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HomeMy WebLinkAboutMiscellaneous - 110 FARNUM STREET 4/30/2018 (3) 1 110 FARNUM STREET 210/107.A-0074-0000.0 J 1 i Date..... ...�. 1129 . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,$SACHus�t / 4 his certifies that..........f..... ..�'�'................ `.. ' .. ................................................ has permission to perform.. .......�.��^�p plumbing in the buildings of......... ....... a.......................................................... at:..,...a:. Q.......r ? . <�-�...... `.............. North Andover, Mass. Fee..too.........Lic. No. /..9.. J ... PLUMBING INSPECTOR Check#4 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY / MA DATE PERMIT# 1' JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION:Q REPLACEMENT: PLANS SUBMITTED: YES Q NOQ 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 f . _ f _j,__J 1 DEDICATED GREASE SYSTEM ___ I W___I _._( _.__.._J ! DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER �( __..__( _j DRINKING FOUNTAIN _ ff _.._ t ______f FOOD DISPOSER FLOOR/AREADRAIN 1 INTERCEPTOR(INTERIOR) KITCHEN SINK .I _._.__J --1 __._.J .___.._► .---___..I _— ( __.__! ____I _._____._I __.__..._ ._._� i ,_ LAVATORY ROOF DRAIN SHOWER STALL f I i _._._ . J � J _ I _ _.-_-. 1 _J SERVICE/MOP SINK TOILET URINAL - WASHING MACHINE CONNECTION �- WATERsHEATERALL TYPES _I I I 4 _I I f ! � _ .._... I WATER PIPING OTHER, __ _ _ __—� f I 7771 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES .f NO Qfi IF YOU CHECKED YES,PLEASE INDICATE THE PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND Q 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 requir ECK ONE 0 LY:ZPWNERT QI SIGNATURE OF OWNER OR AGENT // A /*�N 1 hereby certify that all of the details and information I have submitted or entered regarding this applicat on are true an c to th knowledge and that all plumbing work and installations performed under the permit issued for this application will b in com li I rtin pr ion of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAM ® _ I LICENSE# U// I NATURE (VIP EV JP Q CORPORATION[#��PARTNERSHIP Q# I LLC U – COMPANY NAM _ +-(�}; ADDRESS (j L CITY A ,. , STATE (h_� ZIP TEL FAX CELL EMAIL I l _ �I ROUGH PLUMBING INSPECTION NOTES BELOW FOR.OFFICE USE ONLY FINArL INSPECT111111 NOTES Yes No 4 J THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date................................................... NORT�y, -. Of TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION sACHu . This�certifies that .............. / .......................................t.................................................... has_permission for gas installation .... / ................................................. O.n"the.buildings of....... Ute...... ....................... / �+^�'► at :... :........................................................................, North Andover, Mass. .....:,... Lic. No. �9 �9... .................................... > GASINSPECTOR Check;//5''7- �4 y >•` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l CITY MA DATE PERMIT# y ' 1 C JOBSITE ADDRESS c �- J�'7` OWNERS NAMEa 7 T G OWNER ADDRESS TEL — _— FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT RESIDENTIAL ' CLEARLY NEW:D RENOVATION:D REPLACEMENT: PLANS SUBMITTED: YES D NOD 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 HEATER ! ) DRYERT1 _ FIREPLACE ) FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS - I ( __1 MAKEUP AIR UNIT OVEN h �1 .s=._ u -� - - - l_.- . I_ POOL HEATER ROOM/SPACE HEATER l _ — - -- -- - ROOF TOP UNIT TEST UNIT HEATER _( UNVENTED ROOM HEATER WATER HEATER C OTHER - INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES O'N0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY' OTHER TYPE INDEMNITY ® BOND F 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 EONLY: WNER 0 AGE SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application a true and accurate o e of edg and that all plumbing work and installations performed under the permit issued for this application will be inompliance with a e pr visi ft e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - PLUMBER-GASFITTER NAIMEU.Lt., c � LICENSE#1 ( SIGNATONE MP 'MGF EjI JP D JGF Q LPGI D CORPORATION1]# PARTNERSHIP® _^ ( LLC[J#= COMPANY NAM �lh c, _ j-f_ ADDRESS CITY STATE ZIP - TEL^' — T FAX CELL, _( 710 !EMAIL _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL /INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massa chusetts . Department oflndustrialAccidents ,.. d I Congress Street, Suite 100 Boston,AM 02114-2017 *y. www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Address: � O r-) VL City/State/Zip: - Phone#: C �7— Are you an employer?Check the appropriate box: Type of project(required): `� am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑4-❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.F1 We are a corporation and its officers.have exercised their right of'exemption per MGL e. 14.❑Other 152,§1(4),and we have no,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. #Contractors 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 is providing workers'com ensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and one- sonment;as well as civ" Ities in the form of a STOP WORK ORDER and a fine of up to$250.00 a day a - st the violator. co of this s em ay be forwarded to the Office of Investigations of the DIA-for insurance cove ge verification. I do her certify u 'ns "n enaUles of pel jury that the information provided above is true and correct. Si 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#: r 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 cavy 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 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.:7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ,j ♦f WEp'1"�H • r 0��8N • • BR©of TEAS f • • OA GNs 1 CENSE d ' � pEUMgERS FOD EOW 1.N AN . ��MgER� �x 6o SAN��ER ST o�g►+5 24.E 1� ANOO�IER A _-- 4r Office Use O,I u 014r (ffJtM 1JnWraJ0 ITf tt �ttr u e t� Permit No. y� ;; i9epartment of publit -AdIg Occupancy& Fee Checked Clp BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3i90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK. All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 r (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date --- City or Town of Z/20/,'T2!2� ,451?&/1kWi'/r?P To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) //U /`.di?h%(i1.1 TI3 .moi Owner or Tenant OHN 4- )�I~Iecly 8c-, 'iYS Owner's Address9�� Is this permit in conjunction with a building permit: Yes 19 No ❑ (Check Appropriate Box) Purpose of Building ✓ Utility Authorization No. Existing Service Amps _J oIts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 2-hlficlvrf /0-N) rrFei No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting FixturesSwimming Pool Above❑ In- grnd. grnd. ❑ Generators KVA No. of Emergency Lighting Receptacle Outlets No, of Oil BurnersBattery Units Pf f Switch Outlets -.No.-of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air.Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices I No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW L041 ❑ Municipal Other Connection ❑ No. of, No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP 1+ OTHER: I i INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Comple��Operations Coverage or its substantial equivalent. YES ,;s NO C I have submitted valid proof of same to the Office. YES l� NO ❑ If you have checked YES, please indicate the type of coverage by checking the appygpriate box. INSURANCE IBr BOND ❑ OTHER ❑ (Please Specify) $"r;0!'U A CQp;,�V ` ��/�f/f>C. 106"/ { — G Estimated Value of Electrical Work$ c2 0 ��1 = 5 (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME _ Lo _Z11LIC. NO. Licensee �!J f --:-, ✓ Signature-4^ LIC. NO.Bus. Tel. ufw�sf'�P°7� j Ades �� !/!�/ !� 2n,211f. W[1T -" Nlll2ff C.9Ie) Alt. Tel. No. /j� W Z^,F — j. L,e��. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 i 0/ h Q Date;. .................................. AORTN °, TOWN OF NORTH ANDOVER 3? •�.e • ° °L p PERMIT FOR WIRING ��Ss�cHU This certifies that .`.. r:......^::..'.- :.............. ��-- has permission to perform ...-- ��. .................................... ...................... wiring in the building of..! ,�. �-� a~'.............................................. at./ 6......... ........ . ....... ,North Andover,Mass. YZ) �/v f N"` '-^ Fee .............. Lic.No. ELECTRICAL INSPECTOR e Check # 6.5 Office Use �I�P IItYIttIIIIIIUPtt� of Permit No. fleparttttettt of?;ublir ;vdit0l Occupancy A Fee Checked =6, BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 w9Q (leave tslank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _ ell"?-Ofo City or Town of ,�oRn� � 'f To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address J�sf�lYl.� Is this permit in conjunction with a building permit: Yes 19 No ❑ (Check Appropriate Box) . Purpose of Building Utility Authorization No. Existing Service Amps J� sits Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical work --— l ��/ze.Al w j jfj� ,4! -�1 „lo.of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures SSS Swimming Pool Above In- f-" grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 8 No. of Oil Burners Battery Units No. of Switch Outlets -No. of Gas Burners FIRE ALARMS No. of Zones No.of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tbns KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local €--1 Municipal Other r ❑ Connection ❑ No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring zNo. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy Including Comolt;aff-Operations Coverage or its substantial equivalent. YES LINO C: i have submitted valid proof of same to the Office. YES €i' NO ❑ If you have checked YES, please indicate the type of coverage by checking the appr_Wiate box. INSURANCE W BOND C OTHER C (Please Specify) ItJ &!K7X*4 Q�@—t' I— o (Q Estimated Value of Electrical Work$ 92000.QA3 (Expiration Date) Work to Start_ 4V:Zg'OCi Inspection Date Requested: Rough Final Signed under the Penalties of perjury; FIRM NAME Ls� tr f LIC. NO. Licensee—v��flll? *! - _Signatury LIC. NO. Address ��l��[ ( Bus. Tet. No. - 9.3/� -f— Q Alt. Tel. No. � sp OWNER'S INSURANCE WAIVER: I am aware that the Ucens ee does not have the Insurance coverage Or its substantial equivalent as re- quired by Massachusetts general Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. , PERMIT FEE S �0 (Signature Of Owner or Agent) f �r� O? . AORTM o� TOWN'OF NORTH ANDOVER PERMIT FOR PLUMBING SS US _ 4 This certifies that . . . . . . . . . . has permission to perform . rte. .` - -.-�- a plumbing in the buildings of . . . . . : . . . . . . . . . . . . . . . . . - - . . , North Andover, Mass: Fe-e '. . .Lic. No. �g`� . . . �. . . . . . . . . . . . . . . 3 PLUMBIN' SPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS _ Date Building Location �lQ 2 rO C) P E- 7— Permit#--612d d Owner��1 At-1g,17,01,P Amount � s New Renovation Replacement Plans Submitted Yes No FIXTURES ]p SLBBM. BASEIVIIVT isr.FUM t i �n 1~voOR 4M FUM 5M RfM 6M RIM i ,M R-OOR M BOOR �r (Print or type) �' Check one: Certificate Installing Company Name F,? ,01,2a/l`,q.t) P7e-17` D Corp. Address T ls1 � �� s Partner. � C�t.s'� Business a ep hone C,,,? o? y �� d Irm/Co. Name of Licensed Plumber: / h*Al,,+ "4� � Q/�r.•9 Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ® Bond D Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner D Agent El I herebycertify that all of the details and information I have submitted or entered in above application are true and accurate to the fY � ) PP best of my knowledge and that all plumbing work and in tions performe der Permit Issued for this application will be in compliance with all pertinent provisions of the Mas tts State Plu WCode and Chapter 142 of the General Laws. By: Signature Of (cense um er Type of Plumbing License Title �9.15:la0 City/Town License Mumner Master D Journeyman APPROVED(OFFICE USE ONLY LJ Date. .L� C. G.�.. . .. . F Of`NORTH ,41 :'y3 o� TOWN OF NORTH ANDOVER N _ D t41 PERMIT FOR GAS INSTALLATION •�,S O SACMUSESS�• This certifies that . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . R'e-? 9. . . . . . . . . . . . . . . <; in the buildings of . . . . t?^. .s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. 4 Fee. '7Y. Lic. No.. f/rr (&S* INSPECTOR 5, Check# 3 L 5541 -VIASSACHL;SKM L-,NZFORti1 AMUCATON FOR KIM TO DO GAS FrrMG (Type or print) Date `�/r�?6 /a'6 NORTH ANDOVER,MASSACHUSETTS Building Locations /�/► Al 1-114/,m Permit tf Amount S la Owner's Name '// 6 ) r n/tnCJl2n � New® Renovation 13 Replacement Plans Submitted O tri tit O � :4 EO+ ~ O ' St SUB -BASEM ENT B A S E M ENT 1ST. FLOOR t 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR` 6TH . FLOOR 7TH . FLOOR BTH . FLOOR (Print or ,type) one: Certificate Installing Company Name /-7,�, /1,o cue -��42 Corp. Address /v, Z ! Partner. p /1) A/ c3.3 lP y BusrTness'relep one br,,,l� — 7-120 ll,,4tQ0 / 0-firm/Co, Name of Licensed Plumber or Gas Fitter LNSURANCE COVERAGE, Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 Noo If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0/ Other type of indemnity 0 Bond D 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 13 t hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the hest of my knowledge and that all plumbing ,.cork and installations performed under Permit Issued for this application will be in ,crnpliance xith all pertinent provisions of the�Iassachusett ate Gas de and Chapter 142 of the General Laws. ignature of Licensed Plumber Or Gas Fitter By: dumber ��'� G Tile Citv;Tcwn Gas Fitter License Numver er APPRO`"ED.0 �CEf: E .•,eY; Journeyman Date..qq-71.... ORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING US This certifies that IClec ........................................... ................ has permission to perform ....3A.4-Ac!,(--0 12,e "Aodle I ........................................................................... wiring in the building of.........� .................................................. at.........I.Iq...... ................................ .North Andover,Mass. Fee....3'-I!r...... Lic.No.f.3t6.6(- ELECTRIC&21NSPECMR Check # 5573 {� Office Use Only .r 01 4t C�ommunwraI d 14flu C'C 's.Q11,�J Permit No. �'j i9epartt ent of 19uhlic 5,:sfrtg Occupancy&Fee Checked 1 BOARD OF FIRE PREVENTION REGULATIONS 5 CMR 12:00 3190 (leave blank) , APPLICATION FOR PERMIT T FORM ELECTRICAL WORK. All work to be performed in accordance with th M !!salchusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO ) Date City or Town of To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) //® J596 tW m Owner or Tenant ������/ of, M i'MA/ Owner's Address ME Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization.No. Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ . No. of Meters Number of Feeders and Ampacity �,., n Location and Nature of Proposed Electrical Work �o Del-I w 2 O-Y / —S-*— 2-104 ' No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- __ grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets p2 No. of Oil Burners No. of Emergency LightingBattery Units No. of Switch 410M No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑Other ❑ Connection No. of No. of Low Voltage Nof Water Heaters KW Signs Ballasts Wiring a No Hydro Massage Tubs No. of Motors Total HP p� T- I rIY OTHER: X1964 /J M/ N'!� n?017m o 1�2" G4 Zr� Y C1 -/e it /"�13C fY INSURANCE COVERAGE: Pursuant to the requirements f Massachusetts general Laws I have a current Liability Insurance Policy including Com�pleled Operations Coverage or its substantial equivalent. YES 1./NO L I have submitted valid roof of same to the Office. YES L' NO ❑ If you have checked YES, please indicate the type of coverage by checking the appr,ppftpate box. INSURANCE BOND 0 OTHER O (Please Specify) _,647 OMi94 �:11190JQ,E /NUT OfP //s BS Estimated Value of Electrical Work $ (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME 4EjV i �, i1( LIC. NO. —c'1'05_64 . I;icensee �9ciiic) �i9N.vi i�1 /.� Signature LIC. NO. 1,1 -o G, O Bus. Tel. No. - 5w- A, _�3�7 Address 2 �{ Lot' _ ET Alt. Tel. No. ,6L- QWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE$ (Signature of Owner or Agent) x-&565 �I � Office Use Only �Q11tItID1t1UPFIl# IIf L11FI5�°ttt U5P Permit No. 22 , MpIIL'fT ent of Ilublit _'F[frt11 Occupancy,& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -2`l_ o S City or Town of 1YORT74 /iV/)/) 2 To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) //Q Fi9R ry u m 577�46]iF7_ Owner or Tenant .L Owner's Address Is this permit in conjunction with a building permit: Yes L1 No ❑ (Check Appropriate•Box) Purpose of Building ' !!Jii»-�.:�,I A)(2 `° Utility Authorization.No. '+ Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �-!O Del-i Ag p--P HJ R 00 r`n p No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- __ grnd. ❑ g, d. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets p2 No. of Oil Burners Battery Units No. of Switch 41MM •No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding g Devices No. of Self Contained o. of Dishwashers Space/Area Heating KW Detection/Sounding Devices of Dryers Heating Devices KW Local ❑ Municipal ❑Other Connection No. of No. of Low Voltage . of Water Heaters KW Signs Ballasts Wiring Hydra Massage Tubs No. of Motors Total HP -. HER: iu D !at c � RC1 (_' e i URANCE COVERAGE: Pursuant to the requirements Cf Massachusetts general Laws ve a current Liability Insurance Policy including Comple d Operations Coverage ge or its substantial X1_ submitted valid equivalent. YES �Y NO L=, I d oof of same to the Office. YES Csl NO ❑ If you have checked y c ed YES, please indicate the type of coverage b king the appy��ate box. YP 9 Y RANCE gr BOND ❑ OTHER ❑ (Please Specify) 16�4T/ONA� 6 2 r�s1.1 RE /jyuTwt(_ Ofio OS ated Value of Electrical Work$ /�,Ws Q_0 (Expiration Date) to.Start c2- Inspection Date Requested: Rough q 9 Final d under the Penalties of perjury: NAME v i i e G ! Nlc3'OS�low ee v c _ LIC. NO. nim 1.4�.v.'�%r1 �p Signature LIC. NO. � �3CJS (o Bus. Tel. No. - ss a? W' Alt. T.I. No. R'S INSURANCE WAIVER: I am aware that thei L tenses does not have the insurance coverage or its substantialequivalent s re- by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent se check one) Telephone No. PERMIT FEE s (Signature of Owner or Agent) X-6565 RLqul © K a y G'T� C5 Date/., � . . . . . 5ti f NORTH 1 Y r TOWN OF NORTH ANDOVER O : n PERMIT FOR PLUMBING ,SSACNUS� ~:, This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform�4 :1t�- 1. . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . : . . :- . . . . . at . . . . . . . . . . , North Andover, Mass. PLUMB G S CTOR Check # � 639 P i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS r Date14 Building Location Towners Name k' Permit# Amount � Type of Occupancy New �, Renovation IT", Replacement Plans Submitted Yes E] No ❑ FIXTURES Cn Cr Cn Ln SLIMM &Ail' . EE FLOOR ZD FLOOR �%D FLOCIR 4M HIOOR 5M H AOM 6M FIOM i 7M IWM d SIH PIDGIN r (Print or type) Check one: Certificate Installing Company Nametg��11�1i ori A.J /��!>< ❑ Corp. Address - 7/`3� Partner. r9m AS eer CJ B mess Te ep one p�� ��q •_ sr� � 12--Firm/Co. Name of Licensed Plumber: '7'?20 r*,90i F4-7 IV 4W Insurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El 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 Owner11Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the Nil best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu tate Plumbi ode and Chapter 142 of the General Laws. BY na ure-Ul LIcenserrylumner Type of Plumbing License Title '/ !1 X01`O City/Town f ns mer Master � Journeyman APPROVED(OFFICE USE ONLY The Commonwealth of Massachusetts > Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance AtBdavit Name Plesee Print CItV N „�CYn.� t� 44 P I am a homeowner performing all work myself. ®' I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Comoanv name: Address Ckty: Phone#t, insurarm.Co. PoIcv 9 Corng=name: e st %70o/i Address rh-4,1-1 City: 4`i =JV If IeA C/ /U X/ t!2j F'C/ Phone lnsuranoe Co. _ei ve l S d A.#--'c le PoYcv! Falkwe to secure coverage a required under 3ecdon 25A or MOL 152 can lead to the hnpoaiwn of criminal PWWW@e of.a Ana up to$1,5W.W andfor one years'ImprIbcov.ent_aa wd.n.cbA.Peo onin oh=dASTAP VIIDM ORDERmd-a floe 0f.($10DJ q)Adg agahm-ma I understand that a copy d thle statement may be forwarded to the OAtoe of InvestigaUaa of the DIA for coveraie vwyleation. I db hereby cw*under t pehre and pe lea of perlwy that the Informso m provided above is true and correct. Signature DaW162�0,) .77 Print name 2Ax OItkW use only do not writs in this area to be completed by dty or tam dflder City or Town 1 []Check M immediate response Is required ❑ Building Dept ❑ Lkensig Board ❑ Selectmen's Ofte Contact person: Phone 8 0 Health Department . ❑ Other t: LocationA p No. Date 8 �ORT� TOWN OF NORTH ANDOVER a Certificate of Occupancy ' � • $ S CHUB Building/Frame Permit Fee $ � Foundation Permit Fee $ 71 Other Permit Fee $ TOTAL t , Check 17990 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOV..AT,e,M. OR DEM�O`LIIStlH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. � Q DATE ISSUED: , ic SIGNATURE: Building Commissiornerfinsvector of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: _ ) a `7 Al Map Number Parcel Number 1.3 Zoning Information: V 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Rcquired Provide Required Provided Repired Provided v 1.7 Water Supply 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-777C iiSt(iCt: "/rC F10 M 2.1 Owner of Record Name(Print) Address for ServiceQG : `U '3"1�'7 Lf Signature Telephone 2.2 Owner of Record: s 4 Name Print Address for Service: z t M Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: _ License Number Address �// S ic © Exiration Dae 0e Signa re Telephone r" 3.2 Registered Home Improvement Contractor Not Applicable ❑ lei,--ya 1/� S7 7S-, Comppy NameM _ j 'r Registration Number r Address _ OWNED Expiration Date Si name Telephone i I SECTION 4-WORKERS COMPENSATION(N.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.......❑ No.......0 SECTION 5 Descri tion of Proposed Work check ao appHcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OAf!CIAL USE.ONLY,,. Completed by permit applicant 1. Building / (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) �. 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner I Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, �= lc:r s s Iter as Owner!Authorized Agent of subject 1, property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Y`t,G tr r Print \ ----- Si ature of Ownei/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 0 2ND 3FD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS D]IvMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE v North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM vision of MGL c 40 S 54 In accordance with the pro , 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. dis posed of in: The debris will be Location of Facility) Signature of Permit Applicant g,1© Y Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts > Department of Industria/Accidents Office of Invesdgadons 4 Boston, Mass. 02111 Woflrers'Compensation Insurance Alldavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one worldng in any capacity 0 I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone# insurance Co.. Policy# Company name: C c Address City. Phone# 6 2 s' & Failure to ascure coverage as required under Section 25A or MGL 152 can lead to the imposition of crhninal peruwas of a-fine up to si,soo.w andlor one years'irnprfaomront•as vmdLas.chRN peoaflimin fheIWn de.ST0P WDW.0RDERAnd.a.flne d_(:1IIo.OWeA*agalw,me. I understand that a copy of this statement may be forwarded to the Office of Invesdgedons of the DIA for coverage YwMcatlon I do hereby certify undbr the pains and penalties of e.VUU7 that the information provided above is lure and carsct. Signature Date O S Print name Phone# Offlcial use only do not write in this area to be completed by city or town dficial' City or Town p enai Check y immediate response is required Building Dept 0 Licensing Board p Selectmen's Office Contact person: Phone# rl Health Department Other 01/28/2005 FRI 11:28 FAX 603 898 8269 FOY INSURANCE-SALEM 9001 A,COnr' CERTIFICATE OF LIABILITY INSURANCE DATE("""°°"""' 01/28/2005 PRODUCER (603)898-6320 FAX (603)898-8269 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Foy Insurance Group - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 130 Main St - Suite 103 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Salem, NH 03079 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Terri Truhn INSURERS AFFORDING COVERAGE MAIC V 1NsuRgD Nova Kitchens, LLC INSURERA; Concord General Mutual Ins Co 20672 7 Island Pond Road INSURER B; liberty Mutual Insurance 0046 Atkinson, NH 03811 INSURER C: INSURCR 0: INSURER E: _COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDIN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, FNSR TTI DO TYPE OF INSURANCE POLICY NUMBERPOLICY EFFE VF. POLICY E70r1RAT10N LIMIT$ GENERAL LIABILITY E880015-8 04/01/2004 04/01/2005 EACH OCCURRENCE S j 000.00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ SO OO CLAIMS MAGE a OCCUR MED EXP(Any one person) $ 5 00 01 A PERSONAL R ADV INJURY S 1,000.0 GENERAL AGGREGATE S 2.000.00 ,;E—NL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2.000.00 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY C844790-3 04/01/2004 04/012005 COMBINED SINGLE LIMIT ANY AUTO Me accident) $ 1.00010010 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDI1l.FD AUTOS (Per pecan) X HIRED AUfUS BODILY INJURY S X NON-OWNFO AUTOS (Per eccidmd) PROPERTY DAMAGE $ (Per aeddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S 3 ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION AND TBA 05/19/2004 05/19/2004 X wC STATU• pTH- EMPLOYERS'LIABILITY 8 ANY PROPRIETOWPARTNERIGXECUTIVE EL EACH ACCIDENT S 100.00( OFFIMRIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOY S 100100 K yes,despiye under SPECIAL PROVISIONS bebw OTHER EL DISEASE-POLICY LIMIT S 500,00 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS (iTIFIC&M HOLDER N ..��11 �/,, SHOULD ANY OF YHE ABOVE DBSCRICE0 POLICIES EE CANCELLED BEFORE TME ,/VA^• "l EXPIRATION A THEREOF,7HE ISSUING INSURER►IEEE ENOEAYOR TO MAIL Town Of Andover lO D 5 N NO THE CERTIFICATE FItN t1ER NAMED TO THE LEFT, Building Dept. BUT FAIL E TO LSU NOT E SHALL IMPOSE NO OBUGATION OR LIABILITY 400 Osgood Street DF ANY K HE IT$AGENTS OR RE.-RIES 6,TATIM. North Andover, MA AUTHOR ESFJJT ACORD 25(2001108) FAX: (603)362-8449 ACORD CORPORATION 1988 X. - arnmzo?zu�ea �i ✓ crQaac` ae�4 f BOARD OF BUILDI G,REGULATIONS a License: CONSTRUCTION SUPERVISOR Number: CS 052746 BirilSde e: 02/04/1965 1600es 0?164/2005 Tr.no: 8295 F� Restricted: 00�' � ERIC•F,DUBOIS i- , 7 ISLAND POND RQ, ATKINSON,. NH 038t• Administrator I �� ,� uuea�t� o�✓ �fuaelta Board of Building Regulations and Standards _ = HOME IMPROVEMENT CONTRACTOR _ Registration: 115786 Expiration: 411312006 Type: DBA ERIC DUBOISINOVA KITCHENS ERIC DUBOIS 7 ISLAND POND RD Administrator ATKINSON,NH 03811 f PROPOSAL Eric DuBois, Owner Phone: (603) 362-6480 Date: 1/24/05 NOVA KITCHENS Fax: (603) 362-8449 GENERAL CONTRACTING 7 Island Pond Road Atkinson, NH 03811-2129 Massachusetts Construction Proposal Submitted to: License#052746 Mr.& Mrs. John Bums Home Improvement 110 Famum St. License# 115786 North Andover, Ma. 978-682-3374 We hereby submit this proposal for the following: Main bath and half bath. Remove and dispose of existing fixtures, floor and walls. Install customer supplied bathtub, shower control, toilets and sinks. Install customer supplied tub walls. Supply and install new hot water baseboard in both baths. Supply and install R13 insulation in outside walls. Supply and install fan/light in main bath and fan in half bath. All fans to be vented outside. Supply and install Andersen double hung window in main bath. Install customer supplied tile and grout on floors in both baths. Install all customer supplied decorative lighting fixtures. Install new GFI electrical counter outlets. Supply and install plaster on walls and ceiling with smooth finish. Supply and install new trim molding around doors and windows. Interior and exterior painting is not included at this time. Provide dumpster for all ob debris. Supply all job permits. Total 511,637.00 All Material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner. Drop cloths to be used in all traffic areas. Job area to be kept as neat and clean as possible at all times. Job to be completed in a timely manner. Payments to be made as follows: $.00 Deposit payable upon acceptance of proposal. :$.00 to be paid at start ofjob, $ 11,637.00 balance due in full, upon job completion. Respectfully submitted by: ^ � Eric DuBois Any alteration or deviation from above specifications involving extra costs will be executed only upon written order and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made asoutlinedabove. r Signature .c���ir�� ' Date f 1�rSignature NORTH Town o Andover 0 . No. y78 C% ove LA r, Mass., COC..C."WICK 0"#A-rED % BOARD OF HEALTH Food/Kitchen Septic System -PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT.....!!;;;;GA.* V3 .................................................................................................... .V............ .V.OW S Foundation has permission to 9".JZ!W.MA!4..'... buildings on ......../....1....*.............r.-O.....#.%....1.0...4.0..... .............&....4. ft............... Rough to be occupied as........ .......... 4. S .....AJ ,S/,18. /it kip W dt4AJC GC 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. )&I A / ()q PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERM EXPMS IN 6 MONTHS ELECTRICAL I INSPECTOR UNLESS CONSTRUCUON PTARTS Rough Service ..... .......................................... ............. . .............................. 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. IFS7EE REVERSE SIDE Smoke Det. 7705 Date...<7.7. `�. ..t. �.... 3? °` TOWN OF NORTH ANDOVER 41 ' PERMIT FOR GAS INSTALLATION _ �,SSAC MUSES y r This certifies that has permission for gas installation `'� .:.`.— in the buildings of . . . . . . . . . .. . . .a. . . . . Mf:. . . . . . . . . . . . . . . at . O.4 (a (? +Qvv\ �'`�: . . . . . . . ., orth dover;.Mass. Fee# �:� . Lic. No. X S.. . . . . . .. . . . . GAS INSPECTOR . Check# 2 Z i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC (Print or Type) w /3-, Mass. Date 6 City, Town -- Building ( Permit # PP '' Owner's AT: Location_ //fj rG--h�.n S1� Name u�•n Y Type of Occupancy: New Renovation ❑ Replacement ❑ Plans ubmitted Yes ❑ No ❑ W R N W W y fAY Z tL U; �+ N U) V ¢ .0 W W tS O O O N = H Rf C7 J N W 1` U m F. x Z N v x o w Q > Z Z O f. = x Q m N !- Q tY CC O a O Z W H G7 W Q Y W o N d W Q tU = W 41 t7 f. Z J W 0 W f. X Z W W ~ W ~ N tt G Q W iC Q ~ I- W O > W ►- V J C7 F- W Q W > tY W a Z Q N Q O O W 5 W O F- ¢ s O c7 s U. 3 a c� .� v tr > 'c a t- o ' SUS=BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR STH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check One: Certificate Installing Company Name TncT.+canrl n;1 r� � Tnr ® Corp. Address 27 Cherry Street ❑ Partnership Danvers MA 01923 ° ❑ Firm/Company Business Telephone 97R-777-0701 Name of Licensed Plumber or Gasfitter —�Iase_}z1G>> )r I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner,Agent I have a current liability insurance policy to include completed operations coverage. [� By _ TYPE LICENSE: Title ❑ PIumber Signature icensed Z; Plumber or Gasfitter City/Town ® Gasfitter APPROVED (OFFICE USE ONLY) ❑ Master ❑ Journeyman License Number \ F/lgM 17dA Nnnoc.taa�„�., i,,,, +nce F G:OI M6NWEAL TIS_of mASSAcI�i�SET I S LICENSED AS AN LP GAS INSTALLER ISSUES THE ABOVE LICENSE TO: JOSEPH F GURRY III 3 JOHN ST 'N APT.-...8 ETA UE MA. 01.8.:44-5051 . j `885 05/01/12 788338 J t l ER- CONTROL# G 0 2 0 7 2 5 IMPORTANT If this license is lost or destroyed, notify your Board at the: I Division of Professional Licensure, 1000 Washington St., J 7th Floor,Boston,MA 02118. I I If your name or address shown is changed, notify your board f of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended.It is a personal privilege,and must not be loaned or assigned to.any other person. Keep this License on your person or posted as required by law. ! WARNING THIS DOCUMENT HAS 1 EATURES ENHANCED SECURITY 1 III r Of Location 'IVo. Date ° NORTpf TOWN OF NORTH ANDOVER Certificate of Occupancy $ -------" Building/Frame Permit Fee $ ss a Foundation PZ�4 $C ter Permit $ Se41(r,Pnection Fee $ �u� 2 9 '"!ater Connection Fee $ �• 4,r/ Jg F_ TOTAL $ rry �` Er ) Building Inspector Div. Public Works PERMIT-YO. yy APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZO I SUB DIV. LOT NO. " s COCATION �t-F�w_ .. _An `,� PURPOSE OP-8"*ttH"G 1 wV ld��t r �i d NO. OF STORIES SIZE NER'S ADDRESS , 1 Ft BASEMENT OR SLAB - ARCHITECT'S NAME V SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 1I®/4/_1�5 t oC G 'V,i j e SPAN -- DISTANCE TO,NEAREST BUILDING CJ DIMENSIONS OF SILLS DIST CE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES 14 ->o REAR �r\oj� GIRDERS AREA OF LOT 44, -Ion � FRONTAGE v5\o HEIGHT OF FOUNDATION - THICKNESS IS BUILDING NEW =Y C _�1V✓,,J.) �lv,TySIZE OF FOOTING X IS BUILDING ADDITION V� l MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER RD OF APPEALS ACTION. IF ANY {�/i'1 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES LDG. COST , 000. U PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 4WAWAC PERMIT NO. 0 V1 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ,4 APPROVED BY - • ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS - - r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR R DATE FILED 2 - /0 - /✓ / BOARD OF HEALTH SIGNATURE OF OWNER OR AU HORIZED AGENT F E E /C� 01MtER TEL. .# M.'TR. TEL. j PLANNING BOARD PERMIT GRANTED '.,TR I irc, o 0,:3 19 BOARD OF SELECTMEN 1, a _ n BUILDING INSPECTOR ESi/� I OCCUPANCY BUILDING RECORD.12.. SINGLE FAMILY STORIESTHIS 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 —I 8 INTERIOR FINISH CONCRETE _ 3 l 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW —— _ PIERS PLASTER _ DRY V✓ALl _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1h '/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME - SUPERIOR I� POOR ADEQUATE NONE 5 ROOF . 10 . PLUMBING f GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. )2 FIX.) FLAT I 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 FURNACE - - 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 I UNIT HEATERS J 7 NO. OF ROOMS GAS 1 OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING j1 1 PLANNING _ FINAL ���c �� "'J, FINAL Town of o r ' Andover No 4 A to �4� l orth K Andover, Mass., 19�.L Al CGI 1i��'Eflcn '�...PERMIT T01 10 UILD BOARD OF HEALTH THIS CERTIFIES THAT. �.. .. r ... .i�..XVS......... p � � ••• , • &as "s"- •�0�•.''� ' � RoughBUILDING INSPECTOR haspermission to '' /. ............. tobe occupied as....��'.. ..Aouf. it.0 . a.�....... ............................. 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 M O N T FI S ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START:", Rough Service Final ... .. .... . . .. BUILDIN NSPECTOR GAS INSPECTOR Occupancy Permit Required to Occup-i.) Budding 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. S' 5' Building Inspector -79 FORM U - LOT RELEASE FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** "P-LICANT: c L N ytZ one Ot6 8Z -3 3 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street v t. Number ************************official Use only************************ OMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Health Agent Date Rejected Comments ZVQ P6_4166&S rQ lkl 9&,0 of 5E iC 5 STE Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date I I W- 2. LD Y. a A LL 0 15 7 or.t.t v V;f A t T c w4ft,rr b to C ,,T Not .4 ­c. • C',"'Ili• Ir.1 1 It I,r to POOL 0 wr c a, to _(!4 5.to i,"S Is c..'n ni" to v ......... I lot- n­%P rr LD A,I111 411 E --. .�:, I—_ f j o� 1_o I-o' I -o+ II'_p��l.�. l�- —_'�/Iv wr. A W01 I: C. %1"ut NAYS -1 S 94­4 Alit INC 11-11 vcc)V)l4 CD t,.Iu jjky t,c to,c r I ,-I In Tt R 5. SvrT CVFtv?,-rVA 110.I. -ILL STAI,'DARD WALL SECTION�,i�:CUON t)L7Cj1 CND RA 6-CJI WALL 5 F CT10N rOt-P IDAT ION URCIJARGE WALL ll.-IN EXPANSIVE SOIL WAIA- Z,D: A 114 hl. Pn'1 C•!l'&A%?LR AV' A L Ll 41 VJARW1 A r T. 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