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Home My WebLink AboutMiscellaneous - 12 HAMILTON ROAD 4/30/2018 J . 12 HAMILTON ROAD 210/016.0-0030-0000.0 I Date... .... .. �. ......................... TOWN OF NORTH ANDOVER 9 PERMIT FOR GAS INSTALLATION ss,��ss This certifies that ................................e'....... . .........-J.. .. o has permission for gas installationi....r�AAS VVILI le.....'` ...��..:p, in the buildings ...........`? ..................................................................................... at......... .&......� �n�...�4J......�.�................ North Andover, Mass. Fee.{P..p. ..... Lic. No.49o.-.55.p....... ............. ...................................................... GASINSPECTOR Check# q(A o MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE 4/1/14 PERMIT# JOBSITE ADDRESSI��_-- OWNER'S NAME d /,"J$ l L II�M,L GOWNER ADDRESS I Same TEL 1FAX1 TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL® RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:Q REPLACEMENT:® �� PLANS SUBMITTED: YES❑ N0[] APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 1 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 7-1 Replace Gas Meter: _--_------------------- X 1� and Piping-as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 i co pliance with al7, erWZnt prothe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE# 8736 S GNATURE MP❑ MGF® JP❑ JGF❑ LPGI❑ CORPORATION❑# 3285C PAR SHIP❑# LLC❑# COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY I Auburn I STATE LEI ZIPI 01501 TEL 1(508)832-3295 —� FAX 508-926-4347 CELL 508-832-4614 EMAILJMarino@RHWhite.com !t 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 i t}O'idiNEALTH OF MAIQ SSAG.I$i1 - FJM ERS AND GASFIT'fE.RS .'.;: .":' %<y __,UIPERS-ED AS•A..IU ASTER P,LUJIIf�3�R== ''ISSUES:THl `ftBQVE'LICNSE - _ - ki..'"D .MARIN'0 ' :=FAR`R-INGTON ST - Ul[7f2'C `STER MA 0i6IJr#=-310< 05f01/14 ,_= `6tl`3]=T:_ jGOfVitulfJNWEALTH OF dUTASSACf#U:_SlS =; PLU:1ti11�SERS AND GASFITTERS .Ja^,. •. =__i l,iEIV9=50 AS A JOU.RNEYMAN-`:PUIt1 '- - ' ="="TSSUES THE A86VL LICENSE TO_-= _ -• G STE R �3A 05/01/1 11 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 AC ® DATE(MMIODNYY1') CERTIFICATE OF LIABILITYINSURANCEpage 1 of I F08/29/2013 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 IRY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to theterms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does notconferrights to the Certificate holder in lieu of such endorsement(s), PRODUCER CONTACT 9villiq o£ Maeeachuaetts, Inc. MM PHONE C/o 26 Ce-ntvay Blvd. No,,Exr): 977-945-7378 FA%_NoI. 886-467-2378 P. 0. Box 305191E-MAIL NaRllville, IN 37230-5191D.DRt SS aextificate�@willia.G0211 INSURER(S)AFFORD ING COVERAGE NAIC rt INSURED INSURERA: The ChArtGr Oak Fir) Inaurancg Company 25615-001 R. f[. White Construction Company, Inc. INSURERS:Traval*rL; property Casualty Gpn�pany of Am 25674-003 41 Central street INSURERC:Nati.onai Union Fir) insurance Company o£ 19445-001 P. 0. Box 257 Avburnp MA 01501 INSURER D;Travelers Indemnity Company 25659-Dal INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20297680 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. INSR TYPE Or INSURANCE D0' SUBI 11 POLICY EFF POLICY EXP POLICY NUMBER LIMITS A GENERAL LIABILITY VTC2000 977R9948-13 9/1/2013 '9/1/2014 EAChlOCCURRENCE IF 2 000 000 X COMMERCIAL GENERAL LIABILITY DpppMM EETORENTF,D PR6E8_(Eeocewancrf _ 300_000 CLAIMS-MADE OCCUR MED EXP(Any one arson $ 10�000 PERSONAL&ADV INJURY S 2 0 I),,O D O GENERAL AGGREGATE S 4-1000,000 GEN'LAGGREGATFLIPMITaAPPLIE5PER; PRODUCTS-COMP/OP AGO $ 4,_000,000 POLICY LOC B AUTOMOBILE LIABILITY VT,7CAP 977R955A 1g /1/2013 9/1/2014 OM131ED5INGLPLIMIT X ANY AU70 acc�uent S 2,000,000 ALLOWNED SCHEDULED BODILY I NJURY(Per person) $ AUTOS AUTOS BODILY I NJ URY(Per accident) g X HIREDAUTOS X NON-OWNED AUT08 eraccldent ^� X CoAMAGr Dad X Coll Ded $ C UMBRELLALIAS OCCUR 886766140 9/1/2013 9/1/2014 EACH OCCURRENCE0-0-1-10 00 EXCE58 LIAR CLAIMS-MADE AOOREGATE $ $,400,000 DEO X RETENTION$ l0,000 $ j� WORROCEMPLO ERS'LI ATION VTRRUB 920SA185-13 9/1/2013 9/1/2014 X 0 ' AND EMPLOYERS'LIA61LnY Ate,LI ' D ANVPROPRIETOR(PARTNFPIFXECUTIVE NIA VTC2RuB 8203A71A-13 9/1/2413 9/1/2414 E.L.EACH ACCIDENT $ 1,000 000 OFFICERIMEMSEREXCLUDED? LJ fu(MandatonrinNH) E.L.DI2EA9E-EAEMPI,OYF.E S 1,000,000 �apa be of Ut'ERATIONS below E,L,DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach Acord 101,AddltonPl Reme/ka Schedule,It more—sow It raqulrgd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI.I.ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Evidence of inleuxBence Coll:4197604 Tpl:1694012 Cert:20267680 ®1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Location y � 7 No. �T—`? Date NORTH TOWN OF NORTH ANDOVER ?O:t ..e , ,4•G F L9 i Certificate of Occupancy $ s � r cMusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ — _ TOTAL w Check # 165- 92 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T�130-0 HdCICBI9C bit , rn BUILDING PERMIT NUMBER: 43 DATE ISSUED: /2- SIGNATURE: Building Commission for of Buildings Date 1 - ,30-6-3 Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /r 0 (6 -,)- / D Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dish c—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re aired Provided 1.5. Flood Information: 1.8 Sewerage sal 1.7 Watet Supply M.G.L.C.40. Fld ZIfiBrag Disposal System: Public 0 Private ❑ Zona Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record y Name Tint) Address for Service: Signature Telephone 2.2 Owner of Record: r O Name Print Address for Service: 0 M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: y�GAO O ,S�5- PL-efs-fO-.7- S., I /y!� License Number Address C., / `/Q JA49"X& 97P-4�F17,37 Extpiratio(n Dat? Signature Telephone P 3.2 Registered Home Improvement Contractor Not Applicable ❑ #1--j I Company Name ",5O �L ^� � �� / Registration Number Address r Expirati n D e ^ Signature Tele hone V 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.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7757d1tion ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work- ge!K i240V�el-1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of �f GAO Construction Qv . 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 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 e Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS OT 2ND RD 3 SPAN DINIENSIONS OF SILLS DM/IENSIONS OF POSTS DIMENSIONS OF GIRDERS 1tEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE TOWN Oil NORTH ANDOVER Office of the 13nil.ding Department ��o`� Community Development ,ind Services � p 27 Charles Street North itndover,Massachusetts 01845 CHU D.Robert Nficella, Telephone(978.)688-9j-45 Bundling Commissioner 17nX(9-7 68.8._9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at/in: (Site location) LA:2/& Z--'--)-3a Signature of pefinit applicaAt Date t Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Diozzi,Gas/Plumbing Inspector u The Commonwealth of Massachusetts W d Department of Industrial Accidents Office of Investigations 9 Boston, Mass. 02111 Sys workers'CompensationInsurance Affidavit Name Please Print Name: loallrlf 10,yz,C� Location: city0 C, 2i-C�ui Cc/ Phone # I am a homeowner performing all myself. I am a sole proprietor and have no one woridng in any capacity QI am an employer Providing workers'compensation for nrry employees working on this jobs. Com name. 4 Address 6 CiW, Insurance Co. �� Poli # � V� 10 0 3 Compggy name: Address Insurance-Co. Poli # Fadwe to secure coverage as regtdrect under Section 25A or MGL 152 can lead to the imp*Mm d CFXWW at pe a or arfrhe to f and/or one. lrnprisonrrrent siu7�oaitles in theSamn . understand that a copy of this statement may be forwarded to the office of r �#a . Irn+�tigations of the DIA for c�oMerage verifAcation. db herbythe veins penalties OfPerjury afar the be`iannatiW provided above is true and caorrec� • Si nature Print name � l llG�''� �� Pine JI� W-67 Officiol use only do not write in this area to be co MWW by city or town offide City or, Dcheck ff bwmedWe response is requkea B[uffng t -0Licensing Bea) ❑ contact person: PhoSelechnan's 0 ne# El Health Departr; E] Other i ✓7 BOARD Of BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR, Number: CS 022680 Birthdate:06/09/1939 Expires:06/09/2004 Tr.no: 26824 Restricted: 00 ARTHUR J WALSH JR ` 55 PLEASANT ST N ANDOVER, MA 01845 Administrator _ Board of Building Regulations and Standards j HOME IMPROVEMENT CONTRACTOR Registration: 163358 i� iratio�� n: 7m2004 i Type: Private Corporation A.J.WALSH&SONS,INC. . k Arthur Walsh,Jr. i 55 Pleasant St . N Andover,MA 01845A `� �` Administrafir NORTH ® of ®ver No. 143 q OO L A K 10 . dover, Mass., O 2443 COCHICHEWICK DRATED 7 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... ..... .......................................................................... ... ..............................�.............. Foundation has permission to erect...................... ................. buildings on .... Z............... ................ . ................................... ..... Rough to be occupied as.. ................. Chimney provided that the person accepti this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S � 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.