys" Heating Devices KW Connection No. of Water Heaters KW No, of No. of Signs Ballasts Low Voltage Wiring NO. Hydro Massage lUbs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I homes a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES _4 NO = I Have submitted valid proof of same to the, Office. YES Z NO Z: If you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE SON G OTtijA/"i✓ (Please Specify) (Expiration Date) L6111Aated Value Of Electrical Work S Work to start Inspection Oats Requested: Rough Final Sighed under the Penelope of perjury: (� . FIRM NAME � 9 yl fe, 2 G Z1( LIC. NO. 'Licenep Signature 60f LIC. NO. azeilq =_�-�L_ ... _lhyis any �1' sus. Tel. No. Address All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or Its $615stantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent k one) d 1 (Phan check LJ Telephone No. _. PERMIT FEE $ (Signature of Owner or Agent) X-6565 T' 1016, 1 Of NORT1{ 0 ,SSACNUS� Date .... . <... .l�! TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ...� M`05� has permission to perform �P w� ,� �' �t cJ� • ,e - ............t( .......... .................................................. wiring in the building of ......IGi...6.......Q.b..l ..... .J ''....:....................... kv f 7 &. , •17 4f�4 t.l �.Sf �..`i�. , North Andover, Mass. Fee ...... �1-k� Lic. No. 49.-W �( .......................................................... ELECTRICAL INSPECTOR (Z"'J/22j0/97Al f1:39 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ON V Office Use n �✓ T Gibe GamnWilw lith Qf Ar 5gz#1152tt-� Permit Na. e JJJ _y ErpaZtmriTt of 11u hik �fEtg Occupant/ Fee Checked ^� 3/90 (leave blank) r a BOARD OF FIRE PREVENTION REGULATIONS 527 VMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Eiectrical Code, 527 CM X12 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date M)w or Town of NORTH ANDOYFR To the Inspector of Wires: The udersigned applies for a permit to`per-arm G the /electrical work described below. Location (Street & Number) � 6201. -IV -1-1 /UV n f� /SY Foe ✓� Owner or Tenant Owner's Address is this permit in conjunction vith a building p rmit, Yes No I_ (Check ApprGoriate 9Gx) Purccse of Suiidine "?e 5 / W'P n f iw Utility Authorization No Existing Service Amos _J Vcits Overfimead '_ Uncgrnd Ne'rr Service Amos _J Vcits Over heac Uncg,rna — Numcer of Feeders ane Amcacity Alc, Y Locaren anc Nature or Prcposed Elec;ricai .lerK -� No. of Meters No. of Meters Total j No c V `Vs I No. cf Transtormers KVA No. of-:qn-ing outlets I Abcve^-- in - Swimming — 1 S2Gn eeratcrs KVA No. at Lighting Fixtures i gcot grnc. — Enc. — iNa. at Emergency Lighting No. cf Oil Bunters _ Saaery Units No. at Sw ccs Outlets No. ar Gas =users FIRE ALARMS No. of lanes No. of Detection anc initiating Davlces No. cf Scunaing Oevlces I No. of Salt Containea Oetact:aniSounaing Devices I — Municicai — Other -ccat _ Connecaan _ Low Vattage Wir:nc INSURANCE COVERAGE: Pursuant to the recu rements ct %iassacnusar sr,erat 'Laws urvalant• YES e NG I -< 1 have a current Liaoitity Insurance Poucy inducing CCmC:et a Oceranens Caverace or Its suos:antral eqYES NO _ If 'icu nave cnecxee YES. please Inatcace the ryce of coverage cy nave suomtctea valid proof of same to the Gfiice. criecxing the appropriate cox. INSURANCE E-*� 3GN0 — OTHER _ (Pease acec:ty) (Exotranon Oatei timatec Value of cue _sc-,ncai `Nora 5 wcrx :o Start pj Inseecnon Date Racuestec: Rough Fnal Signea uneer :he Penalties at perlury./��� UC NO. v�— =iRM NAME �U //iI )a r ' :C. NO - C) 0. Licensee �� ter -14 l r/R 5igrat r ��O � (,g.;? Sus. Tat. N ACCress -Z7 114"1 c1 /ten � � L-i9Gt/�fnl/ F � /`/� 0%_�1__ Alt. Tet. Na. OWNERS INSURANCE'NAIVER: I am aware trial n at tre L:cesee goes not nave :ria nsurance coverage or Its suostanual ecuwaler� 9ent cuireo cv Massachusetts General Laws. ane that my signature an r.:s cermit a0pltcation waives this reouirernsnt. Owner (P!ease cnecK ones -eiecr,one No. PERMIT FEE 5 Signature at Owner ar Agent] Total No. Of Ranges I No. Cf Air Conc. ;Cris Heat Total Tocat No. of Oiscosals I No.ar aumcs Tans K.V No. at C•isnwasners .- I ScaceiArea Heating Na. of priers Heating Devices KYJ No. V No. of No. of ',Vater Heaters KW i Signs 3allasts No. -,f MotCrS Total HP FIRE ALARMS No. of lanes No. of Detection anc initiating Davlces No. cf Scunaing Oevlces I No. of Salt Containea Oetact:aniSounaing Devices I — Municicai — Other -ccat _ Connecaan _ Low Vattage Wir:nc INSURANCE COVERAGE: Pursuant to the recu rements ct %iassacnusar sr,erat 'Laws urvalant• YES e NG I -< 1 have a current Liaoitity Insurance Poucy inducing CCmC:et a Oceranens Caverace or Its suos:antral eqYES NO _ If 'icu nave cnecxee YES. please Inatcace the ryce of coverage cy nave suomtctea valid proof of same to the Gfiice. criecxing the appropriate cox. INSURANCE E-*� 3GN0 — OTHER _ (Pease acec:ty) (Exotranon Oatei timatec Value of cue _sc-,ncai `Nora 5 wcrx :o Start pj Inseecnon Date Racuestec: Rough Fnal Signea uneer :he Penalties at perlury./��� UC NO. v�— =iRM NAME �U //iI )a r ' :C. NO - C) 0. Licensee �� ter -14 l r/R 5igrat r ��O � (,g.;? Sus. Tat. N ACCress -Z7 114"1 c1 /ten � � L-i9Gt/�fnl/ F � /`/� 0%_�1__ Alt. Tet. Na. OWNERS INSURANCE'NAIVER: I am aware trial n at tre L:cesee goes not nave :ria nsurance coverage or Its suostanual ecuwaler� 9ent cuireo cv Massachusetts General Laws. ane that my signature an r.:s cermit a0pltcation waives this reouirernsnt. Owner (P!ease cnecK ones -eiecr,one No. PERMIT FEE 5 Signature at Owner ar Agent] '?T' H61 Date... NORTp °;•14,, TOWN OF NORTH ANDOVER 3j •• °L ' PERMIT FOR WIRING SSACHUS� A rr This certifies that ..................................................................... has permission to perform ............ .... . .............. $ wiring in the building of at .................................:.............XIC rth ove , S. Fg Lic. No. ...�/ ..Fee..•. ............. ........... ....... INSPE R WHITE: Applicant CANARY: Building Dept. PINK: Treasurer mint or type) . • "• • • A'sns 1 1%J UV UA51-11 I[INQ NORTH ANDOVER , Mass. _7 70, Bunging Locatlon 7 LjJ,4\—J' Permit Owner's �cC'r Gc Name New Renovation ❑ Replacement p Pians Submitted:. Yes [] No Q 1 � • sue—esMT. • •ASEMANT 1sT FLOOR !NO FLOOR sROFLOOR ITH FLOOR aTH FLOOR GTH FLOOR 7tH FLOOR STH FLOOR sc ' O J M w O IU tl f. = t' V < �a a ° ° W Q MJ X~ �sL = tw Xw r ye� J Installing Company Name E'� /� (� Check one: Certllicale � 1.:4�,� Q� (,c� � © p ""' orp' Q� Address v U � 14 Oily/ 1, � � I d Partnership ❑ Firm/Co. Business Telephone_ Name of Licensed Plumber or Das FftterLu� �� r INSURANCE COVERAGE: Check one I have a current liability Insurance pollcy or its substantia) equivalent. ' Yes ❑ No ❑ It you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy; Other type of Indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does nd have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application wolves this requirement. Check one: %nature of Owner X Owner's Agent Owner ❑ Agent C} I hereby certify that AN of the details and Information I have submitted (or entered) M above application are true and a r le ! the best of my knowledge and that all plumbing work and Installations performed under the permN Issued r thin Ilcatl II pertinent provisions of the Massachusetts State Oes Voda and Chapter 142 of the Geiser once with all wt. T nse: This umber na urs o nse um or or as or neer ,� aster License Number �d L�Joumeyman � I m "f10NEn (OFFICE USE ONLY) V J Date. ,NORTH TOWN OF NORTH ANDOVER 'py i..o ,e,tiOL PERMIT FOR GAS INSTALLATION CU • CM ,SSACMuSEt O This certifies that .. got�41�% [: , Y.... . ill`. /-/ ................ . has permission for gas installation . k. e, � ./-. 4G rt. -�........... in the buildings of ... PP A 0,- 7T .......................... at -!1 A .' S. f ............... No Andover, Mass. Fee. 20, .. Lic. No.. ,/.v.%. ... , ...... . AS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (� _� Locati�^n (,/�V No. Date N°RTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ s�cNus•�� Foundation Permit Fee $ Other Permit Fee $ . Sewer Connection Fee $ Water Connection Fee $ TOTAL C' 90; 197 12:03 $ -/ I Building ngpector 150.00 PRIIl--- Div. Public Works Location—? -7— � i �t � )5a rot �ef /a� 7 � v No. Date D TOWN OF NORTH ANDOVEF Certificate of Occupancy $ Building/Frame Permit Fee $ i 737 i Foundation Permit Fee $ Other Permit Fee $_ Sewer Connection Fee $ Water Connection Fee $ Z•O TOTAL b z 9249 JC v� Buildfn Ins�24� or // Div. 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P 0 X0o A Z _ P VIII I°T �v 111_N =O IItIIIN 0<111 I I INIMMKI 111 1 1 1 1 1 11 1 11,11 a O x N ii !�Zm z� - OM Y 1 yZ2 Cox In M i 1 j>y No v* �mx 3 V N0 00 my3 i TrOZ Day myo Wsz ! �C 0 X0o 1 Oir e0 o O _ �v =O y mm ` �m O W co r M-�g w ;a j � O � O CL CO) y G •O •- 0 COD mm �z mom E Q zipCL c 0 = i.� Q+ _ to of - S v •� w .S p CL 40 a) Z CD m a V H L. 0 Ccc Bomb •— C Z c o h O C2 g O mm r o O � C N AC V + V : � CL C CL C A A � _ C a �a a a { F O 6 I � d M�. C C ',a` r"-4 m C �i p ar tj � mco c a ca �Cm VI m 0 aw "'mm oQ TL .a U w •� a �c w W y �e w ap+ w G w" •t o'o ` A p cn ;a j � O � O CL CO) y G •O •- 0 COD mm �z mom E Q zipCL c 0 = i.� Q+ _ to of - S v •� w .S p CL 40 a) Z CD m a V H L. 0 Ccc Bomb •— C Z c o h O C2 g O mm r o O � C N AC V + V : � CL C CL C A A _ C �a { F O 6 I � d M�. C C ',a` r"-4 m C �i p ar tj mco c ca �Cm VI m 0 aw "'mm oQ TL �v '0 oo F y W ap+ fid, 4.=..�Z_ Co •t C pL= A E dt 3 r N ca V C f- z S CLO. m ;a j � O � O CL CO) y G •O •- 0 COD mm �z mom E Q zipCL c 0 = i.� Q+ _ to of - S v •� w .S p CL 40 a) Z CD m a V H L. 0 Ccc Bomb •— C Z c o h O C2 g O mm Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) YC 57l,✓•r�,��s,f" irr Map and Parcel : Co rpose of! Application (check below) Phc1ne Number of Ap I ant: mangle Family — Two Family 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in exfstenc as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the • parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. ig ature o Owner or Authorized Agent who signed the Attached Budding Permit . at This form must be attached to the Building Permit upon application for such permit. 9 FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section******************* �- APPLICANT: //lilS� � ISS 1zPhone Xi -7 LOCATION: Assessor's Map Number Parcel Subdivision kil Lot(s) Street /l/ '' f St. Number ************************Of 'cial RECOMMENDATIO OF WN ENTS: Conservation Administrator Comments Town P1 Comments f Use Only************************ Date Approved D /� Date Rejected La �.c rc J ca.. a.cu u Date Approved Food Inspector -Health Date Rejected Date Approved e i Inspector -Health Date Rejected Comments Public Works - sewer/water connections �o - driveway permit Fire Department Received by Building Inspector ( Date _ 1� BOSTON STREET 4 i' V Z Q CL V > V 0 O c 06 Q W m c i 0 IL Z 0%01- W ``-W = a 0 0 F- ul W m 0 6 Q ZI d p� W A p U O U z z z A 0 H H x � H If d U cn W� 0 q p0 O� 0.4� o w z U aW q a U 0 6 h ON i Cd c o r 'm R O C "~ O O, C A O m C O m to Q C ca o a. o m cc C C c E L ti � 3 .• m O cc •_ N `ho c o H O m O CLU m aO OIc L •C O GI ��► r �• 0 C C OQ N ' a,CL m CH N O co Z ♦r C O C Q y m C or - CD = : rO N ~ 0 y O L COD 0 'N O.L . O C Z LU E v v 'C O CO) O. 0 -Cos .0 O � s 2 0 C F- L a0.1 06.- CO 2 m v f 10 E � L O Z O y � C I Ccm O•— CD h O O 'E m CO �3 o O CD ICL. Co. a c cc Qc O a. O C CD CL V CO) c C C C _c d CO2 D �' 1••'•'11 O ``t� {\,� 1•�•il � � � � �� i�� mr, II4Gi in W W y ��, o z Ll � Q G i 7 cc E c o r 'm R O C "~ O O, C A O m C O m to Q C ca o a. o m cc C C c E L ti � 3 .• m O cc •_ N `ho c o H O m O CLU m aO OIc L •C O GI ��► r �• 0 C C OQ N ' a,CL m CH N O co Z ♦r C O C Q y m C or - CD = : rO N ~ 0 y O L COD 0 'N O.L . O C Z LU E v v 'C O CO) O. 0 -Cos .0 O � s 2 0 C F- L a0.1 06.- CO 2 m v f 10 E � L O Z O y � C I Ccm O•— CD h O O 'E m CO �3 o O CD ICL. Co. a c cc Qc O a. O C CD CL V CO) c C C C _c d CO2 D (Print or Type) / Installing Company Name �� �?�• Address a % 5 i Check one: Certificate {' [�Corp._, 1706 M El Partner. Firm/Co. Business Telephone 32 1-( —1 '7 `f 3 . .� MASSACHUSETTS URIFORM APPLICATION .:FOR.PERMIT;TO`p0'pL.UMg1NG' (Type or Print) NORTH ANDOVER ,Mass. r-�, . . Date: of insurance coverage �a Building LocationLe' L-4T -7 I rrt11, di j Permit #, Name indemnity Q Owners insurance policy type of Q v New JE' Renovation Replacement Plans Submitted that the licensee of this application does not FIXTURE of the above three insurp.nce coverages. 5 • (Print or Type) / Installing Company Name �� �?�• Address a % 5 i Check one: Certificate {' [�Corp._, 1706 M El Partner. Firm/Co. Business Telephone 32 1-( —1 '7 `f 3 . Name of Licensed Plumber: G �. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability Other indemnity Q Bond insurance policy type of Q Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurp.nce coverages. 5 • _ z X 01 iG < . N Y J 07 :0 O a Z s I. z > W III N Z N- Q O• GG .Q ac z 1- N z a O d~ z r- 0. ft: 1- 0 A ao W � � i °' ~ o ar w trs as yC < °' �` z s ., d z d 3 X z CC o o a � d i° � Q 2 a w z oc Cl a a v z a a oa 0• .. w w (•. �" W o o x. ..a v cc Imo- a >: Q oC W Q th. oC d Q > x 1- O N N X 7 (!1 F X z a O o O 0Z z z .[ W t IG O X 0= W 3 1U• Q < r .. < Q O a -j -A Q ' cc cc C* < O < 1- Y .j a a, to o .+ = t- to W v v c < 3 a m Q SUB-BSMT. ' BASEMENT 1ST FLOOR 2ND FLOOR Z 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR < BTR FLOOR (Print or Type) / Installing Company Name �� �?�• Address a % 5 i Check one: Certificate {' [�Corp._, 1706 M El Partner. Firm/Co. Business Telephone 32 1-( —1 '7 `f 3 . Name of Licensed Plumber: G �. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability Other indemnity Q Bond insurance policy type of Q Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurp.nce coverages. 5 Signature of owner/agent of property Owner U Agent I hereby cettify that all of Ute devils and information 1 toave submiticd (or entered) in aha.e application ate true 204\%Lutate to Ute best of my knowledge and that all plumbing work and installations ererfotmcd under rerntit iesucd for this application will be in compliance with all peslinept p1o•--,4 visions of the Massachusetts State Plumbing Code and Chaplet 142 of the Genual Laws, By Title. Signature of Licensed Plumber Type of Plumbing License City/Town: .APPROVED TOFFICE USE ONLY) License Number I-1 Master ❑ Journeymanjr f i Date .7. 3479 TOWN OF NORTH ANDOVER t PERMIT FOR PLUMBING S SSACHUS� This certifies that ...(gl9.......04 ...�f ........... has permission to perform .. ...Gr....'`..r.......... plumbing in the buildings of .... j) .14 A.f.7.t: .� ............. atu.I .!`............. North Andover, Mas`¢3. Fee #.'O,." . Lic. No.. I.U3. `!y ..... ...... ......... PLUMBING INR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Y� Office use Only of Crama IIn=4 of l IIBsPormit No. 11 3 Itpin tna t of PUblir 0`ttfttq Ocafpancy 8 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 neat,`° blank)�` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 32:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -F 1& or Town of NORTH ANDOVER To the I(ispeiltior o1 Wlres: The udersigned applies for a permit to perform th electrical work described bellow. 3' Location (Street & Number) L a f� �� r .F Owner or Tenant Ci> f L 421LL, Owner's Address:.; . Is this permit in conjunction with a building permit: Yes ; No ❑ (Check Appropriate, Box) Puroose of Building )f NGI� d�cy1/Ly �Gu�/G _ Utility Authorization No. Existing Service Amps —J Volts Overhead Undgrnd r❑ No. of. Meters New Service LZ (DO Amps t Volts Overhead _ Undgrna No. of Meters -f- Number of Feeders and Ampacity Location and Nature of PropRsed Electrical Work/1Grr- �nlh���st! ti L r/i�/tiI/1 4_ No. of Lignting Outlets I No. at Hot ' cs I No. of T ransformers ToKVA t»r. No. of Lighting Fixtures i Swimming Pcoi grna e— gmc. r I Generators KVA No. of Emergency Lighting, No. of Receotacie Outlets I No. of Oil Eurners I Battery Units / 1 No. of Switch Outlets I No. of Gas Eurners FIRE ALARMS No. of Zones Tota, No. of Detection and F No. of Ranges I No. ct Air Canc. tons Initiating. Devices No. of Oisoosais I No.of Heat Total Total Pumas Tons KW No. of Sounding Devices i No. of Serf Contained>; No. of Oishwasners I SoaceiArea Heating KW Oetection/Souncing Devices ' —Municipal No. of Dryers I Heating Devices KW Local n!_Other No. of No. .7T Low Voltage No. of Water Heaters KW I Signs SaiPasts Wiring i_ No. Hyaro Massage Tubs �' No. of Motors Total HP OTHER::` INSURANCE COVERAGE: Pursuant to the reouirements of `.tassacnusers general Laws I have a current Liaoiiity Insurance Policy incluatng Camcioiec Ocerations Coverage or its substantial equivalent. YES 5,Z NO 1 have sucmitteo valid proof of same to the Office. YES ?L' NO = if you have checked YES. please indicate the typi bt coverage by I" checking the approonate oox. t INSURANCE SL BONO = OTHER = (Please Saec:!y) t T t- (Ex01ration Dater' • ,';' , Estimated Value of E!ectncal work S Final , Work to Start Insoecuon Date Recuestec: Rough ; Signed unser the Penalties of penury: FIRM NAME --)'Ho UC: NO.!�' Licensee Signature r LIC. NO. '.!us. To No Address . (jU OL�J Alt. Tal. No. r - eq OWNER'S INSURANCE WAIVER: 1 am aw re at the L:censee coes not nave the insurance coverage or its suostantiai equivalent as re- quirso by Massachusetts General Laws, ano that my signature on ;his permit appiication waives this requirement. Owner Agent (Please check one)+ /) Teteonone No. PERMIT FEE s 445 (Signature of Owner or Agent) x•5565 Date....... Yom.:. H43 4, TOWN OF NORTH ANDOVER 0 4L W'*qW- PERMIT FOR WIRING 11 -- 7 ;,SSACMUSEt This certifies that ... ......................... .............. has permission to perform wiring in the building . ..... ate at'7.5. T. -011F. n tz On-, ................. . North Andover, Mass. 61 Fee.�5.-�'-... Lic. NoR.Oics ............................................................... ELECTRICAL INSPECTOR 03/28/97 10:07 445.00 PAID 1(�� WHITE: Applicant CANARY: Building Dept. PINK: ea surer