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HomeMy WebLinkAboutMiscellaneous - 100 SECOND STREET 4/30/2018Date ...1.�.1151H............ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .Q..0-:.«. ° SPS... has permission to perform ........�......!.. ......u:c,D6,R, ................... plumbing in the buildings of. ........ Lft-xv..6P44.................. )N� P� ...................... at ........A U \ ............................. ....................... North Andover, Mass. Fee..`9.01hic. No..1.` j�. HY)................................................................... C PLUMBING INSPECTOR Check # - t1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK U' � T, CITY rid-�:. R N dov �R ---- _ .._ MA DATE - PERMIT # JOBSITE ADDRESS %ARet—A- OWNE 'S NAME 9 �c_ a2d �-k- POWNER ADDRESS S Y» TEL 91 %-l.%3 -a 555 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: E] RENOVATION: © REPLACEMENT: F*7.� PLANS SUBMITTED: YES 0 NOR FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6: 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ 1 DRINKING FOUNTAIN FOOD DISPOSER — FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET— URINAL WASHING MACHINE CONNECTION _ ... WATER HEATER ALL TYPES WATER PIPING OTHER L— — INSURANCE COVERAGE: I have a current liability -insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES, 'g'g NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY EJ BOND Ej OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. _ CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are 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 pliance with all Pertin provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I GEORGE A. POUDRIER ; LICENSE # j 157n4 : _. SIGNATURE MP[ JPD CORPORATION# PARTNERSHIPE1#r- LLC El# COMPANY NAMEJ G.A.P.S. PLUMBING & HEATING ADDRESS 13 BLACK. POINT RD CITY WEBSTER STATE SMA ZIP 01570 TEL 50$ 461-9349 I FAX j 508 461-9382, CELL 508-789-3486 EMAIL GAPS PL_UMBINGRCHARTER.P�FT Y_ , _! t ---;------- --- -XX I %v E ii _1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 10/9/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Anastasi Insurance Agency, Inc. 4 Brookfield Rd CONTACT Kristi Gravel NAME: PHONE (508)248-1440FAX N .(508)248-1447 E-MAIL .kgravel@anastasiinsurance.com P.O. BOX 12 61 INSURERS AFFORDING COVERAGE NAIC # Charlton City )KA 0150$ INSURER A:We stern World Insurance INSURED GAPS Plumbing & Heating, Inc. 3 Black Point Road INSURERB:Safety Ins Company 39454 INSURER C : INSURER D: INSURER E: Webster MA 01570 r OVFRAr;FC t%C0TI01n ATG A -A INSURER F: ..--• ••- - -- Mr -V1.1. IUIV NUMbLK: THIS IS TO CERTIFY THAT THE POLICIES OF IPlSURAWCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREh4ENT, TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRA OL UBR LTR TYPE OF INSURANCE POLICY NUMBERFOLICEXP YYYY MMLICYY Y LIMITS ACCORDANCE WITH THE POLICY PROVISIONS. GENERAL LIABILITY AUTHORIZED REPRESENTATIVE Paul Anastasi/SHAND EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED A CLAIMS -MADE a OCCUR NPPS184900 /19/2014 /19/2015 PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1, 000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY 7 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident 1,000 000 B ANY AUTO ALL OWNED BODILY INJURY (Per person) $ XSCHEDULED AUTOS AUTOS 6227518 /15/2014 /15/2015 BODILY INJURY (Per accident) $ X HIRED AUTOS }{ NON -OWNED i PROPERTY DAMAGE $ Per accident Uninsured motorist BI split limit $ 20,000 UMBRELLA LIAB OCCUR i EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y! NFR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CtHI IFICDIE HULOER t AKI!`CI I ATInrJ AUUHL) Z5 ('LUIU/Ub) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northeast Electrical ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Paul Anastasi/SHAND AUUHL) Z5 ('LUIU/Ub) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 10/9/2014 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Anastasi Insurance Agency, Inc. 4 Brookfield Rd P.O. BOX 1261 Charlton City MA 01508 CONTACT Kristi Gravel NAME: PHONE (508) 248-1440 A/C N (506)248-1647 EA-DMAIL :kgravel@anastasiinsurance.com DRESS INSURERS AFFORDING COVERAGE NAIC# INSURER A:We stern World Insurance INSURED GAPS Plumbing & Heating, Inc. 3 Black Point Road Webster MA 01570 INSURERB:Safety Ins Company 39454 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMRFR-14-15 R9:VISIA1d NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF iNSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT 09 OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLISUBRI INRR WVQ POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 5_10CCUR NPPS184900 /19/2014 /19/2015 EACH OCCURRENCE $ 1,000,000 'MAG OEa occurrence $ r PREMISES 100 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PIF(IT F-1 RO LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 6227518 /15/2014 /15/2015 COMBINED SINGLE LIMIT Ea accident 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident Uninsured motorist BI split limit $ 20,000 UMBRELLA LIABOCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F—]NIA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below WC STATU- OTH- —1 TORY LIMITS I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION Northeast Electrical AUUMU ZO (LUI U/Ua) INS025 (201 005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Anastasi/SHAND (91988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD >:'SEITT ERS , ,:;.>>:ka TNS`" FOLLOWI9t `- ,`SLUES _l c; a kriA.10URl�EY,'�AIv Fl:L#l;t>..: K GL.ORGE A P 0 U D R i ER" LAC" "T` `R0 MA 01570-3,6W N 6Ift: ; O1 16 2264.z3 y -do gas $-ACh S ,..s:� DRIVER'S a _ LICENSE 9L80 as NUMBER3' DOW 12 Is SEX i8Ef3R6EA s3BLACK-POINT RD WEBSTER,'MA 01570-3605 JJ 4'w ADD 12.20.2013 RevueAS200s u Claim # 2581149 Advantage Claim Services 522 Chickering Road #B North Andover, MA 01845 Adjuster Assigned: G Guarente Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner do( Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Richard Lambert Property address: 101 Second St. North Andover, MA 01845 Policy #: 2581149 Loss of: 2014/04/04 File or Claim No. AD 9962 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 Mass_ Gen—Laws,—Ch.-139—Sec.-3B 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. G 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. 04-09-14 Signature and date _ r Location �l - /, 2 - No. Date /n // - 0Z &O*TM,TOWN OF NORTH ANDOVER • OL Certificate of Occupancy $ Building/Frame Permit Fee $ 1AC NUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $.� Check #,,,"' 5 �, 7 J G Bu ldinginspect, r` V BUILDING PERMIT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT R, RENOVATE, OR DEM01.1S1i .. cow, nu Twn FA ,,trr v r DATE ISSUED: _.... no_.. - SIGNATURE: 4Fsm ;•� Building Commissionerfinspector of.Buildin Date U SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Number Parcel Number C 1:3 Zoning hifoimation: Zonin District _ ..:: Pr.. ased.Use �.: ,.. 1.4 Property Dmensons:: , :LotAres. Froiita e' $ 1.6 BUILDING SETBACKS. ft Front. Yard -SW Yard Rear Yard Required Provide R red Provioed RNUffed Provided 1.7 Water Supply MGLC.40. 54) 1.5. Floud Zone Iufomuhon .8 ewerage Dispbsal System 1 S Public. ❑ Private ❑ Zone Outside Flood Zone - ❑ Municipal ❑ On Site Disposal System d SECTION 2-- PROPERTY OWNERSHIPIATZTHORIZEDRGENT' 2.1 Owner of/ ke/cord n a1 s211 2.2 Owner of Record: Name Print © F,' Address for S ce ;lephone Q Address for Service: 0 z M .2 Registered Home Improvement Contractor ompany Name ddress Not Applicable ❑ Registration Number Expiration Date ie SECTION'4 - WORKERS COMPENSATION (NLG.L: C 1`52 § 25c(6) " Workers Compensation Insurance affidavit must be completed and submitted with thisapplication. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....., SECTION 5 DescA tioh of W,6066d osed Work' checkag opIrC41 _ New Construction ❑ Existm* g Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition. ❑ Other ❑ Specify s ". Brief Description of Proposed Work: 6 Total 1+2+3+4+5 SECTION 6 - ESTIlbIATED CONSTRUCTION•COSTS Item Estimated Cost (Dollar) to be— Completed eCom leted by permit applicant (a)` Budding Pe–ni mt Fee IViilti" slier` , . 1.Building 2 Electrical b Estimated Total Cost of ..Construction 3 Plttmbin .. .Building. Permit fee taI. (b) `� a S 4 • Mechanical HVAC , 5; Fire Pr&&tron, 6 Total 1+2+3+4+5 Check Tiimbei SECTION 7a OWNER AUTHU TIO O BE COMPLETED WHEN OWNERS AGENT _ R CON OR APPLIES FOR BUILDING PERMIT L am/ Adz as Owner/Authorized Agent of subject property Hereby authorize to act on My beh. in hers 1 've ork authorized by this building permit application. n o er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Aent Date I MEW MIME NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2 3RD 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 _= FA C � d y Cl) Ca! Z CO) CL n� r c co � c fl. �• y O CD C) v CDCL O CT CD CD O CD C O H, CD a O y O I to CD C2 y O 'fl Z CD O CD O CCD C� cn n O cn O cn G1: n 7d . C cm 64 0 0 O 0 O c CD .Orta O H O N W A aCos �`.m H ti m O n H m d C sa.-.CML 0m CD O co) O y o m o -o 2 O H CDn co H 7 a � g�c UL m C EL CD CO) s1 CA ==r: Q06. CZ d C W — d �1 C CD H �H CAO 1 CA OO O O :� rr � O �� F g Goo: CD 0=m �C co) CD 0o 0 CD CU m CL"S : nC-) c o moo: o C� Cn O C/)b7 0-3 Irl w0 yd y In w C (D 91 A y 7d 'z7 w 7C - y orf w (� `Cl �7 G 'r7 G C/)91 ti ` O x O E~ y 0 9 0 c North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) ignature of Permit Applicant ,10-11-a2LO( Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE - &-- 2 JOB LOCATION A O ( � Number "HOMEOWNER A 'a ��LE Name PRESENT MAILING ADDRESS �Tow. S7 Street Address 7 X63 63 B Home Phone State Map / lot Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does, not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMBNOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-{aws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. / O --� HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFICIAL N2 7, 3 Date A,y. "°TOWN OF NORTH ANDOVER « 0 16 PERMIT FOR WIRING This certifies that '-'- f has permission to perform " ' ` wiring in the building of . at ZT ' .... �. .. North Andover Mass. Fee... '` ........... Lic. No .............. ................. .: ...................................... i CAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I "r- L (1LrI VJUJ V rrG 9l1wI n UT IV1/L.a,"(,t1UJC11 J Ottice Use only DEPARTA&WOFPUBLICSAFM Permit No. BOARDOFF7REPREVEM ONRFX;ULATIOAS527CMR1200 Occupancy & Fees Checked APPUCAT ION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 / (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ _ I 1 A 0 O 0 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1 <) p fi r, A NJ lev Owner or Tenant E( S ct l i � Owner's Address l OQ ane N io Is this permit in conjunction with a building permit: Yes ® No M (Check Appropriate Box) Purpose of Building Ms ►aF VA1 A Utility Authorization No. Existing Service Amps/ `_Volts Overhead M Underground No. of Meters New Service Amps / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals i No. of Heat Total Total 1 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 F1 Other No. of Dryers 0 Heating Devices KW Connections 140. of Water Heaters KW No. of No. of Signs Bailasis o. Hydro Massage Tubs No. of Motors Total HP OTHER: To4oi� "vW1m op 'I yoob►1!Z l s==Co eaga Rost t1DthetagtxanffZd Vlassadt GawW Laws Iha\,eaa=tLiabt7iiyhnlaatoePtbcyQtdudagCotr ic�, Opaa6cmCo)aawcrits%iEurideqivakrt YES NO limes bnoadvabdptoofofsameiDdte08re YES (2] NO If}uuhmed>I &&YESspleisemdialothetypecfwvaaWbyc ukfftgthe INSURANCE � END CHER WakiDSlatt hspecticnD*Regxstad Shad und°rt7'ie R nalfies ofperjtay: FIRM NAME Eviffm Date Esti� ValuedEJwhml Wctk $ s >� LioaseNa. Limlwe IJI�►� a 1 A 1J o f vi C. Sign. — �`^o� LiW.No a o S D Rsix%TUNTQ _97$-6 �-�}i. _ AddteSc `D'S L c ,r 1V\4, R 4 V\n e 4 u e +<. �M A Cb I g Ll 4 Al Td Na OWNER'SRgR-RANCEWAVER;Iamm%=dattheLkmsedM Mdreitsuranecn�ea�eoritssr lac�rival ante dby ��L and drat my sigr�taaon dts permit wai�.s dtis tit taenrnt. (Please check one) Owner a Agent _ Telephone No. PERMIT FEE $ bc, Ivo r y _ Date 1/77 N2 4628 . o'<40.:'4,0 TOWN OF. NORTH ANDOVER p PERMIT FOR PLUMBING SSACMU`+� This certifies that .. �( .L �...V-. �� �f�trr�!f................ has permission to perform ...... v `� "'� f c� �=• .................... plumbing in the buildings of ... S% L f S ....................... atU.�'...�cG� `� �� gNorth Andover, Mass. Fee 9. Lic. No.. ���.�. Y ...... _ . ........ PLUMBING INSPECTOR Check # �` WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J 3 3 7 6 Date. ll7/.? .... . HpRTM TOWN OF NORTH ANDOVER pya4ao ,e 1tipL p PERMIT FOR GAS INSTALLATION i • r This certifies that ..���. .. �'� f%{ ...................... has permission for gas installation .... in the buildings of ... <..S ............................ . at . �G.�. rr S �'�... ......... North Andover, Mass. Fee. Lic. No..12,......... IAS INSPECTOR —"HITE: Applicant CANARY: Building Dept. PINK: Treasurer Date No 4.6. This certifies that .. t .�. .. •�=j • � � '•!�............ • • • • has permission to perform ......... . plumbing in the buildings of ... S C.�. ....................... at ��! .�.. �S c r. ` /(.. G f • • • • • • • •_North Andover, Mass. Fee 7 i.. Lic. No..,/ Z/ �. t!. .......... L .. " . ......... J f PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. t .�. .. •�=j • � � '•!�............ • • • • has permission to perform ......... . plumbing in the buildings of ... S C.�. ....................... at ��! .�.. �S c r. ` /(.. G f • • • • • • • •_North Andover, Mass. Fee 7 i.. Lic. No..,/ Z/ �. t!. .......... L .. " . ......... J f PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ASO d d 6F Date Building Location lid ��/� Owners Name U Permit Amount Z Type of Occupancy New M Renovation Replacement Plans Submitted Yes � No FIXT41RES r • .p i :1 -------------.-..�.----.- • "'�--------MM--M---.-.--.-.M is • ��5���������������������� NOMMOMMOMMOMMONNOWWWWWWOM (Print or type) Installing Company Name Address L Geo o sTQ� rf /✓ A Business Telephone G Q 3..5 / 9 Check one: Corp. MPartner Firm/Co. Certificate Name of.Licensed Plumber. AIZ l a dh 1� Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: ❑ Liability insurancepolicy Other type of indemnity ❑ Bond Insurance a.. er: I, undersigned, have been made aware that the licensee of this application does not have any one of the above three ins e svitffir6-Owner Agent D I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing We and Chapter 142 of the General Laws. By:igna or Licenseuum er Type of Plumbing License Title City/Town icnse 74umoer Master ❑ Journeyman APPROVED (OFFICE USE ONLY - -" r Date...'.'...........`...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .............................................. has permission for gas installation ........�................... . in the buildings of ..... ...................................... at ................................... . North Andover, Mass. Fee......... Lic. No........... ..... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP U PARCEL 2 � e MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING 7G 0 (Type or print) Date �(/� Q' t9 o2 O 1-9 c) NORTH ANDOVER, MASSACHUSETTS I Building Locations d )e coot J 6 D � �/l Permit # Amount $ Owner's Nam Sob, e Ne -N ❑ Renovation ®' Replacement ❑ Plans Submitted ❑ (Print or type) CAk one: Certificate Installing Company Name A,. } Li Corp. Address 1 �z A,6Z grggea �' �iP�� f A A ❑ Partner. Business Telephone S''' ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter —,o&,'/ r! /2 is 01 / fl INSURANCE COVERAGE Chect!f� I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please ind' a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owners ce Wa' er. I aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mas ws, afore on this permit application waives this requirement. Check one: Signhfure of Owner or Owner's Agent Owner M"/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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 1/ 1,:36 714 ❑ Gas Fitter License Number ❑ Master Journeyman - ,12ND. FLOOR • r (Print or type) CAk one: Certificate Installing Company Name A,. } Li Corp. Address 1 �z A,6Z grggea �' �iP�� f A A ❑ Partner. Business Telephone S''' ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter —,o&,'/ r! /2 is 01 / fl INSURANCE COVERAGE Chect!f� I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please ind' a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owners ce Wa' er. I aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mas ws, afore on this permit application waives this requirement. Check one: Signhfure of Owner or Owner's Agent Owner M"/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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 1/ 1,:36 714 ❑ Gas Fitter License Number ❑ Master Journeyman 'Location h -n No. L a Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r -v x TOTAL $ i kheck,#- J U Building J(Wector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1> BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: C Building Commissioner/Ineector of Buildings Date SECTION 1- SITE INFORMATION 1.1 /Property Address: 1.2 Assessors Map and Parcel Number: Map N tuber Parcel Number VVV 1.3Zoning 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 ReqWrW Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNS SHIP/AUTHORIZED AGENT 2.1 Owner of Recor jl -DF L S A L1 g /. ('� V /" ✓ 1�C7 J Name /(ri t) Address for Servi 77> Sign a Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 69 rn X Z O v rn P 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 a8 in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Prop s�etl Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant ` � OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7aO AUTHORIZA. BE COMPLETED WHEN OWNERS A OR CONTA(ACT,09 APYLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date 11 111901 0101W9 E151,1111113111 -M NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DEI IENSIONS 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 f N V Town of North Andoverof Na RTM qti Building Department o 27 Charles Street North Andover, Massachusetts 01845 ?, a� (978) 688-9545 Fax (978) 688-9542 �' o e0 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be dis osed of in /at: l Facility t A/0AAn1 Date of NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. e NORTH 1 Town of North Andover 3 a� Building Department 41 � A 27 Charles Street " North Andover, MA. 01845 ��s •,r4�g D. Robert Nicetta SA Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE 7 - JOB LOCATION 2690 Number "HOMEOWNER '74 Name PRESENT MAILING ADDRESS- A �. City Town Street Address Phone 7 State G /0/ , ra,0�� Map / lot &_5 'Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she derstandrts,6nd of No. Andover Building Department minimum inspection proc r and requi�r� that he/she will comply with said procedures and requiremenv/ /j HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFICIAL CD m m C/) 0 m CD o .. a o _ CD Cn CD a O 7 LIEWJ CO) .p d O CO) "0. C C O CO2 E Cl) CD O _ CD CD CA CD CO) FE Al O —• H O Q N ao5CD .o to • „+�•✓I O �' m n m � ciao m cz Z NwLA �. �► O.~i O. p m �o m d C y N � N O m sz S 7 OCD Co o Z�.n O N l7 CD C CO) ...f )WAMb CL ca o C C � m O N O m C a -+ ��•.•.��•.yy O C's,4W* co W CL N m !^ S S- co)t O V J N t O , 300Fw CO : 0 0 ... ; O O o o : Q z t�)o C,o W N 'O -• : �® CD ate, c) cm cn o cn CO ?y w 7n oGoc w cn 'o?? CrJ O w � O ?? w n PO 'rl r � C/)n b S I 41®6 NORTh 1 ,SSAcmus� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that J>'q !0 `:'/:5'4/ .. D Q.0 l� �' .. P�! . <-{ .... has permission to perform .. Pv '. f, , , , , , , , , , , , , plumbing in the buildings of ....................... at. /.4�A... ?�� o.h.� ...?-..... , North Andover, Mass. Fee. -- ��. Lic. No.. `l.3 .c2' 3....... „ ...: UMBING INSPECTOR 09/10/99 14:45 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP _ MASSACHUS PARCEL 19,03 �- (Type r print) 100 - Building Location , UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Date_ )wners Name �G` (� ' Permit 4 4el Amount of Occumnev, e f OL k Y -T - New M, Renovation EI Replacement ® P1ans.Submitted Yes ® NoEl FIXTURES (Print or type) 0 I Check one: Certificate Installing Company Named / G' 106( 1-rP / / j ' j� Corp. Partner. 0-firm/Co. - -- Name of Licensed Plumber: Insurance Covera ee: Indicate the typ msurance coverage by checking;the apprnate box Liability insurance policy Other type of uideinnityElBond. ®� 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 — 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,unde�P. ermit Issued.folYthis applicat on".w• l .be in, compliance with all pertinent provisions of the Massachusetts State.Plumbing Cnd Chapter 142 of the Gen w . By: 717=e ot Licensedum er Type of Plumbing License Title Z 9' _. City/Town � ;- cease. , um er -..Master'.,' �_ Joun - -- APPR=&VDD (eWFICE USE ONLY -