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HomeMy WebLinkAboutMiscellaneous - 11 ARDMORE COURT 4/30/2018 A PAO Rl�,- Go kA .,.r.... ... .,,..�..�:-ew.�,;........r,+.-___""`.raw.�-•.o-a.-�....;�.�*+�r»+.�:w�l,...-...r....-^.la--'c..et.-rft4�+:.+b,-.,v�F%*...e. «S ry Date..................................:.............. �NORT�y TOWN OF NORTH ANDOVER h 9 PERMIT FOR GAS INSTALLATION j S3gCHU This certifies that .................: `-'''( i� ..................................................................... has permission for gas insta lation .:.................................. in the build'ngs of.... .....t�. .. .- .`!..�t .'^....................................:. at.................. . ..:...................................:., North Andover, Mass. Fee .-........ Lic. No. ....�5..'��..... ....................................................:.......:........ GASINSPECTOR 72(0 Check# 09933 Date. /W...f.��.........' ` 1091 ` of".SRT"'tio TOWN OF NORTH ANDOVER 031 • �� •• C9 PERMIT FOR PLUMBING This certifies that.........: :. .` .. ... ............................................................................. has permission to perform....V` ... ..... `. '...1..............5......................... plumbing ' the buildings of.... t?�'. .. -!4............. at.....1 ................:. ...........................................................:......., North Andover, Mass. Fee c)n........Lic. No. �.�pZ r'�.... .................................................:..........:.................... PLUMBING INSPECTOR Check# ��� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE _ ( PERMIT# I'®� JOBSITE ADDRESS OWNER S NAME �,C�r' " OWNER ADDRESS TEL JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL ) EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT:©� PLANS SUBMITTED: YES NO 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/OIL/SAND SYSTEM i __-__I _J11 f .. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY I J ....__.__._� ( _. 1 _-.-_-..I ____J _.__J —AL—A ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET f -J __ __I URINAL _ f WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i I I # I — 1 —J WATER PIPING OTHER -_i INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES P—•116-0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER OTHER TYPE OF INDEMNITY © BOND 0 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 Q AGENT ID 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 an cc a the best ofwy k e e and that all plumbing work and installations performed under the permit issued for this application will be in compli a ne r isi of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME / l/s2s _ n•ei4 LICENSE# SI .ATURE MP 9B1P Q CORPORATION F-11#©PARTNERSHIP#=LLC COMPANY NAME ; ADDRESS { _ �,^ V—� TEL CITY Cr��k STATEZIP-- � -- -- — �� ,� II FAX CELS _.�o_Q��1._ EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTIONWOtFA Yes No THIS APPLICATION SERVES-AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r„ �i I ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,r �` vJ 7 1,i CITY MA DATE PERMIT# 1 / % UV JOBSITE ADDRESS G?� ,✓l r-c CG c..._ IOWNE S NAME t"G OWNER ADDRESS d (.v . _ TEL f— AX'. — I TYPE OR OCCUPANCY TYPE COMMERCIALF, EDUCATIONAL E] RESIDENTIAL�— PRINT CLEARLY NEW: RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES F---Jj NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER �I CONVERSION BURNER COOK STOVE DIRECT VENT HEATER ( � _ . J DRYER .. _ _I _ . ..._. . . _ , FIREPLACE FRYOLATOR �.�. �_ l —r1 FURNACE GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN `�-- POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER _I UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 10 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGESY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej 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 0 AGENT 1:11 SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate Aip best of my I o and that all plumbing work and installations performed under the permit issued for this application will be in compliance e ' ent pr is! the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFI TER NAME _ � LICENSE# t'� SIGNATURE MP GF D11 JP 0 JGF LPGI CORPORATION j#�PARTNERSHIP©# LLC[I#L :.._____II COMPANY NAME: vtt¢ _- -__ADDRESS L`= CITY STATE ZIP ]TEL _ FAX CELL _ O EMAIL — ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION 1110TES ISYes No �.. THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of-Investigations a.� 600 Washington Street Boston,MA 02111 kvtj www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): ZS P4�7 Address: \ City/State/Zip: glA Phone#:c�Z�z C2 ) Are you an employer?Check the appropriate box: Type of project(required): .1111 am a employer,with 4. ❑ I am a general contractor and I 6. ❑New construction empi s full and/or part-time).* have hired the sub-contractors c 7. E]Remodeling 2. am a sole proprietor or partner- listed on the attached sheet. ship and'hava no employees These sub-contractors have 8. ❑D_ emolition working for me in any capacity. workers'comp.insurance. y ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T-Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ` Insurance Company Name:. f I J� Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup 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 cert&under the pains and penalties of perjury that the information provided above is true and correct. - Sien ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Inform.ati®n and. Instructions r Massachusetts General Laws chapter 152 requires all employers 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 ofhire,- express or implied,oral or wxitten." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the 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 producedacceptable evidence of compliance with the insurance 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 the 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 number listed below. Self-insured companies should enter their self-insurance license 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 permit/license number which will 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 indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the 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 Conmollwalth of Ma ssa chu setts Department of Industrial Accidents. Office of Inivestigations. 600 Washington Street Boston,MA 0211.1 Tel,#617-727-4900 ext 406 ox 1-877:MASSAFB Revised 5-26-05 Fax#617-727-7749 www.mass,govaa ,1 • COMMONWEALTH OF M115S CRUS TTS ® o y-.1qJL=Muo g Bill BOARD OF PLUMBERS APD GAS-F,1 TTERS t` ISSUES THE FOLD OW(NC LIaCENSE: LICENSED AS A JOURNEI'MAN S1?:LB x A1?A, C h0�ri�E 6 RUTHCIRCLEe \\`{�, - � Lu: .r ` fAIIERt�'I LL 1'A 01832-8, 00 i 26054Ol t1 + 2L2411 . . t .COMMONWEALTH OF MISS OMUSETTS PLUMBERS AND GASF;I.TTi=RS 1 g ISSUES THE FOLLOWING LIC�ENS,E {� 17 LOEtJSED AS A MASTER/rPLUM$ER a :. M H�LMES ADA ,t , N Z' • 'i, �f�, r� w RUT": { AERNILL . `MA Od832900 18> 244 4 0z 0.1: 16 <... 2012MassachusettsElectrical Code Amendments 527 CMR:2.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§.3L,the Permit application form to provide notice of insfia11 of wiring shall be uniform throughout the Commonwealth,and applications shall be filed- on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shalLbe limited as to the time of ongoing construction.activity,and maybe.deemed_bytheJnsp.ector_of_Wires abandoned.and.invalid,if-he—.. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwis a applicable expiration date,any permit or approval that was "in effector existence"during the qualifying period beginning on August 15,2008.and extending'through August 15,2012. G Rule 8—Permit/Date Closed: J� �j d ***Note:Reapply for new permit E Permit Extension Act—Permit/Date Closed: � l 4 { ' Date.... ..... ....8..... ��. VLORT" TOWN OF NORTH ANDOVER p PERMIT FOR WIRING f ��,f _ • ACOMW _ This certifies that .... L ...... ............................ h r; has permission to perform .........6 �7Y ................... ➢wiring /in the Molding of....... a4e/. IQ el .....f'Y.�� .F ................... at....l..e!/...��DMMF.....c ........................... .North Andover,Mass. Fee:..�..>..��.. Lic. ..... .. . • �J /JQ ELECTRICAL INSPECTOR Check # 7228 � Commonwealth of Massachusetts Official use oeely Department of Fire Services Permit N 7 Z Z Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYP4ALL INFORMATIOA9 Date: 'Z f%02,9!0-07 City or Town of: M Ayo oyut To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical wo-ik described below. Location(Street&Number)lL. A�Q m*or. co Y/L f • Woos��e Co ti 04 � Owner or Tenant (N p p O ♦ C4 OF Telephone No. Owner's Address S " Is this permit in conjunction with a building permit? Yes Or No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps 1 Volts Overhead E t 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: 'REI Mae - c Q V hl ayt ; L♦,% 1vt • Completion o the ollo►vin table ma be waived by the Lzu2ector of Wires. No.of Recessed Luminaires No.of Ce17.-Susp.(Paddle)Fans o.o ota Transformers KVA 1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Above o.o Emergency Lighting g Pool arnd. ❑ gmd. ❑ Battery Units a No.of Receptacle Outlets No,of 017 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No­.of Detection an InitiatingDevices No,of Ranges No.of Air Cond. Total s No.of Alerting Devices No.of Waste Disposers eat °mP er ons o Self-Contained Totals: go- Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ unictpa ❑ Other t Connection No.of Dryers Heating Appliances XW Security Systems:* No.of Devices or Equivalent No.of Water KW o.o _. _ o.o Data Wiring: Heaters Si s: Ballasts No.of Devices or Equivalent Telecommunications' Wiring: No.Hydromassage Bathtubs No.of Motors, Total HP No.of Devices or Equivalent OTHER: V%P Attach additional detail if desired,or as required by the Inspector of Rhes. Estimated Value of Elecpical Work: (When required by municipal policy.) Work to Start: 3i ft-)14 7 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 V' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRMNV1. IT�Ti1./h1i �L ,f►111KAL =/K LIC.NO.: ��y�2r� Licensee.. Ove X.Ovbtv Z 010, Signature LIC.NO.:$4IJ7t irr�e (If applicable,enter exempt"'n the lice tuber li Bus.Tel.Nb.g ✓7 J� Address: 1 y C� _ G W eN t o Alt.Tel.No. t '57 *Security System Contractor License" for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Bability insurance coverage normally required by law. By my signature below;I hereby waive this requirement I am the(check one)n owner ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature _Telephone No. a- - All r • F A i G 0 k. w i Date. .. .r . ... . . HORTM ?�.<� •�,;.,��aoL TOWN OF NORTH ANDOVER K PERMIT FOR PLUMBING 3 SScwusE� This certifies that .c :� . . C�` ^'"9. . z. V has permission to perform . � 7 �^f,. . . . . . .:�.�. . - `,-. . . . . . plumbing in the buildings of . . . . f . at . . . . . . . . . . . . . . . . . �. . . -.`�-a- , North Andover, Mass. Fee. . . . .. . . . .Lic. NoU; .. . . . . . . . �-: . . . .- . . . . . . . PLUMBIN INSPECTOR Check 727 a MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date a f(0 1 p•7 NORTH ANDOVER, MASSACHUSETTS � Building Locations � ��' Il �c`�MCX,P_ �nur"�'" Permit# Amount$ ap Owner's Name New D Renovation Replacement Plans Submitted z a j w w a Q = F x a H ti m cn H w z p O z w d S w F a > Q ti Gz E" Z F F W V Q > O F W ,� F W V cG �- v, 07 O 7 O v� a x o x w 3 a v a a > A a F o b ' SUB-BASEM ENT B A SE MEN T 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . F L O O R 5 T H . F L O O R 6TH . FLOOR 7TH . FLOOR 8 T H . F L O O R (Print or pe) Chec one: Certificate Installing Company Name � 0.0i Corp. Addressgli Partner. f-n m4 o9;24a Business"I e ep one Firm/Co. Name of Licensed Plumber or Gas Fitter Da ij A 4 INSURANCE COVERAGE Check on pell 1 have a current liability Insurance olicy or it's substantial equivalent. Yes No� If you have checked�es,please' dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 Bond 0 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 13 Agent D I hereby certify that all of the details and information 1 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 C9de`an6\ChaDtcD 142 of the G eral Laws. By: Signature of Licensed Plumber Or Gas Fitter All— Title Plumber PL-�5077-M City/Town 0 gas Fitter License Numoer L=1 Master APPROVED(OFFICE USE ONLY) Journeyman �O• The Commonwealth of Massachusetts Department of Industrial Accidents k1VOffice of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):.gfmj e(`S u Address:^lot? ArJ1 nQ±Dn_ ao,tAAe_ City/State/Zip: 1)re.(, 0 I g&Q Phone.#:� Are an employer?Check the appropriate box: Type of project(required):. 1.LTJ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.msurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑Other employees. [No workers' comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 theoli ob site P cy andjob J information. Insurance Company Name: %rvtt.aJ v(`cO TnS't'Q rl Le A'OenTo 2T,7G- Policy#or Self-ins.Lic.M _Z_-& -3 y QSr O a -'T�fl -D 7 Expiration Date: c9 J J&)pg Job Site Address: City/State/Zip: Np�.�-T�f}p/BCl4 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 we1l 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 cert" der the pains and penalties of peri that the information provided above is true and correct. Signature: Date: W 710 7 _ Phone#: 7�;— S Ll Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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,association,corporation or other legal entity,or any two or more of the 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 evidence of compliance with the insurance 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)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry 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 the 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 number listed below. Self-insured companies should enter their self-insurance license 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 b.sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current V policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the 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 burn 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. #617-727-4900 ext.406 or 1-877-MASSAFE - -- - - - - Fax#617=727=7749------ _ ...,-.- Revised ..-Revised 11-22-06 www.mass.gov/dia Location� A rdmmz No. 5 Dater J NORTH TOWN OF NORTH ANDOVER : F •. Ow R s Certificate of Occupancy $ Building/Frame Permit Fee JACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 19982 � Building Inspector TOWN OF NORTH ANDOVER #OPTM APPLICATION FOR PLAN EXAMINATION °f•�`" '• �U Date Received 9 L Permit NO: Too -J ' �aa,KMus�` Date Issued: — IMPORTANT:Applicant must complete all items on this L ga_ e LOCATION PROPERTY OWNER Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE No Residential Residential 0 New Building 0 One family ❑Addition Q-Two or more family O Industrial C3-"emtion No.of units: 0 Repair,replacement 0 Assessory Bldg 0 Commercial 0 Demolition 0 Movingrelocation Other ❑ Others' ❑Foundation only OF WORK TO BE PRE] D DESCRIPTION � r?,4 Vl'14P- 14 f Kk cb- Identification Please Type or Print Clearly) 7 �( � OWNER: Name: Phone- 3 Address: avid d 6 Phone:CONTRACTOR Name: ( Address: Ql e q5,q11 5 � )l5�-11� Supervisor's Construction License: Exp. Date: � Ex � � r �7 Home Improvement License: p• Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.•512.00 PER 5100&00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER I F. Total Project Cost : �'� ��5' FEE:$ a}l Check No.: Receipt No.: 1 9qj�2 Page I of 4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be j obtained. Roofing,Siding,Interior Rehabilitation Permits o Building Permit Application v Workers Comp Affidavit U Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Addition Or Decks u o Building Permit Application ❑ Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L.Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations(If Applicable) ❑ Mass check Energy Compliance Report(If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned)to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report In all cases it a variance or special permit was required the icant most then get this recorded omce must stamp atedecision from the Registry oftDeeft Board of Appeals that the appeal period is over. The pp One copy and proof of recording most be submitted with the building application Doe:INSPECTIONAL SERVICES DEPARTMENT:aPFORMOS Page 4 of 4 i Buildin Setback ft. i Front Yard Side Yard Rear Yard Required Provided R uired Provides Required =Provided Dimension Number of Stories: Totals square feet o Q f floor area, based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA— For department use I i Page 3 of 4 Doc:INSPECTIONAL SERVICES DERAR TME4T:BPFORMOS CMMed JW.Jan.20ob TYPE OF SEWERAGE DISPOSA Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ F�Packaging/Sales p Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ Electric Meter location to project NOTE: Persons contracting with unregistered con Factors do not have access to theguars anti Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH DATE REJECTED DATE APPROVED ❑ ❑ COMMENTS FIRE DEPARTMENT -Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signa�pates Driveway P •+•+�• h II a 6 b NORTIy TO" Of _ over dover, Mass., ' O COCKICKEWICK 7�S RATED P'P�,��y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... Q�. .12�cC ,�C.,.... . .......................... ..........................................................:...... Foundation has permission to erect........................................ buildings on.A.1..... x.d Rn,a.!�-G�,...Q. .... ?.�d..�cd Rough to be occupied as....,s.t'Y.w-1.......�=.�.���...� �'��. ���... Chimney ............... ...... ............... ............... .............................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough ...... ... Service . ........ . ... .. ... .. .... ............ BUILD ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 1[__SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): w et -rml1 Address: � L City/State/Zip: ,fC)`�`� �" MUyy Dlxl/c- Phone.#: Are you an employer?Check the appropriate bog: Type of project(required):. 1.[31 am a employer with 2— 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g E]Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.# required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: C Policy#or Self-ins.Li c.M. C T Expiration Date: `51 U 7 Job Site Address: lo wod� k/d`*_ �r?_ - X/�mQK/frylor/S City/State/Zip: OZ F-(l5 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 insuran a coverage verification. I do hereby certify under th i d penalties of perjury that the information provided above is true and correct Signature: _ Date: a/ Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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,association,corporation or other legal entity,or any two or more of the 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.es. 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 evidence of compliance with the insurance 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)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry 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 the 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 number listed below. Self-insured companies should enter their self-insurance license 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 will 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 indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in I (city or town)."A copy of the 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 �telephone Department's address tel hone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE Fax#617=727_7749----- - Revised 11-22-06 www.mass.gov/dia 11/14/2006 09:20 FAI 9786885350 MACDONALD PANGIONE 0002 DATO&O-RA, CERTIFICATE OF LIABILITY INSURANCE i 41200 PRODUCER THIS CERTIFICATE IS ISSUED AS A rdATTER OF INFORMATION MacDonald Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLAER. THIS CERTIFICATE DOES NOT AMEND EX'[END OR P.O. Box 428 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE MAIC 0 INWARD D G Contracting,Inc INSURER A: AMERICAN HOME ASSURANCE 19380 428 Pleasant St. INSURER 8: N Andover,MA 01845 INSURER C: INSURER D; INSURER E: COVERAGES THS POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWTTHSIA-DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. pX I POLICY roUlAgt RoAYE e Y eiMNio�D TION LIMITS GENERAL LIABILITY EACH OCCURRENCE 9 COMMERCIAL GENERAL LIABILITY PR MISES a oxuran� 6 CLAIMS MADE ❑OCCUR MED EXP am Porn 8 PERSONAL BADVINJURY ; GENERAL AGGREGATE ; GFN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO ; POLICY PRO LOC AUTOMMLB LIABILITY COMBINED SINGLE UMIT $ [Ea acUdenl) ANY AUTO ALL OWNED AUTOS - BODILY INJURY ; (Perpereon) SCHEDULED AUTOS HIREDAUTOS BODILY INJURY $ (Peraaefent) NON4WNEO AUY03 PROPERTY DAMAGE -• (Peracddm,q AUTO ONLY.EA ACCIDENT E GAMOR LIAIRMY ANY AUTO OTHER THAN EA ACG S AUTO ONLY; AGO S E1:CESSIUMOREL1AILIABU Y EACH OCCURRENCE S OCCUR El CLAIMS MADE AGGREGATE ; s -- ; DEDUCTIBLE S RETENTION S WG$TATO GTN• A WORKERS COMPENSA'TIONAND WC8955680 03/31/06 03/31/07 EMPLOYERS LIABILITY E,L EACH ACCIDENT $ .._ 100 O O ANY PROPRIETORIPARTNERIEXECUTME E.L DISEASE-EA EMPLOYEE S 100,000 OFFICMNEMBER EXCLUDED? 11 yea da-.6b.under EL DISEASE-POLICY LIMIT ; f�O OOO SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLJCtn BE CANCELLED BEFORE THE ONRAT10N DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Of Needham NOTICE TO THE CERT MCATE HOLDER NAMED TO THE LEPT,BUT FAILURE TO 00 SO SHALL 470 Dedham Avenue IMPOSE'NO OBIXIAWN OR IJABIIJTY OF ANY IOND UPON THE INSURER,IrS AGENTS OR Needham, MA 02492 REPRESENTATIVES, AUTHORIZED REP - NTATiVE t ACORD 26(2001108) 0 ACORD PORATION 1998 r f k Z� iz i VA 47, j 'c 4vt") 3, Ar, fj-, C7 It ZE Tl,p7' to 'or 55K. litt�oi��sed Stsdd� Baird of Si�itding R TdN A _ IMPitdVEMEN C �- � 'GUL 21 u Dr�ll� GULEZI PL SA 5T '" �� r - A "taistrati�r tSft'�ii al�ll)OVE� MAb184� N - r-- � '�a;strc�Zusel�a a r� �'�1e�nammonrue�l� o�.v � • BC1Al2D.©F suiLOINGjttECUt,aT10Ng u, License: CON'SFRUCTI©N�UFERViSO } Number'-CS b01821 giith�late10IO2J4359 53960 x ' Ex��raa .1ISf0212007 tr no: tC Restricted,: � DAVID P OULEZIAN V` c 428 PLEASAN � �-` fi ST {�t•AfVDOVER, ivFA 0?845` CommissionetxAt t - j f" DG CONTRACTING INC. Kitchens,Baths,Additions, Home repairs, Finished basements,Decks,Excavation work David Gulezian President 428 Pleasant Street, North Andover, Ma. 01845 OFFICE; (978) 689-4797 HOME; (978) 683-0397 FAX; (978) 686-6337 MA LIC # 001821 INSURED Home Imp# 120199 January 21, 2007 Woodridge # 1.1 Ardmore Kitchen and Bath remodel Kitchen Remove kitchen cabinets, remove appliances. Install new ADA approved cabinets in off white.wood with taller(9")toe kick and lower counter. Install a new cook.top, oven and dishwasher. Appliances to meet ADA code. Re-paint the kitchen as needed. Install new counter tops. Install new sink and ADA approved faucet. Install new vent hood. Bath Remove and dispose oftu" nk and toilet. Move the toilet to meet code, install new toilet.( needs to be moved over 1 inch) Install an ADA 60" x 30" ride in shower unit. Move the sink to the other wall. Install new sink, ( sink on an angle). Install ceramic tile floor. Re-paint the bath. This price does not include any work not listed here. Price includes Building permits. Total Above: $ 17,575.00 Thank you It is ok for D o th o work / signature Title -r1A` � Date D �� .4 Date............... ............. Coo TOWN OF NORTH ANDOVER 'PERMIT' FOR WIRING S USEt 4. This certifies that ............ ............................................................ has permission to perform ... wiring in the building of...... ... ....�w mow., 4v.,..................... at.//.... ...................................... North Andover,Mass. Fee�.t............. Lic.No&..7.(. ELEcrRicAL INS ECCOR Check # . 65,51 Commonwealth of Massachusetts Official Use Only 64 Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONSP Y Occu anc and Fee Checked � w [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 03/16/2006 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) l 1 Ardmore Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive,North Andover,MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installed medicine cabinet Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above ❑ In- E:1o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection PP No.of Dryers HeatingAppliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. Icertify,under the pains and penalties ofperjury,that the information on th' ppI* ation is true and complete. FIRM NAME: Landers Electrical Co.,Inc. LIC.NO.: A5912 Licensee: Terrence J.Landers,Vice-President Signatur �� LIC.NO.: 9743 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 978-686-3828 Address: 1000 Osgood Street,North Andover,MA 01845 Alt.Tel.No.: 978-686-3829 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $20.00 Date.f�/ . .!��G.<. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �7S SAC14US� This certifies that . . . . .! U.C. C'. . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .LA,<i v. c^. . . . . . . . . . . . at. . ./. .l. .'. . . . . . . . . ., North Andover, Mass. Fee. . L. '. Lie. No../. P�OMBING INSPECTOR Check # 6777 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Locatio Owners Name oa- �d �W� Permit# ?j? �y� J Amount ll &TCjP-y � ! Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No twu El FIXTURES d > C'n C9 � 3 my.X SMEM ISS FUM 4 O 3Y41' IM 4FLOOR �`�M 5M /11MVCM ELOC Q/ 1�7{.A.AM (Print or type) Check one: Certificate Installing Company Name #Zj_J d P)/� A 0 ❑ Corp. Address F-1 Partner. usmess e ep one \® Firm/Co. 01 Name of Licensed Plumber: Insurance Coverage: Indicate type of ins ranee coverage by ecking the appropriate Krond Liability insurance policy Other type of indemnity ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p f ed un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massae usetts St Code d Chat of the General Laws. By: 1gna e o icense mer Title ypeof Plumbing License City/Town um i ense er M Aaster Journeyman ❑ APPROVED(OFFICE USE ONLY f1. ffj0LF P UH$LNF c& HEATM6 INVOICE NUMBER: X19103 INVOICE DATE: 14-DEC-05 P. O. BOX # 2229 SALEM, N.U. 03079 RANDOLPH H. HIOLF TEL: 603-$96-6505 MA. MASTER PLUMBER 12299 I:AX:SAME CALL AHEAD CUSTOMER: WOODRIDGE HOMES CO-OP TELEPHONE: ADDRESS: 1 O'WOODRID6E DR. PAX: CITY,STATE.POSTAL CODE: NO. ANDOVER,MA.01845 PO NUMBER: 11 ARDMORE CT i ORDER DATE GARY START END DATE AMOUNT vDY � SOgo.00 3 13=DEC-05 . 520.00 2ANDY TEMP ADJ. 1.00 $$0.00 14-DEC-05 80.00 PERMIT 1.00 X32 50 : , ,.: 1 s-OEC-05 32.50 RECEIVED ASPECTIOR 1,00 g0.00` 80.00 J 14 2 Q 2005 BY r TOTAI::ACTIVITY jCOST: �J t 2:50. i . 1)TOE 1IPOtRIYASTE 1- GA BRASS, hEMO-Vk S`L TUI3 : 65.00 1) 1/2 C 90 DRAIN/SHOWER HALVE 2.$0 0. 1/2'.CXM F IASTA LL HANDI—CAP.TUB 2.00 ?) 1/2 C COUP MOVE SHOWER VALVE 1.00 :1/2CX E DROP.90 LOCATION FROM.I±ROId1 SIDE 3.00 10`) 1/2 COP TUBE L 'WALL TO DRAIN SIDE Of TUU. 10.00 3).1/2C.MILMANGE#t HAVE WORK INSPECT D 9:00 1) 1-1/2 PVC SLIP EXT. 2.00 0.00 0.00 TOTAL MATERIALS COST. $94:$O IET. 10 DAYS THANK YOU TOTAL BILLING: $$07.30 Invoice �. . ... Date. . . . . ... . .. . ` NpRTh °F 1,y0 o� TOWN OF NORTH ANDOVER F D • PERMIT FOR GAS INSTALLATION . Io> 9 �9SSACMUSEt This certifies that . (.iC. ... . . ..T has permission for gas installation !t.•'1�. . .. . . . . . . . . in the buildings of at ,� ( i/. .</�!?. . , North Andov�r,, Mass. Fee,7 f Lic. GAS INSPECTORe% Check# �/ MASSACHUSET'T'S UNIFORMAPPLICA N FOR PERM TO DO GAS FI'T'TING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS �j Building Locations � Permit# �`� Amount$ Aw er's NameJ'1 yy��os New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ U a a o x v. .4 W Fr D" " Ey LYi Z O.� OUA4 94 aLn Da z w Ga O a W 0F. E F O SUB -BASEM ENT' BASEM ENT- 1ST. , NT1ST. . FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . F L O O R 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or ty ) Check one: Certificate Installing Company Name IG�Y1 (� ��/� LTi ❑ Corp. Address 2 L s "^� ❑ Partner. Business Telephone 'Firm/Co. Name of Licensed Plumber or Gas Fitter '✓1\ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No❑ .+ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 4!9--. Other type of indemnity ❑ Bond ❑ AOwner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑. I hereby certify that all of the details and information I have submitted(or d)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pe rmed der rmit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State as Cod apt 2 o th eneral Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber aele 3/ 3 City/Town ❑ Gas FitteriL c�ennsse Numer ❑ Master Journeyman APPROVED(OFFICE USE ONLY) � 4 f i Date. 06 c i 1h TOWN OF NORTH ANDOVER O� PERMIT FOR PLUMBING ,SSACMUSE� f� This certifies that .. . .f f . . . . . . . . . . . . . . has permission to perform �( plumbing in the buildings of at . . . . `- . ^- < . . . . . . . . . . . .`. . . ., North Andover, Mass. Fee-4 . .Lic. Nol--?d.l, . . . . . . . . . . �! PLUMBING INSPECTQFt Check # 6306 MASSACHUSETTS UNIFORM APP ICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS II ate 1 fi1ti y Building Location C' Owners Na C �� 0 A ennit# Amount 't�-v Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No 1 FIX URES Ste» BASEMErr ZUFL" a>HH-CM 5M FUM sM>A 7 ' gm FIlOC(Et (Print or type) CA Check one: Certificate Installing Company Name 11 .Corp. Ad ress ❑ Partner. 3D usmess Te ep one c _ HmVco. Name of Licensed Plumber: Insurance Coverage: Indicate te tyKof 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 ❑ I hereby certify that all of the details and information I have submitte (or entered)in above application are true and accurate to,the best of my knowledge and that all plumbing work and installations porme Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta ode and Cha eral Laws. BY na e o icense um r g e ype of Plumbing License Title City/Towncense u r Master Journeyman ❑ APPROVED(OFFICE usE ONLY Location I I A r—'vs Mr)R aC` No. 91 8 Date TOWN OF NORTH ANDOVER 0 „ Certificate of Occupancy $ i ,Building/Frame Permit Fee $ /u �+s cMugE CHU Foundation Permit Fee $ s^ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ .TOTAL $ ! u 8 1971 Building`Inspec or No. Andover Collector Div. Public Works __ _ ___ - __ -- `�tiitL,JC�a F r�0 ^ w�4 AJ'�tw\ ' �a.• i 1 a. 1/i yy�.«....+I'�.Y i"\��4• F✓ie �:pCl�li f� �. da/ R _ � _ ... _ .. _. -. � w��i ! ��.��.. li.� ice.. r � � r .� Location I I Qin�1a exrf2 / I No. ! Date o °RT►, TOWN OF NORTH ANDOVER F „ Certificate of Occupancy $ Building/Frame Permit Fee $ 'rl •O��no•�,y� ,SSACNUSEt Foundation Permit Fee $ II Other Permit Fee 's k $ ySewer Connection Fee $ " PAY&wage Connection Fee $ i u' l 4 MITOTAL Q -_-` ��• Andover Collector Building Inspector Div. Public Works 4 _ _ _ t s` .T�;. �,'��', r o �h `i�`:f`:4 F i -�' !!'.�i. 1�� � k2 �+',��.t le�+� a��• �.. .,"/ is C? " +.C. _tom'. _. ._ - _ . —f 4.V s�}i PEa�uT�N�. o�.l S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1✓ JMAP i4O. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONX I SUB DIV. LOT NO. - LOCATION PURPOSE OF BUILDING OWNER'S NAME ✓ I fir-. ,® ���' NO. OF STORIES SIZE OWNER'S ADDRESS ,0��� T BASEMENT OR SLAB ARCHITECT'S NAME /v A SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME i � SPAN DISTANCE TO NEAREST BUILDING ���vF �� MENSIONS OF SILLS -- --- DISTANCE FROM STREET O / POSTS DISTANCE FROM LOT LINES—SIDES R GIRDERS s AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION V THICKNESS IS BUILDING NEW / SIZE OF FOOTING f✓' / O X IS BUILDING ADDITION v% MATERIAL OF CHIMNEY N IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND O �Q WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER A/ BOARD OF APPEALS ACTION, IF ANYAv IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS .�'CdLr� tai SS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES -� EST. BLDG.�COST -I-•K l 8 q: /J PAGE 1 FILL OUT SECTIONS 1 - 3 �.?Ob� �� I � R]V�.QIL>�}-'C, r�C� ('L EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 12 �(�� \�yq,.�Q ��, 1 EST. BLDG. COST PER ROOM - �— SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANID APPRO ED BY BUILDING INSPECTOR /I l� DATE OILED ✓ � f (� / BOARD OF HEALTH SIGNt. TURF OF OWNER OR AUTHORIZED AGENT T F E E 0E, PLANNING BOARD .s PERMIT GRANTED 19 I BOARD OF SELECTMEN OWNER TEL.# CONTR.TEL.# BUILDING INSPECTOR CONTR.LIC.# BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW'D PIERS PLASTER _ DRY VJALL _ UNFIN. 3 BASETENT AREA FULL FIN. B'M'TAREA _ '/ 1/1 y, PIN. ATTIC AREA - N_O BM'T FIRE PLACES HEAD ROOM MODERN KITCHEN n. WALLS I 9 FLOORS CLF�7BOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDV✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER­B LK ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT 11.SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER - ROLL ROOFING MODERN FIXTURES TILE FLOOR - TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNArE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'ml 2nd _ ELECTRIC 1}t 13rd if NO HEATING r 'r G NORTH . , • own 0 , h ` 6 a. O 4 L over ., No. 218 o -'rte ' DRIVEWAY ENTRY PERMIT CCCC 19 � C HIM1 K WICK er1 Mass., 4v !• ` BOARD OF HEALTH `-4 w y fl r Y 4 � ' THIS CERTIFIES THAT..... .. .. .. . ' �................... ....... , has permission to erect ... �.`-... .... buildings on .. f� .1r ....,,.,,, ', RoughUILDING INSPECTOR ..• NS y �/ . Chimney s tobe occupied as...... ................................................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSftCTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough °r Buildings in the Town of North Andover. Final p VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRZAL INSPECTOR Rough UNLESS CONST C R ® Service Final .... .. ... ......... ........ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requi d to Occupy Building Rough a Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector r _. J 5x ky��p _ Is WINpO SLAEL- \ ;l 1 N D O W R E A A® fl4T 10 E R 5 2) -SONG: P�4TtC) GC>NT o w u o(,A 111i; WOODEN R- f .PARTITION MOM OF wOcDEN PARTITION �� OwNERSHIR ILL MA r �PC*T JSPItCCIA S -- - _ ELOCA oom -:§rs9;�%�--_..�a�, <. ,g. _ _ .'.-,: *•� '9 .'aaw�-cJ�-�3 ._ _. ?a.:� `tea=a^-�Y's.+.�+... .�-a,�.•a � ,._..L�`:.--_._-:="-�.�"'`�-�" '�'-£ ••--- �{ ". Y ' ' y ♦7 '' k 5 1, � 1 ' + ' `R ./ ill C: ' Ili to tt— — A _._ . , v 6 O lo— & N. ori". y,•, J t: ��. R P M1, , la d T r _ PA R. �o aT i r At�o�n�R�.:._co T_ "F r67 � 09,15Y-- M1KALE, • E� MERGApo till �e O( $ SLALE NOEJbA�E:;I :. s T TED-TO t :4� `'R'��F., �� �'• � h :.4 til �y' M b .w rNt14*9Y .x F iy ;.i . ti. ,♦.,,.. ..... ,:. •..:p .. ,n. iYMi1L;1 ..' � � � L i WAG.•a,.ctiEi�aCill.c.1'9":rW;aeF.(G:a.�1Y1RCh�.♦'�.cYl.wG�.&;7'1Kkt1i"`.�d.t":as5ty'�Li:4L..LhWi.'I,sJdi,:wtiliv:iYd:�`a+.A,CA44Ldaw2�u k4 �.iU�ffi4�P I F.. � � k$S�&4kdfLWy9.iiY„�1iM110iA6rlISLiQ.aakrdl5v'a!'.•id�ifwl . �'"•`. .. K J•w vW .d J+79Wn7++.r ww.M M^F�dga !+«�+Pr ri+� -b+nwdw.+°e Wreg.wi.+.+'nwvwv�rvw+rcrul+ vwn.. .. 53� J ":tra�0.,tu.!i..5•itk'ta::.. r .,w.wa+ w .�:�dumnG�Ska+a4� _ •..:�"' "�'fFkt'��t�?.�i�,t!i '�3S'�•'4'r;A�'.'._ n.�. ..�ttsl�fi':�fi�'atd3:c.' ' .cam' :r+� .- — =:�iYF°'� - ...._.,. - ..•,. ,ca..asvnma_�._.xa.: .w.T.:.t....,e.rm:....�`s:Y [.e,�:s♦"c'43f1 � r-,a.,�ad * �V r I ' �t�N.= � _•�• ! �1 ! i.. I I I /. 1 1 / k' ' ry� n M � IV I IV Im r]PJ LFINAL F I RTH own Of _ 6 O An(d 0 No. 218 Ch DRIVEWAY ENTRY PERMIT1 er, ass.. MAU aa 19 A C HI HE WICK\� h 0R ?� BOARD OF HEALTH THIS CERTIFIES THAT................... . . ..... .. ................. ,...... ® BUILDING INSPECTOR has permission to erect .... ........... .... buildings on ...�.� .. .... ........::................. ... Rough to be occupied as..... .t �r, ..... Chimney Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONST C R �. service �Ll.ow C.catis s'�'j2trt,C�'�I o,p p� t o Ft X l .. .. ......... ....... Final t1 D n%Ir n vh L_ r&c = o Ar/o, o e `;g j BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requi d to Occupy Building Rough Final Display in a Conspicuous Place on the Premises ' Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector � ' . . ^ ' Ridge Wood Drive North Andover, Massachusetts 01845 ' - 714p6one6820093 June 18, 1991. � Mrs. Doris Mercado ll Ardmore Court / No. Andover , M4 0184� � � | Dear Mrs' Mercado:: ' Enclosed please find the Wood Ridge Homes Deck Specifications.. ' Please note that any deck exceeding ten feet by ten feet requires board approval . Any deck ten feet by ten feet or less may be op - proved by this office' | i Upon approval , a building permit is required from the town of � North Andover before construction can begin ' A deck will be con- � sidered on improvement once the final cost and o ropy of the building permit is recieved by the office' Please contact the office if you have any questions regarding this process' Sincerely / B RK T C01%'1PANY Paul E. Bengtson Property Manager � � � �