Loading...
HomeMy WebLinkAboutMiscellaneous - 100 GREAT POND ROAD 4/30/2018 (2)N Claim # Advantage Claim Services 522 Chickering Road #B North Andover, MA 01845 Adjuster Assigned: Glenn Guarente Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner C�/ Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: John R. Niceforo Property address: 100 Great Pond Rd. North Andover, MA 01845 Policy #: 3013212 Loss of: 2015/05/29 File or Claim No. AD 1820 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass._Gen._Laws,_Chapter_143,Section_6 to be applicable. If any notice under Gen—Laws,—Ch.-139—Sec.-3BMass _ is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number,,date of loss and claim or file number. Glenn Guarente Title: Adjuster On this. date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. / 06-15-15 Signature and date U --w Date .... z.... ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. has permission to perform ....................... wiring in the building of ................................................. ...... . .... . North Andover, Mass. Fee .32............ Lic. No/4.,9.,7e ..............I* ......... ELECI'R Check # 8555 X\\\ aOfficial Use Only . Pen ift No. �} ancy and.Fee.Checked c OF FIRE PREVENTIORR-EGU TIONS. . �07j BOARD cave blank APPLICATION FORPEILVIT'TO ERFO�M LECTRICAL WORK All work to be perfmmed in accordance with Wtho, Elect�icat.. ; 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IN TIM Date: ®O City or Town oh To the I p ctor. f Wires: By this application the undersigned gives -notice of his or -her intel do a perform the leetrical work described below. . Location (Street & Number) Owner or Tenant !�I_ d J.. i S e� 1 �'— Telephone No. Owner's Address Y� Is this permit in conjunction with a building permit? Y ❑ No (Check Appropriate $oz) j Purpose of Building. Vtqq..Autht rization No. Existing Service Amps. / Volts Ove Bead ❑ Und . . ❑ No. of Meters. New Service Amps ,__Volts Ove head E] Und ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed: Electtfcal Work: !/ iss Rls .:..,,, r s wnives/ hu dip hunec[nr of Mirec J '4. No. of Recessed Luminaires ._-- -- Jo No:ofpesP(Pad, a) Fans: o:Total KVA nsformers . No. of Luminaire Outlets No. of Hot Tubs ` erators KVA No: of Luminaires ov' .. SwimmingPosri.; d. .❑ d:' . �. No:.o ; mergency Ughting $atte : :Units. No. of Receptacle Outlets No: of Oil Btruers ALARMS No. of Zones No. of Switches No. of Gas Burners and o of.tec -D vi InMatin -Devi es No. of Ranges Na:of•Air Cond: Tons o. of Ale>:ting Devices No. of Waste Disposers : p eat ump.;. Tatuls: um ` r I ons o::o ' : ontain ed etecdoiMertin Devices := "`: ' No. of Dishwashers :... Space/Arca ;Heating .X W' u c pa 1 Connection 0 Other No. of Dryers r7' HeatingAppliauces ' KW ecu:.r9 yyssttems: No: oflyevices or Equivalent No. of Witter KW HeatersSi, No.-. o o: o ns Ballasts: ata Wiring: . No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. ofMotors Total ISP el Nomm eviceso r uivaT No of Devices or E uivalent ' OTHER: M. AIf= aatrronae aeras! y aes req oras requuw ay ine inspector q/ rues. Estimated Value of Electrical Work:' (When :by.:municip ..policy.) Work to Start. Inspections to be.iegpsted in.: rdaniee with Rule 10, and upon completion. . INSURANCE COVERAGE:' Unless: waivedbythcowner; no p:. kfoF:the;p . ce.of electrical work may issue unless the licensee provides proof of liability:` inchiding;"comp] .. operation". co. ge or its substantial equivalent. The undersigned certifies that such coverage is in force_ , and has exl�ibi .: Proof o€same to the permit issuing office. CHECK ONE: INSURANCE BOND .❑- OTHER: 0'. (S)ecify:) I certify, under the pains aced penalties of perjury;. that: the inf . , atlon on this pli adon Is hue and compIdA ' FIRM NAME: v�11-1� C� PSV 5��'i12 P L'IC. NO.: Licensee: 7 Signature -LIC. NO.: W2 A (lfapplicabk enter " t"!n license b�rline) Address: O %G art �'�'bb �"�1 C� ap Bus:'I'el. No.: 06 3 870 4V Alt. TeL No::978 5 /10 *Per M.G.L. c. 147, s. 57-61;tecluity.worlc requires Department o Public Safety "S"License: Lic. No. OWNER'S INSURANCE WAIVER. I ani aware that':the Lic.. does' have the liability insurance coverage normally zequired by law. By mysignature below, I hereby.waive:ti is tequi nt.: I am the.(clock one)- L] owner ❑ owner's a ent. Owner/Agent •.Signature Telephone No PERMIT FEE: $ jO t O C? Date.. ...... . ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................1. '.q e , 4- .... . .. JA ... ...... ............................ has permission to perform,. wiring in the building of..�" .......................................................................... at .... /.O..Q ........ ............7. ".. rh Ando ver, Mass. FeeELE RICALINSPECTOR ti Check # 8247 Commonwealth of Massachusetts h Official Use Only 'A Department of Fire Services FOccupancy t No. �Z BOARD OF FIRE PREVENTION REGULATIONS and Fee Checked 07] n— m k an 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 WINK OR TYPE ALL INFORMATION) Date: 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) / D0 ".10/„ Js" 1?)A 1Y) PW Owner or Tenant /I✓/�',e ��RO Telephone No. Owner's Address tam Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service 42W Amps 1020 0 y0 Volts Overhead Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und d ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: AIAI vv uu-1 y aesirea, oras required by the Inspector of Wires. Estimated Value of Electrical Work: (�O0 , (When required by municipal policy.) Work to Start /7 g 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 X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenaides o perjury, that the informatwn on this application is true and complete. FIRM NAME: P4%vL/&Eogel L Cra Zh . LIC. NO.: ,i% Licensee: �,Oj^/� � Q(�Lj Signature � (If applicable, erste "exempt " in the liq a number line.) LIC. NO.: 7 Address: f Bus. TeL No.: `�%/$fo ` Alt. Tel. No.: *Per M.G.L c. 14 , s. 57 61, security work req es Department of Public Safety "S" License: Lic. No. 7-7 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 Signature Telephone No. PERMIT' FEE: $ FA 9 41V The Commonwealth of Alassachuseft Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 { ' www mws gov/dia Workers' Compensation Insitrance Affidavit: Builders/Coatsctors/Eiectriciaas/plQmbers 1i]>,LCant IIIIFOTIQat1oQ P}o�eo D—:—.& T -_tt_ Name Address: City/State/Zip:_ Phone #:/ Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition' 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12. F1 Roof repairs 13.[] Other Homeowners who submit this afr�tavit indicating they are doing all work and then hire outside ontrtractors must submit nalilam Policy asnew affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the rrsme Of sub -contractors and their workers' Quip policy itnvation. 1 am an employer that.is prquidlarworkers' compensation insurawe or a to elm Below is the Policy and 'ob site information. f �' mp y PJ' Insurance Company Policy # or Self -ins. Lic. #:_ .Z/T[/ -X"; Jc %Q - � Expiration Dom: Job Site Address:_ lQ� (o/�p,�.�—Por>b. �% `City/State2ip:Nt 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 C01 601 er the pains anes of erjury that the information provided above is true and correct Date—0 Official use nnly. Do not write in this area, to be completed by city or town officiaC City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Insaector 6. Other Contact Person: Phone #: Are you an employer? Check the appropriate box: I.0,i am a employer with 3 4. ❑. I am a general contractor and I employees. (full and/or part-time).* . I am: a.sole proprietor. have hired the sub -contractors listed or partner_ on the attached sheet. I ship and have no employees These sub -contractors have working for me .in any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required-) 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself [No -work=' comp, c. L52, § 1(4),'and we have no insurance required.] t employees. [No workers' comp. insurance required..] fAnY applicant that checks bafl I mus[ also fill out the section below showin their workers' bo Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition' 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12. F1 Roof repairs 13.[] Other Homeowners who submit this afr�tavit indicating they are doing all work and then hire outside ontrtractors must submit nalilam Policy asnew affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the rrsme Of sub -contractors and their workers' Quip policy itnvation. 1 am an employer that.is prquidlarworkers' compensation insurawe or a to elm Below is the Policy and 'ob site information. f �' mp y PJ' Insurance Company Policy # or Self -ins. Lic. #:_ .Z/T[/ -X"; Jc %Q - � Expiration Dom: Job Site Address:_ lQ� (o/�p,�.�—Por>b. �% `City/State2ip:Nt 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 C01 601 er the pains anes of erjury that the information provided above is true and correct Date—0 Official use nnly. Do not write in this area, to be completed by city or town officiaC City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Insaector 6. Other Contact Person: Phone #: Information aild Instructions Massachusetts General Laws chapter 152 requires all empIoyers 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, assDdiation, corporation or other legal entity, or any two or more ofthe'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 evidencezf compliance with the insumnce'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) arad phone numbers) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' 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 city or town that the application for the permit or license is being requested, not' he 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 numberlisted below. Self-insured companies should entw their self insurance' Iiceme 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 permittlicense number which vvilI 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 indicaiting,current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy ofibe 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7745 Revised 5-26-05 wwwznass.gov/dia FAI HOR7p 1.0 O 9 s � i ,SSACHUS� This certifies that Date. 7/ TOWN OF -`NORTH ANDOVER PERMIT FOR PLUMBING ................ .. ... . has permission to perform ......M 10. i h...—D AA. � `t^....... . plumbing in the buildings of . k.i.C<..% °!-, u at .. �D.O.../? c4+ { .�^ . ........... . North Andover, Mass. i Fee . 3v..... Lic. No.. 71.3 .'.. PLUMBING INSPECTOR Check # 7 )r =7783 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 7/14/08 Date Building Location 100 Great Pond Road Owners Name Niceforo Permit # Residence Amount 30 Type of Occupancy New Renovation Replacement 1:1 Plans Submitted Yes No FIXTURES (Print or type) Installing Company Name Waldman Plumbing & Heating Inc Address 12 Essex St, Lynn, MA 01902 Check one: 1370C Certificate ® Corp. riPartner. Business Telephone 7 R 1— 5 9 j— 7 4 9 (1 El Firm/Co. Name ot`Licensed Plumber: Michael Waldman Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy vim' 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 1-1 Agent 0 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 M� to Plumbing Code and Chapter 142 of the General Laws. By: SignaSigna cens�um erer ' Type of Plumbing License Title M-7234 In'/Town icense Number Master Q Journeyman PROVED (OFFICE USE ONLY Date+/ . Ir.. i--...... MORTM ..ao ,•1ti Op "-OWN OF NORTH ANDOVER r-20ya lot - PERMIT FOR GAS INSTALLATION t� This certifies that ...�. .............. . has permission for gas installation . 572 r. ............ in the buildings of........................ . at 1A0. -6 .—Aef,�P- . North Andover, Mass. Fee. :/,IC.� . Lic. No..,7...:..... . GAS INSPECT Check # 53.1 .A MASSACHUSET'T'S UNIFORM APPUCATON FOR PERNIITTO DO GAS FTrrING (Type or print) Date Z S O NORTH ANDOVER, MASSACHUSETTS Building Locations loo G Owner's Name New Renovation ❑ Replacement ❑ r� Permit # Amount $ A C- Plans Submitted ❑ (Print or type) ,n /% Ce one: Certificate Installing Company Name. S ��Ic- Corp. Address LioX �_. ❑ Partner. BusinessTelephone (� �(„ /91C ��t7 �rm/Co. Name of Licensed Plumber or Gas Fitter `OV -V,01 - 2 INSURANCE COVERAGE Check 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. ❑ Liability insurance policy 0 --Other type of indemnity 13Bond 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 ana mtormanon 1 nave suonuueU kul cinc►cu/ „u awvc aFFnn auv,. — __— w.== u=..__ +•. ... 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 Massachu s Zee Gas CV and Cha yr142 of General Laws. By: Title City/Town PROVED (OFFICE USE ONLY) Pl— Signature of Licensed Plumber Or Gas Fitter ❑ Plurnber 3 ❑ Gas Fitter License Number Master ❑ Journeyman Date...? .1z.. a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that �. ' �.. .......... .. ......... ......... . has permission to perform .. ................... . plumbing in the buildings of ..-... . ` at .......... .......f.:..... , North Andover, Mass. r Fee .'?< ..... Lic. No..! ...... �/.'n! .............. PLUk 1t;G/ INSPECTOR Check # j 5;75 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS J � / loo 6:eelg�/ �i/1 ° /Ce/ �j�/' rl/ I66 Date Building Location Owners Name �r Permit # Amount 7) Type of Occupancy New Renovation Replacement Plans Submitted Yes No (Print or type) Check one- Certificate / / Installing Company Name `414� 71-4/ Al k?11a� Address ✓ &�Wsk e J- u� Partner. Business Telephone Firm/Co. Name of Licensed Plumber: J Insurance Coverage: Indicate the type nsurance 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 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 Stat Pluma ha 142 of the General Laws. By: Signature of Licensea Flu—mue—r Type of Plumbing License Title a ho City/Town i ense INUMDer Master APPROVED (OFFICE USE ONLY Journeyman ❑ i (Print or type) Check one- Certificate / / Installing Company Name `414� 71-4/ Al k?11a� Address ✓ &�Wsk e J- u� Partner. Business Telephone Firm/Co. Name of Licensed Plumber: J Insurance Coverage: Indicate the type nsurance 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 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 Stat Pluma ha 142 of the General Laws. By: Signature of Licensea Flu—mue—r Type of Plumbing License Title a ho City/Town i ense INUMDer Master APPROVED (OFFICE USE ONLY Journeyman ❑ Location /06 �� Y No. Date �'pRT1TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $_ Foundation Permit Fee Other Permit Fee Sewer Connection Fee ko Water Connection Fee R TOTAL 2 10678 Building Inspector Div. Public Works W IL qoY 0 O m G� W < 0 - W N a 4n i XN to m N W w > 3 % ul c Z m Z U. O W F O _J a J F W C 0 LL 0 0 0 O U 0 4 Z Q. O LL i IL0 0 W IK W a N D N i Z m a ID O H H 09 W of d 2 i Z 0 O P Z / V 1— IL � I Q 0 � z o ` o N I. /W pal f K< 0 Z z < O a z < � 0 0 a a W 7 w < W W = < z U z z u >p F E N J 0 0< r M 1 M .a U) C J 0 O _ K a d LL O ' a z _0 a Z W : a O W 0 a F z 0 rc LL } W z i 0 _ Z U U. 0 0 0 0 LL < LL O W W a f 0 0 _z N � I _J W m z I- w_ J Z(n wO m f 0 W < a J 3 O W Z Z 0 m m Z 0 < i i U U U LL 0 O O a < < 0 J N N N W m m m 0 0 10 < a a W 0 O u LL 0 a f z W I W m J a W C 0 F i m 0 4 z 0 u 0 Z 0 J_ m m M Z 0 z � C F c J � � a 0 a W � N z Os 0 J LL c W um :3 J W J Wcc V 0 N a F F O a OW 0 0 Z V V = N f j m O 4 G Z 0 ^ z ^ z u m c 0 u 0 u 4 0 C r a a a 0 4 It Wul p O O W s a � A f 0 a x 0 m LL ^ W LL W U W 7 R y W < I u <F< 7 J F a z n W W c/1 1 0 O Z < /� 1, v a Zow: 0 � Z W W F Is a IL 6 x Z W 0 z Z J 0 u u u F � a a o o d aL Z < pj J U m <3 a < m m V 3 3 i a a a w j O 0 < J W W W a J F F z LL 0 0 0 Z 0 O O m W 0 a F z 0 rc LL } W z i 0 _ Z U U. 0 0 0 0 LL < LL O W W a f 0 0 _z N � I _J W m z I- w_ J Z(n wO m f 0 W < a J 3 O W Z Z 0 m m Z 0 < i i U U U LL 0 O O a < < 0 J N N N W m m m 0 0 10 < a a W 0 O u LL 0 a f z W I W m J a W C 0 F i m 0 4 z 0 u 0 Z 0 J_ m m M Z 0 � C F c J � � a 0 a W � N z C Z W c 0 m 2 0 J LL c W um :3 J W J Wcc V 0 N a F F O a OW 0 0 Z V V = N f j m O 4 G Z 0 ^ z ^ z u m c 0 u 0 u 4 0 C r a a a 0 4 It Wul p O O W s a � A f 0 a x 0 m LL ^ W LL W U W 7 R y W < < u <F< 7 J F a n n W < 6 � N O v r J W J Wcc V W F O O O V V = O v C F W A0O y w W Z W 0 < 0 � Z W W F a IL 6 n; t V G~ 8Tm G 0 O �JODipi��w D< N T D D y ti ZZ0A-nn-4m'x00> -1 0 A y m N (D/1 A n A TIQ o A W m A O 0 ro y N a�l� Or A O AP^mp D AT T nn y �, w m a Nnzz A A A A �r Z Z A Z O O O O N= v A O 1 y C A m T w Z D T O T Q� N Z T O x A 3 n A> >Z T Z Gi N O Z C) 0 7+ s ti m C N; 3: "N O NN D Z 7cmm K { as 0 On ii D v ; ZO O N O Kjm D " 0 I III�IIilll I � � i _ U) II Z m O O C) a -DzDAOmOv r A a x Ny T A 1 rrODO:;<>OD -i ; y Z x H m D N 2C D ti D n x NOpAO n tC ; T T 0 z T c Z{yD v x v Zi Cb C N n (A:,2 -1 D C A T n T T O r r v n G x I m y r x O T O ti [i v; x O Z v T T_ A T T O T A D (1 2 m- Z O`; Z -i N N o D T A O Z N C Z O A H A W a D O y s x y O m 'm Z ;2 D y 1> w> Z` m O D A T N N y x O A Q O O T x O m A N K n; r y A m r Z 0 T (1 n y y O O A +�0 ~A z Axizz �_X a w yNDD �s Z N O OZD A D Z A.1~ '^ '� A p O 7C y N '� C I my a T r (1 A A � I IKIK II�� �A v T Am Z N X a 00 A O IIII —LI I 1 J�Hil- Q b 0 n c D ^z n >01 C) N yry zm DO yzz Cox D n 0 0 y°:E mim mX -izD xyn yoo �z_ MOM TOM �I y M 0 r pzIn -+0r oy0 r -+ ?�z �v xv y XD n x mm fA -q ym D0 3 C v_ z 0 m in n 0 v 0r• ON 11 O L O v Z O G. O y C cm i O h O O 'E m m 0 CD CL. I -- CD CD O.D 3� O O � O m o a M cmcc C p�C/q.�� w �v a O CD* Z ca C w C.3 V� c C C �y s 0 a � a � a a F ' Vv w a cid ►�1 r-' (d(� 0 w 0 a4 u U caa o aG a w W o w u coz a w ���hhl o aG w cn w"c E cn O L O v Z O G. O y C cm i O h O O 'E m m 0 CD CL. I -- CD CD O.D 3� O O � O m o a M cmcc C p�C/q.�� w �v a O CD* Z ca C w C.3 V� c C C �y s 0 F ' O �C ^^ n C A � E a a� xt 1' 02. . L O: CD O t; m c mi E oe � CO H H h cm o: CID, 3 ®� y C m o Cn a a' L--: !/7 m ® c ♦♦♦iii���DDD•"s:s.0 - CMW cm t d Cm or O B E o Ate- p C ® d Q1 C Q y O C •O 2 026:5 0 N 0.2 ~CD CO) W C .0 O C Z r U. .y O O H W�E C = S clo c y Z o L3 CD CIO a • � C 'C .. S w a em � C �=�aZm� O L O v Z O G. O y C cm i O h O O 'E m m 0 CD CL. I -- CD CD O.D 3� O O � O m o a M cmcc C p�C/q.�� w �v a O CD* Z ca C w C.3 V� c C C �y s 0 Date .... ��. 7- e7l' ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ......................................... An has permission to perform ................. wiring in the building of ......... ................................................ .............. / at ..... . /./75..) ......... A� .4�' (.)� - -- ............ - ...... ..... a . ............ .North Andover, Mass. Fee . ........... Lic. .......... ..................................... # 13717 EL.EcTRICAL INSPECTOR Check 5119 Official Use Only Permit No. v �/ DO -4--e 4 puGhe S1610 Occupancy & Fee Checke&-� BOARD OF FIRE PREVENTION REGU 'IONS 527 CMR 12:00 APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK All work to be performed in accordance with th Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date~ dl Tai uic inJpc4lV of i�ilrcS: Town of The undersigned applies for a permit to perform the electrical work desi d below. Location (Street & Number 4ty©ya-a 1 -?o,- > 2p Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes a No Y\ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead 9 Undgmd 0 No. of Meters New Service Amps Voits Overhead 0 Undgmd 0 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work rA") , l OTHER:" f'v5 �/-3Y1J •• INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaleYE = NO s hay.esu valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE BOND - OTHER a (Please Specify) O '� (Expiration Date) Estimated Value of. Electrical Work$ Work to Start�S ��' Inspection Date Resquested Rough Final Signed undert e Penalties of perjury: FIRM NAME rt rvQA-5Ti,;;, t5le-C lL� s� �r - -r,!/� LIC. NO. Licensee�I�n*� ewzei`� NO. l(oY 7'1 A �"/ vy f �' Bus. Te o. 1.003 -?21 Lib^ o /! Address ` )bo ��'�� r � _ el. No. '7 2 - LIP 3 - / 1 5 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws_ And that my signature on this permit application waives This requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ r (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fhdures Swimming Pool gmd 0 gmd 0 Generators KVA j No. of Emergency Lighting No. of Receptacles Outlets / No. of oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices t Heat Total Total No. of Diposal No. Pumps Tons KW No_ of Sounding Devices NoJ of Self Contained j No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Vollage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER:" f'v5 �/-3Y1J •• INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaleYE = NO s hay.esu valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE BOND - OTHER a (Please Specify) O '� (Expiration Date) Estimated Value of. Electrical Work$ Work to Start�S ��' Inspection Date Resquested Rough Final Signed undert e Penalties of perjury: FIRM NAME rt rvQA-5Ti,;;, t5le-C lL� s� �r - -r,!/� LIC. NO. Licensee�I�n*� ewzei`� NO. l(oY 7'1 A �"/ vy f �' Bus. Te o. 1.003 -?21 Lib^ o /! Address ` )bo ��'�� r � _ el. No. '7 2 - LIP 3 - / 1 5 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws_ And that my signature on this permit application waives This requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ r (Signature of Owner or Agent) Name: Location: City Phone am a homeowner performing all work myself. F -1I am a sole proprietor and have no one working in any capacity aI am an employer providing. workers' compensation for my employees working on this job. Comoanv name: Address City Phone # Insurance Co Policy # Company name: Address City Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' E] Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone #: El Health Department 0 Other FORM WORKMAN'S COMPENSATION 1-1 .....,.......c s %a usysruni" ArrLlVAI Wtj run rrt1Ml1 t u uu rr.ura auas lPtlnt or Type) NORTH ANDOVER, ,Mast. OatsL3_10-22— Building Penni 2-,?— 2— locatlolon l Owner' , Name s /"O / vi c e Cal?D New O Renovation Replacement p Plans Submitted: YesC3 No p �iXTUAE3 . Installing Company Name � O w in / n Business Telephone Name ollicensed Plumber Check one: 0 Corp. 0 Partnership 0 Firm/Co. INSURANCE COVERAGE: check I have a current Ilablity Insurance policy or Its substantial equivalent. Yea ( No D It you have checked yW, please Indicate the type coverage by checking the appropriate box A liability Insurance policy O . Other type of Indemnity O Bond O Certificate OWNER'S INSURANCE WAIVER: I am aware that the licenies 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 Agenj Owner p Agent 0 I hereby certify that all of the detalls and Information i have submitted tog entered) in above app(katlon are true and accurate to the best of my I nowledge and that allpiumblng wak and Installations performed under the p rmil Issued lot ilia application will be In compliance with all pertinent provisions of •Massachusetts State Plumbing Code and Chapter ij:SseNumber Germal By Title uta Clty/Town 1S7443 I AF'f'fiOVEf) (OFFICE Type of Plumbing License: Master p USE ONLY Journeyman Date 3252 "oRTM TOWN OF NORTH ANDOVER o� ,�.a ,•1tio ° PERMIT FOR PLUMBING ,SSACMUS� This certifies that .J4 .r -f.P.`�// ..... ............... has permission to perform ...1?.0 4te o.y A hq&i . t ................ plumbing in the buildings of .. Al. .................. at. / Q U...6�./.�P!? ........ ... North Andover, Mass. Fee.. � 7 . Lic. No.. alb.. `/3 ... �. ....... . PLUMBING INSPECTOR 43/05/97 48:56 45.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer w 7�1e Commonwealth of Massochusetis : �:`�"`''•'` ;�.� . Department of AibficScJcry acc.e+wcr � I�a'o�eet�a BOARD OF ME PREVERn6N REGULATIONS S27 CMR,1100 3/90 (i il.a.a •t.w►) L APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All awh to be performed in accordance %ith the Mauaehuseeu EJettrks) Code, S27 CHR 12:00 (PLEASE PRI.Ni IR nM OR 7TPE ALL INFORK.M01q) City or Town o_`il/ u vG �i To the Inspector of Wires: The LLnC•rsigned applies for a permit to perform the electricals work dcscri�)ed below. Location ('street 6 Number)_ leer 0.rer or Tenant_ ,i/)jJ, All C /Z.2 O'ner's Address (' z. '(— Is this permit in conjunction with a building permit: Yes ^ Ngo / L5' ❑ (Check Appropriate Box) Purpose of 8u11di:,g G` y Utility Authorization NO, Existing Ser'.ice _a+7`� Amps / Volts Overiicad �dg'Td C No. of ::et%Ys Few Service ___Asps / Volts Overhead ❑ Undgrd ❑ No. of lietrs Number of Feeders and Ampaeity Location and Nature of proposed Electrical Work No. of Lighting Outlets ao. of Lighting Fixtures No. of Receptacle Outlets No, of Switch Outlets No. of Pinges Nc of Disposain A. of Dishwashers No. of Dryers No. of Water Seaters No. Hydro Massage Tubs R: No. of Hot Tubs Svfaaing Pool Above❑ srnd. No. of Oil Burners No. of Cas Burners No. of Air Cond. Iota to: No. of eat Total s Ten Space/Area Heating Heating Devices No. of Transformers kd. ❑ Generators XpA No. of Emergency Lighting Batte Units FIRE ALARYS No. of Zones Im XW not ozaro. of Si s Ballasts No. of Motors Total HP m No. of Detection and Initiating Devices No. of Sounding Devices No, of Self Contained Detection/Sounding Devices Local 11Municipal Connection❑Other Low Voltage INSURANCE Cpl' UC;E: Pursuant to the requirements of Massachusetts Central Lava I have a current LlabjUly Insurance Policy including Cotpitted equivalent, YES NO P Operations Coverage or its s sianilal I have submitted valid proof of same to this office. YES�O b❑ Ii you have checked Mi please indicate the type of coverage by checking the appropriate box. INSURANCE OND ❑ OnMR ❑ (please Specify) G Estin,ted Value of Electrical Work 5 piration ate) Work to Start ZZ- Inspection Date Requested: Rougher /J �`//ginal Signed under the penalties of perjury: FIRM NAMErel IC.. N0. J.3 -'r LicenseeSignature C. Address /%i•Tel. No./.F'7 O'LR'S INSURANCE WAIVER: I am aware that the License does not have the.inseur♦nce coverage or is sub- stantial equivalent a! required by Massachusetts General vs , LRat my signature on this pe it application waives this requirement. Owner Agent (Please check one) c� Telephone ago. PERI{ii FEE S p�V• V Signature of Owner or Agent 5 !.'I"�l^'rY•.-lh:r+'�.. r -i -..�^ v �irn.—.s.�1-w.�.s.YT:.. ... -c t Yv ..- . ...,.. ;iDate ... ..7 /70.. e 766 O't...o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .................. .........5 ........ �"�: �..................... has permission to perform .......... e4. e ` ... wiring in the building of ........ N!.f e� ................................................................... at .....c.�._... l �......1(:�!?:PGT z.... ..... , North o aSS. Fee. �..11 .. Lic. No .. „. ........... ............................................... ELECTRICAL INSPECTOR C(tR 47 �/1/97 08:54 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer