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Home My WebLink AboutMiscellaneous - 114 MARBLEHEAD STREET 4/30/2018 (2) 114 MARBLEHEAD ST TET�+ 210/009.0-0019-0000.0 Date..,/ .; .�` .O `.... ;. N0 N o= �' TOWN OFA. RTH ANDOVER PERMIT FOR GAS INSTALLATION qe.0 �9SS.1C MUSE��y r ,a ,is certifies that . ��tx has permission for gas installation . . .`: �4�?. -e. . . . . . . . . . . . in the buildings of : . / . . . . . . . . . . . . . . . . . . . . . . . at ,�.h 1. ?. . . . .'??%' . ?'�" �' • . . ., North Andover, Mass. GAS1INSPECTOR / -y Check# f 1 S c 5-725 7 2 ate` MASSACHUSETTS WA -ORM APPLICATION FQR PERMIT TU DO GASFtTTtNG tt'ti or T e): �� Masi Date r ,�' Perrt3ft #_SZ '''7. .' ` Building Locatlons � C/ Own�r's Nariae �� TYPe of Occupancy +' //�'' , New ❑ Aenovatlon [] Fieptaceinent P1arisSubmitted: .Yes ❑• No(]. I . N, w N X C V1 vs yr .v �- oa u, oc ,n cc p rn x w' J N th U ra �-. z 1, �:- m u t. ¢ o .o Fw ac ''i. o ;-c�: x u c. b s� d > o, a o :SUB BSMT yS7 FLOOR. 3}{D FLOOR aRD FLOOA, 4Tti FLOOR STH FLOOR..;; 6TH FLOOR .-' 7 Tai FLOOR 87}{ FLOOR lnsta1Hng Company Name_G/ ,LL l �J� ,� �- b'. ,; Check one Certlticate # Add;". - i =L C�l�' `f i� :4 p-r-tion f, r --� �J -� ❑ Partnersfilp Business Telephone J ra ' l 7, - ❑'. :r LCo Narne'"of Licensed PlumbeC or Gas Fitter "J�•„ ' �, .” `,' JNSURANCE COV AGE I have n curre ab.iffly insurance policy or its substantial equivalefit which meets the requfretnenfs of MGL Ch 142 Yes. Nil ❑ 11 yo,:!h'' a checked yes please Indi the type coverage by checking the appropriate boX. A Itabiftty Insurance ;policy '[ !Other ay e afi Ind , it ❑ Bond'O OWN€la S INSURANCE YYAly - f am.aware'fhat the Ilcer see does not have :the tnstrrance coverage required by Chapter 142 of the Mass General Laws, and-.itat my signature .on: h!s permit application watves,ihts requirement;. Cheek one Ownec❑ Agent ❑ S+gnaluie of t�,vner or Owner s.Agent I heieby certify that all of the details andinformat�on 1 have subrnitied"tor entered)(n above application are true ard,accuraie to the best of my knowledge anis that ail,piunibinq work end fnstalatCons performed underthe"errnit issued,ior ttils.appilcailon will be in compitenee wish e!� perilnent provisions of the Massacfiusetts Stale Gas Code aril Chapter 142 of the Gene of taws.,'_ BY T e o[Ucense Title P.iumber ig iu e a c nse _ um er ar Gas atter asfrtior /I1� aster Ucense Number Gdy/Town Journeyman N't'fKMD O. C .O Location // No. 3S— Date ^A r�'1 N0RTOWN OF NORTH ANDOVER . o� ...o ,��4, 3? � •SOL i s . i Certificate of Occupancy $ s�CHUs Building/Frame Permit Fee $ b S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S is Check #14747 Y 3 i Building Inspector r� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING psi BUILDING PERMIT NUMBER. DATE ISSUED: _ l& I — SIGNATURE: AIW(&, Building Commissioner/Inspecfor of Buildings Date SECTION 1-SITE INFORMATION I z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 ZoningInformation: V V 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas -Frontage- 1.6 ronts e1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 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 0On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name(Print) Address for Service a Signature Telephone 2.2 Owner of Record: I 1 Name Print Address for Service: z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3 Licensed Construction Supervisor: Not Applicable ❑ �ref f G I Licensed Construction upervisor: d(.Oct�' CM0 License Number Jdres o �3 a�a Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ CompatW Name I ��k4 Registration Number Add e s �J r �a �� Expiration Date f Si na ure Telephone 4 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 rmit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Descri tion of Proposed Work: _ a S SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be C USE 0 �� 66 Completed by permit applicant ' ... •..<,. ,..:. . ...:; .... .K .[Y,.t• Ria x^rs: 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Oo .0 Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) LJ Check Number SECTION 7a OWNER AUTHORIZAVION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as OwnerCuthorized Agent subject property Hereby thorize to act on My beh if n 1 matt lative o work authorized by this building permit application. , Signature'of Owner V Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property. Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A e Date 0010101 NO.OF STORIES SIZE r BASEMENT OR SLAB 4 SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE - _ &.10lEfL91AI/MAX O ✓l�.C![+.7CJ.(,YZClri q BOARD OF BUILDINGI REGULATION5 ' License: CONSTRUCTION SUPERVISOR Number: CS 069815 Birthdate: 09/23/1965 IIIA _ Expires_:09/23/2002 Tr.no: 5313 Restricted To! 00 ROBERT W TREPANIER JR 14 EAST CAPITOL ST METHUEN, MA 01644 Administrator I �I I , i � I Y ACORM, CERTIFICATE OF LIABILITY INSURANCE 0DATEMM DD/YY) 5/(24/01 ROD1dCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION )oherty Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR '.O. BOX 1985 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' !1 Elm Street >ndover, MA 01810 INSURERS AFFORDING COVERAGE ISURED INSURER A:Travelers Group 'repanier Tile & Remodeling INSURER B: _4 East Capitol Street INSURER C: fethuen , MA 01844 INSURER D: INSURER E: :OVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLIMITS DATE MM/DD/ DATE MM/DDI GENERAL LIABILITY I680354N9485INDOO 10/27/00 10/27/01 EACHOCCURRENCE $500 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire)s300 000 ME D EXP(Any one person s5,000 CLAIMS MADEa OCCUR ) _ PERSONAL&ADV INJURY $500OOO GENERAL AGGREGATE $1,000,000 i GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $1 OOO O00 POLICY PRO JECLOC T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) it GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I i ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WOCSTATITS ER OTH EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER ]ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS rile Work. . . . '_ERTIFICATE HOLDER ADDITIONALINSl1FED•INSURERLETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION David and Lynn Eikenberry DATE THEREOF,THEISSUING INSURER WILL ENDEAVOR TOMAI LID—DAYSWRITTEN 8 Judson Road N0710ETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT,BUTFAILURETODOSOSHALL Andover, MA 01810 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORI ED REPRESENTATIV �z ACORD25-S(7/97)1 of 2 #12607 ✓ (J J 0 ACORD CORPORATION 1988 Town of North Andover o& NORTH � �. TL4D •by ao Building Department o� _ o� 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 gc�us��5 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, anda condition of Building permit.# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s150a: The debris will be disposed of in/at: Facility location Signature NApplint 0 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. WORTH Town of E over 0 No.3s o�A C000 CO H,� ,., dower, Mass., 7 ORTE AD P"? y '9S H BOARD OF HEALTH Food/Kitchen rhRMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.:.5 .. .... ..% ......7D..A.v. .4.vv1q' ...0........... ................................... Foundation p R. . g 1 I�— '.�.. b � .�. ....44 Rough has permission to erect... �41� ............ buildings on .... ................. ............ to be occupied as.........�.......... ...14�. .. �...�...................................................................................... 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-Lawsr lating to the Inspect' n, Alteration and Construction of Buildings in the Town of North Andover. !� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ...................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. No 4 % x` 7 a ".°RT:�tia TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING SSACHUSE� This certifies that . . . . . . . . . • . . . . . . . • • • • • • i has permission to perform . ...!. ... '�''.-.��. . . . . . . . . . . . • • • • • • plumbing in the buildings of . _. . �. . . . .�. . . . . . ... . . . . . . . . . ,h. . . . . . . . . . . . . . �. :.. . .!�� . . .�., North Andover, Mass. Fee Lic. No.�/�/ f.�. . . k; --,f2�t.-. . . . . . . . . . . . PLUMBING INSPECTOR Check # / I- C (% WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS rL/ Date Building Location I►"1 )6 AaA i Ar Own Name f, Permit#�, Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No El FIXTURES z wcc xccx a Z H a W W d cc W W a A p„' Z w x �H4VIC >(3�91VII�1T ISE FWM �1 FIDQZ �M FLOM 4IH ROM 5MHIM IM 6IH RfM 7M FLOCR SIH Hfm (Print or type) p ii Check one: Certificate Installing Company Name\ -W 371' vl 4 Ii n Corp. Address 7 10 "1'�e IJ A/� F1 Partner. . 6)nb Business Telephone C"7X95-7— 6dj3 aFirm/Co. Name of.Licensed Plumber. (d — ca vt Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ �hsurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance v rgnature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac s �Zatelumbing Code and Chapter 142 of the General Laws. By: Signalure 7 Licenselpfurnuer Type of Plumbing License Title City/TownLicenseIumoer MasterJourneyman ❑ APPROVED(OFFICE USE ONLY 7 4 Date......``.. b TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ....................................... ...... ........... .. .... ..... has permission to perform .... .................... wiring in the building of..... q 0 .......................... at....................................................................../.-Z.. North Andover ENiass. Fee. Lic.No . .......... �..... .......,. ............................ , / ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only3, u41! (90mmunwtato of Ifflassar4usefts Permit No. Bepartment of Public =tfetg 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 R 12:00 (PLEASE PRINT IN INK OR TYPE ALL I FOR ATION) Date �U SZ� ?�,� City or Town of 41 -thy f''h To the In ctor of Wires: The udersigned applies for a permit to perform the electrical wor de cribe below. Location (Street & Number) ev— �✓ ,�/� -� Owner or Tenant , Owner's Address S 0 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 /J j Lavation and Nature of Proposed Electrical Work ►`'�''l�'J �' 2- ,/1.��a �'I fsf -FA4 NgS. of Lighting Outlets No. of Hot Tubs No. of Transformers TotalKVA I No. of Lighting Fixtures Swimming Pool Above In- _ grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 2— No. of Oil Burners Battery Units No. of Switch Outlets I 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 FYI o. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local ❑ Municipal Other Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage �Tubs I No. of Motors Total HP OTHER: `' INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or'its substantial equivalent. YES LX NO C I have submitted valid proof of same to the Office. YES K NO C If you have checked YES, please indicate the typecoverage by checking the appropriate box. 3 INSURANCE X BOND C OTHER C (Please Specify) 0 vvp �'��/ Expirat' n Date) Estimated Value of Electrical Work$ l i Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAMEZ4-143,4 Z7_ G/e �� C� 1--4/G LIC. NO. S 3s Licensee Signature ,( /LIC. NO. (2.59.3 3 Address .yt1 rIlle/ee-zly6- 12-o /�/�1�0/.-2�. /��(( s aL No. [o '3 — 9-3/ It. Tel. No. OWNER'S INSURANCE WAIVER: 1 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) x6565 Date. 7- . .... .. .. NORTH ..� 03�0"a••�ao ,a,ti0 T TOWN OF NORTH ANDOVER f P ' PERMIT FOR GAS INSTALLATION 9SSACMUSEI This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . ..�. . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . c �. :/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . North Andover, Mass. C- Fee. y.'. .. . . Lic. GAS INSPECTOR Check# / 4393 MASSACHUSETTS UNUMM APPLICATON FOR PERMIT TO DO GAS G (Type or print) Date,/ 03 NORTH ANDOVER,MASSACHUSETTS Building Locations 1 I I(G /�"'1 � S Permit# J 3 Amount S Owner's Name New❑ Renovation ❑ Replacement Fr Plans Submitted ❑ w � � a a a o . 0 of 0 a W W x A a E» O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR STH . FLOOR (Print or type) �•�i G Check one: Certificate Installing Company Name ❑ Corp. Address r `'' ' 90,v �� 14 777 ❑ Partner. Business Telephone Q ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under P,46vnit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State e a 142 of the Generai Laws. By: Signature of Licensed Plumber Or Fitter Title / Ga Plumber V City/Town ❑ Gas Fitter icense Ntimber Master APPROVED(OFFICE USE ONLY) E3 Journeyman Date. .?. . . .. .. ... . . ... .. ,ORTH Of 4' ( or TOWN OF NORTH ANDOVER An PERMIT FOR GAS INSTALLATION h SACMUSEtA This certifies that . .t!e. t!I 1('.4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . LA . �� . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . ` A . /�1h�r. .�. `.�., North Andover, Mass. Fee. . Lic. No./. . S . . . . . . . . . q.... . .L GAS INSPECTOR Check# / I > 4394 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date l� Building Location q["I., Owners Name P&4- Permit 4 Amount Type of Occupancy New Renovation ® Replacement E3/ Plans Submitted.Yes No FIXTURES Ln fnLH r ' _ A ► SLBH VK i R4SEMENr M TLOCR 2M HIM fid]HIM 41H HIM 5M RDIR 6M ROM 7IH HfM SIH iFIO�t (Print,or type) p Check one: Certificate Installing Company Name�'ecl 1-1 Corp. Address P- 2' '✓05e 403 k14 G3U 7 ❑ Partner. Business Telephone 63 ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy B Other type of indemnity El Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations rm der Permit Issued for this application will be in compliance with all pertinent provisions of the Massach efts a and Chapter 142 of the General1aws. By: igna 57 Licenseaum r Type of Plumbing License Title 611 o City/Town ice se NumDer Master Journeyman ®- APPROVED(OFFICE USE ONLY