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HomeMy WebLinkAboutMiscellaneous - 12 WRIGHT AVENUE 4/30/2018Date8841 TOWN OF NORTH ANDOVER' .�� --•.'. °oma PERMIT FOR PLUMBING �+. °S� e- 7 V This certifies that .....tJ`. , ..:� ........................ . t has permission to perform .......r/ . ...................... . plumbing in the buildings of .... .................... at ... 0.... ,h .I.� . F...... j .. , North Andover, Mass. Fee. .3d . Li c. No.. f%l . ..... ?- :. PLUMBING INSPECTOR Check x G t S I r. --. 0 th, 0 1 FIXTUKES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: r1 rzbr\\r% NY>A taV Q -r , MA. Date: > '�.> �1 Permit# 1 Building Location:Owners NameN-0 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ® Plans Submitted: Yes ❑ No m r. --. 0 th, 0 1 FIXTUKES Z z O 0: Z to tf! Q Y 9 "i O. W W 19 Z a z ~ a� z a) z Q W a Q rQ V Z 0 O J m O m LU a Q W O Q z W a O W z W W z a U.U. a U 3 OO N 3 V Z a i» a Y j a S Q= W W W a a a y y°az'c SUB BSMT. BASEMENT 7 r -FLOOR 2 FLOOR 3KOFLOOR 4. FLOOR T"'—FLOOR 6 FLOOR 7 FLOOR 4-0 8 FLOOR Installing Company Name:G-e,SRrLNceS`re- Check One Only Certificate # .��,�� ® Corporation Address \\- \ y 'vara �k C� Cityrrown: `..1 %n t A n State: ❑ Partnership Business Tel:"' \ 63ti 'A`�Lt1 Fax: ❑ FinnlCompany Name of Licensed Plumber: —'Y► a Q.r %r k `(*K) ax G INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes Zj No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy JKJ 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Sionature of Owner or Owner's Aqent I hereby certify that all of the details and infornation 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations periormed under the permit issued tar this appucauon wru ne in compliance wnn an Pertinent provision of the Massachusetts State Plumbing Code and Chapter i42 of the General Laws. By Type of License:\A J , Title ❑ Plumber Signature of icensed Plumber Cityrrown ^O ,meter License Number. vnCo �S .esnn.�n r^CeC Iace ul v% ❑.ioumeyman iJ Aft toot T iJ 0 J . ............ 1A At Iv ;�Z- jjv�lj WORM! vuh— &"T�w stay; alf vul"p. vvy M, 0 Yyalww' wal jolge. h" -jq4 nmmq am no 4 AMP& 40 F�' 0 .5 Amu ."No" A" Iwo, lawl, I.-, tac t J& SAW qvwu . ............ Date ..°?!�/:......... . 3? �` TOWN OF NORTH ANDOVER O + D • PERMIT FOR GAS INSTALLATIO d/ • p9 +^ 7 j O+...o ••�SSy I SSACHUSE 4 This certifies that ....� . ..`?. .......................... . has permission for gas installation . k.. ................... in the buildings of ................................ at ... ,� ..... �- .�.' .'. y. ...`` 1.'... ?. , North Andover, Mass. Fee. 3o Lic. No.c��.j ... ... ��. _...�:: < �...... / GAS INSPECTOR / Check # FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town-X) r � nV RY . MA. Date: -N Z\ V Permit# W Building Location: `Z. W If � O�h'� kV t Owners Name: �T wn C.\ S C o \ ` 1 V►� �' Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ® Plans Submitted: Yes ❑ No FIXTURES W W t• to DILI Z H en uJ y V 0 U)~ i H 0 XGCUJj m= Z O F- g 0J Z F W W ? N lr 0 2 at 0 W M 1". D W !Z W W > 2 b7 W m Z Q W W �. O H Q W~ W C X = ti LU > Z I -4C W V W 2 0 J W} J H H O Z 2 J O O u. }�. O = W IW– W W H v rn c c Q i Q m i g W O a ZaQ P>>> 3 O u . a X SUB BSMT. BASEMENT Tr -FLOOR 2 FLOOR 3 FLOOR 4 -FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name.�T I;— �, �'cn�\ n k �Q r �t C t: S k lh� Check One Only Certificate # z W Corporation 1- n Address City/Town%... � t -,C o\ A State: ` "` . ❑ Partnership Business Tel:LkOl C -n 1c1 ti"�= 440 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter.7— r 9—� 2. t-'% C k W e. q vA INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes. please Indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 Other" 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Sionature of Owner or Owners Agent By checking this box KJ—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 rhy 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 taws. BY Title IN Plumber ❑ Gas Fitter Signature oflicensed Plumber/Gas Fitter ($ Master ❑.fourneyman License Number: Z� 0 LP Installer Aa..ta,a m;. tL 7j S-1 C7 I IM Location /a `�/ RSG 14 7- A 0,r— No. ENo. y Date TOWN OF NORTH ANDOVER o Certificate of Occupancy $ s�cHusEt�'' Building/Frame Permit Fee $ �"� U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Ba o F 17807 6�- '-�Building Inspector I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Z t�kw! BUILDING PERMIT NUMBER:DATE ISSUED: SIGNATURE: /L Building Co"ssioner/lngwor of Buildings Date C1T lTT\ A1T - a ■ 1V1\ 1- X1116 11\1• VlU\1f111V1\ 1.1 Property Address: - 1.2 Assessors Map and Parcel 173 Map Number Number: _ �3, Parcel Number d 1.3 zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water supply M.G.LC.40. 54) Public ❑ Private ❑ 1.5. Flood Zane Inforantion: Zona Outside Flood Zone ❑ l.s Muoicipal sewerage Disposal system: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT E:. Z.1 Vwner of Kecord )LOMA /aa-2-60ibiln Lv ,t Name Print �— s ( ) Address for Service U 2`.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 3.2 Con Telephone movement Contractor wigi L AL 4-,0. Address for Service: -/1, / 0, '�J' ,� % Not Applicable 0 License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date . r L 4 SECTION 4 - WORKERS COMPENSATION (KG -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 it. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check an a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Deniolition ❑ Other ❑ Specify Brief Description of Proposed Work: iaxc� ckc SECTION 6 - F.STIMATF.n CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) J. 3d 0 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 /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 OWNERIAUTHORIZED AGENT DECLARATION E I, ,as (r/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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND3 RD SPAN ' DIMENSIONS OF SILLS DIMENSIONS OF POSTS t 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 M FORM U -LOT RELEASE FORM ja J: vJ eoo. Joc, r� INSTRUCTIONS: This form is used to verify that all necessary approvals/per'm'- i1i 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)' )"loci4e, Xd4 JAO PHONEq ' ✓ /a LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) - STREET G FL f- �c ST. NUMBER—,Z',&6 ********* OFFICIAL USE ONLY ** Key AGENTS: NSERVATIi9N MmINISTRATOR DATE APPROVED DATE REJECTED TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm ti R ���%iae inrtm-nuar�rver�ll� o�. ,��tctscrc��cdtl� BOARD OF BUILDING REGULATIONS G License: CONSTRUCTION SUPERVISOR I Number: CS 064384 I a Birthdate: 04124/1957 Expires: 04/24/2004 Tr. no: 20986 Restricted: 00 KEVIN M BROUILLARD SR ,l 59 PELHAM ST METHUEN. MA 01844 Administrator . ,� ✓fib t0�fY7%1)d471'dfi(,lllR O� �%rsra.�iuc�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 137695 Expiration: 12/19/2004 Type: Individual KEVIN M BROUILLARD KEVIN BROUILLARD SR. 59 PELHAM ST. C 1..... METHUEN, MA 01844 Administrator C/V-C� 4COIRDn, PRODUCER IINSURED THE HOWE INS AGENCY 4 PUNCHARD AVE ANDOVER MA 01810 K M BROUILLARD REMODELING KEVIN BROUILLARD 101 EVERETT STREET LAWRENCE MA 01841 COMPANY A NATIONAL GRANGE COMPANY B COMPANY C COMPANY D 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS DAMAGE GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx] OCCUR OWNER'S & CONTRACTOR'S PROT TBD 5/05/04 5 05 05 GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP/OP AGG $ 500, 000 PERSONAL & ADV INJURY $ 500, 000 EACH OCCURRENCE $ 500, 000 FIRE DAMAGE (Any one fire) $ 100, 000 EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM MED EXP (Any one person) $ 5, 000 AUTOMOBILE LIABILITY TBD ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 5/03/04 5/03/05 COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) 100,000 BODILY INJURY $ (Per accident) 300,000 DESCRNMON OF OPERATIONSA.00ATIONS/VEHICLES/SPECUIL ITEMS BROOKS SCHOOL, NORTH ANDOVER TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE ,J David T. Louis // DL A rlPROPERTY DAMAGE $ 100,000 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EEXCL WC TAT TORY LIMITS ER EL EACH ACCIDENT $ EL DISEASE -POLICY LIMIT $ EL DISEASE -EA EMPLOYEE $ OTHER DESCRNMON OF OPERATIONSA.00ATIONS/VEHICLES/SPECUIL ITEMS BROOKS SCHOOL, NORTH ANDOVER TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE ,J David T. Louis // DL A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 - Workers' Compensation Insurance Affidavit Name Please Print Location: city Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 17 1 am an employer providing workers' compensation for my employees working on this job. Company name' Address City Phone # , Insurance Co. Policv # Company name' Address City, Phone #: Insurance Co. __ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as _welLas _civil.penatties in lbe lam d -a -STOP WORK _ORDER..and. a .fine .of.(.$100.00)-a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penelt� of pedurd that the information provided above is true and Signatu Print Official use only do not write in this area to be completed by city or town official' # o6 -15W,00) City or Town Permit/Licensinq ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other Town of North Andover' Building Department 27 Charles Street y �o �•• North Andover, MA. 01845 ,,:' D. Robert Nicetta Building Commissioner (978),688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name Home Phone Work Phone . • PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs.more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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) s 8kffiature of Permit Aliplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector PROPOSAL - CONTRACT Reliable K,M. BROUILLARD SATISFIED Service CUSTOMERS FINISH CARPENTRY & REMODELING are Our best SHEET NO: Kitchens • Decks • Additions & More ADS DATE: AG `/7 01 6167Ar COMPLETE DRYWALL SERVICE 978-794-0247 • 603-898-5849 Proposal Submitted To Work To Be Performed At Name 7 S�-An Street •r I dinox1a)eLs Street / 'V6 e City G - � D City State— State 4 • Date of Plans Architect Telephone Number - % We hereby propose to furnish all the materials and perform all the labor necessary for the completion of Y O 9 koO • 411 e -A bile el ,'S G o f V. ld-smfilld � LAJ iC� "q/X4Atp All material is guaranteed to be as, specified, and the above work to be perormed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlik manner for the sum of i9aO � DOkJ✓i 9191-AAC ® tM-D Dollars ($ 1� L,Q�oq be follows: with payments to made as o )gad• 'Due K o� com Ile�an . 3 7 Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. Owner to carry fire, tornado and other necessary insurance upon above work. r Respectfully submitted Lic. # 0643814 Note - This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted t Date Signature'A iaa LITHO IN U. 6. A. PROPOSAL - CONTRACT SATISFIED S 4 Service e K.M. BROUILLARD CUSTOMERS FINISH CARPENTRY & REMODELING are Our bestADS SHEET NO: Kitchens • Decks • Additions &'More tetA DATE: AUS , 17 I q COMPLETE DRYWALL SERVICE 978-794-0247 9 603-898-5849 Proposal Submitted To Work TIoB,ePerformed At Name a Street Street City. State— City -- Date of Plans State Architect Telephone Number re hereby propose to furnish all the materials and perform all the labor necessary for the completion of r r Q 2 O D fyl /IVo S ' „ 2 , t t . . �. Q. 40 0 �4 -e-,:5 �- s o0 0� fn els t? All material is guaranteed to be as specified, and the above work to be perormed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of 017 53 !'l in9 D -_CO/j workmanlike 9':24 2 •��%Frp—g- be follows:9a61� Aki/' with payments to made as �'� r S GD P�e_ , n o to �—D b Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. Owner to carry fire, tornado and other necessary insurance upon above work. Respectfully subin o 4�v Lic. # 064384 11,z�G Note — This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted ' Date Signature v �t�XJ LITHO IN U. 6. A. t Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS ti U LOT NUMBER SUBDIVISION DATE REQUEST FILED V d' DATE READY FOR INSPECTION l0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUC D S NOT MEET ALL APPLICABLE CODES. SIGNATUREL94—AIU/-\JV� ROUTING CONSERVATIO - DATE oZ PLANNING DATE D.P. W. — WATER METER DATE 0 C!�— D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED 0 TOTHE INSPECTIO!QUEST DATE. ATURE/ r Might Side Elevation Sketch t %2 ► c, ,c ply w O'C-4 Ship 1�- �l0 gou!5F o W.AU . a x 8 f)T _73-n I' sT- 14;( . <-, 2-• 2Y ID PT' r3e #9 m �zlX(ePT Po6"r 60 ACReTrz, o" DL °e P Left Side Elevation Sketch n qi PT- � AA i 1 Yi�<IYF' P r << A X 6 PT ""C iST 2 - a -)0 eT 6t � 4 I Ccm O CO O O 'g m m CD CD �3 O O Q O O d CL C a h � � C O V C Z tsCLO V y C C C ■ C c CLy Q a � � t, -m o N � to=� � or- v) a � v a w � a a. cc� � a w co a w z X: E I Ccm O CO O O 'g m m CD CD �3 O O Q O O d CL C a h � � C O V C Z tsCLO V y C C C ■ C c CLy Q t, -m o N � to=� � or- a. cc� :s o X: E C � P �►; _ �► E C� i O p0 2-ts y m = y 0 0 m z �ca ' cm m Cp J .. y p ` a ' A x= y O O :0 CD O CLL.) cm h m L Z O omC Of Q= d C t m O t+m iii y O O •O z r. " a. g Qf 2 m mw p N w m��= •N W = � W�E dZ v 0 �y Z C� m v m � p 'fl aO Q CO)a 2 A m a can I Ccm O CO O O 'g m m CD CD �3 O O Q O O d CL C a h � � C O V C Z tsCLO V y C C C ■ C c CLy Q D�CiC 1."�Ci�� `t"G� tach �7i 100 d n DOM9 b�m�y �. d b to 0 b>r�� � o � oZ � y . b { chi v t I ?4 v t a � I ?4 v ■ 0 THECOMMONWEUTHOF DEPARTMMEIVTOFPUBi BOARDOFFIREPREVEV ON, 0 APPLICATIONFOR PERMIT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE P (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical wrk escrib Location (Street & Number) I Owner or Tenant >oa� SETTS Office Use only Permit No. 97(MRI2.019 Occupancy & Fees Chec d RMELECTRICAL WORK ELECTRICAL CODE, 527 CMR 12:00 Date below. To the Inspector of Wires: Owner's Address Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps �a=Volts Overhead M Underground � No. of Meters New Service Amps Volts Overhead =1 Underground No. of Meters umber of Feeders and Ampacity cation and Nature of Proposed Electrical Work c4j,r,tA 3 '- S cQ s vrq C. o. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA o. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 1:1round of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones of Ranges No. of Air Cond. Total Tons No. of Detection and of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices Space Area Heating KW JofDishwashers No. of Self ContainedDetection/Sounding DevicesDryers Local Municipal Other Heating Devices KW Connections f Water Heaters KW No. of No. of Signs Bailasis ydro Massage Tubs No. of Motors Total HP Covar, RIIs=oDilleIBgtuta iariS�ISCmaal aws Iiabl�'tyhmnanoefbkyin WffigComplete CowWoritsatbsUtia aMvala�t YES ® NO valdptoofofsametotheOliim YES j—T If)wlRveched0dYB,plea9ei xk*the typeofcoverage by box 1L_===J MURANc BOND E3 OTHR r—I (Pleasespediy) (�ss 4-e 11 Work toStart %a— I'7 0 to hnpecfimDateRegxsW Signed underTlcar1al6esofpajtuy. a--- FMMNAME [ ioa>see � ��� Signature ESt1MamdValued11earica1Wodc $ Rough io?- a� - < y F91at J Iica>seNo. LimiseNo BusinessTelNo. 1'i"�,_-R'SINSURANCEWAIVER, : -5-6)- aA VS � � �\,r, 2 � ' ti F -t i� �rt �)tf� a3o3 c AITUNo. IamawatediltheLm>,sedoesnothav+etheinstuar ecoveWormsubst neialequivaialastegtmedbyMmdnsettsckneralLaws mathatmysgiaaueonthispenrritapplicationwants thistegmenm / t5 3 396 96 5 7 ?3 PI se check one) Owner Agent a �i J Telephone No. ERMIT FEE $ signature or Owner or Agent Datelwan.1 ... j4p.q 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ��4 D ..... 4&m.aa.4-1) ............................ has permission to perform .... ...4rs g � - .. PAR. R. 4. /,/ . ....... wiring in the building of ... 46-A)AA ....... 0.61GA&AA . ........................ at ....... tA......�*Lre................ , North Andover, Mass. Fee.f/rV.'*--P--. Lic. No.'AI:B4 ri� .............. :: P -"h 0" ELECTRICAL INSPECTORCheck # ( 5476 THECOMMONWEUTHOF DEPART IEWOFPUBI BOARD OF FIRE PREVEN770N APPLICATION FOR PERMIT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical Location (Street & Number) % � /aJr- /, vl� -� Owner or Tenant 2 TIS Office iUse only Permit No. / CMR12.-00 , �2 Occupancy & Fees Chec d IRM ELECTRICAL WORK ELECTRICAL CODE, 527 CMR 12:00 Date ! (J below. To the Inspector of Wires: Owner's Address Is this permit in conjunction with a building permit: Yes © No ID (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ?- AmpsZa=Volts Overhead Underground No. of Meters New Service Amps olts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _ t.� r� s v� j�20�, C No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round El ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices NR. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other Ido. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• ]iiun&=Gc)v qr- Rum=tothew4mmiatsofMa%admsmG=iWIaws IharesthyiwdvalidprwfofsametotheOffim YES INSURANCE "V, BOND r7 MIER r7 FleweSpa*) WodctoSlatt Jo? -f7 -0Z4 kgectionDatcRec)e0d signed tmderTrPwaltiesofpajury: -- � HRMNAME licensee signahle Ilartrt YES W NO If you haveclledW Y0,p1c%eirx iratethetypeofoDvwWby Es1irrwdVahieofE1ecfticalWodc$ Rough ia- ao - <)y Fit L=wNo. 0? ) U 01 J 2 Lic rwNo c2 \O a,\ ` 1 BusirmTel. No. ArNrr-. � -5'6 )4oA\S q,,l\a, „4 2-). A) F4 0_Vez4C o34"3C Ak-Tel.No. OWNER'S WSURANCEWANE, lam awatethattheIicaisedixsnothavethei uz=oovw.4eoritsabsu6aleg valalast gmedbyMa%adnlsettsGartalLaws andthatmysig>ithueonthispemvtapplicationwaivesthistegime nent. (Plepse check one) Owner Agent Telephone No. Sq PERMIT FEE $ signature or Owner or Agent ACOR TM CERTIFICATE OF LIABILITY INSURANCE 11/04/200 ' PRODUCER (603) 772-6438 FAX (603) 772-6547 Hoyt -Costello Insurance Agency, Inc. 37 Portsmouth Ave PO Box 1011 Exeter, NH 03833 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Jared Brouillard 256 Halls Village Road Chester, NH 03036 INSURERA: National Grange Mutual Ins. Co 14788 INSURER B: INSURER C: INSURER D: INSURER E: CnvFRAAFS 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. INSR TR DD' NRR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONI DATE (MWDDIYYI LIMITS AUTH 12E`DREPRESENTATIVE GENERAL LIABILITY TO BE ISSUED 11/16/2004 11/16/2005 EACH OCCURRENCE $ 500,_000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ S0,000 CLAIMS MADE F__j OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 A GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PROECT LOC J AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- IMIT-11 ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CFRTIFICATF Hn, DFR CANCFLLATIAN ACORD 25 (2001/08) ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Pete Schi l l ereff 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Pete' s Electric BUT FAILURE TO MAIL SUCH NO CE SHALL IMPOSE NO OBLIGATION OR LIABILITY 111 Chester Rd . , OF ANY KIND UPON THE INSU ER, ITS A TS OR REPRESENTATIVES. Raymond, NH 03077 AUTH 12E`DREPRESENTATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 Z V ig H � U ~ N CG �. U CAW ZJp M 0 W w ❑ M �a� UZz C LU o: z :j �-> U) Q L9 Z U W J Q F J J J oog W W ❑ :n OW ❑ O ~ > LL -1 - OC CC N O CD 'j W F- J � � Q W a W CA oC %D W N Q Ln x Q N U .in N O� N Ln 0 n 0 M n O oC 9 N O N Date. h?.-. i ..C'.`.!.... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that jr ha's permission for gas installation ..j?! P. ........... in the buildings of ei ?.,s. h ........................ . at .c......... , North Andover, Mass. Fee. Lic. No.. ..... ......... ..... GAS INSPECTOR Check # F I ) C 4580 MASSACHUSETTS .UNIFORM APPLICA (Print or Type) IVO ' 1JA1,=6f1p1' , Mass. Date Building f.'G X7 /� r/ New "i Renovation ❑ 2o - FOR PERMIT TO DO GASFITT1NG 19" 4Lj Permit # q 9 OP -6 Owner's NameAl�ilc,/ a Type of Occupancy ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name Poule I s Gas Address 39 Oxford Avenue Haverhill, MA 01835 Business Telephone 978-372-6783 Name of Licensed Plumber or Gas Fitter Charles H. Boule' Check one: ❑ Corporation ❑ Partnership il Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have. checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy A 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 C3 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of th�raJ43. T of license: Plumber ature of Ucensed Plumber or astiter Title Gasfitter Master license Number M312�_/ T3558-- Journeyman City/Town _ APPAOVE� 1 EMEMEEMEREM memo onommommussonso Eff ME NEMESES WICKS MEMNEEMEMEN mossonsommomom MEN son MEN sommossonsommosom IRM MONSOON Installing Company Name Poule I s Gas Address 39 Oxford Avenue Haverhill, MA 01835 Business Telephone 978-372-6783 Name of Licensed Plumber or Gas Fitter Charles H. Boule' Check one: ❑ Corporation ❑ Partnership il Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have. checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy A 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 C3 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of th�raJ43. T of license: Plumber ature of Ucensed Plumber or astiter Title Gasfitter Master license Number M312�_/ T3558-- Journeyman City/Town _ APPAOVE� 1