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HomeMy WebLinkAboutMiscellaneous - 100 JOHNNY CAKE STREET 4/30/2018 (3)Am r� .y Location �f>a JO AN N Y eA Kee S No. �5 CY Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # so/ 4 i I � 3 � tel/✓! `�",�- Building Inspector 1.1 Property Address: �- 1.2 Assessors Map and Parcel 1077 A Map Number. dumber: _t9la Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private ❑ 1.5. Flood Zane Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT ' 00 L V' 11. V's L' h i Us I N U 2.1 Owner of Record Name (Punt) Address for Service -y�lo Signature Telephone 2.2 Owner of Record: i' Name Print Address for Service: Signature Telepon SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: i _ 1's OW � D 6so^ � _ C. 14 QZ`�►Q6` euC ,d , NA, License Number Address A"^'C (r D—s i n? 0 i%8 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone r SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a ble New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: ii> I SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1 Item pp Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) / 4 Mechanical HVAC 3 Fire Protection 6 Total 1+2+3+4+5 Check Number SECIIUN 7a UWNEK AUTHUKIZATIUN TO BE CUMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 2:>&V� CUU`l1 a k0x--_ , as (h,,,ner/Authorized Agent of subject property Hereby authorize to act on half_ir a m rs relati - work authorized by this building permit application. ��ss §ignature of Ver Date SECTION 7b OWNER/XMORIZED AGENT DECLARATION r 1, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDVIBERS iST 2'qD 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE MASTER 9ATH rt g„ $t 84 11 • 'Z � F,yt'E �L LAUNDRY sNowFR �L X11 ! t5 S ,a clo") POW13ER � R FInM n V6tir MN Mat.f u6�i'� 3lyZ,r x �,�2n aR No 1'10 Tell Ei : So" titin i X' r', 3311 Y1" ygr' 22" co m x m m m CA v m CO) "o C06OZ O d a� a� .p � o o p CL c�mc CDD O d O CO) CD 0 d O H C• O y M C2 CDO CD Ma ml CD 3, y CA s � Go m d0 d0 y _ �a • n Z poC =r -o to a 0 w w _. CL CL o �O =0 y 0 �� : Z = O 0 : O U2 � C m n p to C =rCD CL VI O O CO) O A C 7 Come a m y oa Ito a ��� C!1 0: '� CSD m �. _ m o 0 p =r Err too oCD eomlu go� 0 — A �o 0) W M 0) W M Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . P.. /.1... r' . /I./z ... .............. has permission to perform ..... P !.!� ... 1 -�/ plumbing in the ++buildings of .. 6- ..<!../.. at. ........:. ` North Andover, Mass. Fee. Lic. No..�f.� .. f .. �.....l : 4 ..: ....... PLUMBING INSPECTOR Check # 6..�1 MASSACHUSETTS UNIFORM APPLI (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location /" 3UHA1X%1 C4-ec ST. New Renovation 1..� of Replacement FIXTURES FOR PERMIT TO DO PLUMBIN jj"CLZ Plans Submitted Yes Date -Lo Permit # Amount 13 No ❑ (Print or type) Check one: Certificate Installing Company Name 4)N� tu'• I Corp. Address 3` YePL SM ey-7 Partner. Ila cry � 'n/Ai Business Telephone Firrn/Co. Name of Licensed Plumber: 047 - Insurance 47 -Insurance Coverage: Indicate the type of 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 ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac4uset tate Plu ng C d Chapter 142 of the General Laws. Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License icense INUMber Master El Journeyman n 1 R Date ... 7- 21 u ,- ..... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....!.3 ........l........c... has permission to perform .......... wiring in the building of ......f!.. ,.�. ? F s, .. f ............................................. if `� ,North Andover, Mass. at .... jam . .................r... `........................� ....... Fee .......... ........... Lic. No. L. r. ... ............... -�,�" " t. ---- .......................................... �ELECTRICALINSPECTOR Check # 53511 0 MECOMMONWE LMOFMASSACHUSETTS Office Use only DEPART1b WOFPUBLKSgFM Permit No. S 3 J f? BOAROOFFNEPREVEMONREGUMHONS52 (M]2.IW Occupancy & Fees Checked^'7 J " + APPLICATTONFOR PE TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDA CE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL :)t ON) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform try electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes po No a Purpose of Building Existing Service Amps Volts Overhead New Service Amps / Volts Overhead Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7i� (Check Appropriate Box) Utility Authorization No. _ Underground Underground No. of Meters No. of Meters TO- of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above 1:1round Below Generators KVA round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons' No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of igns Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• lnst 8rMCoWrar- R=31t1DftwgtmernalsdMamchuMCanWLaws IhmaamartLiabtbyhmaaoePokyini*gConipi CowWorilsmb9arialegmiat YES ED NO IbaNtahrritbdvaldpoofofsametotheOffmYES rT ffyvuhawdrd®dYES,plemm&*dcMxofwvw4pby dlod&gthe box LJ I��JJ 1NstI1tANCE BOND r7 GUIER a r1m&Y) Es=tadVakxcfl kclncal Work $ WoitDStat h>spectimDaeR d Ra* rural Sigredur&rTrPambesofperjury FIRMNAME �,chr3�2t� /�ouSsCr4'2l��fG GLL LimWNo. Lioam'e Sigrauue T�2 LicffwNo /� BtlsirmTelNa 3- 70 7916 Arlrhr� A /� ld/C 1 .37 / /:5/6 ' 1114 (S,�jg6� A1tTUNo. OWNER'SINSURANCEWAM91 IamawaethattheLioawdoesnothaletheinam=aAW,Warils&*93 almpva)entasre4mWbyMasm d LqtlsGareralLaws ardthatmysigrhnecndispem> ffhcabcnwaivesthereglmanart (Please check one) Owner Agent Telephone No. PERMIT FEE $ Signature of Owner or Agent Date. 9515 '�',; •:'� TOWN OF NORTH ANDOVER A PERMIT FOR PLUMBING - go* This certifies that ....4�, .............. P/'/Cc/'�' has permission to perform ... +4�► °-.!m`' ... 01 plumbing in the buildings of ..... .................: at ..... �00 ... i!��/? . a*.. North Andover, Mass. zo ao 1 3'3 Fee. ...i .... Lu. No .......... ............................. . PLUMBING INSPECTOR Check x �� FIXTURES W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: N EMA. Date: Permit# Building Location: l w O CAVf, St Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: g— Plans Submitted: Yes ❑ No ❑ FIXTURES W Z D W to w V O U) x _ to m x 0 O �>. I ~ U) O 2 w w ZO Z W N W z o m W 0 W z W F W o O o F- n l- i 74 it > w z ua a Q w� o ME: Z W } z W w� J z� H H O x I- H W Z MW H W a' W O z O t zzili I-- U C 0 W 0 0 x x J O a H>>> 3 0 SUB BSMT. BASEMENT - It" FLOOR 2 FLOOR 3 FLOOR 4 FLOOR WH FLOOR 6 --FLOOR 7 FLOOR 8 FLOOR �� Check One Only Certificate # Installing Company Name: ('� „(�, ,/t%_ Address:�0 I�/110 O.(f CityITown: p State: ❑Corporation , ❑ Partnership Business Tel: � �� " � � �- ©�, �� Fax: [.Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes TNo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ;5- 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner El Agent 11Signature of Owner or Owner's Aaent By checking this box ❑; 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the nest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. Type of License: By 9RIumber Title ❑ Gas Fitter Signature of Licensed Plumber/Gas Fitter ❑ Master c� Cityrrown 5�Llourneyman License Number: °47 APPROVED OFFICE USE ONLY ❑ LP Installer VCity/Town: MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING V4—ma_rMA. Date: 41 Permit# BuildingLocation: CQ!kC �� �(� l%11.�/ L�t Owners Name: $lavyho Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: W Plans Submitted: Yes ❑ No ❑ FIXTURES LU LU Zto v = Q x to O F- Z H O Z J >. Ir Z U) O z w m O w 0 N w W W m �O Q d H D O W X W U ) Z W Z Z N 0O W W = ti W a' � O > W w Z O 1- O z -.10 LL N= W w w Z >- 0: to Q Q m W O Z O y > Z~_ D o o i= g >O 0. W�>>> 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR iwFLOOR Installing Company Namelx,7�m. Address:ity, Business Tel:gh a Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy o If you have checked Yes. please indicate th A liability insurance policy OWNER'S INSURANCE WAIVER: I am away, Massachusetts General Laws, and that my! Owner or Date. Af.: 711........ . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .14.A f-0 • • ..... • . has permission for gas installation .tt 4' ...�T .��?!'S• in the build'ias of ..N4/ -/e......1 ................ at . �q . Y.`.1.0 ?`' . 694 • S • • . , North ndover Mass. N;�A...> Fee.?—�..' �.��. 3- . Lic. No.F ... ./f�c�r. GAS INSPECTOR Check # 7845 cnOCK One Only Owner ❑ Agent ❑ tsy checking this box U; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Pluming Code and Chapter 142 gfthe General Laws. By Type of License: ❑ Plumber Title�❑� Gas Fitter ature of Licensed lumber/Gas Fitter "aGas City/Town ❑Journeyman License Number; APPROVED (OFFICE USE ONLY) ❑ LP Installer Date.7/ 4 ................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING U 0 J - Thiscertifies that . .........................................................-,....0 ................................... has permission to perform wiring in the building of...... . .. ...... IV\ ..... .. 0 . I . ............ ..................................................... ........... ...... at ........... i DO --To k ", ►, .1 ... C93.L..7.9 ............... ................................................. North Andover, Mass. Fee ............. . ........... Lic. No- ....... L dD .......... .... ........ -12 ALcrfuCAL INSPECMk Cfyeck It -2-+ 7 orcmuwfir , psad�et�edoe OF tE� REW ATM4 T APPLICATION FOR PERW TO B. CTRICA VVM � -. ��City or orTws A/0 oVP.r -To, in hqwdo,q-ry- Locadea mod& xmer) / o® Jo nn �. erTe dli r,70 mQra� asAM= cv 1s i� � was s perm` . Yes No E P of. lwsrumser*e Amp I -vow ovatmao uuwdo -iced �[Csr Se�ioe Antes Iia ofMders ! TT b oversd❑. Usftd # 9f a0A Lewikm=d?WmofPr*pewdXcd*dWGdc d d 'o jiYWlYiFiw Q � XVA i% �Te. oi�,otTebs �A Of ALARM GfzeAw ` �{�1 YYaaw�v OR baaof Pimps ofAkC=& Tom ofWmb [106W- vmftg 7 -� � � OfDrym — Tota l& gvalne 1o,�te r a � � 10; amd � RteaSe ���of��re10 g�UBAi�iC� G °wm' s ar ismbs6wbi eqAvaimiL1 FOX NAX& L �Lw- NO-1� �e�psa in � Att. Tei. No.� dnm I .Ida i�rf.Es�. a 147, s. 57.5f,se'? Jces na4havee► mm O BOU6ANM W I er�t away to *0 I a� e F owner _1_-3 bye BY MY ,y wanre 'ss 5 Tri. • The Commonwealth of Mussachawft Department of Industrial Accidents Office of Invesfigadons I Congress Street, Suite 100 Boston, MA 02114-2017 _qCnX11_ www.massgov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Business/OMmAzation/in&vidtW): Address: City/Mate/Zip:-15 FZ,44Y tlA, Are you an employer? Check the appr 1. I am a employer with employees (full and/or.part time).* 2. ❑ I am a sole proprietor or partner- ship aiid have no employees working for me in any capacity. [No workers' comp. insurance required] 3. [1 I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Phbne nate box: 4. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. iifsufmce.$ 5. E] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reauired.l 0 7 - x'66'• 7y67 TYW of pro) (reluiref: 6. [] New construction 7. 0 Remodeling 8. [] Demolition 9. [] Building addition 10.ffElectrical 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 mfoimation. Homeowners who submit this affidavit indicating they are doing all work and thea hue outside contradws must submit a new affidavit in� swI :Co .tors that check this box must attached an additional sheet showing the name ofthe sub -contractors and state whether or not those eaffm have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is diepolicy andlob site informs iott. Insurance Company Name:__ (.7 Y A R.17 IAVY ttkkv C Policy # or Self -ins. Lic. #: /�/() u% C z l 3 6 �j Expiration Date. 7/,;91//.? Job site Address:00 JGh11 t)U CYa S -t City/State/ZipN -"C\(el � ►yA M XS Attach1t 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 top $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD 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. Ido herebi certify rat pains an url> ofP�l that the information provided above is true and Cary" Ofi?dd rise only. Do not write in this area to be conTleted by try or town ofjkW City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/rown Clerk 4. Electrical Inspector 5. Pl mbing Inspector 6. Other Contact Person: Phone#: ' .. 4 ��, Date ........ ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ A ..... ..:........ S!' `..t....... /./ has permission to perform .......G✓, r.."`...........,<-��!.�t`'.P...-i.................... wiring in the building of ............. ..�.. , �-.. .......... .................... �../, North Andoveerr�,,Mass. Fee.,af..,.`?..�............ Liv<o-e.�f .....................*'.:.f �.. ' 1�.. . .. . ....... %ELECTRICAL INSPE�MR Check # �� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. l t,8 BOARD OF FIRE PREVENTION REGULATIONS 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 ININK OR TYPE ALI. INFO ATION} Date: /G - 3 �/ 3 City or Town of: -� &,- rz _ To the Inspector of Wires: By this application the undersigned gives notice of his or ]gr intention to perform the electrical work described below. Location (Street & Number) llJ 11 f� 7 -(— Owner or Tenant Telephone No. Owner's Address -�- Is this permit in conjunction with a building permit? Yes No ❑ Building Permit # Purpose of Building ii t �� , f Utility Authorization No. Existing Service 2y) Amp /zb l 7-y" 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: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans r ° ota Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Li Fixtures P�� Swimming Pool A onus ❑ - ❑ � nd. nd. o. o Units Emergency Lighting Bane Units No. of Receptacle Outlets Z. No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 3 No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers sp Number eat Pump m Totals: ons ... ._............" o. o e - ontaene Detection/Alertl Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑Other Connection No. of' ers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o atero. Heaters KWSigns o o• o Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage, Bathtubs No. of Motors Total HP Telecommunications ofiring: No..off Devices or Equivalent OTHER: INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance or eiecmcai work, may issue wumt, the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. TMs undersigned certifies that such coverage ' orce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: l0Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and completes Current Insurance certificate trust be on fits in our office and affidavit must also he filled out with each application. y� FIRM NAME: 15; 2 � / / r/. ?J LIC. NO.: /T /�y YV Licensee: l „j�Y4� Signature LIC. NO.: _ (If applicable, en .r "exempt " in the license number line.) Bus. Tel. No.:o�'y��S� Address: 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) 0 owner ❑ owner's agent Owner/Agent PERMIT FEE: $ Signature Telephone No. ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL 1. ROUGH PECTION: Passed Failed — [ ) Re -inspection required MUM - r i /G`--r_IF (Inspecto Signa re - no initials) 2. FINAL INSPECTION: Passed — [ j Failed — [ ) Re -inspection required ($50.00) - Inspectors' comments: (Inspectors' Signature - no initials) 3. UNDER GROUND INSPECTION: Passed — [ ) Failed — [ j Re -inspection required ($50.00) - Inspectors' comments: Date Date (inspectors' Signature - no initials) Date 4. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — [ ) Re -inspection required ($50.00) - [ j Inspectors' comments: - no 5. INSPECTI - OTHER: Passed — [ Failed — Inspectors' comments: 'Signature - no Date Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. This certifies that .... ... .6/" .tlf� ................ . has permission to perform ..�h, :................... . plumbing in the buildings of.................................. "t ../o-VQ-'r'ry--6. Sf .............. North Andover, Mass. Fee .1�1p, SID.. Lic. No... 'l�. .......................... ... PLUMBING INSPECTOR Check # NVT MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _CITY[' MA DATE : PERMIT o JOBSITE ADDRESS /00 OWNERS NAMEF POWNER ADDRESS TEL.I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL D RESIDENTIAL PRINT CLEARLY NEW. F-11 RENOVATION: F-1 REPLACEMENT: 9-ji PLANS SUBMITTED: YES[] NOD FIXTURES I FLOOR -4 BSM 1 2 3 4 5 6 7 8 9 10 111 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIO]USAND SYSTEM --f .---_.-__..I 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM .. . .. . ......... ..... -J DEDICATED WATER RECYCLE SYSTEM DISHWASHER . . . . ..... ... I F DRINKING FOUNTAIN ... ... .... FOOD DISPOSER FLOOR /AREA DRAIN ..___-__I ... ....... INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK .. . ........ - .... .... ..... - ... . ... ... TOILET URINAL _J WASHING MACHINE CONNECTION F'7 F= . .. ... .. WATER HEATER ALL TYPES 1= E-71 -..J 7 -D WATER PIPING OTHER ------------------- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY [ BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [3 AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i — PLUMBER'S NAME LICENSE # SIGNATURE IVIPM JP El CORPORATION WJ#F y PARTNERSHIP0# LLC D# [:7:= COMPANY NAME ADDRESS CITY .I,,)c, L/f, STATE ZIP FAX CELLF_ j EMAIL ..A NVT io - y -t3 o�G� i -� � D-(/� l-�� David J Cunningham Builders LLC 78 Old Johnson Rd. E Hampstead NH 03826 603-378-0898 NAME/ADDRESS Bill, Marie O'Mara 100 Johnny Cake St. North Andover, MA. 01845 j i Estimate DATE ESTIMATE # 7/15/2004 56 ITEM DESCRIPTION i TOTAL Bathroom This estimate is for remodeling a master bath. This is a estimated breakdown of subcontractors and cost.This is for labor only. Carpentry Gut room to the studs and existing sub floor, frame 1/2 walls, blueboard and 5,200.00 plaster, copper pan and durarock shower, vanity installation, sub floor, trim, waste container.( per hour rate $40.00) Plumbing Replumb shower, vanity, toilet, tub and install new fixtures.( does not include 3,000.00 any updating for code, per hour rate $45.00 ) Electrical j Install new switches, plug, fan and wire tub ( does not include any updating to 800.00 code or demo work, per hour rate $45.00) Tile Labor rate for installing marble $9.00 a square foot. Regular ceramic $4.50 a 2,200.00 square foot HVAC ! Hook up one run to master bedroom off main trunk 300.00 Bathroom i This estimate does not include permit fees, painting, shower door, electrical or j I i Plumbing fixtures, tile i I i i i I i I I TOTAL $11,500.00