HomeMy WebLinkAboutMiscellaneous - 13 MAPLE AVENUE 4/30/2018 13 MAPLE AVENUE
210/019.0-0
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Date.... ..Zl..... ...
pT~,~ TOWN OF NORTH ANDOVER
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n PERMIT FOR WIRING
13S,C►U
This certifies that ....... ..............[.C... 1 ....................................
has permission to perform ........&*,d.....S:� U/�...(U�f . .
�..
wiring in the building of.........�/ 4..,T//,�....................................................
at .......1.. ....Jr...... ..., ` .............. ...............North Andover Mass.
Fee S-.��ic.No. 5P.b.:.... OYl ! ............
IL ELECTRICAL
ELECTRICAL INSPECTOR
Check# /�
j Commonwealth of Massachusetts Official Use Only
`z a Department of Fire Services Permit No. L
Occupancy and Fee Checked
�M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 MR 12.00
(PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: �� L�,
City or Town of: NORTH ANDOVER To the Insp ctor 6f Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant - �' >C f� �- Telephone No.
Owner's Address /,
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of BuildingS-e, &,n: a!, Utility Authorization No.
Existing Service Amps / Volts Overhead Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting
4 rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: - """ """ """ ""'' Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No. of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
r
No.of Devices or Equivalent
FoTHER-
Attach
additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of),lectr'cal Work: (When required by municipal policy.)
Work to Start: 5 z-�– /f Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE O GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains d .enalties of perjury,that the information on this application is true and complete.
FIRM NAME: il—e(, �ije� ��%C LIC.NO.: 2 js$i-1/
Licensee: Signature a,�� �:� LIC.NO.:
(f applicable,enter "e�mpt"in thg license number line.) �� C-:h-- Bus.Tel.No.: 111?i" 1
l
Address: = Alt.Tel.No.:
*Per M.G.L c. 147,s."57-61,security work requires Department of Public Safety"S"License: Lic.No.
�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent �RHIT FEE: $
Signature Telephone No.
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❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: hi accordance with the provisions of M.G.L.c. 143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed `
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an
electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the t
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012.
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑
❑ Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass 0 Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass 0 Failed Re-Inspection Required($.) ❑ y
Inspectors Comm ts:
a
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass 0 Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass IN Failed Re-Inspection Required($.) ❑
Inspectors Comments: z
Inspectors Signature: Date:
(FINAL INSPECTION:
Pass 0 Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
DEB WEINHOLD ... TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
The Commonwealth of Massachusetts
z Department of IndustrialAceldents
X.-- :;f _--- I Congress Street,Suite 100
Boston,MA 02.114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legib
Name(Business/Organization/Individual): 5 j� e `� / ✓;ro o,
Address:
City/State/Zip: u/"✓s` L Phone#:
Are you an employer?Check t�e appropriate box: Type of project(required):
1.Q 1 am. employerwith employees(full and/or part-time).* 7. El New construction
2.r�. am a sole proprietor or partnership and have no employees working for me in 8. n Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
�
4.FJI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. _ —
12.0 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.$
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c.
14.0 Other
152,§1(4),and we have no.employees.[No workers'comp.insurance required.]
i *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submif 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'compensation 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/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of peijuty that the information provided above is true and correct.
r r'
Si nature: �Z./� ��/ _7_.._.�_. _. .�.._ Date:
Phony'#: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
i r
t
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=contractor(s)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 carry 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 t
(i.e.a dog license or permit to bum 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
- R
�>4�°' COMMONWEALTH OF 11IIASSACHUSETTS
ELECTRICIANS 4
ISSUES. T.HE FOLLOWING L!``CENSE;,
AS A REG JOURNEYMAN >E�CT,R'�I�C-I,A?,� � +
THE;.ODORE RAFT EL I S
jjJJ 1 �`
5 FL0YEI.;ST
3� UG�I MA 01306-1524.;: ')
X7742 _.�.
('pp OM
MONWEALTH OF MASSACHU'SE STT
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EL
URI CT ANS
1;5SUES THE FOLLOWING LIEIrNSE AS A t�
RI Cf1AN
REG!STET ED MASTER E:LECT
RAFTEL I S ELECTRICAL SERVICES L '_
T`H`EODRE: RA FTE uA S ZW
5 FLOYDST Ii
AuU > r�A..:41906 1524 '
„07-/31�1:b z7743 l
20887 ' _ _._-
Date.. �t ?.............
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t NOR7M
3:;•';�``.°:'1"�O� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
USEt
This certifies that ...Il.U1 ✓ .............................................
has permission to performY
►-". .! .. . . ..t. .. .. ............................
wiring in the building of.... My&....5.7...................................
at............................................................................... .North Andover,Mass.
fiy
Fee._ . ............. LIc.No,14(--74...................................... �...........
i. ELECTRICAL INSPECTOR
"A Check #
THECOA MONWEALTHOFMASSACHUSETTS Office Use only
DEPARTAIENTOFPUBLICS4 Y "'' 5� Permit No. �.�
BOARD OFFMPREVEM70NREGUTA770NS527 aM 12:1X1
Occupancy&Fees Checked
APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street&Number) 13 A+O,-r AveSi—
Owner or Tenant Jrdff G ,C-.V-1,D�c
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 / Volts Overhead M Underground No. of Meters
New Service AmpsVolts Overhead M Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work A/+T rte-%
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
�t/f�%r2Li�SDG IV,3 KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
round ground
No.of Receptacle Outlets Q No.of Oil Burners No.of Emergency Lighting Battery Units
O
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
/LFei`z `�r2i
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local a Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
t lo.Hydro Massage Tubs No.of Motors Total HP
OTHER AI5NZC. /J��� ✓5E7147A��l /�/T��f �liui��2 Q ES
hmranceam rage.Pursm oDthe regtmamcrtofNbmc usettsCelaalLam
IhaNeaamlLiability hmaarmPolicy inch*igCcrnplete 01perabons Covwegeorits subauklequivalaft YES NO
Ihave aftnittled valid proof of same to the 011ioe.YES Ifyou have checked YES,please irtdicale the type of oovaage by
d>addngthe box
INSURANC��BOND r7 MIER M (Please Spey)
FxpiraticnDale
Esttmaled Value ofE10=cal Wodc$
wodc ro Start 'J � hit Da�Regttes�d . Rarglr Finalsigned urtd?r tTie Patalbes of perjtuy.
FIRM NAME t�r9,/%D &-2tz-'2:c4x- LicffwNo. /f-1g63.4
Signa m --- LimwNo
Busin s Tel.No. 7 7er S 5-7 3,J
Ad1i 9-7� 6�z zc.z
At Tel No.
OWNER'SINSURANCEWAIVER;IamawaretAdrLicerwdoesnothavethennarmeoover�oritsabstrMgrrdaltasrequitedty,Nb adarsettsCelralLaws
and that rry signs lure on this perrrrit gpplicawn waives this regtriter ul
(Please check one) Owner F-1 Agent
Telephone No. PERMIT FEE$
tgna re o caner or gen
/ THE COMMONWEALTH OFMASSACHUSETIS Office Use only
DEPARTA1EWOFPUBUCSA M -t- c
v1/1
BOARD OFFIREPREVEM ONREGmHoNS527CtY17Z12.00 Permit No.
Occupancy&Fees Checked
APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
?LEASE PRINT IN INK OR TYPE ALL INFORMATION
) Date -7 �
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) 13 E:-
Owner
=Owner or Tenantj f� �'IL
Owner's Address
Is this permit in conjunction with a building permit: Yes E: No a (Check Appropriate Box)
Purpose of Building
Utility Authorization No.
xisting Service Amps �Volts Overhead Underground r7 No.of Meters
4ew Service Amps / Volts Overhead Underground No. of Meters
umber of Feeders and Ampacity
location and Nature of Proposed Electrical Work Ar rte,
�No.of Lighting Outlets No.of Hot Tubs , �
� � No.of Transformers Total
,3 KVA
No.of Lighting Fixtures / �j ` Swimming Pool Above Below Generators KVA
V round Fround
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
I No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
I Tons
io.of Disposals _ No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
iNo.of Dishwashers/r Space Area Heating KW No.of Sounding Devices
No.of Self Contained
t Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Vo.of Water Heaters KW No.of No.of Connections
Signs Bailasis
Vo.Hydro Massage Tubs No.of Motors Total HP
je,%do 4
'HER. /�5% (� 5+.i°3 /'' Z 11�i�7T•�r�/ /<'il'C,J�r-k-i e4iJ.=ti 'Y'
I
haffarreCovcag`.Pleatanttothe C=WdlLaws
IhaveagaitLiabilitykurtartoePohcyurkxiTComplex CoverageoritsmbAm>dalegttivalaY YES NO
I have a bmamd valid proof of same to the Omoe.YES r7p Fyeu have ched®d YES,please irrlicate the type of coverage by
dx ddng the aPR�box_� L�
1 Vs(JRAN� sOND a MIER r7 (Pleew
Estirrl Value OfOatmealWork$
Work to Start �" lhspect)mD eeRWsted . Roughi Final
Sig,Lfjundtr rPenaltiesofpeju !)
tFIRM NAME Lit eNo. I � 6 , g
Iia�tve /%%�rrri 1144 0='3/.2 Signature
LkffwNo
j-7L- % � BuSin;Tel NO. V?� ;+7 37 5—? 3 V
rte _ .� Alt Tel No. 7 t*.9'.- ` -'-',
JJ;ER'S INSURANCE WAIVER,I am aware that the Licerm does not have the in ur re oovaage orits su al egtrival as ret�ured by M �Genaal Laws
.u�that my sgoue on this prmnt application waives this regtmemal
(.Please check one) OwnerM Agent
Telephone No. PERMIT FEE
rgna ure o caner or gen
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� �� � � � � �^ D G ��
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Date.
f
O'tHORT:�tio TOWN OF NORTH ANDOVER
10 w PERMIT FOR PLUMBING
'� o • i
SSACHUS�
This certifies that . .fit.!Q". -'.e". ./. /'/Z. < rC.`... . . . . . . . . . . . . .
has permission to perform . . . . (: //.° `. '
plumbing in the buildings of . .'� C/_�� ! c�F�. . . . . . . . . . . . . . . . . .
at . .P . . ... . . . . . . . . . . . .. North Andover, Mass.
Fee. 63.r. .Lic. No./O . . . . . . . . - �)--�.... . . . . . .
PLUMBING INSPECTOR
Check # > t S
6922
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIlV
(Type or print)
NORTH ANDOVER,MASSACHUSETTS r G
2 n
je'
DateBuilding Location J Owners Name J !'"�� Permit# L,-
Amount 4 3
Type of Occupancy
New Renovation Replacement ��„-'Plans Submitted Yes No ❑
'- 'T TURES
� W
i
7
32
>�
a�n�nerR i
sn HaR
7MROM
(Print or type) a Check Certificate
Installing Company Nameyj ` f �l C-G�_ corp. ,�a q
Address PS Partner.
Business Telephoneke"l- -5 ❑ Firm/Co.
Name of Licensed Plumber:
Insurance Covera¢e: Indicate the ty2p,6f insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
threeinsurance
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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts St e P b'ng a and Chapter 142 of the General Laws.
t
By: Tignalure or LicenseaPpmoer
Type of Plumbing License
Title
City/Town tc nseum eTi r Master Journeyman
APPROVED(OFFICE USE ONLY. ❑
}� L� '
Date. . . �`!�.�.!. . . .....
r,ORT/y
TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
d '`s,9SSACHUSEt
This certifies that . . . . . . . . . . .
has permission for gas installation . . .C? f .7 �. . . . . . . . . . . . . . .
in the buildings of . .S.<. . �.. . . . . . . . . . . . . . . . . . . . . . . .
at . . 3. . . y-1'44. l:. . . . . . . . . . . . . . . ., North Andover, Mass.
Fee. .3 Lic. No. . . . . . . . 91z'. �.. .. . . . .
GAS INSPECTOR
Check
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5523
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MASSACHUSETIS UNIFORMAPPUCATONFOR PERM TO DO GAS FrrrING
(Type or print) Date l G b
NORTH ANDOVER,MASSACHUSETTS
Building Locations 3 e Permit#
�t
Owner's Name SACKAm unt$
SQ�I-l�1 �j P
New❑ Renovation ❑ Replacement Plans Sued '❑
U94
W W �" O OU F x x v'
z C z W
Gw w z a A r��" a
H 3 a a 0' oa a ° H o
z a z
SUB -BASEM ENT
B A S E M ENT
r 1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) 0� C G_. Check once: Certificate Installing Company
Name
Address �C t� ❑ Partner.
Business Te ep one 7 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter �/ /9�l'► E�I17/i�f l� j
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it' stantial equivalent. Yes IJNo[3
If you have checked yes,ple e indicat a 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts tateLGas de 142 of the General Laws.
Si e of Licensed Plumber Or Gas Fitter
By: lumber /GAIL
Title
City/Town ❑ Gas Fitt ice Number
ED-, aster
APPROVED(OFFICE USE ONLY) ❑ Journeyman
BOISE" Double 1-314" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1F1302
BC CALC®9.2 Design Report-US 1 span No cantilevers 0/12 slope Monday, March 27,2006 13:38
Build 141
File Name: VIEL 032906.13CC
Job),"ame: VIEL Description: F1302
Address: 13 MAPLE AVE Specifier:
City,State,Zip: N ANDOVER, MA Designer: WALTER DION
Customer: Company:
Code reports: ESR-1040 Misc: PRELIMINARY ONLY
2
'�` '�y,�r� A cF+,„•A �`z.� �k,, ''��� ,;,����... ,s�Y� x aa- �t" .,�1 � �. !`„s��� � ��1r� t w A'i,..� �+�. ti9 ..�,Y t
12-00-00
B0,1-3/4" B1,1-3/4"
LL 2520 lbs LL 2520 lbs
DL 1390 lbs DL 1390 lbs
Total of Horizontal Design Spans=12-00-00
Load Summary Live Dead Snow Wind Roof Live
End Tag Description Load Type Ref. Start E d 100% 90% 115% 133% 125% Trib.
1 Standard Load Unf.Area Left 00-00-00 12-00-00 30 psf 10 psf 14-00-00
2 Unf.Lin. Left 00-00-00 12-00-00 0 pif 80 pif n/a
Controls Summary Value %Allowable Duration Load Case Span Location Disclosure
Pos.Moment 11730 ft-lbs 55.1% 100% 1 1 -Internal Completeness and accuracy of input must
End Shear 3218 lbs 40.7% 100% 1 1 -Left be verified by anyone who would rely on
Total Load Defl. U463(0.311") 51.9% 1 1 output as evidence of suitability for
Live Load Defl. 0718(0.201") 50.2% 1 1 particular application.Output here based
Max Defl. 0.311" 31.1% 1 1 on building code-accepted design
properties and analysis methods.
Span/Depth 12.1 n/a 1 Installation of BOISE engineered wood
P P 9
products must be in accordance with
Notes current Installation Guide and applicable
Design meets Code minimum(L/240)Total load deflection criteria. building odes. obtain Installation Guide
Design meets Code minimum(U (8
360)Live load deflection criteria. or ask questions,,please call
(800)232-0788 before installation.
Design meets arbitrary(1 )Maximum load deflection criteria.
Minimum bearing length for BO is 1-1/2". BC CALC®,BC FRAMERO,AJSTM
Minimum bearing length for 61 is 1-1/2". ALLJOISTO,BC RIM BOARD-,BCI®,
Entered/Displayed Horizontal Span Length(s)=Clear Span+ 1/2 min.end bearing+ BOISE GLULAMTM SIMPLE FRAMING
SYSTE1/2 intermediate bearing PLUS@,VERSA R® 'VERSA-RIM
VERSA-STRANDTM,VERSA-STUDO are
Connection Diagram trademarks of Boise Wood Products,
b �d— L.L.C.
a
k'
C
a minimum=2" c=7-7/8"
b minimum,:3" d= 12"
Member has no side loads.
Connectors are: 16d Sinker Nails
i
Page 1 of 1 J
BOISE" Double 1-314" x 9-114" VERSA-LAM® 2.0 3100 SP Floor Beam1FB01
BC CALC®9.2 Design Report-US 1 span No cantilevers(0/12 slope Monday, March 27, 200613:38
Build 141
r' File Name: VIEL 032906.13CC
Job Name: VIEL Description: F1301
Address: 13 MAPLE AVE Specifier:
City,State,Zip: N ANDOVER, MA Designer: WALTER DION
Customer: Company:
Code reports: ESR-1040 Misc: PRELIMINARY ONLY
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B0,1-3/4" B1,1-3/4"
LL 1680 Ibs LL 1680 Ibs
DL 916 Ibs DL 916 lbs
Total of Horizontal Design Spans=08-00-00
Load Summary Live Dead Snow Wind Roof Lire
Tag Description Load Type Ref. Start End 100% 90% 115% 1.33% 125•/6 Trib.
1 Standard Load Unf.Area Left 00-00-00 08-00-00 30 psf 10 psf 14-00-00
2 Unf. Lin. Left 00-00-00 08-00-00 0 plf 80 plf n/a
Controls Summary Value %Allowable Duration Load Case Span Location Disclosure
Pos. Moment 5193 ft-Ibs 39.1% 100% 1 1 -Internal Completeness and accuracy of input must
End Shear 2049 lbs 33.3% 100% 1 1 -Left be verified by anyone who would rely on
Total Load Defl. U741 (0.13") 32.4% 1 1 output as evidence of suitability for
Live Load Defl. U1145(0.084") 31.4% 1 1 particular application.Output here based
Max Defl. 0.13" 13.0% 1 1 on building code-accepted design
properties and analysis methods.
Span/Depth 10.4 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
current Installation Guide and applicable
Notes
Design meets Code minimum U240 Total load deflection criteria. building codes.To obtain Installation Guide
g ( ) or ask questions,please call
Design meets Code minimum(U360)Live load deflection criteria. (800)232-0788 before installation.
Design meets arbitrary(1")Maximum load deflection criteria.
Minimum bearing length for BO is 1-1/2". BC CALC@),BC FRAMER®,AJSTM
Minimum bearing length for 61 is 1-1/2". ALLJOISTO,BC RIM BOARD-,BCI®,
Entered/Displayed Horizontal Span Length(s)=Clear Span+ 1/2 min.end bearing+ BOISE GLULAMTM SIMPLE FRAMING
SYSTE1/2 intermediate bearing PLUS@),VERSA ROIMVERSA-RIM
VERSA-STRANDTM,VERSA-STUD®are
Connection Diagram trademarks of Boise Wood Products,
L.L.C.
b d
a
c
a minimum=2" c=5-1/4"
b minimum=3" d= 12"
Member has no side loads.
Connectors are:16d Sinker Nails
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFWr R(3 .
Print or Type)
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NORTH ANDOVER Mass. Date
kuilding Location /-3 /*Ivle &✓e Permit # 70 7
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Owners Name
-' New '7 Renovation D Replacement fa' Plans Submitted El
FIXTUPES
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1ST FLOOR
2HDFLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
ATH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name ,cps?a p1h),y //141 Q Corp.
Address _ed _ Partner.
212tL�c�EI 1-1a SS. U l9 t d Firm/Co.
Business Telephone: g 4ff �y3 �p q,.� d
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy 0 Other type of indemnity Q 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 coverages.
Signature of owne�agent of property 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 perfomud under'Permit iueed to: this application will be In compliance with all MUnent
provisions of tho Massachusetts Slate Gas Mode and Chapter 142 of the Genual Laws.
By TYPE LICENSE:
lumber T
Title Gasfitter Signature of Licensed
City/Town: Master Plumber or Gasfitter .
Journeyman
APPROVED (OFFICE USE ONLY) License )Dumber
t ,
UELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FE,_
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GEfANTED
DATE 19
GAS INSPECTOR
" Date. /.. . . . . .. . . . .
NORTH TOWN OF NORTH ANDOVER
Q�ttlEo y q�0
c� zt: op PERMIT FOR GAS INSTALLATION
o9Q
9SSACHUSEt
This certifies that JA'
has permission for gas installati' ,' i '.' . . ... . . . . . . . . .
in the buildings of . .�. . . . ... . . . .. , . *. . . . . . . . . . . . . . . .
at . ../. . . . . . . . . . . . . . . .. North Andover, Mass.
Fee.,,�;.". . . Lic. No. . . . . . . . ... . . ... . . . . . . .
::: . . .
GASINSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File