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HomeMy WebLinkAboutBuilding Permit #131-11 - 530 FOSTER STREET 8/12/2011 BUILDING PERMIT "°oT bgti TOWN OF NORTH ANDOVER 3? $`'' ` +'' '° oL, APPLICATION FOR PLAN EXAMINATION ,. Permit NO: Date Received Date Issued: 9SSAc Hus���"� 2 ^/� IMPORTANT: Applicant must complete all items on this page 4LOCATION? w y . r p PROPERTY P)NNEI l d. 4 e b-R n4 Pnftt -' M P PARCEIL 0IIaG°C3iSTRICT HISTORIC DISTRICT yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition V Other f 'Septic Wel 13 Floodplain l Wetlands ( Watershed Di trict Wafer/Sewer DESCRIPTION OF WORK TO BE PREFORMED: C� Pe(-T On. 30 )c9Y- / �L' zap k ��2� lam► -A/ 1, 6yece 74dc / Identification Please Type or Print Clearly) OWNER: Name: V o%e -FRe- Phone: 9;7 P-6 F-T-57/a Address: �6-30 ; A54-ex-, .31' A A7G/e„Z-.; CONTRACTOR NameMIKGhcL CS hone: fercr �.• 5 f iv 7113 Supervisor's Cnbstrc(anicerlse Exp. -Date: Jv Dome Improve "'6Li else. �° Exp. `pat ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7Sp © C.) FEE: $ � Check N .: aq T 7 �7 0. a�}- 1 NOTE: ersons contra ered contractors a access to the guarantyfund Signature of Agent/Owner Signature of contracto r, Location No. �_ Date NO�TM TOWN OF NORTH ANDOVER f? • • Of ` � Certificate of Occupancy $ MUS<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # +- I 24e i Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE D.EPARTMEN Temp Dempster on site yes A` Li Located at 124-Main Street Fire;Department sign4bire/date Q COMMENTS a v Dimension Number of Stories: Total square feet of floor area, based on Exterior. dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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 the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH Town of CN = o , dover, Mass., ^�^ O - LAKE COC R I C H E1111CK 0''ATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......�...... V.. ... .......................... ... ,.... .............. ..... ................................................... Foundation has permission to erect........... ......... buildings on ...5$?......... .. S .....e........... Rough to be occupied as................ ........ r- . .J Chimney provided that the person accepting thi permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIRT�ATS Rough ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in.a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To BeDone FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): p�_4f C M Pa/l ( 6,74t Address: /3 �Ivq,, A-,-) 574 City/State/Zip: GU/0C 4 ,PS el. r M4 Phone#: 79/- 7019- Yciy c) Are you an employer?Check the appropriate box: Type of project(required): 1.[9 I am a employer withorly O 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.N Other /e 07 *Any applicant that checks box#1 must also 511 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. 3Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I / Insurance Company Name: Renu b !1 c, Ci o 11 t, Policy#or Self-ins. Lic.#:_(& C. 7 ? 6)/6 3 cD Expiration Date: old f&l Job Site Address:_ 3® _ _ S7z2 Sl/ - City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under lie pains and penalties of perjury that the information provided above 's tru and correct Si nature: � Zr 1 Date: Phone#: 701�� yCIZJ`o Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/5/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michael Bonacorso NAME: Bonacorso Insurance Agency, Inc. PHONE (781)273-3200 (NC.No):I781)273-0600 xtI:83 Cambridge Street ADDRIESS:mike@bonacorsoins.com P.O. Box 1502 CUSTOMEER R D#20003879 Burlington MA 01803 INSURERS AFFORDING COVERAGE NAICk INSURED INSURER A:Re ublic Franklin Ins. Co. INSURERS Travelers Indemnity Peterson Party Center, Inc. INSURER C Hartford Insurance Co. 139 Swanton Street INSURERD: INSURER E: Winchester MA 01890 INSURER F: COVERAGES CERTIFICATE NUMBER:2010 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL WVD SUBR POLICY EFF POLICY EXP LTR I POLICY NUMBER MM/DD MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea 0. mence $ 500,000 A CLAIMS-MADE FxI OCCUR X X CPP 4361629 10/9/2010 10/9/2011 M ED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE _$ 2,000,1000 GEN'LAGGREGATELIMIT APPLIESPER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED AUTOS X X BA 92968836 10/9/2010 10/9/2011 BODILY INJURY(Per accident) $ X SCHEDULEDAUTOS PROPERTY DAMAGE X $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS Underinsured motorist BI split $ 1,000,000 Uninsured motorist BI split limit $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LAB HCLAIMS-MADE AGGREGATE $ 5,000,000 DEDUCTIBLE $ A RETENTION $ X X PMB 4361631 10/9/2010 10/9/2011 Is A WORKERS COMPENSATION X I WC RYLMT- I OTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) wc 4361630 10/9/2010 10/9/2011 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,desaibe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C Equipment Floater X TO BE DETERMINED 10/9/2010 10/9/2011 Leasedand Rented Equip: $100,000 Limit DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD i I '- Zl:r••:rihtr•ctt, - I�� Ir;rrtntcnt Ort' Public Board I1' 131111 11rI ntl:rr cl, —' Construction Supervisor License License: CS 60219 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2013 Tr--: 13389 t r 'J .tea-...Sl�ii,. .. ... ... _.__ _.. .,. .........`�� .•.'.fiLa'a.`..a:..+:.�: --...�:✓` u� - t � .1 VI. -�. a ��n��212.10uELI Di9El�LfirPLPfff� IMPORTANT DOCUMENT 5 � of iftamt ���i..5taffreISSUED BY 5 REGISTERED cu�F Date of Manufacture C, 5 APPLICATION o- ' NOR. NUMBER 5 5 NUMBER NDUSTRIES INC C 5 � EVANSVILLE, INDIANA 47711 Order Number 5 5 F121.4 E MANUFACTURERS OF THE FINISHED S TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 5 657150 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California Fire 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: S 5 Serial #: 8109000(l) rrSr Description of item certified: 5 CENT MATE 30W X 45 VL W W 5 _ Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOHN BOYLE STATESVILLE NC Signed: '' 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 ClCP[PCPr�LI�C�CJ�CPCJ�CPCPr�r�r�[J�[PCJ�r�[J�[Pr�rJ�C1�Cl[J�rJ�CJ�t PCPry[l[P[PCPCPCJ�C1rJ��PGI[JCJ�cP[P[PCP[P[1rJ�[PCJ�[nCJ�[PCPLI�CJ�CP�PL1[PCPCJ�[PC 1�C1CP[J�CPC�r�rPCJ�[PC f[PCPCP[Pr�[P[P 0 ' I1 'I Eft ot"M Use OrlyL�am inwrafth af -giusar4urt}5 (�Q Permit No. Etputmttri of Vublir £'ifctq Occupancy 3 Fee Checkedy,= BOARD OF FIRE PREVENTION REGULATIONS 527 C JR 12:00 3M Qeave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Qa or Town or NORTH ANnOVFR To the Inspector of Wires: i The udersigned applies for a permit to perform the electrical work described below. Location (Street & Numbers Owner or Tenant SS 61 Owner's Address Cc- O Is this permit in conjunctions with a building permit: F Yes _ Na v (Check Appropriate Box) Purocse of Building N+ /d -ei-„ Utility Aumanzation No. � Y.=�s 2— j Existing Service Amos _/ Vcits Overhdad UnaUnagma No. of Meters New Service 1414" Amps ia,�7Zy0 Volts Cverreac .S� UncS:no r No. of Meters Numoer of Feeders anc Ampacity Location aria Nature of Prcoosec Elec:ncal .11crr i No. Or L gnrfng Outlets No. _: Hct _-=s i No. ct—ransrormers notal KVA I No. at Lighting Fg =cot i Swimmin above.— :n- grna. _ grnc. _ Generators KVA j No. of Emergency Lighting No. Ot Recectac:e Outlets No. at Cd =urner7 sarery Unita No. of Swllch Outlets No. cr Gaa =urners I FIRE ALARMS No. of Zones No, of Aanges I No. at Air Circ. Total No. of Cetactfon ano tons Initiating olavfces No. of Oispasale I Nc.at `!eat Total Tofaf Lim.a s Tons KW No. at Sounding Oevices No. of.Sart Containea No. of ^visnwasnars - Soacefarea r+eanrq K♦v Da:ee::oroSaunalnq Devices No. at Or/era I Hea:ing Devices KW Local - Munlcioal ^—Other I Connec::on No. at No. of Low Voltage No. of Nater Heaters KW I Signs Sadas:s Wiring No. 4yaro Massage Tubs I Na of Molcrs Total tip I OTHER: j i INSURANCE COVERAGE. Pursuant :o the requirements at massacnusers ;enerai Laws I have a current Liaoiiity Insurance Policy ,nc:ucing Car,a:etee Ocerati s Coverage or :is suos:annal aeufvalent. YES — = 1 nave suamiltea valid ,.root of ame to the Office. YES _ If ycu nave cneacea YES. alease inafclte :he type of coverage ey . checxing the aoproon^ ox. - INSURANCE _ BOND = OTHER = (Pease Scec:y) 67 (t;Aofratton Oatel Eshmateo value PI E!arncat Work i worlt :o Start 16 Inscec•lon Data AacGes.ec: Rougn J.6 S;gheo under :he Penalties of perjury: FIRM NAME G UC. NO. Licensee �iwi `.f s i �ss�o�S:gnat_re UC. NO. ',g,� Acaress rlGS Alt. Tel. TJo. OWNER'S INSURANCE WAIVER: I am aware that the Licensee aces not nave the maurance coverage or Its suastantlai a0ulvalent as re- aufreo by Massacnusetts General Laws. ano that my signature on :n:s :ermit aopficatfon walves this realeirement. Owner Agent (Pease cnecrt onet sieonone No. PEPIMIT FS=— S tSignature of Owner or Agvi,t, r._. N2 1 i i 9 Date...Z.. 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING '4CHUS This certifies ......... ....... r............ has permission to perform ...... �.'.I.D.......................................................... wiring in the building of ? .. -: .......... ................ at....0 ... .............. North Andover,Mass. 2rel Fee 7() .................. Lic.NO. . ............................................................... ELECTRICAL INSPECTOR 08/18/98 09:43 370.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer -;f N- O Date?............................... NORTH I 3j �,„�`-.:•..."o,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUSE� ✓ This certifies that ...1...... ..... ....................................::........................... has permission to perform ....................... . ......--.......-,!'r!-`......:....................... wiring in the building of _-n �.. -_ ' ..J!'� at......................... ........ ............... .North Andover,Mass. Fee-� Lic.N04.).l. . ............................................................... ` ELECTRICAL INSPECTOR 06/11/98 09:48 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer /(�Q �{�(. Ottke Use Only t V4r �%dlIIT1WIIlUEEIlt11 LTf Permit No. f 999' It;Tmtnztrt cf 'Public 2%aft:tq Occupancy A Fee Checked";z BOARD OF FIRE PREVENTION REGULATIONS 527 C JR 12:00 3W peeve blank) rv: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:C)O (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate or Town of_NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street 8 Number) _ .�.� u J'-//-e- Owner COwner or Tenant Owner's Address Is this permit in conjunction with a builCing permit: Yes _ o _ (Check Appropriate Boxl Purocse of Building -� � w Utility Authorization No. � j Existing Service Amos11"_J /tits Over •eaa _ Unagma r No. of Meters New Service 2a'19 Amps/_�—;'fa Volts Overreacna r No. of Meters U S: Numoee of Feecers ane Antraclry Lccaticn ane Nature of Prccosec Elec:::cal .ycrx No. of L.•gnting Outlets No. a. ct '.-as Tota, I ' " No. KVA No. of Lighting Fixtutis i g a,Swimming Above.— :n- — grno. _ grnc. _ Generators KVA No. of Emergency Lighting Na. of Receotae:e Outlets No. of Cil =urners 3arery Units No. of Swlten outlets No. or Gas Earners I FIRE ALARMS No. of Zones No. of Ranges I No. of ,air ,::C.rc. Tota, No. at Ciftecuon ano lons Initiating Cov,cas No. of Oisoosals I No.--r Heat Tota, Tota, ?u-cs Tons KW No. ct Sounaing Oev,ces No. of :S40:on Contained n No. of v,anwasne - ! SoacvArea Heating �v Oar:e :oroSounaing Oevtces No. at Oryers I Heanng Cev,ces KW Lcca, - Munlcioat —Other I Connec::on No. v NO. of Low voltage No. of Water Heaters KW I Signs 3allas:s Wiring No. 4varo Massage Tuos No. of motcrs Total ►+P .r I OTHER: INSURANCE CCVERAGE. Pursuant :o the reauvements at %lassacn."ars ;eneral Laws 1 have a current Liaoliity Insurance Pout/ ,nc:uc,ng C:mc:etec O s Caverage or :is suovantial ocuivaent. YES 1 nave suonbfteo vatic ;root of same to the Office. YES Lt—ff =It -;cu nave cnec-xeaS ,lease lnolcate me t Y . type of coverage Cy checx,nq he approonate oox. • INSURANCE 6 = OTHER = tP'ease _oec:yt (Eaolration Oate? Estimates Value of!ec:ncatork S work :o Stag ' Insoecaon Oata �atxes:ac: Rougn ft.' � �LFnaf Signed unser the enaules of rlury, FIRM NAME ` -/''r Jr- 01 4 1 x IC. NO. z7 Licensee g. ` Signature UC. NO. Aaaress Sus. :u. No.�7�� All. Tel. .?o. OWNER'S INSURANCE WAIVER: I am aware :nat the -:censoe coes not nave the insurance coverage or its suostanhal acufvalent as re- ou,rea oy Massacnusetts General Laws, ano :nat my signature on ::::s :ermlt acp„cation waives this reotx,rement. Owner Agent (P!ease cnecit one? :e,eonone No. P£AMIT FE_ S - Isignature of Owner or Agenu Date �. . . . . * ..3773 r q i ��.NO°T:��c TOWN OF NORTH ANDOVER f PERMIT FOR PLUMBING IR SACHUS� d Q This certifies that �_- . . . . . . . . . . . . . . . . . . .,; has permission to perform . . , -. .,. . . . . . . . . . . . . . . .� C7� plumbing in the buil ings of .>�.�.':�'?:�?!✓.�:-�: .� ...3 n at. . . . . . . �' . . . . . . ., North Andover, Mass.`s Fee(, D. . Lic. Nwo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer T ED U9 , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Type or print) 7—'NORTH ANDOVER,MASSACHUSETTS 7 ,`� l Date uilding Locations �> © 0 f/ e� Permit # 7� Amount �7d ✓' r Owner's Name New Renovation Replacement 0 Plans Submitted l , FIXTURES rA CA rA W � F Cd n t>~ Q W Q Cn a A AC Q E w w d d F `7 04 F Cn Cr SWUM &ISIT')El�(f M FDM 2M F M Z Z �FLOQ2 4II-i FID(R 5M RfM 6M RIM 7M FWM SIA FLOCK (Print or type) Check one: Certificate Installing Company Name d f C Corp. Address ''L Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type f insurance coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnityElBond Insurance Waiver: I,the undersigned,have been mdde aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent El 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the G Laws. By: +gna re ot Licenseaum er Type of Plumbing License Title - e City/Town tcen mer Master Journeyman ❑ APPROVED(OFFICE USE ONLY 11 4 � ti CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number CP/ Date 49c,12of © THIS CERTIFIES THAT THE BUILDING LOCATED ON 13L9 �d.S*eX S MAY BE OCCUPIED AS 400 I1 FA^-IYA-9*IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. �V* �• "';';,,o CERTIFICATE ISSUED TO • ADDRESS JK e0 7 ,NAGMUSBuilding Inspector NORTjy TONM `' 0 - over:, O r No. 02/ * dover, Mass., 19 re. �O9A cocM CNE iex S AATEO �G BOARD OF)HEALTH PERMIT T D Food/Kitchen Septic System BUILDIN G INSPECTOR M.C:5AWA . . THIS CERTIFIES THAT......................... �o: ......................rZ.......-................ .0 r.:....... .........L................... Foundation X, has permission to erect.................... ................... buildings on � dST......................... .............. '... to be occupied as.......................................... rn?G.� �............ A. �'4.i...1. ............... .................. .................... mney - rcvided.that the person accepting this tYhe terms f he application on file in f P p p g t s permd shall m every respect conform td o f pp this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Finale `/L �/a -� Y 9 P Buildings in the Town of North Andover. PLUMB G INSP ! , VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ST EL UNLESS CONSTRUCTONIE� 77n774 ....................... Service . . . ............. UILDING INSPECTOR Occupancy Permit Required to Occupy Building GA9INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Route Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT p Until Inspected and Approved by the Building Inspector. Bume< Street No. ��