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HomeMy WebLinkAboutBuilding Permit #482 - 857 CHESTNUT STREET 12/29/2006Permit NO: Date Issued: LOCATION TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Applic esfh J Date Received must complete all items on this v P n - PROPERTY OWNER ��+9- J � C'4 'e e– I Print _ Z MAP NO.: } L PARCEL: �� ZONING DISTRICT: TYPE AND USE OF BUILDING TYPE OF IMPROVEMENT [mew Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition ❑ Moving (relocation) HISTORIC DISTRICT YES ❑ PROPOSED USE Residential Non- Residential ❑ One family ❑ Two or more family ❑Industrial No. of units: ❑ Assessory Bldg ❑ Commercial ❑ Other ❑ Others: ❑ Foundation only I DESCRIPTION OF WORK TO BE PREFORMED I Identification Please Type or Print Clearly) OWNER: Name: STa' C'>���-r�- e-- Phone: Address: CONTRACTOR Name: Address: i0 Y`z &OLCJ4, tv 038 A/ Supervisor's Construction License: C,5 Exp. Home Improvement License: ) L42G V- Exp, NORTFr� O�St�[o �6q+ o � � t \�1 pogArgo'PP.'l�/ Date: �� 6 Date: LlZ 0 9 ARCHITECT/ENGINEER -S �c }`b5- -� Name: Phone: Address: yv f �i LCtA Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMAW5(, OST BASED ON $125.00 PER S.F. JTotal Project Cost:$ 2 OOp FEE:$ Check No.: i 3 A --i- Receipt No.:—�&-- Page Iof4 Or - Location --2 No. 01Z Date d MORIN TOWN OF NORTH ANDOVER O 0 AL Certificate of Occupancy $ Building/Frame Permit Fee $ ,sS CNUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9 9 0 0 1�--�- - - Building Inspector Date..................... JMWWWORTH ANDOVER op PERMli FOR GAS INSTALLATION asf a SSACHUSEt . .. This certifies that ..! ............/..... .i .................. has permission for gas installation .......................... in the buildings of ........... .c:r " .._................... . at �..... . ........ � ,�� . " � ... �: -, , North Andover, Mass. ( ✓ 1. Fee.0 :.:�. Lic. No!./. ;' c w . GAS INSPECTOR WHITE: Applicant CANAR"uilding Dept. PINK: Treasurer GOLD: File TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 11 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Dumpster on Site ❑ Electric Meter location to project co,nructcng wit unregistered contractors do not have access to the guaranty and _.� Signature of Agent/Owner / Signature of contractor I sro'Z.t Plans Submitted ; ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS G DATE APPROVED TE REJECTED DATE APPROVED CONSERVATION n P: COMMENTS HEALTH COMMENTS J DATE REJECTED DATPROVED . FIRE DEPARTMENT - Temp Dumpster on site Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: I Water & Sewer Comments Comments Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 56 36, I 3& / 9. y / �o G -� I Dimension ' Number of Stories: I Total square feet of floor area, based on Exterior dimensions. 5-76 Total land area, sq. ft.: 0c) LI . S S5 • {-1- NOTES and DATA — (For department use) I i I I I I Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPPORM05 Created JMC. Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/ElevationPlan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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) o Copy of Contract ❑ Mass check Energy Compliance Report ion from the cases if a v I riance or special permit was required the Town Clerks office his recorded must stamp the at ethe Registry of Deeds. In all applicant must then get Board of Appeals that the appeal period is over. The app application One copy and proof of recording must be submitted with the building app Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 0 Location No. Date a f TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ '`Sewer Connection Fee $ ;ZteerConnection Fee $ 49 X993 Building Inspector Div. Public Works C� PIERIMIT 110. 4/ ,3 v APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. tZ PAGE 1 MAP 4J0. I LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE SUB DIV. LOT NO. O� ff sL — ! r��J �06 C 1/29 C��- LOCATION LOCATION Crc.� r{. PURPOSE OF BUILDING 51 ^ C - �lW�` i/QO OWNER'S NAME �C �Q NO. OF STORIES .2 L S5,4 i OWNER'S ADDRESS BASEMENT OR SLAB 1� ARCHITECT'S NAME1 an SIZE OF FLOOR TIMBERS IST�Q 2ND 3RD BUILDER'S NAME V�c51" AJ SPAN DISTANCE TO NEAREST BUILDING _- DIMENSIONS OF SILLSb POSTS I DISTANCE FROM STREET �1©s DISTANCE FROM LOT LINES - SIDES �(p �/ REAR ��Q t j0 " GIRDERS YfC�XJ,y L FRONTAGE 'Q2 AREA OF LOT T US,0Q r 1 HEIGHT OF FOUNDATION p / THICKNESS IS BUILDING NEW�O SIZE OF FOOTING ��` /Of X I0 It IS BUILDING ADDITION �� MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE�iGS I ] IS BUILDING CONNECTED TO TOWN WATER j��S 1 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES t PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE aS+ D Q OWNER TEL. #-�j-R2o 1 PERMIT GRANTED CO iTR. TEL. #�4�ZZOD 19 CO"QTR. LIC. >#Q.i2% tv AMR d,# 142 113! tllDtl G DEPARTMENT ks,�, D 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /30,Qd0 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN oulwmu Imur6GTDR 1 `' , , I OCCUPANCY SINGLE - FA LY STORIES _ MULTI. FAMIL h _OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOII FINISH C0114CRETE3 I 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D _ PIERS PLASTER _ DRY WALL ?— 3 BASEMENT 11 1 NO B MT FIRE PLACES HEAD ROOM b MODERN KITCHEN 4 WALLS 79 FLOORS CLAPBOARDS 8 1 DROP SIDING CONCRETE _ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD",/'D ASBESTOS SIDING _ COMMON J_ STUCCO ON FRAME MASONRY ATTIC STRS. & FLOOR RAME TINDER BILK. MASONRY WIRING 5 ROOF I 10 PLUMBING GABLE GAMBREL HIP PIPELESS FURNACE BATH 13 FIX.) MANSARD TIMBER BMS. & COLS. TOILET RM. (2 FIX.) STEAM FLAT SHED HOT W'T'R OR VAPO WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK GAS SLATE B'M'T 2nd _ 1st 13r�dj NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES 6 FRAMING II 11 HEATING WOOD JOIST V PIPELESS FURNACE FORCED HOT AIR FUF TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPO WOOD RAFTERS _ V AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ 1st 13r�dj I NO HEATING BUILDING RECORD { 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1 t i ( • I, 0 � • �: :1 i1 Li�I. .: i{� 17 N I it Ip: I ]I I III; 1 �, • I �IA II{ , .I I �9 '!I•—. I 1�IG�lI ' �.I II 11II '':� si �+ A 2s� ��•+ ' � 1111,1i.� V; ; y.,/�6 it !r .t,�� 'I -I f i•f 10 1 I I? ..��7 .• 1 tt 1. 1 � 7 n t If.' � I I: �C`►�..� ! I,I I � ri i MI � t Ij I i'!� �f 1' II. ai l�, ( I � � i i i ,,� �` I `+-� ��� c .i. 4EsIT"b`i�t�tli`ni��y rl I�, IIt���l�i�!I�i1Rj�f,,;"_��ti��i����i��l.11�i i I � '� �� Rf�,.. , � i' �;�•�� ��I'.! , tl i •� I 1 . I ! ;.` ,I I.' I. ,' ,A+ta.lr ff'I` ti•v.�4Nt 1 +.' li7! tt i�� .. �I 1�il �, itl I ,it ' M ff t y � :} ll I I; i il`' a Illi,, i� e l I !• 4 _ I, 1 I f t{.�' �1� SIIy 4� ' ij: ' f�' � + � t '!;I f ! (' I'{`11 Z3(, t' '�i, i• t I'_ ! I. 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Billerica, Ma. 01821 License # 049727 General Conditions: Architectural & Engineering Site Supervision Permits Insurance Interior cleaning Utility Labor Debris Removal Division 1: General Requirements The following items are Allowances. It is intended that these items be paid directley by the owner. The amounts provided are representative of median range pricing. All Allowance items are subject to change by the owner. Allowances: Carpet ($17.00/ yd.) $1,700 Tile ($7.50/ sq. ft.) $1,950 Hardwood Flooring $4,000 Kitchen Cabinets $8,500 Appliances $8,000 Rebuild Stairway to 2nd Floor $4,000 Dormer 2nd Floor (Weather Tight Shell) $12,000 Debris Removal $4,000 Total $44,150 Division 2: Sitework Clearing and Grubbing Excavation and Trenching Septic System Piping Grading Trenching Respread existing topsoil Total 13 $4,900 I f• � Division 3: Concrete Footings 101' x 20" 30001b Walls 10" x 20" 30001b Waterproofing below grade Basement floor 30001b Steel Reinforcement Anchors Basement Windows as required Total $9,400 Division 4: Masonry Construction of Stone Fireplace as shown on plan. Firebox: Standard Firebrick Flue: Clay flue tiles with decorative top as shown Fieldstone facade to match existing Bluestone tops for new stairway Total $15,900 Division 5: Metals Lally Columns Bridging Hangers Total $800 Division 6: Wood Rough Carpentry: Exterior Walls: 2x6 16" O.C. Interior Walls: 2x4 16" O.C. Sheathing: 1/2 CDX Plywood walls and Roof Subfloors: 3/4 CDX Plywood Sills: Pressure Treated over Sill Sealer Roof Frame: 2x10 16" O.C. Floor Frame 2x10 16" O.C. Exterior Trim Pine, Flat to match existing Exterior Window Case: Pine, brick mold Exterior Door Case: Pine, brick mold Total $19,900 Finish Carpentry: All interior wood trim is stain grade pine Interior Doors: 6 Panel Pine Casings: 3 1/2 flat pine Baseboard 4 1/2" Colonial with base molding Closet Interiors: Standard Shelf and Pole Stairway: Oak Treads, Oak Handrail and Painted Risers Total $8,100 Division 7: Thermal and Moisture Insulation: Attic: R-30 Exterior Walls: R-19 Basement Cieling: R-19 Vapor Barrier: Tyvek or Similar Soffit Vents Ridge Vents Roofing: Fiberglass (25 years) Ice and Watershield Siding: Striated Shake with Backer Board Total $8,400 Division 8 Doors and Windows Exterior Doors and Windows All doors and windows in new room to be wood Windows: Wood, Doublehung, insulated glass with snap in grills and insect screens French Doors: Wood with divided lite All windows in the remodeled space will be aluminum to match existing Total Division 9 : Interior Finishes Walls and Ceiling : 1/2" GWB Walls and Ceiling Moisture Resistant GWB Wet areas Smooth Finish skim coat plaster on walls and ceilings Closet Interiors, Rough Coat Flooring (See Allowances) Painting and Staining $8,500 Total $11,700 � j " Y Division 10 Specialties Not Used Division 11: Equipment (See Allowances) Division 12: Furnishings (See Allowances) Division 13 & 14 Not Used Division 15: Mechanical: Plumbing: System to be design built to conform to code. Plumbing Fixtures: See Allowances Total $8,100 Heating: System to be design built F.H.W. Baseboard system Total Division 16: Electrical $4,500 Design Built to meet all applicable codes. Includes two exterior flood lights, two exterior GFI Recepticles. Total $5,650 Is . . PRICING INFORMATION TOTAL CONSTRUCTION COST TOTAL ALLOWANCES TOTAL NET CONTRACT $105,850 $ 44,150 $150,000 SUNSPACE DESIGN / DATE Thomas J. igro Presi en Stephen CrabtreeAtw., � DATE 3 S Y�- r ti1- ma 47 R w i D�Wp WN I• a.• I -m us u2 �a� a .. a ti1- ma 47 R w i D�Wp WN I• a.• I -m us W S W W Z Z � H 6 N a= 0 O a N• O p+ .S O s O ;>J CJ C aL' e- Z \�\1 .r CJ.:Q W O »ti va w _ - sc o 7 0 W O w V, L!J ...1 9 b OLLJ V: * ::? J f 02 L V 0 p C- U L1a. o. ° a s wx LL LL ... J m0tzo a ZO< g02p !_ uwV 0 � iO z�3 _ N} CJ N�oox ,% o Xi _ C7 mN °Woz H � LL 2 O� Hew �u�w 4 W N M NO M Iz 3 :) w a i 0 Q P ., o m ? � z v 0 o 1- O -' V i H rn H _ Q ¢ a N �iz r h m o f W c o z O FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. *****************Applicant fills out this section***************** S4CJe.:i jt VAPPLICANT: 14 ( I'A fr-'_@e Phone LOCATION: Assessor's Map Number Parcel Subdivision he(Ve Lot(s) _ Street C %" v-- Sr St. Number Y6_ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: 4`� '^ E Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food In/s�pector-Health Septic Inspectori-Health Date Approved Date Rejected Date Approved Date Rejected Comments 5Sb5 19,PP,_;9Rs Tb z6- sUr<iC%E"NT FDS' ozlg Public Works - sewer/water connections - driveway permit "Fire Department - Received by Building Inspector _ Date 0 C; W 0 z 40 c o .o c 0 c �0 0 c ` �•ac ev ea CO c z o tz m kceoa Eco s O o � C.)$ as c_ all � CO) m 3 j O m � C m > H C C w E m 4b: m C l m ' cr. o o� � c t s acs m �� •mor CM �Z o F—C Q O y m C •O = m m C N .. c A z M 'E v o w .y O om== g COD c m 'F, o = W O = O C/) z 0 a z 0 U U O O 01 U O O O v Z CD CL O y G C CD cm I � � G _ Lo O �C �E m m co 0 CD CL o °o CD L !d 00. 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C XMX �EX aQ zaWa O U W W pq W N Q WQ C _ U �-- Q �W A W H o Z LL- Z Z Q H <Z E--- W Q W = - X = F— o U ry u > N. �z LLI W oo y r^� V ! x a N �l CZ Wok W i Q W 4 I H J Q WQZ Q3 0 _J Z Q QH Q UZ F--iQD FWD �pqW CONSTRUCTION MANAGEMENT CONTRACT OWNER STEVEN CRABTREE 857 CHESTNUT STREET NORTH ANDOVER, MA CONSTRUCTION MANAGER GREENLAND CONSTRUCTION, LLC MATTHEW J. BURKE P.O. BOX 737 RYE BEACH, NH 03871 (603)231-7057 CONSTRUCTION MANAGER CONTRACT SCOPE OF SERVICES PARTIES: Matthew J. Burke, as manager of Greenland Construction, LLC with a place of business in Rye Beach, New Hampshire and Mr. Steven Crabtree of 857 Chestnut Street, North Andover, MA 01845. LOCATION OF HOME: 857 Chestnut Street, North Andover, MA. HOUSE PLANS/DESIGN: The Construction Manager will assist the Home Owner in locating or having drawn an acceptable house design plan that both meets the needs and objectives of the Home Owner, as well conforming to all constraints of the site including cost. PERMIT APPLICATION; The Construction Manager will coordinate the permit application process. The Construction Manager will have the building permit issued in the name of the Home Owner with the Construction Manager designated as the licensed construction supervisor. All permitting fees shall be borne by the Home Owner. CONSTRUCTION COST ESTIMATE: The Construction Manager will develop and present the Home Owner with a preliminary cost estimate after construction drawings and plans have been finalized. The preliminary cost estimate will be updated and refined as the Home Owner makes material choices and sub -contractor bids are received. It may be necessary to substitute materials or design considerations in order to meet the budget objectives of the Home Owner as the actual projected cost differ from the preliminary estimates depending on sub -contractor availability, materials pricing and Home Owner choices. The Construction Manager will notify and obtain authorization from the Home Owner for all increases in estimates of greater than 10% over the preliminary estimate. The Home Owner acknowledges and agrees that the preliminary cost estimate is subject to adjustment and the final cost of completion may be substantially in excess of the estimate. This may be caused by several factors, including but not limited to, material and labor shortages, price changes, surcharges and availability, as well as, cost due to Home Owners final selection of fixtures, appliances and amenities. The Construction Manager will attempt to advise Home Owner of any potential increases in the cost of construction on a timely and regular basis. CONSTRUCTION SUPERVISION: After receiving bid proposals from various sub -contractors and suppliers, based upon received proposals, the Construction Manager will make recommendations to the Home Owner as to who, in the opinion of the Construction Manager, are the most qualified, and whose price is within an acceptable range. In some instances it may not be possible to obtain more than one or two prices for a given job because of the tight labor and sub -contractor market. In instances where a limited number of proposals are received, the Construction Manager will make recommendations based on both past experience with the sub-contractor/supplier and the sub -contractor's reputation with -in the industry. The Home Owner shall contract with all sub -contractors at his sole discretion for all segments of the construction. The Construction Manager will supervise all the work on the site to insure that the work is done in accordance with the construction drawings, specifications, plans and permits. The Construction Manager shall be the authorized agent of the Home Owner for purposes of advising sub -contractors as to what actions, corrections or repairs are required to obtain satisfactory work in compliance with the plans, specifications and permits from each sub -contractor. The Construction Manager shall thereafter report to the Home Owner any such deficiencies in a sub -contractor performance and recommend Home Owner take action, if warranted, with respect to any sub -contractor. PROJECT ACCOUNTING: Every week, or as work is completed and invoiced by sub -contractor, the Construction Manager will prepare a Payment Detail Analysis, showing all invoices recommended for payment. The Home Owner, after the opportunity for review and discussion with the Construction Manager shall approve for payment all invoices he deems acceptable for each sub-contractor/supplier appearing on the Payment Detail Analysis. The Construction Manager shall inform the sub-contractor/supplier of the reasons for any reduced or withheld payment. The Construction Manager will prepare a Progress Report along with invoices. The Progress Report shall list all cost and expenses to date, and provide an updated estimate of the cost to complete. Problems or anticipated request for choices by the Home Owner will be outlined at this time. FEES: Matthew J. Burke, Greenland Construction, LLC will be paid $13,000.00. Payment to Matthew J. Burke, Greenland Construction, LLC will be made in phases. Upon completion of: Excavation/foundation/backfill/frame lumber delivery (20%) $2,600.00 Frame/roofing/siding labor (20%) 2,600.00 Rough electric/plumbing/insulation (20%) 2.600.00 Plaster/finish carpentry/tile (20%) 2,600.00 Finish electric/finish plumbing (15%) 2.000.00 Clean up/dumpster removal (5%) 600.00 TOTAL $13,000.00 INSURANCE: The Home Owner shall insure the property prior to the start of construction, with both a Homeowners Liability and Adequate Coverage, including a completed projects endorsement. The policies shall name Matthew J. Burke and/or Greenland Construction, LLC as additional insured. Matthew J. Burke and/or Greenland Construction, LLC will carry Workmen's Comprehensive Insurance and Liability, which will cover any directly employed workers, or workers who for some reason are not covered by their employer. MISCELLANEOUS WORK: Matthew J. Burke and Greenland Construction, LLC may bill Home Owner for miscellaneous work performed, or for expenses that are incurred which are related to the construction. Such expenses include, but are not limited to, labor or materials billed to, or paid by Matthew J. Burke or Greenland Construction, LLC as a matter of convenience or to expedite delivery. These bills will be net invoiced every week in the same manner as other invoicing by the Construction Manager. Non -skilled labor performed by Matthew J. Burke, Greenland Construction, LLC, the Construction Manager or outside laborers retained by Matthew J. Burke, Greenland Construction, LLC or the Construction Manager, including but not limited to cleaning up job site, pick-up and return of materials will be billed to Home Owner at $30.00 per hour. The Construction Manager shall be responsible for the initial evaluation and inspection of any warranty related deficiencies by the Home Owner. The Construction Manager shall investigate the matter and contact the responsible sub -contractor to correct the warranted defect. The Construction Manager shall charge its time at the rate set forth above. The Construction Manager shall not be responsible for correcting any alleged defect. All such defects and the correction thereof shall remain the responsibility of the Home Owner. The Construction Manager shall be available as an expert witness for the Home Owner. TERMINATION: Either party may terminate this contract after giving a thirty (30) day notice to the other party. Any payments outstanding must be paid in full before termination is effective and any outstanding permits must be transferred prior to termination. DATE: jez�-J-1-A-z-� ome Owner: Steven Crabtree Construction Mana er.- ' Matthew J. Burke, Greenland Constru tion, LLC The Commonwealth of Massachusetts UfDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): ,tfC - L Address: -1 p 5�3 City/State/Zip: Z� 17egr✓t, Phone #: 6Q; -23%' Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. 1� I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. We are a corporation and its required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. R New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ 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. Contractors 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. information. tt f Insurance Company Name: C L1y 'r} S' Svt Policy # or Self -ins. Lic. #: 009,332-S- (j' f,, 19 Below is the policy and job site Expiration Date: le Job Site Address:y� U��) ��� �" J City/State/Zip: j�, �+i r '�, I� G'l�� 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�2= sESi nature: j( ' Phone #: 6 ct) - 2� 3 1- 10 4— tion provided gbo /is true and correct: 14Date- IZ Z e (x 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 #: Date .. !a. -Z'? l� ... w I_ ' TOWN OF NORTH ANDOVER o P • . G PERMIT FOR GAS INSTALLATION This certifies that ... t..`.. ,........ . has permission for gas installation .......... in the buildings of .r'..- �'!....................... . at . !P4S,..:,1�^�! ..!�-� , North,Andover, Mass, Fee:-�5-.GLic. No:l.�.'r.s�'•�'•''........ . GAS INS G; R Check # 17/ (/ 1- re , 'i1.4 � U MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FTI nNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Locations /�/� / �� �"�rJ' ` Permit # -�--� Amount $�� Owner's Name New ® Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) )I nl I� (� l / /l r ( /��)641 �--"' Name L'V ' / , 1 � � t� a Address )'t UOQ t Name of Licensed Plumber or Gas Fitter ?1 one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. LAA INSURANCE COVERAGE • Chec one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 13Liability insurance policy ro Other type of indemnity ❑ Bond Owner's Insurance Waiver: 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 mtormanon i nave suonuucu ku, cin;icu) in awvc alip .,a.,.,,l al. LAU. al— u.....u�„ best of my knowledge and that all plumbing work and insta ns performed un ermit Issued for this application will be in compliance with all pertinent provisions of the Massa,�k6settt#e Gas Cod n Ch�oc of the General Laws. By: Title VED (OFFICE USE ONLY) Signature of bcensed Plumber Or Gas Fitter 03 Plumber UZ 1-96 Gas Fitter License Number Master Journeyman 6TH. FLOOR (Print or type) )I nl I� (� l / /l r ( /��)641 �--"' Name L'V ' / , 1 � � t� a Address )'t UOQ t Name of Licensed Plumber or Gas Fitter ?1 one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. LAA INSURANCE COVERAGE • Chec one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 13Liability insurance policy ro Other type of indemnity ❑ Bond Owner's Insurance Waiver: 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 mtormanon i nave suonuucu ku, cin;icu) in awvc alip .,a.,.,,l al. LAU. al— u.....u�„ best of my knowledge and that all plumbing work and insta ns performed un ermit Issued for this application will be in compliance with all pertinent provisions of the Massa,�k6settt#e Gas Cod n Ch�oc of the General Laws. By: Title VED (OFFICE USE ONLY) Signature of bcensed Plumber Or Gas Fitter 03 Plumber UZ 1-96 Gas Fitter License Number Master Journeyman Date ..�:� ... /.Yn-0.77. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................... D—n-Z ..... ............................. has permission to perform .......... ......... ........ wiring in the building of .....................11.'............................... at .......... F, .-7 ........ North Andover, Mass. Fee .... Lic.No...1?0174, ...... ............... A& CTRICALINSPECTOR t EL Check # 6 Y 7 n Carnrno, wealth o f Y jajjccci a alij Official use only '? rn(�/� 1 t �'77 Permit No. `• K-t�OParinient a1 }iia �ervica� � BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked ------ 7'_." APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All worl< to be perlornied in accordance with the Massachusetts Electrical Code (iNIGC), 527 CINIR 12.00 (PLE:ISEPRINTININK 01? TYPE ALL INF01W.t770ty) Datc: 3. /«l d City or l'own of: _ a /,?,y do tl-4/L To the Iuspectorof I'Yrres: By this application the undersigned gives notice of his or her intention to perlorm the elecn'ical work 1.,l..... Location (Street "�: Nurilber) e h -3' T n vTT Owner or Tenant C R 0 ,6 T2 Owner's Address Is this permit in conjunction Ivith a buildin; pernlit? Purpose of Building Existing Service A111p5 / NJUlls Ne-., Services / Volts Yes ❑ No ❑ Telephone No. (Check Appropriate Box) Utility Authorization No. Overhead ❑ Overhead Number of Feeders and Anlpacity Location and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No. oftlieters: L� � � `rte �---•�-�_.,�. Cvnrnletian o%t/tv fin!/,,,,•,'„� ,,.t,,„ ...,... r._. -___•_ , , No. of Recessed Fixtures No. oCLighting Outlets - No. of Ceil: Susp. (Paddle) Fails No. of blot Tubs •.� ,•,, • �� i�ulrctl ov it: urs ccto,• of IVires. tyo• of 1'otal Transformers KVA Generators hVA t o. o mergency fig lung Battery Units FIRE ALAR11IS NO. of Zones No. of Lighting Fixtures ISwinzminaPool Above ❑ 1u- b mid. rnd. No. of Receptacle Outlets No. of Oil Burners No. orSwitches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Ranges Total No. of Air Cond. Tons �No. of Alerting Devices No. of Waste Disposers Heat Yurl)p iYuniber "Tons Totals: —` — --'- KN V No. of Self -Contained Deteciiotr/AlertinQ Devices _ No. of Disliis aslzers Space/Area Heating KtiV Local ❑ Nunicipal ❑Other Connection No. of Dryers No. of Nater Heaters KW Heating Appliances Iti\V. No . of No. of Suns Ballasts Security Systems: No. of Devices or Equivalent Data r „ /iriva: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP _. Teleconlmui ications `Viruig: No. of Devices or E uivalent OTHER: Aaacn aaatuonat detait iJ desired, or as retiuired by the Inspector of {Vires. INSUR.AtiCE COVERAGE: Unless waived by the owner, no permit for the performance ofelectrical work may issue unless the licensee provides proof of liability insurance including "completed operation” covera_,e or its substantial equivalent. The undersigned certifies that suchcoverage is ill force, and has exhibited proof ofsame to the permit issuillg office. CHECK ONE: INSURANCE ET BOND ❑ OThiER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with INIEC Rule 10, and upon completion. I Certify,under t pains anal penalties of perjury, that the information on this application is trite and complete. FIIZtiI NAME:. Buddy Electric Inc LIC.NO.: 12017:-.A Licensee: Vireent B. Danders JR Signatur i L1C.N0. 23684 E (if applicable. cuter -exempt - in the licence number line.) Bus. Tel. No. 9 -4455 Address: 24 C`ol aai-P Pr 1\i Anr7nvPr Ma 01RQc; s Y Alt. Tel. No.: OWNER'S INSURANCE NV•AIVER: I am a%varc that the Licetuee does not have the liability insurance coverage normally required by law. By riiv signature below, I hereby waive this requirement. I am the (check onc) ❑ owner E]owner's ai,ent. O11'ller/Agent Signature 'Telephone No. P,t'R:1fIT I L•E: S ,fit CSA.. r. -n - � Date../—S� .j�.........el .....? ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................... ............................... has permission to perform ...... wiringin the building of ............. ..................................................................... at .... fI!C2 ...... .................................................. North Andover, Mass. 10eg, " 436��f4 ... Fee ............ Lic. No . ........ ..................... ........................... ELECMICAL INSPECT6i Check # s I _ `"� \ _ CammolcweaCl� a f �ad�acficede(� a 2epar(nwn('1 ira sarvicaj BOARD OF FIRE PREVENTION REGULATIONS Official use Only Permit No. Occupancy and Fee Checked Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK work to be perlornicd in accordance with the Nlarachusctts Electric, Cask 0"'IEC) 527 CMR 12.00 (PLE,4SC PRINT LV hVK 012 TYPE,,ILL iNFOIW,1770it) Da to: % -. r _ 6 City or Town of: A' p 4 mo 0 u&k .. To the Inspector of l-Yti•es: By this application the undersigned dives notice of his ur her intention to perform the electrical work described below. Location (Street mac: Number) Owner or Tenant S %G .f t= yi J % &k- ,L �/� � ,�{ 7- Rc Z'C Telephone No. Owner's Address _S/1 il Is this permit in conjunction with n buildin; permit? YesNo ❑ (Clieck Appropriate Box) Purpose of Building _ �a o L � j�. zi � � � Utility Authorization No. P; / 4Existing Service Anips / Volts Overhead ❑ Uudgrd ❑ No. °f tllctcrs . Ne%v Service Amps / Volts Oycnc�::d ❑ Undgrd ❑ .No. of iti eters•' Number of Feeders and Anipacity 3 ft L� f G (loci 41). Location and Nature of Proposed Electrical Work: L t R 4-- 4 Q 0 f C fA /1 - No. of Recessed Fixtures No. of Lighting Outlets No. of Ccii.-Susp. (Paddle) Fails`IN°• No. of lint Tubsit _ ..,.m UC ,Larval oy ulc //is oeCto, 0rI1'irrs. °t Total 'transformers IhVr\ GKti , Generators A No. of Lighting Fixtures SwininrinQPoul Above ❑ lu- E]t b =riid• grnd. o. o mergeiicy rg itiiig Battery Units No. of Receptacle Outlets D No. of Oil Burners FIRE ALARII•IS No. of Zones No. of Detection and Initiating Devices �No. of Alerting Devices No. of Switches No. of Ranges No. of Gas Burners No. of Air Cond. Tota Tons \`o. of Waste Disposers % tical Yunip plumber "Tons __ KW_ _ Totals: �' �- - No. of Self -Contained DetectioulAlertino Devices No. of Distiivashers Space/Aren Heating KWLocal ❑ Municipal ❑ Other Connection No. of Drvers J. Heating Appliances XNN Security Systems: i No. oCDevices or E uivalent Na. of Water i No. of No. of „ Heatersl k �ti ins Ballasts Data ,✓iring: No. of Deyices or E uivalent No. Hydromassage Bathtubs J No. of illotorsTotal IIP ITeleconiniunications Wiring: No. of Devices or E uivalent OTHER: ,+....... v„u, urlau y aesrrea, or as required by the Inspector of Wires. INSUR.�NCE 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 [lie permit issuing office. CHECK ONE: INSURANCE U BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work:' (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cct•tifj•, ttltder thte pains and penalties ufperjury, that the inforttration on this application is true aro! complete. FIIZNI NAIIIE: Buddy Electric Inc LIC NO.: 12017:_.A Licensee: Vincent B. handers JR Siariatui 684 E (If applicable. enter 1.evelllpt " in the license number linLIC.NO. 23 e.) 13uS. Tel. NO. 9 3 4455 Address: ('tel aria Tl_ 1�7 11nr7nvPr9 Ma 01245 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am a�r­arc that the Licensee does not /rattle the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check: oric) ❑ owner ❑owner's a�,ent. Owner/Agent Signature Telephone No. Pf:Rt1IIT TL.L: S %D PA� 8 k /- X 1-07 p4i 6', 66 Date ... (.6 .-... /.9..'..o . ......... 0 - TOWN OF NORTH ANDOVER PERMIT FOR WIRING I& This certifies that ..... Vu ...... ........ 1-,u.e . .......... ....... ................. ......... ........... ... ........ .... has permission to perform ...... %� ... /P ... wiring in the building of ........S! 4-c,-4 ..... .............. at ...........-6-.........7 ............................................... ...... . North Andover, Mass. Fee .47 ........... Lic. No. . . ............. ...... * — ELECTRICAL INSPECTOR Check #15-1 9E N Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. L ` 6G BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank 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 IN INK OR TYPE ALL INFORMATION) Date: 10-17-2005 City or Town of. NORTH ANDOVER to the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 857 Chestnut Street Owner or Tenant Steve Crabtree Owner's Address 857 Chestnut Street Is this permit in conjunction with a building permit? Yes ❑ No Telephone No. 978-683-8201 (Check Appropriate Box) Purpose of Building RESIDENCE Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ADD 12 KW EMERGENCY GENERATOR & TRANSFER SWITCH No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑o. d. 917nd. ofEmergency 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 an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW ......... -Contae No. o Sem Totals: Detection/Alertina Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers HeatingAppliances pp KW Security Systems: No. of Devices or Equivalent No. of Water KW No. o No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydro massage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10-17-2005 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify,under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J. IANNAZZI, INC. LIC. NO.: 13592A Licensee: WILLIAM J. IANNAZZI Signature LIC. NO.: 13592A Bus. Tel. No.: 978-686-7300 Address: 191 CHANDLER ROAD ANDOVER, MA 01810 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. _ Commonwealth of Massachusetts Official Use Only -- Department of Fire Services Permit No. 0 ` ro BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank) 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 IN INK OR TYPE ALL INFORMATION) Date: 10-17-2005 City or Town of. NORTH ANDOVER to the Inspector of Wires.- By ires.By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 857 Chestnut Street Owner or Tenant Steve Crabtree Telephone No. 978'6838201 Owner's Address 857 Chestnut Street Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building RESIDENCE Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ADD 12 KW EMERGENCY GENERATOR & TRANSFER SWITCH • No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ gnid. d. o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o Detection an No. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Num er Tons ........................................... KW No. o Self -Contained Totals: Detection/Alertin 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 No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Hydro massage Bathtubs No. of Motors Total HP Telecommunications Wiring:No. No. of Devices or Equivalent OTHER: INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10-17-2005 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J. IANNAZZI, INC. LIC. NO.: 13592A Licensee: WILLIAM J. IANNAZZI Signature LIC. NO.: 13592A Bus.- Tel. No.: 978-686-7300 *Address: 191 CHANDLER ROAD ANDOVER, MA 01810 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Date. i13 oX. 7 "I.. TM,% TOWN OF NORTH ANDOVER �?•`� _•'•°oma 0 -ULM-*- PERMIT FOR PLUMBING ,SSACMUSE� This certifies that .... .... ...... /? . has permission to perform ..... ............. plumbing in the buildings of ..� at 7,,.z . ............ North Andover, Mass. �G Fee. ..... Lic. No.. !.? .. �..�. ...... � .. ...� I .......... PLUMBING INSPECTOR Check # -JQ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 12 _ L J� L Date O.`7 )4 1 Building Location �� % C ,4s lb t% Owners Name S�C,/CrrJ �y r9 Tr^eT Permit # L Amount— / Type of Occupancy New Ef Renovation Replacement 0 Plans Submitted Yes No FIXTURES (� (Print or type) (J) (� / Check one: Certificate �, Installing Company Name % T , L, i' �y,►�.� �� b- %iL ci Corp. 0 Address -L 6 r / Partner. usiness Telephon �„��) 2 ?�,• 2._(iG S Firm/Co. 1 Name of Licensed Plumber. �'� �_ Insurance Coverage: Indicatathe f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity [] Bond ❑ insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent 11 I hereby certify that all of the details and information I have sub ' ed (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in ati s perfo der P it Issued for this application will be in compliance with all pertinent provisions of the Mas c State P g C e Ch 142 of the General Laws. By oxXicensea FI!1TKr Type of Plumbing License Title License rc nse um er Master Journeyman 11 APPROVED (OFFICE USE ONLY MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) n z �.,•_ __ , _, Mass. Date19 > City, Town Permit It Buildi. g owner( T4 ' l?Lr AT: Location 12 Name %Gf_ -�— Type of Occupancy: WeW 41OXW New Renovation ❑ Replacement ❑ tt Plans Submitted Yes ❑ No ❑ 1��53 1,� I ONE ONE (Print or Type) / i2A /`�/�{• On : Certificate Instal ling Company Mame �i^f_�,v,l /G heck Corp. Q Add ❑ partnership firm/Company Business Telephone z6V Name of Licenod Plumber or Gasfitter 1 hereby certify that atm of (lie details and information 1 have submitted (or entered) in above application are true and accurate V to best of my knowledge slid that all plumbing work and huinilallons perfonncd under Pcinill lrsued for Ibis opplleatlon wll be In compliance col all peg neat provisions of time Massachusetts Slate Gas Code and Chapter 142 of the General Laws. I 1 / %� By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE Plumber sfitter rMaster M Journeyman 'Sighature 'of I.icerfsed Plum.f r sfitter License Nunn er ► Date.................:,.. NORTH TOWWOF, NORTH ANDOVER pftao ,^1ti0 PERMIT FOR GAS INSTALLATION s i • Ar xi 1993 f This certifies that ........ ..... , .. c ................. has permission for gas installation .............................. in the buildings of .................. ....................... at ..... ......:.......::.::... North Andover, Mass. Fee...,..... Lic. No........... .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) •~ V /V - /'FMass. Date ( � .7—df 19 Building Location 8`_7 Cke-st-.- & Owner's Name Map: Lot: Zone: New Renovation J Permit# 09 Type of Occupancy Replacement J Plans Submitted: Yes J No ❑ Installing Company Name Eastern Propane J S. Inc. Address 'dater St • Danvers N!G 01923 Estimate Value of Work: Check one: Certificate Corporation J Partnership Business Telephone ( 508) 774-1 O 3C J Firm / Co. Name of Licensed Plumber or Gas Fitter0e—A—, 'ev"o INSURANCE COVERAGE: I have a curre�bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No J If you have checked yes, ple se indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity J Bond J OWNER'S INSURANCE WAIVER: 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 the permit issued f r this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen Laws. By Type of License: 6 G/ lumber Signature of nsed Plumber or Gas Fitter Title Gasfitter Master License Number City / Town Journeyman APPROVED (OFFICE USE ONLY) a z O r m m N 7C m A s m N � S LO } : C*4 1 \ \� �§ ca CIO, ^ jinI ,IIz �I§ S\ �\� Z % \ 7»-. w q w LLI . ¥ o.� » r ».mow,$ < u ® 2 LU § I /. �z0 �z> \�/< iDP) � z . \ \ .� _. .14 1 \ \� 0 0 ca CIO, ^ jinI ,IIz .\ �\� �/ k //CD �z0 o ■e �®���® LL. o z , o ozQ \m�I2,\w2a / ca 'Al ca CIO, ^ jinI ,IIz _ \/6 �