Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 136 CASTLEMERE PLACE 4/30/2018
CASTLE ERE 136 37-A-0 34-0 PLACE 210/037.A-0034-0000.0 � r ' Date.!U/1ol0i. . ...... . . TM of TOWN OF NORTH ANDOVER } PERMIT FOR GAS INSTALLATION SACMUSE� This certifies that ,/? `t'll�'�-5.�0�'k'S. 0.�4ax�.oC;! �. �• ti has permission for gas installation ./� �e—. in the buildin s of . . . . . . . . . . . . . . . . . . . . at ., North Andover,, ass. Fee JZJ:ZU Lic. No./P 47.�. . ��rA- . . GAS INSPECTOR Check#� 7849 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 11)6r9Ot 'r , MA. Date: w�� '%( Permit# Building Location:��j p p� I I�e Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional❑ Residential New: Iteration:❑ Renovatio n. ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES — co Lu Lu z Q N L) _ MIX W Op wW } cn O v) w z I— z o Lu W o W o W F W W M 5' w m o 0 aui LU LU W v) V Z w z i O u� Lu o x LL x Z wco X z Lu � tY fn J Q Q O W O O LL 1— F W I— w W fn > Z 2 v o o LL (a9 0 = _ � O m � w H D .Z7 > � O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR INQ 6 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: r Check One Only Certificate# � J�� -0 Corporation Address: YYYY�tttk City/Town:_ L-gro cQ State: Business Tel: ��ro�'3'��7 I _ Fax: El Partnership Name of Licensed Plumber/Gas Fitter: rS� El Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indic the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertip9int provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By �, Type of License: 01 ❑Plumber — Title ❑Gas Fitter [I MastSignature of Licensed Plumber/Gas Fitter e n city/Town DJ neyman License Number: APPROVED OFFICE USE ONLY P Installer ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM IDDfYYYY) TM FlO/OS/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Diane DeCaria Braley & Wellington Insurance Agency Corp. PHONE A/C No Ext): 508-762-3834 508.797.3507 AIC No 44 Park Avenue n DRESS, ddecaria@brale ywellingtongroup.com P.O. BOX 15127 INSURERS AFFORDING COVERAGE NAIC# Worcester, MA 01615-0127 INSURER A: Acadia Insurance 179789 INSURED INSURER B: Starr'Indemnity & Liability Co Haffner's Service Stations Inc. INSURERC: Liberty Mutual Insurance Co. 2 International Way INSURER D: Lawrence MA 01843 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2011-2012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAVDLSUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY CPA0151878-1 06/01/2011 06/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SEAS E occurrence) $ 250,000 CLAIMS-MADE r-il OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,006 POLICY PRO- X10 JECT LOC $ AUTOMOBILE LIABILITY MAA01518 79-1 06/01/2011 06/01/2012 (Ea accident $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED $ AUTOS (Per accident) X A9948, M $ X UMBRELLA LIAB X OCCUR 2084 06/01/2011 06/01/2012 EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION WC131S366957-02 06/01/2011 06/01/2012 XTORYLIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV�YIN E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? I .- N I A (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover AUTHORIZED REPRESENTATIVE 1600 Osgood Street ((/ Noirth Andover; MA 01845 Diane DeCaria/DIANE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD �I Date. . NORTH "OWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 s o� _ �'♦ ,SSACMUS� l 1� This certifies that . . . �(A . . �V. .t . . �H 5. . . . .?t.�7. . . . . . . . . has permission to perform . 1 . . . .. k... . . . . . plumbing in the buildings of . . . . .. . . . . . . . . . . . . . . . . . . . . at /. P1 . . . . . . ., North Andover, Mass. �/ t/ Fe-�_3G..S U.Lic. No../.,).j�7. . . . . . . .�,>>.. PLUMBING INSPECTOR Check # 8701 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City1Town:/Va r4L% M�� `�G , MA. Date: /.77 Permit# nr� Owners Name: f!'j� Building Location: I-T4 6"1��,��tet" i Type of Occupancy: Commercial ❑ Educational❑_ Industrial ❑ Institutional ❑ Residential lip New: ❑ Alteration: ❑ Renovation: 2"- Replacement: ❑ Plans Submitted: Yes❑ No ❑ FIXTURES z z O vi W z > c=i wUJ o: N w a. c>= ? ~ z to z N ¢ 0 Z Z w N w to Y to ❑I a LU C, d X 0 ❑ w rn w Z ct: W o ?-1z ❑ i— � CL Y ¢ = w w w Z z 0 H 0 0 0 z f- _ � Ell- m m o ® o t¢2 s � �J g �0'. NJ � j < � � O SUB BSMT, BASEMENT 1 FLOOR 2 FLOOR 3 R FLOOR 4 FLOOR 5 FLOOR . . 6 FLOOR 7 FLOOR 8 FLOOR ,( Check One Only Certificate# Installing Company Name: �D Somas U���-r �`� �(� (? i .0'f�orporation 3t tt1LS�va� [�Rd. }-,��,s state. r4 (� Address: Il �- ( CitylTown: p��t�5 039APT ❑partnership Business Tel: 063 3�7-17pc0 Fax- pp 4D yq,-- E]FirmlCompany Name of Licensed Plumber: �t9 ►'ti�S Tc �D INSURANCE COVERAGE: ��No have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes L�" ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ a hranme��^� r" OWNER'S INSURANCE WAIVER: I am aware that the not have the in='-ranee coverage required by Chapter'42 of the t>riassachusetts General Laws,and that my signature on this permit application waives thisCheck One Only y Owner ❑ Agent ❑ LSignature of Owner or Owners Agent - hereby certify that all or the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: - Sign of Licensed Plum r fit`s _ ❑Plumber EtVaster City(fownof urneyman License Number: APPROVED(OFFICE USE ONLY) 1 101712011 t 96`/ 4 Date..7.—...2 ,4oRT#1 TOWN OF NORTH ANDOVER 0 ,wivqw PERMIT FOR WIRING ss, us. This certifies that ... A5 . . ..... ..... . . ............ .. ..... .......................... ....................... has permission to perform ... ........ ............ wiring in the building of�. .. ..... at ........ Ando1q,Mass Fee..�.4��:..... Lic.No.............. ....... .... ........................ ELEcrRICAL INSPEt R Check # 3z-Jr-—/a Permit No. Ir ti Department of Fire Services Occupancy an( Qecked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blk APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 5P_J r-/D City or Town of: NORTH A"OVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to rform the electrical work described below. Location(Street&Number) / Owner or Tenant ,� Telephone No. Owner's Address Is this permit in conjunction with a buildi'ng/permit? Yes F] No ❑ (Check Appropriate Box) Purpose of Building ti P�� �� 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: FB Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires S No.of Ceil:SusP•(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above No.of Emergency ig mg No.of Luminaires Swimming Pool rnd. grnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection andInitiating Devices Tot No.of Ranges 2 No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No. c Self-contained � P Totals: '���� �� ����*�������������������������������������������������� Detection/Alerting Devices No.of Dishwashers �, S ace/Area Heating KW Local❑ Municipal El Other P g Connection No.of Dryers Heating Appliances KW Security Systems: y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring. Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: -Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: 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 p airs and penalties ofper"ury,that the inf rnza 'on on this application is true and complete. FIRM NAME: p LIC.NO.: K-,;' Licensee: �,4_�— Signatur LIC.NO.: SOM (If applicable,enter "e mpt"in the license number line.) �/ Bus.Tel.No.:� Address: [�e C S �/�S r�•y /u ��� �� Alt.Tel.No.:103-G 7��•yiy/ *Per M.G.L c. 147,s.57-611,,security wo k eq ears 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 Owner/Agent PERMIT FEE: $ z fy Signature Telephone No. r- I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MM 02111 4 ��• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): � Address: e-6,-C, ��E-- City/State/Zip: k 5 fa ,y +U H D�x ff Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction eam' yees(full and/or part-time).* have hired the sub-contractors 2.� sole proprietor or partner- listed on the attached sheet.I E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.Lic.#: 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 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 Itereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: 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#: 9763 / /- / e- /o Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING r. This certifies that ............................................................................................. has permission to perform ......... .... mt— ................... ........................ wiring in the building of.............. 134 at............................ .1 North Andover,Mass. 0 Y3— L............ ................. ... .... Fee.��e` ic.No.............. ..................I................................ ELEcnucAL INspEcTOR J Check # C. monwea&of Vamac4wett6 Official Use Only f cc�� cc77 ��� eLJeParfinenE o�.}ire�erviceb Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT-RrINK OR TYPE ALLINFORMATIOA9 Date: I\ 1 I'�,�I p City o Town f: _NUr0il p1n6ouAr To the In— sp for of Wires: By this applicati dersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant Larr/� �l/( � �h Telephone No - - 1W Owner's Address Same. 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 ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overbead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IR IU-AC6 C WV-\0k1h2!5 ov\ kt S1 jIar/Lc lk`k7i Completion ofthefollowing table may be waived by the Inspector of Wires. r 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 AboveIn- o.o mergency Lighting No.of Luminaires Swimming Pool rod. ❑ rnd. El Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump I.Number I TonsKW No.of Self-Contained Totals: .. ............. - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW cal Connection No.of Dryers Heating Appliances Security Systems:* No.of Devices or Equivalent �► No.of Water KW No.of No.of a Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: p Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: 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. CHECKONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Self Insured I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ADT 5ecurity Services Inc. LIC.NO.: C-45 Licensee: Mark A. Brophy Signature _ LIC.NO.: C-45 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No. 978-657-0443 Address: 155 West Street, Suite 6 Wilmington MA 01887 AIt.Tel.No.: *Per M.G.L.c. 147 s.57-61 security requires s De artment of Public Safety« „ License: Lic.No. 00953 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 Signature Telephone No. PERMIT FEE: $ . r o Date. . ....`....`�............ i �aORTM TOWN OF NORTH ANDOVER OL p PERMIT FOR WIRING ,SSACHUS� This certifies that has permission to perform...,_:i ...................................................................... wiring in the building of ......................................... ��.....----:..--a-/.......................... !. o Andover, s. Fee..! ............ Lic. .............. . .. ...... ............. ............, LECTRiCAL INSPECTOR U Check # 88G9 �... Commonwealth of Massachusetts Official Use Only Department of Fire Services FPermniit No. BOARD OF FIRE PREVENTION REGULATIONS pancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527CMR 10WO RK (PLEASE PRINT LV INK OR TYPE ALL INFORMATION) Date: & - 3-09 City or Town of: NORTH ANDOVER To.the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) c�!'o w. Owner or Tenant u a Telephone No. Owner's Address S � Is this permit in conjunction with a building permit? Yes No Purpose of Building �e �. / ` E] (Check Appropriate Box) ' -4!� Utilittyy 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 followin table mdy be waived b the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus No,of p.(Paddle}Fans Transformers Total . No.of Luminaire Outlets f KVA No.of Hot Tubs Generators KVA No.of Luminaires Jr Swimming Pool Above ❑ �_ o, o mergency rg g d• rnd. f7Batte Units -{ No.of Receptacle Outlets No.of on Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiatin Devices � Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW Self-Contained Detection/Ale Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal No.of Dryers Heatin A Connection ❑ Other Heating Appliances Security Systems: No.of Water No.of No.of Devices or E ...valent Heaters KW No.of Data Wiring: Si s Ballasts . No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring: ' OTHER• No.of Devices or E ..:valent I Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: 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 I certify,under the pains and penalties ofP ❑ (Specify:) ury,that the information on this application is true and complete- FIRM NAME: �� � yC/�� , Licensee: �� �A-,.�o� LIC.NO.: Signature Si � (If applicable, enter exempt"to the license number line.) LIC.NO.: S pM Address: � C - 1— A",N. t7tuN /1 I X/ !�3 8 y8 Bus.TeL *Per M.G.L c 14 7,s 57-61,secunty work requires D Alt.Tel.No.:Soo -� OWNER'S INSURANCE WAIVER: I am aware that the Licens a does noSaft hav'e,the liability Lic.No. required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ranc cov❑eraowner's gent. Owner/Agent Signature Telephone No. PERMIT FEE: $ • ' � 4 �: �� - � � _ �. The Commonwealth of Massachusetts Department of Industrial Accidents z C ! Office of Investigations a 600 Washingion Street Boston, MA 02111 www-mms gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers A licant Information PleasePrint em bl Name(Business/Orgmization/Individual): Address: e U_- City/State/Zip: Phone #: . 03 !P y.2 _ Are you an employer?Cheektthe appropriate box: 1.❑ I am a employer with 4. Type of project(require{): ❑ I am a gener7contrwactoremployees(full and/or part-time).* have hired th6' �ew construction 2•�am.a:sole proprietor or partner_ listed on the �• ❑Remodeling ship and have no employees These sub-contractors have working for mein any 8• El Demolition y capacity, workers' comp.insurance, [No workers'comp.insurance 5. ❑ We are a corporation and its ❑g, Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself[No-workers'comp. C. 1.52, §1(4),'and we have no insurance required.]t employees. 12•❑Roof repairs [No workers' 13-El Other comp. insurance required_] 'Any applicant that checks bo)e#1 must also fill out the section below showing their works s'compensation 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. xCantnu tors that check this box mustattached an additional sheet showing the name of the sub-connectors and their workers'comp.policy finfo do am n. mptoyer that is provuting:workers'co►npensattore utsurance for my employees: Below is the policy and job site information. Insurance Company Name: I 1 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 Section 25A of MGL e. 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 r y under the pains an d Penrltes af P e1that ormation p thein f Provided above is true and correct Si tore: Phone#: v ci o,fj`iciaf 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 ?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 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 tihe 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'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,nottthe 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-inswanoe 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 L 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/iicense 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 ffidavitThe 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 t 600 Washington Street Boston, IIIA 02111 TeL 9 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax 4 617-727-7749 Revised 5-26-05 . www.mass.gov/dia l S 10647 Date....... NORTH ] TOWN OF NORTH ANDOVER 91 p PERMIT FOR WIRING ,SSAGMUSEt This certifies that'.......... �©.?/....4-4 51��. has permission to perform ... (,�.. !-{-�..........:. ,t7:. .�-�.............. CQ wiring in the building of................ " L..... . 1.fe4............................... at.... :L5 .... ... -.... orth Andover,Mass. Fee... Lic.No..7�11't�................... .... .. �A.. . E RICAL INSPECTOR t Check # N Commonwealth of Massachusetts No. Official use/only '� Permit �L? Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) to 1P,✓-AQ ,r c, Owner or Tenant L A r f—{ .d-,L,esj o/9 M, Ilua `i Telephone No. Owner's Address /4 Is this permit in conjunction wil a building permit? Yes ❑ No ❑� (Check Appropriate Box) Purpose of Building ���S! cl ex-5 , ll� I/ 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 t Location and Nature of Proposed Electrical Work: QO�((,� a,}N D Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transfor KVA No.of Luminaire Outlets No.of Hot Tubs Generators CV_VA Above N . - mergency Lighting No.of Luminaires Swimming Pool grnd. ❑ rnd. ❑ Battery Units Receptacle Outlets No.of Oil Burners F?RW ALARMS INo.of Zones No.of Switches No.of Gas Burners No.-of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained P Totals - - Deteetion/Alertin Devices Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other [ Dryers Heating Appliances KW Security Systems:* No.of D ry No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: 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 covers a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE GOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that t//he information on this application is true and complete. FIRM NAME: o /2,G r, LIC.NO.: 75J0rn22 Licensee: D11?J E460 Signature LIC.NO.: G y5!p L (If applicable,enter 11yxenipt"in the license,,n�ymber lingg.) /'t� y ` l / Bus.Tel.No.: 9'711 375 Address: �� S � ��— lY�N���`aA N. 63� e Alt.Tel.No.: /,o3-&Y2=7/y/ *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 PERMIT FEE: $ Signature Telephone No. f - The Commonwealth of Massachusetts .^i ' 1 Department of Industrial Accidents � Office of Investigations ysyi;� i 600 Washington Street Boston, MA 02111 www.nzass gov/dia , Workers' Compensation Inshrance Affidavit: Builders/Contractors/Electricians/Plumbers A;iplicant Information Please Print Legibly Nairie(Business/Organization/Individual); Address: City/State/Zip:� f sf�y /U Dwye Phone#: Are you an employer?Checkthe appropriate box: 1.❑ 1,titn a employer with 4, Type of project(required): ❑ ]am a general contractor and 1 ❑ en ees(full and/or part-time),* have Mired the sub-contractors 6. New construction 2. am.a.so)e proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling � ship and.have no employees These subcontractors have S. 0 Demolition working for mein any capacity. workers' comp.insurance. } [No workers'comp.insurance 5. ❑ We are a corporation and its 9' ❑Building addition wired 10. Electrical repairs officers have exercised their ❑ p rs or additions 3.❑ I din a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.[No-workers,comp, c. 1.52, §1(4),'and we have no 12,❑Roof repairs insurance required.]t employees. (No workers' comp. insurance required-] 13.❑.Other 'Any applicant that checks borf#f must also fiif out the section below showing their workers'compensation policy in t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box mustattached an additional sheetshowing the name of the sub-contractors and them workers'comp.policy i nformadoa I ant an employer that is-providing:workers'compensation irzsurancefor my employees: Below is thepoticy andjob site information Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 1 Attach a copy of the workers'.'compensation policy declaration page(showing the policy number and expiration date). ` 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 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 ce nder the`pains d pen les o perjury that the information provided above is true and correct Si ature: Date: Phone#.- 12e LE-Of,ra only, Do not write in Gyrs arca,to be con�leted by city or town offtciaL n: Permit/License# ority(circle one):Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspectorson: Phone#- Date. 49. .. . .. . HORTN 2 0*. 0 „•o ,e 1 oOm TOWN OF NORTH ANDOVER . .off • PERMIT FOR GAS INSTALLATION SACHUSEt This certifies that . . . %.--,. . . f has permission for gas installation ...... ��: . . . . . . . . . . . in the buildings of . .� ';?z �-�- �-r ..f. . . . . . . . . . . . . . . . . . . . at .=rte North Andover, Mass. Fee -�� . . . Lic. No... . . . . . . . . 1a . . . . . . . . . GAS INSP,EpT� Check# 11� 9 6783 MASSACHUSE M UNIFORM A.PPLICATON FOR PERM TO DO GAS F1TTIn1G (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Loqations ( le A ce n Permrt# Owner's Name //,, Amount New r+ Renovation D Replacement D Plans Subm11 itted � w z - ' a cc 1 F wCQ Gwif.. C v W Q � W � �. y o � F W y .Z, x a m z C > Q w > < a F } o > F v , s C z e o 0 o z w c x SUB -BASEM ENT 0 A S E M ENT 1ST. FLOO R 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . .FLOOR STH . FLOOR (Print or e) Check one: Certificate Installing Company orp. oL(o?12 Address >y n ,Z1,2_ r /'1,Q ©e f530 0 Partner. ,— �orf tiusmessa ep one �K 3 � � oZ,`�/ � Firm/Co. Name of Licensed Plumber'or Gas Fitter _:7_/-1; cs o FINSURANCECOVERAGEt liability Insurance•policy or it's substantial equivalentCheck one: cked Yeses lease indicate NP the type coverage by checkin the � °nce policy Other type of indemnity ropriate box. 13 Bond ❑ Owner's Insurance Waiver. I.am aware that the licensee does_ no_ t_h_ave the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this Permit application waives this requirement. Si Signature of Check one: gn Owner or Owner's Agent g O 1 hereby certify that all of the d (or ent weer ❑ Agent details and information 1 have ❑ best of my knowledge and that all plumbing work and installations performed under in above application are true and accurate in the compliance with all pertinent provisions of the Massachusetts S e Gas Code d Chapter for this application will be in apt 2 of the General Laws. By: Sig ure of License umber Or Gas Fitter Title Plumber City/Town, ❑ Gas Fitter License um er alVaster APPROVED(OFFICE USE DNLY) 0 Journeyman The Comm0ft wealth of Massachusetts Department o In _ .f dustrral Accidents O rece 0 vestiea fIrzations uciil i 600 Washine�o�Street Bosco l M1. _ , �� n, M,4 02111 1V14, v Workers' Compensation Insurance.A�fitla s guyder/Contractors/Elect ' Aa Iica.nt Information ridians/plumbers Please Print Legibly Name (Business/Organization/Individual): -FOt= 0 k�� Address: y G City/state/zip. : t/Gr G� �� 17 /�I/� ��� 0 Phone#: Y 937 "(0� A,r�e you an employer?Check the appropriate box: 1.L`1 1 am a employer with g 4. ❑ I am a aq_ Type of project(required): OJT emPloyees(full and/or part-time).*jerntt .* have hired the l ub_�contractor tors 6• �ew construction 2.[] I am a sole proprietor or partner- Iisted ozi the at sheet 7• ❑ Remodeling. ship and have no employees These strb_contractors have working forme in any capacity workers' g• ❑ Demolition comp. insurance. [No workers'. comp. insurance �..❑ We area P uranc . 9. ❑ Building addition required_] corporation and its officers have exercised.their 10-❑ Electrical repairs or additions f 3.[] .❑ I am a homeowner doing all work right of ex emption per myself. [No workers- comp. c. 152 p MCL 1 L❑ Plumbing repairs or additions insurance required.] t employees.' 1,(4)'and we have no [No workers 12❑ Roof repairs comp. irisu 1.3. e raise Ot required.] ❑Other Anil applicant.that checks box#i.must also fill out the section below showing their.workers'compensation policy information. t f-iomeowuerF who submii-this affidavit indicatiti,they are doirr.tt ;c.rr' tContraetors lha�check this box.musi St u Even hire outsi&contraciure rnusi submii a n-affidavit indicating attached an additional sheet showing the name of the sub-contractors end their wor !;saah. I am an ensployer that is providing workers'comperrsation 1=.,camp.policy,information. information assurance for m3'employees. Below is the poficy and job site i Insurance Company Name: I` G Policy#or Self-.ins. Lica.#: CC O d 7/ Expiration Date: 30 Sob Sit`.Address: 0?6/0 City/State/Zip: A, ObA� �✓ Attach a copy of the workers' compensation policy declaration page(showing the oil Failure to secure coverage as required under Section 25A of Policy number and expiration state). fine up to 51,500.00 and/or one-year imprisonment.as well as MGL 152 can lead to the imposition of criminal penalties of a of up to.S250.00 a day against the violator. Be advised that a co Penalties in the form of a STOP WORD ORDER and a fine Investigations of.the DIA for insurance coverage verification. pY of this statement may be forwarded to the Office of I do hereby certify under the pauzc and penalties.of perjurY that the in or f mation provided above is true and correct Signature: Phone#: Official use only. Do not write in this area, to be completed by cityor town of iciaL City or Town: Issuing Authority(circle one): PermittLicense 4 L Board of Health 2. Building Department I City/Towu Clerk 4. Electrical Inspector S. PFumbin- 6.Other b inspector Contact Person• Phone i i Information 2.nd 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 inciudi-nu the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, associati on or other legal entity,employing employees. However the owner of a dwelling house having not more than.three ap tm arents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maiint.-nance,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 o r local licensing agency shall withhold the issuance or renewal of a license or permitto operate a business or to construct buildings in the commonwealth for-any applicant who has not produced acceptable evidence o►f 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-contractors)name(s),address(es) and phone number(s)along with their cerrificate(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 LL C ar LLP does have_ employees, a policy is required_ Be advised that this af!ida.vit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Theaffidavit 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 rrgr&rding the law or if you are required to obtain a workers' compensation policy;please call the Department at the nn<rnber.Iisted below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that theafndavit 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 of7 Investigations has to contact you regarding the appii=L Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that mist submit multiple permitAicense applications in arty 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 Iicenses. A new affidavit must be filled out each year. Where, a home owner or citizen is obtaining a Iicens" or permit not related to any business or commercial venture (i.e. a.dog license or permit to burnleaves 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,teiephone and fax number: The CommonWtEdth of Massachusetts Department of•industrial Accidents. Office of LavesfigatiEons 600 Washington Street Boston; MA 02111 Tel. # 617-727-4900 C=406 Qr 1-8-77-MASSAFE Revised 5-2645 Pax#617-7-7-7749 ��'.mass.govldia fIG S Date.., � ... ...... . . NORTh1 pf o� '` OWN OF NORTH ANDOVER F D PERMIT FOR GAS INSTALLATION S ACMUSES This certifies that . . . �� �'?. f�".j ` . 0- •�•f.j,, n has permission for gas installation in thebuildingsof . . .hvt t . . . . . . . . . . . . . . . . . . . . . . . . att. . . . . . . North Andover, Mass. Fee. ?.�'� . Lic. No.. L/'//7 ��. . r 6ASINSPECTO Check# 6744 MASSACHUSETTS UNIFORM APPLICA7MN FOR PERMIT'TO DO GAS FITTING (Type or print) Date ,' >3 (� ` d 7 NORTH ANDOVER, MASSACHUSETTS Building Locations n Permit e/.e-1 Kr l t T c.4 Owner's Name Amount$ 3 �_ New Renovation Replacement ❑ Plans Submitted W COD9 .4 z�' - x � � o m � � y . c z GW z x a W F o > w az Q w a E• > w r, 0 > w UrA MFL 0 rx SEMENT 3 -� U C > a 0 _ ENT O LOOR LOOR LOOR OOR OOR OOR • OOR OOR (Print or type) Name �j ��� � �, Check 9Ae: Certificate Installing Company Corp. Address 2f^ IQQ� ake to Cg Partner. Business letephone. Firm/Co. Name of.Licensed P.lumber'or Gas Fitter FINSURANCE COVERAGE a current liability Insurance,policy or it's substantial equivalent. Check onehave checked Les,please indicate the type coverage by checking the appropriYe ate box. No�13 ty insurance policy Other type of indemnity D Bond Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter :of Mass. General Laws,and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: er ge Agent hereby certify that all of the details and information I have submitted(or ente red)ed) in bv pplication�a and accurat best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in the compliance with all pertinent provisions of the Massachu tts State Code and Chapter.142 of the General Laws. By: D Sig ature of Licensed Plumber Or Gas Fitte Title mber L C� 4 CIty�O`m' Gas Fitter �Icl.ne umbe 1 Master APPROVED(OFFICE USE ONLY) Journeyman 73 5J� J / Date... !..�..p/,.U...... Of '40 T" 14' 00_ . TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION 4 �9SSACNUSE�t� This certifies that . . .� Y . ./��.;!.�. .r� . , . ��� �-� has permission for gas installation? in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at /Y. -7. ;r 6: .: . North Andover, Mass. Fee. . /.! �.�G Lic. No.A S5.':. . . . . t% .V ^ . . . . . . . . . GAS INSPECTOR Check# �( 1 SSAUNIFORM APPLICATION FOR PERMIT TOS O DO GAS FITTING I - MA. Date: 3 Zoo Permit# 7 Cityrown:-99-CIL,401 Owners Name: Building Location: f� b �s rI Y G Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional ❑ Resideniial Yp No New: � Alteration: E] Renovation:❑ Replacement: ElPlans Submitted: Yes FIXTURES � -b WI WI U) J x ❑ W p W W LU Q N 1-- NOQ W m x h- t) -J W Z 0 Z H Z O o F- 4 ❑ W_ X ` y- O W W W m l- W N O W MW- ❑ u_ > 0 U W W � Z � 0 z W I" 0 = Z W Ul W -L a y W W Z N J r Q to W O Z O N Z Z W B I QQ 0 = Q u1 W > 0 O W Q� ❑ Ol �, x x p a' I I I I I SUES B9MiiT.—TsTI I I I -FL;OR 2 FLOOR 3 KU FLOOR 4 FLOOR 5INFLOOR 6 FLOOR 7 FLOOR 8 FLOOR AA Check One Only Ce tific/ate# Installing Company Name: �6� (�� °c Corporation 1 �w State: Address:--J 3 t �- City1Town: ❑ Partnership Business Tel: f�0 3 313 $700 Fax:�� ��� `'� 9 Z ❑Firm/Company J 44 Name of Licensed PlumberlCas Fitter: � INSURANCECOVERAGE: '' �insurance policy or its substantial equivalent which meets the requirements of MGL.Ch,142 Yes �No❑ I have a current Ilabillty box below, lease indicate the type of coverage by checking the appropriate If you have checked Yes, p � sond ❑ vuiei type:%; iJ.lcmnLJ A liability insurance policy nanter 142 of the ,; h„C I i OWNEP.'S INSURANCE WAIVER: I am aware that the licensee does_,_._._not_have the insurance coverage rGyulre.. .., �T my Sil}^tur9 on this,pEr iiit appilCatlOrl VJ51''Je5 wla requirement. . ..aw , and tri-._ Check One Only t n Owner ❑ Ages -� Signature of Owner or Owner's Aaent i lication are true and gv checking this box❑.I heresy certiry that all of the details and information I have submitted(or entered regardingthis app accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will e in _l compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General -6--rcenssei sey� m` ❑Plumber Fitter Signatur Licensed Plumbe as Fitter itle 'J��� aster ❑,journeyman License Number: Citv,Town ❑LP Installer APPROVED(OFFICE USE ONLY) Date.���.� HORTM TOWN OF NORTH ANDOVER �• O PERMIT FOR PLUMBING F ,SSACMUS� This certifies that . . .� :'7. . . P. 3 0,,, has permission to perform . . . ..Y . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . J/!z� /.(,. .� /. . . . . . . . . . . . . . . . . . . at .'`. . . . . . . . . . . . .. North Andover, Mass. �0a Fee./// Lic. No.).7.9 S.'.1. . . . . .. . .. . . . . . . . . . . PLUMBING I4SPECTOR Check # 9 Y 8666 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City[Town:�fPi��' MA. Date: g1�j /)�6�'!7 Permit# I .... � Building Location: /J4,, �.�c 5 �.�^��� r �� Owners Name: I Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ Residential New: ❑Alteration: ❑ Renovation.:❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES z z O Y Cn to U to rn d z I Y N Q Q N z F- N O W � > a9CzW JZJ � � O �I C ( W E Q I W � O W N J Q = W W W Qtj W U ►z— = a0. 0 U > O O LL O z z Q Q Q h C3 co tl SUB BSMT. 1" FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR pCheck One Only Certificate# Installing Company Name; �-�V,,ar`n tiu corporation Address: dk City[Town: ST®, State: ❑Partnership Business TeL ee 3 Fax:—4P-5 B—A c11 L� [] Firm/Company . Name of Licensed Plumber: INSURANCE COVEPAGE: I leave a current liabinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No Elil!t If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2r, Other type of indemnity ❑ Bond ❑ C y o licensee A..^^ insurance cOvcra�t regUircd Dy C �api6r 142 of the OWNER'S INSURANCE WAIVER: ! am aware that the I:....n.....: ���,not have tl=? fviassachusetts General Laws,and that my signature on this permit application waives the Check One Only Owner ❑ Agent ❑ LSignature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. B Type of License: `Titre ❑ Plumber ignat Licensed Plumber 0^IGI'�`ste r j City/Town ❑Journeyman License Number: APPROVED(OFFICE USE ONLY) / 1 i CA S L EMERE PLA CE 327.9' � L=31. 4' 1 a 1 I 72' LLJ `\ O LOT ® OA CASTLEle9ERE PL. A,!=54,579 S.F. 18.3,?' 4J' ?ss. ;a, PROPOSED ADDITION N ct� b .SEE =0 S .6790 PG.B SEE` PLAN 9459 i PROPOS6 ADDITION i CLIENT: V. DA MCHUGH THIS CERTIFI&TION IS MADE AND LIMITED TO THE ABOVE CLIENT. MICHAEL SERGI 1136 CASTLEMERE PL. NO.AKDOVERUA. LOCA TION. DATE: 315,109 SCALE:1&=50 CHRIS I &SERGE hsROLAND7 SURVEYORSEERS p 160 SUMMER Sr. HAVERHU.M.0 OIZ50 TEL. 978--.373-0370 f @;009 BY CHRISTIANSE'N A SERGI INC. i DWG.NO.:07065002 rffNORTH And ONAM Of over 0 No. �l _ _ - _ _: o �` dover, Mass.LA E , COCHIC EWICK 0RATED p?�t�C7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............a/ ................... ........................................................................... Foundation haspermission to erect........................................ budings on ./�6.............. ................................................................ Rough to be occupied as... 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-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRU S Rough .................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DF,PAR_T-MFur Until Inspected and fluor-owed-by the Rijiir1inn 1nenn^#-r NORTH Town of2 I� ° � O Andover Nm No. o dover, Mass., I� COCHICHEWICK 0RATED �7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. �................. .................................................................................... Foundation 04'00 has permission to erect........................................ Adings on ./ .............. ................................................................ Rough to be occupied aS... AoV 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-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough K0� Final ` — PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS LESS CONS 1 R V S Rough ................... ........................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Mn 10hlnn-nir nry Wall To Be- Done __FIR-F_TIFPART'MFNT __ 3943 Date...... ..1..`. c- TOWN OF NORTH ANDOVER O � 9 PERMIT FOR WIRING SSACMUS� This certifies that ...ze, `...:......'.'........./!.. :..�.............�.f...�...................... Ci (1I �' Y has permission to perform '1l� ►viring in the building_of........ �.....�.............`...; .............................................. at...... ... ............(...�. .. .. ............... ........ .... ,North Andover,Mass . .. ...... . , . Fee...., . ... ...... Lic.No. .......... ........L................. ........:............. ELECTRICAL INSPECTOR Check # l' 7-�- RnMA1�:,1\ Commonwealth of Massachusetts Uriiciu! u,e Oil[Y Department of Fire Services Frm,,tNBOARD OF FIRE PREVENTION REGULATIONS nd Fcc Checked 1r.:tvc bl:utkl --- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to tx pertiinncd in accordance with the Massachusetts Elee;trica! C:ode(MI:(:)• 527 0\41Z 12.1)0 WI,F-4S£I'RIArT IN INK UR TYPE ALL INFORMATION) Date: City or Town nf: By this application the undersigned gives nottc f his ori heUon to PerforTo mhu the electricral w�r�descri Location (Street & Number) 3tS bed below. Owner or Tenant 1A�► l Owner's Address ` Telephone No� �o776d Is this hermit in conjunction with a building permit? yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AInps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amos / Volts Ovcrltcad ❑ Lndb ❑ r u 1 No. of Mcters Number of Feeders and Arnpacity — Locatiott and Nature of Proposed Electrical Work: Completion o rhe lollowinX table may be waived by the lruoector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle) Falls t 0• ° oral • No. of Lightin; Outlets No. of Hot Tubs Transformers KVA Generators I(VA No. of Lighting Fixtures Swimming Pool °Ve ❑ �grid.rt' ❑ ° o mergency igtiting -rnd, Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE AEDevices o. or Zones No. of S�vitcltcs No. of Cas Burners °• o Detection and Initiating es No. of Ranges No. of Air Cond. oral Tons No• of Alices No. of Waste Disposers cat amp um er ons P o. o SccdTotals: DetectionDevicesNo. dDishwashers Space/Area Heating KW (,ocat Con tICCti0t1 ❑ Other No. of Dryers Heating Appliances KW Security 'ysterus. No. u ater No. of Deviccs or Equivalent i o. of Heaters KW Si us Ballasts Data Wiring: No. of Devices or Equivalent [No. Hydromassage Bathtubs INo. of Motors Total HY eiccc•^•music-" to, t ^s "b - No.of Devices or Equjv2!e!,t OTHER: Arrach add;r;ona!acre;!;�dcsirrd, or as r quire by Ute inspectoSof INSURANCE COVERAGE: Unless waived by the owner, no permit for die performance of electrical work may issue unless the licensee provides proof of liability insurarice including"completed operation" coverage or its substantial equivalent. Tlie undersigned certifies chat such c�ov/erage is in force, and has exhibited pro°f of same :o the permit issuing office. CHECK ONE: INSURANCE /j BOND ❑ 01-HER ❑ (Specify Estimated Value of Elecirical Work; (Ixpintion L7atcj (When required by murtic:uat policy ) Work to Start: Inspections to be requested in accordance with acC Rale 10, and upon completion. /terrify, under rhe alns and penalties of perjury, that the information un tlrrs ae carLorr is rine ant!cunrplete. FIRM NAME: //(ice 1 LIC. NO.: �� Licensee: _�/yj 1/ff Z()')�i 7 _ Signature i LIC. NO.: ..2 / (If aPPI xable, enter -exempt' in the licenke number linea Address. lfieS - �^ f� S- Bus. Tcl. No.. 7 Li S OW`<F4t'S (NSliI�?.`1CC�l'AtvER. l act,zwace t`ut !te e Lc doer nor ho _• c^iabiitty�isu al. nlce ovuape tturm3 Iv equired by law. By ,try signatur below. i hereby waive ,his r tirement. I am th- ;,thee' Jrvner/Ageitt - ane) ❑ owner U owner's agcat. )iy�n:+turc Telepnonc No, I PEK,111T E EF: S