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HomeMy WebLinkAboutMiscellaneous - 135 BRENTWOOD CIRCLE 4/30/2018 (2) 135 BRENTWOOD CIRCLE 210/064.0-0037-0000.0 --- i s Date....... '..6.........7.. f NORTH 1 TOWN OF NORTH ANDOVER j p PERMIT FOR WIRING �ssAcmUS This certifies that ..................(!A.79.........�—�.....T�..l---f ,......................... has permission to perform .......... ...:........................... ./.....f....� ,!?ei'th� wiring in the building of.....r..........4144.441!v.........F........................... at.......�.�....:..............� . ,:..r%C.................�North Andover,Mass. )'ee...,J�ar`��'' -^. Lic.No..57j...-a.-�./.......... st iLECTRICACINSPECTO Check # 7 8546 ' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No, BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMJT TO PERFORM ELECTRICAL W All work to be performed in accordance with the Massachusetts Electrical Code M r Y O R � (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: p� ^) 527 CMR 12.00 City or Town of: NORTH ANDOVER — J G To the InspectoY of"Ices: By this application the undersigned.gives notice of his or h r intent'on to pe orm the electrical•woi`k described below. Location(Street&Number) 3� �'�� Owner or Tenant Owner's Address e__ Telephone No. Is this permit in conjunction with a building permit? Yes ❑ NoCheck A Purpose of Building_ S�yl ( , Appropriate Box) Utility Authorization No.�o Existing Service Amps / Volts Overhead ❑ Und rd ---- g ❑ No.of Meters New Service -2-_DQ Amps j()/ 110Volts Overheadj ❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: w 106; S . V 70 i # Com letion of the followin table maybe waived by the I ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total -7 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o,o mergency ig ng errid. rnd. ❑ Battery Units — No.of Receptacle Outlets No.of Oi)Burners FIRE ALAI2"v;'iS No.of bones No.of Switches No.of Gas Burners No..of Detection and No,of Ranges No.of Air Cond. Total Wtiatine Devices Tons No.of Alerting Devices No.of Waste Disposers Heat pwnp Number Tons KW No.of Self Contained Totals: _ ........._............__._.. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.ofo. No.of Devices or Equivalent Heaters KW Si s Ballasts . Data Wiring: • No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: No.of Devices or E ruvalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of ple4trical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10 and upon on coni Teti i INSURANCE C P on. GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provi es proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force, and has exhibited proof of e o th ermit issuing office. CHECK ONE: INSURANCE 'BOND ❑ OTHER ' /f I certify ❑ (Specify:) Zapp �%iunder thepain and penal 'es erjury, hat the information onica&FIRM NAME: (/ � on is true and comp I LIC.NO.;V03 Licensee: Q Signature (If applicable, e re'exemi�O/:n thi license num r I'ne) LIC.NO.: Address: Bus.Tel.No.. *Per M.G.L c. 14 ,s. 57-61,security w rk requires Deparirne -o Pu lic Safety"S"License: Alt TelLic.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 [0 owner's-agent. Owner/Agent Signature Telephone p one No. P E RMIT FEE: ,S +e r The Commonwealth of Massachusetts k j j1 Department of Industrial Accidents Office of Investigations 600 NEQshing ton Street Boston, AL4 02111 {' www.nwss.gov/dia . workers' Compensation Insitrance Affidavit. Builders/Contractors/Electricians/plumbers Aippticant Information Please Print Legibly Name(Business/Organizafion/Individual): Address: City/State/Zip: Phone#: . Are you an employer?Check the appropriate box: 1.❑ I aro a employer with 4. Type of project(required): ❑ I am a genera(contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El am.a.sole proprietor or partner_ listed on the attached sheet.t 7. ❑Remodel}ng ship and have no employees These sub-contractors have 8. Q Demolition working for mein any capacity. workers' comp. insurance. [No workers'comp..insurance 5. 9. ❑Building addition ❑ We are a corporation and its required-] officers have exercised their 10•7 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.(Q Plumbing repairs or additions myself. [TIo•workers'comp. c. 1.52, §1(4),and we have no 12.required.] employees. [No workers' ❑ Roof repairs insurance re q ] 13.L]Other COMP. insurance required.] *Any applicant that checks bo)e#l must also fill out the section below showing their workers'ooinpensmion policy information, t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 3Conttactors that check this box must attached an additional sheet showing•the name of the sub-contractors and their work—,c__ in.0,ta on. 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/Siate/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). t Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 perjury that the information provided above is true and correct Sienature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Essuing 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#: 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 tnrstee 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 I52, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'cflrnpensation 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 regar-dirig the law or if you are required to obtain a workers' compensation policy;please call the Department at the numberlisted 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia _ Location � 3 �3tek4y0o C `-`k No. / Date l a r D oZ HORT1y TOWN OF NORTH ANDOVER Of •'o , ,1•C F 9 ` Certificate of Occupancy $ GMUS Building/Frame Permit Fee $ y �A y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 16060 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH AONE �OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �3 / DATE ISSUED: ® 2 X ic SIGNATURE: t "�' Building Commissionenq for ot*Bw1dings Date SECTION 1-SITE INFORMATION I O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 711j)-ood (fit Map Number Parcel Number / 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired Provided Required Provided v 1.7 Water Supply M.G.1—C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ ,Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: 9�e 73d,-46,7, Signature Telephone I 2.2 Owner of Record: Name Print Address s for Service. O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ i� -,& /Licensed Constr4ction Supervisor: / License Number mn Address y Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name U 707 Registration Number r Address r f i Expiration Date Zz Signature Telephone 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 auapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: //2 S �J� bbl?/�X S i�f i�ci� l S ea C �� c� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beOMMIdx USE ONLY Completed by permit applicant ' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (t,) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner 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 ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1 2ND 3KD 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 BMDING CONNECTED TO NATURAL GAS LINE 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: (Loca ion of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector I G The Commonwealth of Massachusetts Department of Industrial Accidents d Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit Name Please Print Name: wao Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance.Co. Policv# Company name: Address City: Phone#: Insurance Co. Policv# 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 well_as_civil.penakiesin.-the.form d-a STOP WORK_ORDER.and..a fine of_(.$1DOM.)-a day against.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Y I do hereby certify undQr the pains and Wallies of er* that the information provided above is true and correct. /-' Signature �t'!'-� Date z&C ~2�d 2-- Print name 4- G�'Ocac-� f Phone# �� � 7 9 Official use only do not write in this area to be completed by city or town official City or Town Permit/Licensing Building Dept ❑Check if immediate response is requiredLicensin Board D p Selectman's Office Contact person: Phone#: Health Department Ei Other i Client 19227 JOHNHORA M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Yd PROD .•R 04/10/0 US New England THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA 'O BOX 6360 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND L.750 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO . vlanchester, NH 03108 INSURERS AFFORDING COVERAGE NSURED John Horan Construction LLC I INSURER A: Hartford Insurance Compal INSURER B: 21 Evergreen Dr. _. Hampstead, NH 03841 INSURER C: INSURER D: µ :OVERAGES INSURER E: — 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. aH fH TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 1POLICY EXPIRATION I DATE(MWDDNYI DATE MM/DD/YY LIMITS GENERAL LIABILITY 04SBAGQ8654SB 04/01/02 X COMMERCIAL GENERAL LIABILITY 04�01�03 EACH OCCURRENCE $1, 000` 200 FIRE DAMAGE(Any one tire) $3 0 0, CLAIMSMADE X, OCCUR MED EXP(Any one person) $10 -. - PERSONAL&ADV INJURY $1 0 0 0E-0-0—,000 I I GENERAL AGGREGATE $2 . O.op 0O O GEN'L AGGREGATE LIM ITAPPLIES PER: -----•--PRO. LOC j PRODUCTS -COMP/OP AGG $2 0 OPOLICY ------...__. - ---- AUTOMOBILE LIABILITY . ANY AU10 ! I COMBINED SINGLE LIMIT (Ea accidenp I$ ALL OWNED AUTOS. .. ......._.._._ ..._. SCHEDULED AUTOS', BODILY INJURY (Per person) i$ HIRED AUTOS NON-OWNED AUTOS I BODILY INJURY (Per accident) Is PROPERTY DAMAGE I (Per accident) $ GARAGE LIABILITY AUTO ONLY $•EA ACCIDENT ANY AUTO � — ----•_--- ------ OTHER THAN EA ACC__ $ _ EXCESS LIABILITY I AUTO ONLY: AGG $ OCCURCLAIMS MADE i i EACH OCCURRENCE $ AGGREGATE—_ $ DEDUCTIBLE $ .--- RETENTION $ i -- ---- ------ WORKERS COMPENSATION AND 0 4 WBC I C2 6 9 80 4 01 0 24/01/03 TH WC STATU• D • $ EMPLQYERS'LIABILITY 0 X TORY LIMITS _. .ER I E.L.EACH ACCIDENT E.L.DISEASE-EA EMPLOYEE $1 O O O 00 OTHER E.L.DISEASE-POLICY LIMIT $S O O ()On I SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS perations usual to the insured RTIFICATE HOLDER ADDmoNALINSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF TH E ABOVE D E SCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Carl Woekel 81 Son Inc. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAILI.O-...DAYSWRITTEN 853 Ocean Blvd N0710ETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT.BUTFAILURE TODOBOSHALL Hampton, NH 03842 IM POSE NOOBLIGATIONORLIABILITY OFANY KIND UPON THE INSURER,ITSAGENTS OR REPRESENTATIVES. AUTNO IZED REPRESENTATIVE Q. I :ORD25-S(7/97)1 of 2 445204 , XCE O ACORD CORPORATION 1988 t ACOR TM CERTIFICATE OF LIABILITY INSURANCE TE(MNU°D/YY) PRODUCER TM Services, LLC 603-293-2791 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 7425 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Gilford, NH 03247-7425 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED INSURER A: CARL WOEKEL & SON INC INSURER B: 853 OCEAN BOULEVARD INSURER C: HAMPTON NH 03842-2516 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIP.E".1ENT, 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'rHE 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 POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMIVUDDrM DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY FIRE 4/01/2002 4/01/2003 FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ rJ 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY JE T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS $ (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTYDAMAGE $ (Per accident) � GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND I TORY IMITS OT EMPLOYERS'LIABILITYRH EL.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BOXFORD MASSACHUSETTS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR MIDDLETON ROAD REPRESENTATIVES. BOXFORD MA 01921 AUTHORIZED REPRESENTATIVE ACORD 25-S(7/97) ACORD CORPORATION 1988 a BOARD OF BUILDING REGULATIONS i �+ License: CONSTRUCTION SUPERVISOR Number: CS 002707 1 Birthdate: 07/30/1929 Expires: 07/30/2003 Tr.no: 12359 Restricted To: 00 t CARL W WOEKEL �' -//�—e 147 WASHINGTON ST (. METHUEN, 'MA 01844 Administrator r lions and Stundurds License or registration Ilid for individul use only CONTRACTOR before the expiration dw. If found return to: Board of Building ReaUtious and Standards One Ashburton Place 12,1301 14 Boston,Ma.02108 Corporation II 6-111141 Aiiniini�trsuur Not valid wiftstgwittu•e NO IFH Aw QED � ® of No. 0� ,C dover, Mass., ia _ q_o ORATEC S H E BOARD OF HEALTH Food/Kitchen F)ERMIT T D Septic System T BUILDING INSPECTOR THIS CERTIFIES THAT.........1.....4.4............. .....1 .�r O./ ............................................ ...................... ...... Foundation has permission to erect... ! , ........ buildings on .......� ... .... 04JT 00 �i Rough to be occupied as..13. * ..... .A..... .. ... �y/0� ............................................... 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-La ,s relating to the I pection, Alteration and Construction of Buildings in the Town of North.Andover. `' #//,; P; A 0 _ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ................................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. FF SEE REVERSE SIDE smoke Det. 3 43 J Date../ . . ... . .... 1:. RT" TOWN OF NORTH ANDOVER 4, PERMIT FOR GAS INSTALLATION 9SSACNUSEt ". This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . att.5r ;f :. . •: :Y ! . . . North Andover, Mass. Fee/!" .. . . Lic.'No.. .,:/.- . '. . . . .. x, T : . . . . . . . . 1. a � L_ % ' - GAS INSPECTOR . WHITE:Applicant CANARY: Building Dept. PINK:Treasurer JypeASSACHUSETI'S UNTFORM APPLICATON FOR PERMIT TO DO G AS FITTING or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 42 S zce— LJ e� 1 4:4 C r l7 Permit 9 3 Amount S Owner's Name /,j L /�C u L� 1 ' cJ A j c�r� l_iy New® Renovation ❑ Replacement ❑ Plans Submitted ❑ A n Z r Cn .^• suaSE .M E . T — BASE .v1 Ev r IST. F L 0 0 R t 2.N D . FLO U R 3 R D . F L O O R 1T 11 . FLOOIt 5T H . F L U (YR 6 T if .F L O O R 77 It . FLOOIt 13T 11 . F L O O R (Print or type) / Check one: Certificate Installing Companv Name J n j,& O 2� C�RI-40 Pklol b//V a, ❑ Corp. Address 0 66 X ;;k oy 6 172 e o- 14-t--e ❑ Parmer. iY1 i9- n L k j Business Telephone Q��_ G ,?S 3 © FIrm%Co. Name of Licensed Plumber or Gas Fitter SA 1c/)9-LG,__R�e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No r7 If you;"ave checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Owner Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter t421 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agenr 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 pertormed under Permit Issued For this application will be in compliance with all pertinent provisions of the Massachusetp State Gas Code and Chapter 142 of the General Laws. Bv: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber 'D,3631 CICviTowrl ❑ Gas Fitter Icense Numoer ❑ Master 4PPROVED uFric:=usF:!)NI.Y, ® Journe,man Date.? �l G. 3.... .. pORTM TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACHUS Et This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .� t . f . . . . . . . . . . . . . . . . . in the buildings of . . f. c r c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . ?. North Andover, Mass. c 7-Lic. No.. Q S Fee. . GAS INSPECTOR Check# 4395 MASSA CHITSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS I+TITIlNG (Type or print) Date NORTH ANDOVER,�,M,,ASSA�TZe.9CHUSET�TS Building Locations S— lU��toc Gam. Permit# Amount$ 3p Owner's Name New❑ Renovation ❑ Replacement Plans SubmittedrA ❑ a w x o rA d a o w Q o W x F a a H o a d z w O W a x g o o w 3 A c7 a° �' A a H o SUB-BASEMENT BASEMENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR y 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) /,�� Check one: Certificate Installing Company Name /�- /. `� El Corp. Address f7' /go x- 2/&3 �1/-" , A/ ' O"'y, 25 ❑ Partner. Business Telephone LOT:> Log-000 ❑ Firrn/Co. Name of Licensed Plumber or Gas Fitter ;;;Z71C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked y�,please ito the type coverage by checking the appropriate box. Liability insurance policy MrOther 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 he 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 u90yr Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StateiGkghapter 142 of the General Laws. By: ignature of Licensed Plumber Or Ga�itter Title Plumber Q l/C) City/Town ❑ Gas Fitter Icense mer ��vlaster ✓❑ APPROVED(OFFICE USE ONLY) ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� '� � / f Date 1 U Building Location/357 X0,,-1� C;,< Owners Name V j s ����� 1 Permit# Amount Type of Occupancy New 1:1Renovation ® Replacement Plans Submitted Yes No FIXTURES Lf Gn A StBBM B4S9"M M ILOCR 2MFUM �FIOCR 4M FIOCR 5M E OCR 6IH FIO(R 7IR FIIOCR SIH FIDCl2 (Print,or type) Check one: Certificate Installing Company Name c-'` Corp. Address Atw ?/j13 S19/'�"4 ��` ' 070 7 E] partner. Business Telephone ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyEr Other type of indemnity Bond El Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner D 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 Amder Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusW&5hz bale and Chapter 142 of the General Laws. BySignature ot LMFUMum r Type of Plumbing License Title 16 O City/Town ice se Num5er MasterJourneyman APPROVED(OFFICE USE ONLY