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Miscellaneous - 11 HAMILTON ROAD 4/30/2018
11 HAMILTON ROAD \ 210/016._ 0-0033-0000.0 I I Date.. ..I2..�. ........................ f OF NORT/i,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 8$�CHus� U�P112 c� U vv Thiscertifies that ....................................................... ..................................................... has permission for gas installation ... ............................................... in the buildings of....`- .v .... .. ".:5.............................. .................................... `---1' 2C a , North Andover Mass. at............ ` ............................................................................. No , Fee ....... Lic. No. ..�.� .... .... GAS INSPECTOR Check# " )� r r� PO Box 55098 Boston,MA 02205-5098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: DARREN T HOPKINS and FELICIA M HOPKINS Property Address: 11 HAMILTON ROAD,NORTH ANDOVER,MA Policy Number: HMA 0285814 Claim Number: BOS00049414 Date of Loss: 2/15/2015 Company: Safety Indemnity Insurance Company 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, Chapter 139, Section 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 number. Jedd Canane Claim Examiner 2/19/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3347 Fax: (617)531.-8897 Email: JeddCanane@Safetylnsurance.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY {— MA DATE PERMIT# IZ7 lT JOBSITE ADDRESS OWNER'S OWNER'S NAME GOWNER ADDRESS TEL��y FAX TYPE OR EDUCATIONAL OCCUPANCY TYPE COMMERCIAL PST ® RESIDENTIAL CLEARLY NEW:E3 RENOVATION: REPLACEMENT:El PLANS SUBMITTED: YES 0 NOE] APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - - � COOK STOVE DIRECT VENT HEATERI DRYER - FIREPLACE FRYOLATOR — FURNACE GENERATOR GRILLEC— INFRARED HEATER LABORATORY COCKS L — MAKEUP AIR UNIT OVENI- POOL HEATER ' ROOM/SPACE HEATER ROOF TOP UNIT [- TEST �- UNIT HEATER _- UNVENTED ROOM HEATER WATER HEATER } �� OTHER ................... . ........................................._ - - - --- - ---� =-- -- INSURANCE COVERAGE I,Liave a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES ENO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ` LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY El 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. SIGNATURE OF OWNER OR AGENT ONLY: OWNER ! ENT hereby certify that all of the details and information I have submitted or entered regarding this appl' ation are true an a 'u t th st of y knowledge and that all plumbing work and installations performed under the permit issued for this application w be in com Iia a 't II Perti ro sion of the Massachusetts State Plumbing Code an Chapter 142 off the General Laws. PLUMBER-GASFITTER NA I(W LICENSE# Q/ SIGNATURE IVIP�MGF 0I JP J JGF� L I� CORPORATION R# PARTNERS IP®#L- 9 LLC E]# COMPANY NA j•-. ADDRESS -J CITY ( STATE l'1A' ZIPrTEL 3 FAX�� CEL T ' _. 0—_![MAIL / ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTO R USE ONLY FINAL INSPE TI NOTES 1 Yes No 30� c 0a THIS APPLICATION SERVES AS THE PEI ZMIT ❑ ❑ FEE: $ PERMIT# I PLAN REVIEW NO rES v The Commonwealth of Massachusetts -� Department of IndustrialAccidenis Office of Investigations qu 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Tndivi ual): L (n Q Address: City/State/Zip: Phone#• Are y an employer?Chec the appropriate box: Type of project(required): 1. I lam a employer with 4. ❑ I am a general contractor and I 6. ❑New construction IV employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub-contractors have S. [J Demolition working for me in any capacity. workers'comp.insurance. g. E]Building addition [No workers' comp.insurance 5. FJ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[1 Plumbing repairs or additions myself. oworkers' cow. c. 152,§1(4),and we haven 12.n Roofre airs insurance required.]t employees.[No workers' 1311Other 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 aie 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 their workers'comp,policy information. I am an employer that is providing 7ers'compensation insurancefor my employees. Below is thepolicy and job site information. Insurance Company Name:. 1(jc C Yj t Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip:4-d Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 imprisomne , s wellas civil penalties in the form of a STOP WORK ORDER and a fine of up torO6.0 a gainstviolator. B�ge Vr- t copy of this statement may be forwarded to the Office of Investigthe D for• ante covercati Ido here certo and r th pins nd Ina er' that the information provided above is true and correct. Simature: Date: r l Phone#: q) �-- —g�3 Offrcial use only. Do no 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-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 carZLwrRQrs'compensation insumnce Tf_ LLC or LLP doGs4mv@-- 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 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 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 ladustdal Accidents Office of Investigations 600 Washington Stxeet Boston}MA 02111 TO,#617-727_4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Fax#617-727-7749 Www.ixlasszovl is Date.... 1.. l ............................. �pORTF� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that'f* ......`....C........e,.....�!1n4eAt4i �rJt^,aa has permission for gas installation . 4 W« 3. .e inthe buildings of..- -5............................................................................. at........�.k..........+��m, ... . ......................... North Andover, Mass. Fee ' '....... Lic. No. ..�-fir ...... .00.... ................................................... GASINSPECTOR Check# � n � � 0 � 3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE 3/24/2014 ERMIT# JOBSITE ADDRESS Am� v\ OWNER'S NAME GOWNER ADDRESS I Same 1 TEt] _._ ___ -- ��FAXr TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIALE] PRINT CLEARLY NEW:® RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES[j N0[j APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace Gas Meter x 11 and Pi in as Needed h INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE# 8736 SIG ATURE MP EI MGF® JP[J JGF[j LPGI[j CORPORATION E]# 3285C PARTN SHIP®# LLC®# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE MA ZIPJ 01501 ]TEL (508)832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAILI JMarino@RHWhite.com 0\ � 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ bS o t FEE: $ PERMIT# PLAN REVIEW NOTES 1 I _ _ _=:COJNpi :O'IVWEALTH OF MASSAE. U -- - --= --s•: - 5julli MINIM. - BERS AND GASF T7'E W -=- 1 f ."S C fCk S'ED AS•A•MASTER P?,�U �R }✓�`r:' - ".-ISSUES TH.E`A13QUE'•9.UC6NSE fd:' =:3~ R12IYIVG i ON ST _WQR ESTER MA 0: �14"LiZ I-0= "' 6 05/OI/14 � { I : =s_C;OitliMONWEA'LTH OF dUTASS/AC3'#ISE, P'L*Tip, RS AN❑ GASFI—TE-R LCENvSED AS A JOURNEYMAN Mul , =l-SUES THE ABOVE LICENSE =JDSE'PH`✓>D MARINO _ 1 3` Fi4fRT=NGTON Wow. STS R .- �9A 016 :4==3Fb9 05/01/14 `�.. pill 1 i 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 ACVRD CERTIFICATE OF LI DATE(MMIDDNyyyi ABILITY INSURANCE Page 1 of 1 08/29/2013 THIS CERTIFICATE IS ISSUED ASA 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 Polic0es)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 certifleate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTANAM .CT willia of Massachusetts, Inc. PHONE C/O 26 Cea]tury Blvd. N0_QCD- 877-945•-7378 FAx-NO) 888-467-2378 P. 0. Box 305191E-MAIL Naghville, TN 37230-5101 D.DRESs aextificateawillia.com INSURER($)AFFORDINGCOVERAGE NAICIt INSURED INSURERA: The Charter Oak rico Insuranco Company 25615-001 R. X. White Construction Company, Inc. INSURERS.Travo7.gr9 property Casualty COAtPany or Am 25674-003 41 Street 0. Box P. 0. Box 257 IN5URERC:Nati0nal Union Piro Insurance Company of 19445-001 AubUrn, MA 01501 INSURERD;Travelers Indamnity Company 25650-001 INSURER F,; INSURF,R F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER; 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 OR 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. INSRTYPE OF INSURANCE OD' SUB POLICY EPP POLICYEXP vvvn POLICY NUMBER LIMITS A GENERAL LIABILITY VTC2000 977X9948-13 9/1/2013 .9/1/2014 EACHOCCURRENCE 2 1,000,000 X COMMERCIAL GENERAL LIABILITY TO RENTF,D ��� I S Its occurnnuo _ 3 0 tl,00 0 CLAIMS-MADET OCCUR MED EXP(Any one ereon R 10�000 PERSONAL&ADV INJURY S 2 000,000 GFNERALAGGREGATE S r}r00( OOO GEN'LAGGREGATFL RITOAPPLIESPER; PRODUCTS-COMPIOPAGG $ .1.000,000 POLICY LOC AUTOMOBILE LIABILITY VTJCAP 977R955A-13 /1/2013 9/1/2014 X OtaBNEDSINGLF,LIMIT ANYAUTO $ 2,000,000 A{I,O 'NED SCHEDULED BODILY INJURY(Perperson) $ AUTO' AUTOS BODILY INJURY(Peraccident) $ X HIREDAUTOS X NON-OWNED _ AUTOS er PER_nt $ X Co Ded X Cc11 Ded S 00 C UMBRELLALIAB X OCCUR BE8766140 9/1/207,3 9/1/2014 EACH OCCURRENCE $ 5�X00,000 EXCE58 LIAt3 CLAIMS-MADE AGGREGATE $ 1000,000 DED $ RETENTIONS 10,000 S D WORXERS COMPENSATION VxRK[jS 8205A185- 9/1/2014v - ANDEMPLOYERS'LIABIL 13 9/1/207.3 ITY }� Y N TAR,Y,LJ. D ANVPROPRIETORIPARTNFRIFXECUTIVE VT C2KUH S20 9A71A 3 MITS ER � NIA 1 9/7./2023 9/1/2014 OFFICER/MEMBFREXCLUDED7 � E.L.FAGHACCIDENT !F 1,000 000 Iiy((MenC7ltletorryYlnNN) E.L.DI8EASE-EAEMPL0 EE S 1,000,000 ee,deebe undnr UEGSUKII+I IUN U-0PURATIONS below Fl.DI'EASE-PoLICYLIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aggch Aeord 101.Addltonal Remarke Schedula,If more ep eea Is roqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence Of xnmuxance AUTHORIZED REPRESENTATIVE Colli4197604 Tp1:1694012 Cert:20267680 ®1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I i. . DATE: SCOTT L. GILES FRANK S. GILES II SEPT. 15, 2003 REVISIONS: FRANK S. GILES i"OF SURVEYING - ��°� FR " o� SITE J R P PROPOSED FOUNDATION )AC Pnl- 17 T �' Q*( EXISTING FOOTPRINT P SCALE: 1 INCH= 40 FEET 50 DEERMEADOW ROAD P?� - �i3 NO. ANDOVER MA 01845 P r r 80 � Ff$S\OC� MAP 16 ° 40 r TEL: (978) 683-2645 qNa SURvO sSP MAP 16 PARCEL 37 E-MAIL: FrankGilesSurvey@attbi.com SEPT. 15 2003 PARCEL 34 LOCUS 1000 ,x 1 INCH= 1600 FEET r L PLAN OF LAND tiL MAP 16 L LOCATION z9 LLLLLL .C�"r ,r �s 'L L Ly' PARCEL 33 11 HAMILTON STREET MAP 16 4 �L LOT 2 N. ANDOVER,MA. PARCEL 29 k- �, a d � DRAWN FOR AREA=10,000 SY LESLIE M. HOPKINS 3 MAP 16 100°0 PARCEL 38 ZONING DISTRICT R4 MAP 16 "k PARCEL 30 SUBJECT PROPERTY M O AP 16 MAP 16, PARCEL 33 PARCEL 32 11 HAMILTON ROAD `Q HOPKINS, LESLIE M AREA=0.23 DEED BK. 5521, PAGE 101 D.O.5.1946 MAP 16 PARCEL 31 I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NORTH ANDOVER, MA. AT THE TIlVIE OF CONSTRUCTION. THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR �G ONLY AND SUCH USE IS FOR THE DETERNIINATION OF ZONING CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED, C:\CLIENTS\PARKER\PLOT PLAN.DRG Location Aq No. —�� 1� Date Aa u MaRT►, TOWN OF NORTH ANDOVER 41 Certificate of Occupancy $ cHuEta' Building/Frame Permit Fee $ s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # -2n l p 167 : Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. Y� DATE ISSUED: SIGNATURE: .� Building Commissioner/InT2 for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 (e — 1fMap Number Parcel Number�,g.� t � . � 1.3 Zoning Information: 1.4 Property Dimensions: 0e97!— Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water S ly M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Z &zv/6 s /1 XGAtltoy, /Z�. /l1.A &C • O Name(Print) Address for Service - 6S - SSS Signature Telephone 2.2 Owner of Record: W Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Lice sed Construction Supervisor: Not Applicable ❑ 11 ' &L- ,licensed Construction Supervisor: �y/� 5 O R 9 �Gr{�� S/• /�� A/�G(�IJLt- /�'/Lt, O1�s�lJ License Number mn Address 511 /o 5 > M /1-\ ��mks E � q7 5f y75 dao 3 Expiration Dat 3 Signature Telephone rm 3.2 Registered Home IImprovement Contractor Not Applicable ❑jv Company Name 06 X11 lir y/L_L S- /G» A��UL�✓ /, /p/ Registration Number r Address 7 ! ff- ,�/ i/`/G.� r X7.5 �a a 3 Expiration ate ^ Signature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes..... A2 No.......❑ SECTION 5 Description of Proposed Work check allapplicable New Construction ❑ Existing Building ❑ Repair(s) 11Alterations(s) ❑ Addition 411 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: n aveL�-1-- r�1+P,� V- yJk4n moll xl � _ :67 `17i,It lG 1� Lj�� 1�Lv�cc l, pla L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 44Z Multiplier 2 Electrical (b) Estimated Total Cost of > (n� r_� SOGC� Construction (0 3 Plumbing p Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 1q9—.1F0—Z5 Check Number SECTION 7a OWNER AUTHORIZ4TION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L�S�� �o,�I�l� as Owner/Authorized Agent of subject property Hereby authorize !��a!h A�,Y/eg A�s to act on My behalf,in all matters relative to work authorized by this building permit application. / Signature of Owner ' Date SECTION 7b OW/NER/AUTJHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject i 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 f �,Gyj�!f /-A-- �- 2/A/'/0 3 Signature of Owner/A ent Dat — NO. OF STORIES SIZE f BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND RD 3 SPAN MIENSIONS OF SILLS DMIENSIONS OF POSTS DINIENSIONS OF GIRDERS f MIGHT OF FOUNDATION THICKNESS SITE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U LOT RELEASE FORM Pk->i\--tows �. nQd r' C o rvu�e 7-ZL-�3 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT C� U � '2 B �(ti� PHONE-" � LOCATION: Assessor's Map Number PARCEL I l SUBDIVISION LOTS) STREET 1''A 1 -Rcc ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** REC ENDATIONS, TOWN AGENTS: CO SERVATION ADMIN TRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm E.M.H. Construction Corporation 9 Bartlet St. Suite 102 Andover, Ma. 01810 978-475-8203 Residential Construction Agreement Where the basis of payment is a Fixed Sum Please read this ajereement carefully and make sure you understand it before signing it. This Construction agreement has legal force and effect and binds those who sign it to the terms and conditions stated below. Consultation with an Attorney is encouraged. Notice: All home improvement contractors and subcontractors engaged in home improvement contracting in the state of Massachusetts, unless specifically exempt from registration by provisions of chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,Ma. 02108. Designated Registrants Name: E.M.H. Construction Corp. Mass.Registration Number: #106898 Sales Rep.Name: William Hurley Construction Supervisor ID: #052262 This agreement is made on July 1, 2003 between E.M.H. Construction Corp. hereinafter called the "Contractor"and: Leslie Hopkins of 11 Hamilton Road,North Andover, Ma. Hereinafter called the "Owner". The Owner and Contractor agree to the terms and conditions set forth below: SECTION 01 Description of Work to be performed: In accordance with plans Supplied by Bruno Associates and specifications attached to this agreement by Contractor, as set forth in addendum to plans or specifications, exclusions or other documents describing project scope before commencement. Above mentioned documents shall be initialed by both parties upon signing of agreement. Contractor shall provide sufficient labor,materials,means,methods, and construction management administration,to complete project as described above according to the terms set forth in this agreement. All pians and specifications as described above are included in and hereby form a part of this agreement. SECTION 02 Agreed upon price: Contractor agrees to perform work described in plans and specifications and according to terms and conditions set forth I n this agreement for the Sum of $142,800.00 RIGHT TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than an address of the Contractor which may be his main office or branch thereof,provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See attached Notice of Cancellation. HOMEOWNER: DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES By signing below E.M.H. Construction Corporation and the Owner stated on page one of this agreement hereby agree to all terms and conditions included in this agreement: Owner Signature: Additional Owner Signature: Contractors Signature: DATE OF TRANSACTION: 2117103 NOTICE OF CANCELLATION You may cancel this transaction,without penalty or obligation,within three days from the above date. If you cancel, any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned by the Contractor within ten business days following receipt of your cancellation notice.Any security interest arising out of the transaction will be canceled. You must make available to the Contractor any goods delivered to you or your residence under this agreement,in as substantially good condition as when received,or you may comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractors expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty days of he date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make goods available to the Contractor,or if you agree to return the goods to the Contractor and fail to do so,then you remain liable for performances of all obligations under this agreement. Co cancel this transaction,mail or deliver a signed and dated copy of this Notice of Cancellation or any other written iotice,or send a telegram to E.M.H. Construction Corp C/O William Hurley 9 Bardet St. Suite 102 Andover,Ma. )1810 or contact office at 978475-8203 NOT LATER THAN MIDNIGHT OF I HEREBY CANCEL THIS TRANSACTION. DATE: 3WNERS SIGNATURE OWNERS ADDRESS ALLOWANCES Lestey HoWns 11 Hamilton Road No.Andover. We ITEM CONTRACTOR SPECS EACH AMT TOTAL PLUMBING FIXTURES Bath Iav sinks Choice $125.00 2 $250.00 Bath lav faucets Choice $75.00 2 $150.00 Shoveler valves Choice $100.00 1 $100.00 Toilets Choice $175.00 1 $175.00 Fiberglass Tub/Shower Choice $800.00 1 $800.00 PLUMBING TOTAL $1,475.00 ELECTRICAL FIXTURES Exterior rights Choice $30.00 3 $90.00 Varsity strip lights Choice $30.00 2 $60.00 Hall/bed/other lights Choice $30.€10 5 $150.00 ELECTRIC TOTAL $300.00 CABINETS Vanity Lineal Footage $200.00 5 $1,000.00 KJTICABS TOTAL $1,001.00 FLOORING Tile material All Lite areas-$4.00 Per Ft $4.00 300 $1,200.00 Carpeting $18.00 Per SCS YD Installed $18.00 40 $720.00 FLOORING TOTAL $1.920.00 MISC FIXTURES Towel Bars Choice $15.00 2 $30.00 Paper Holders Choice $15.00 1 $15.00 Mirrors Choice $50.00 1 $50.00 Garage Doors Choice $800.00 1 $800.00 MISC FIX TOTAL 5895.00 TOTAL OF ALLOWANCE ITEMS $5,590.00 NOTE- ALLOWANCE ITEMS ARE NOT EXPRESSED IN MAIN BID-PLEASE ADD THIS TOTAL TO MAIN BID s I I MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I I I I Checked by/Date I I i TITLE: PLAN NO. NA 6731 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-8-2003 DATE OF PLANS: 5-7-03 PROJECT INFORMATION: ADDITION TO EXISTING HOUSE COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N. N ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 162 Your Home = 135 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1140 30.0 30.0 19 WALLS: Wood Frame, 16" O.C. 640 13.0 13.0 31 BSMT: Conc. 8.0' ht/7.0' bg/8.0' insul 390 19.0 19.0 9 GLAZING: Windows or Doors 120 0.310 37 DOORS 126 0.310 39 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date J I l TITLE: PLAN NO. NA 6731 1 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 5-8-2003 Bldg. l Dept. l Use I I CEILINGS: [ ] I 1. R-30 + R-30 I Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C. , R-13 + R-13 I Comments/Location I I BASEMENT WALLS: [ ] I 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 cavity + R-0 continuous I Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.31 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? ( ] Yes [ ] No I Comments/Location I DOORS: [ ] I 1. U-value: 0.31 I Comments/Location AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I DUCT INSULATION: 4 i [ l I Ducts shall be insulated per Table J4.4.7.1. I ► DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or { joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the ► manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I { TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual ► or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 1250 of the design load as specified I in Sections 780CMR 1310 and J4.4. I ► SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from { non-depletable sources. Pool pumps require a time clock. I { HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I ► PIPE SIZES (in. ) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: ► Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I CIRCULATING HOT WATER SYSTEMS: [ ] { Insulate circulating hot water pipes to the following levels (in. ) : I { PIPE SIZES (in.) { NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS ► HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" { 170-180 0.5 I 1.0 1.5 2.0 i 140-160 0.5 { 0.5 1.0 1.5 I 100-130 0.5 { 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- Comoro uwah of W=ad=es,is cDepamnmt ofInd=tniacAxidenU ofInvz*ati= 600 WtlShsnBton.Street Boston, MA 02111 Workers'Compensation Insurance Affidavit Please PRINT L edbly APPLICANT INFORMATION I Name: Location: CiTelephone#: ty: ❑I am a homeowner performing all work myself D I am sole proprietor and have no one working in my capacity . (I am an employer providing workers'compensation for my employees working on this job Company Name: Address: City: Telephone#: an %�/^oty� Y -- Policy#:Ty W 5O 7 UB Insurance Comp y or homeowner and have hired the contractors listed below who have the following D I am(circle one) sole proprietor,general contractor workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company. Polite Company Name: Address: Telephone M City: Policy#: Insurance Company: Atrach additional sheet if necessaryup to Failure to secure coverage as required under Section 25A of fMf L 115B rm of�OP WORK ORDER and a fead to the imposition of me criminal $100.00 a day against me�500.00 and/or one years' imprisonment as well as civil penalties in understand that e copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties of peerjury that the information above is true and correct /j^ �/�� Date:18 l o Signature:/ �ll e v 1 Phone# 279 610 — Print Name: '� Official Use ONLY-Do not write in this area ❑Building Department Permit/License#: o Licensing Board City or Town: o Selectmen's Office a Health Department ❑Other 0 Check if Immediate response is required ✓,n F ✓d / Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration_ 106898 Expiration: 7/2812004 Type: Private Corporation E.M.H.CONSTRUCTION CO. William Hurley 9 Bartlett Street,Suite 102 Andover,MA 01810 Administrator BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 052262 Birthdate: 05N41959 Expires:0514/2005 Tr.no: 11053 Restricted:.00 WILLIAM A HURLEY 9 BARTLEiT ST#102 ( ,y-e ANDOVER, MA 01810 Administrator 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) Signature of Pe it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector N-1 I T : / Wtfit.. �S IA t /OU Z8 �- /ap ' ccr CERTIFIEfl- PLOT PLAN e raaTury TNnT 7luc t n7 Is r1oT.vi TliE FIA. _ _ _ _„� ,�, rr �� V lit I I J IOU ! T t I C� m/ C/Al A Oar o/ CER7IPY 711A7 TINS LO'T 13 NOT 91 711E F.I:A. CERTIFIED PLOT PLAN FLOOD MUM) ZONE. 7113 CCnTWICATIOU 13 BASED OF LAND IN Oft! 711_ SURVEY MAMMAS OF OIIIERS, AND IS NOT A f ROPCRTY 5Ut?VCY, ron mon*iGAGC PtIKPosCs ONLY. I CERTIPY 'THAT 'THE BUILDINGS ARe LOCATED AS SHOWN, AS DRAWN FOR AND •ft1A'T'•Timy CONP0I31.1EO 10 JHE 70f G BY-LAWS , OP '1111! CITY/ OF 1/��.4•/ WIILN CONSTRUCTL'o. it SCALE 1'* DEED Book Z_�/-2_/ PAGE -- LOCATED AT AREA /U, DU a ,) `i? PLAN /S 9 Z, P. ASSESSOR MAP moom No. 22150 ©LOCK �clmc °� R.A.M. ENG NEERING uNOS 160 MAIN STREET LOT 2 HAVERHILL, MA. ' 50E1-X72-04 49 ORTH Town o -Andover _ _ CAKE O, dower, Mass., /p —��o?yd 3 COC MIC HE WICK AOA 7E D j SSA USS FOR EXCAVATION AND FOUNDATION THISCERTIFIES THAT ....... ............� . ........!V.5...................................................... ...................... has permission to excavate and pour foundation at ... If A ) � q40 R pI ...G=.„a... ... . ....a....�......+ glorDw for the purpose of... �iV� �......t. �� The person accepting this permit must return to the office of the Building Ins pe ;;114;; ified plot plan show of building thereon before Foundation will be inspected. /4&/3.3 001M VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. C6 BUILDING INSPECTOR NORTH E Town of , Andover No. 4; 9 /�-7-aoo 3 o,� �OCH,� dover, Mass., s RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......i .Sr1. ............ � �y S .... ..................,....... ..� ......... . .. Foundation �' 4 has permission to erect../ 1!b01�............... buildings on ...... ............................................................ Rough I to be occupied as...rt.... t AAc ..... •3.. .A .a0p a rr. fit/ I'�...� #04$WILChimney .. .. . . . .. . . . provided that the person accepting this permit shall in every respect conform to the t ms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin t e I ion Afteration and Construction of Buildings in the Town of North Andover. ,/,&/� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations_Voids this Perm' . Rough PERMEXPIRES IN 6 MONTHS Final IT UNLESS CONSTRUCTION STTS ELECTRICAL INSPECTOR VService ............................A........ ....• .... ou BUILDING INSPECTOR 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: SEE REVERSE SIDE smoke Det. (I/ CERTIFIED PLOT PLAN 1 LOCATED IN NORTH ANDOVER, MASS. SCALE.-1"=40' DATE.3/1/2004 a - , - off Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. ASSESSORS MAP 16 PARCEL 33 100.00' N _15'+ EAD O EXI_ STING oDWELLING $r HSE.#9 M + 4 N 100.00' HAMILTON ROAD I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE P�ZH tlF R THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE o� S L WITH THE ZONING DETERMINATION OF ZONING 3972BYLAWS OF 0 NORTH ANDOVER CONFORMITY OR NON-CONFORMITY STIR WHEN BUILT WHEN CONSTRUCTED. 3 12 Date.. ..... ........... .. NORTH 3�01 tom'. °L TOWN OF NORTH ANDOVER PERMIT FOR WIRING # o'"'444``` ����• �,SSACMus� This certifies that ../ '. ..`�`�....St............................................................ has permission to perform ........ .�-. f`�� �.......�........ ............................................ wiring in the building of ' t............... .................>.ILECTRICAL ..... . North Andover,M S. . Lic.No..�� 7�'.... INSPE R Check # � � �� 5t58 Official Use Only Permit No. Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 r APPLICATION FOR PERMIT O PERFORM ELECTRICAL WORK All work to be performed in accordancewith the Massachusetts Electrical Code 527 CMR 12:OD (Please Print in ink or type all information) Date�� ,1 8, 2vo To u e inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. /r! Location(Street&Number ��/ m/`10/vriRt Owner or Tenant Z P S /�° Valp 1l of Owner's Address // 7VAI A4 , / Is this permit in conjunction with a building permit Yes a/ No 0 (Check Appropriate Box) Purpose of Building �s')Ca 6 r G���G�. mAff'!°�'BP®�!`/ f ��7�/y Utility Authorization No. O�D✓ 7 T Existing Service___/ Amps 1 ZD Z O Volts Overhead V Undgmd a No.of Meters Newtervice d-00 Amps 1200-110 Voits Overhead Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IvZ d — X 4,ei be , lowjo & No.of Lighting Outlets O — V 0 No.of Hot fuse TotalNo.of Transformers KVA Above 0 In a No.of Lighting Fbdures Swimming Pool gmd a gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.ef Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No: .;,Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.o6I No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal I Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER. INSURANCE COVERAGE. Pursuant to the requiremenSts of Massachusetts General Laws / I have a current Liability Insurance Policy including Com feted Operations Coverage or its substantial equivalent YES ANO have submitted valid proof of same to the Office YES yN0 s If you have checked YES please indicate the type of=veerage by checking the appropriate box. INSURANCE a BOND - OTHER a (Please Specify)_�/�eFPllPO kn o xA,/g,( /�4 q ir ron Date)a Estimated Value of:Electrical Work$ (Exp Work to Start Inspection Date Resquested Rough All<< 64l t. Final Ai/r!(lx,1l L Signed under the Penalties of perjury: FIRM NAME dN /!n., tr7 ! LIC.N0.6�6-7 Z/ Licensee Signature LIC ND S'`f/y/e �a 11nd y A/F. �� ��N /1 ��v�Bus. Tel.No. Address / OWNERS INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachus Generai Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Telephone No. PERMIT FEE $ Agent) N2 Date... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING "SACHUS This certifies that ....... .......................(..... has permission to perform .... ?AAJ .......OJ-1.%T ...... ..T wiring in the building of...... ... JLr—ck...... ?.L.................... at....[.�....... ........................ .North Andover,Mass. Fee.... ......... Lic.No. ............. ELECTRICALINSPECTOR .......................................... WHITE: Applicant CANARY: Building Dept. PINK:Treasurer �_..�jy►2 Office Use Orny Permit Na ?.+�� e0�11}1t0"itZf/�.c'Tr+�Ol�?lrfssT>?v�rr�G%7s 9rpcRt•�o•� Pa6ltc Safcry Occupancy,&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 U9 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the MassachusElectrical Code 527 CMR 12:00 etts C� (Please Print in ink or type all information) Date To the Insp or of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant X1-4 1� � y' t l�Y✓���' t f t� --- Owner'sAddress Is this permit in conjunction with a building permit Yes ❑ No Q_ (Check Appropriate Box) Purpose of Building Utility Authorization No. F)dsting Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters t MN Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters N ber of Feeders and Ampacity I.ocadon and Nature of Proposed E!ecrical Work r� ✓!f� �� �t, `( � z .Su Wl e Total No.of Lighteng LightenOutlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Poo gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Bunters Battery Units No.of Switch Outlets No of Gas Bunters FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Dioosal No. Pumas Tons KW No.of Sounding Devices No./of Seif Contained Nil,of Dishwashers Soace/Area Heating KW OetectioniSounding Devices ❑ Municipal ❑ Other No of Dryers HeatingDevices KW Local Connection _a Na of No.of Low Voltage No.of Water Heaters KW Signs Bailases Winn No.Hwm Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If yYou.4ave checked yr S plea indicate the type of ye hacking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) _���F1cs� t/l�L�'� /� '�l (ExphT4n D e) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties ferju :i - FIRM NAME X33 Ll C.NO. f Ucensee Signature 4 LIC.NO. Bus.Tel No. Address Alt Tel.No. OWNER'S IW CE WAIVER: I am awaroAat the L censes does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEF (Signature of Owner or Agent) Date" . . . . . . . . . O y f "aR7" TOWN OF NORTH ANDOVER X? p PERMIT FOR PLUMBING SSACMUSE� This certifies that . . . .. .•. . . . . . . . . . : . . l` . . . / . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . ;t . .. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of.. . . .. . . . . . . . . . . . . . . . . . . at .//. . . . . . .. . . . .. . . . ... . .. . . . . . I. . . . . . . North Andover, Mass. j Fee-. . : . . . . .Lic. No.. . . . . . ,. . . . . . . . . . . . . . . PLUMING INSPECTOR Check it 5 ; 7 MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO (Print or Type) PLUMBING 410W I, V 2k_e - , Mass. Date --->•-� c�_F 20 „ / LL = -- Permit # Building Location_ J! h�.FIA?✓LTDAi � � �P. Owners Name y Type of Occupancy New Renovation 0Replacement1 ' Plans Submitted: Yes❑ No 0 FIXTURES B.P. # SEWER# SEPTIC # z OLn to z z Z V' Q w v0 ~ Z to 0TW -W U Z m = in P U F— � Y N O Z n Z a Z 0 = cam. z = 3. ,Y t" Q � .0 Q = � ¢ ~ z In io z z u� H . 0 U a _ 3 m to D o g = a o ¢ ° m p o SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR , 3RD FLOOR _ 4TH FLOOR k STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR _1111dl -ELM Installing Company Name `��,p,�►A%� PLiN11i��(rt a-�y ��/ Address Check one: Certificate 5 ❑ Corporation ------------- Bwsiness Telephone 9�sa, 7>� ❑ Partnership Nome of Licensed Plumber or Gas Fitter ❑ Firm/Co. r^� INSURANCE COVERAGE: I have a curre t liability Insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes No ❑ If you have checked ves, please indicate the type of coverage by check(n thea ' 8 appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ 1 hereby certify that all of the details and information i have submitted(or entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title Signat of Licensed PI ber City/own APPROVED(OFFICE USE ONLY) Type of License: ❑Master 4Journeyman License NumberZ _