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Miscellaneous - 14 COTUIT STREET 4/30/2018
14 COTUIT STREET 210/024.0-0002-0000.0 I ISI I i Date... .Q, �. ................... OF NORT/1 Y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i » This certifies that A P4,f........P/lYX has permission for gas installation ...C.'N .............................................. inthe buildings of...................................................................................... at...../Y....(204.7,t9.lf.., ........................................',North Andover,Mass. Fee.�`),...0)..... Lic. No. .Q�r�.'al...... .�.1.�. ...................... � ' Check# _ r' •' •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY - MA DATE PERMIT#. JOBSITE ADDRESS Y OWNER'S NAME I - Q . OWNER ADDRESS _ ITE FAX TWE O OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL ® RESIDENTIAL CLEARLY NEWT-1 RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YESEI NO APPLIANCES Z FLOORS- BSM' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BQOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER %dr— FIREPLACE J _. T FRYOLATOR FURNACE l _. L __._1 J .--_-- GENERATOR GRILLE IN HEATER Y - LABORATORY COCKS MAKEUP AIR UNIT - OVENPOOLHEATER - ROOM/SPACE HEATER ROOF TOP UNIT ----- TEST UNIT HEATER __I--I Y.J�_�hJ _. I__.. { ---- J UNVENTED ROOM HEATER -117 WATER HEATER OTHER _._. _.._..... ....... i J _ f INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO E 1 IF-YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EI OTHER TYPE INDEMNITY © BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT M SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 have submitted or entered regarding this application are true pd 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 comp' nce with all Pertinent pr 'si of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAN E _ lJs L _ _� LICENSE# _-- _3 ( SIGNATURE MP[A MGF G7 JP Ll JGF Q LPGI 0 CORPORATION©#o?K ]PARTNERSHIP[2#O LLC 0#L �1 r-- COMPANY NAME Y� / c�f N - ADDRESS o C��L� ✓��!_42'...U1 ? - 14 ------ —_-J CITY11 � _ _._ _I STATE MZIP TEL FAX CELL _ EMAIL a/l_ol�ef- � jl c{ i •Cv _ _ _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No v Ze THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES f Tke Conzwonwealth of Massachusetts Departazent of Industrial accidents Office of Invesiigations 600 Washington Street Boston, MA 02111 mvw rags&gov/din Workers' Compensation Insurance davit:Builders/Contractors/Electricians/Plumbers A©piicant InformationPlease€ra ntyed`b y Name(Business/orgaumhon/Individual): Address: �� � ? 'Al � City/State/Zip: ! ,���- � Phone#:— AreXou an employer?Check the appropriate boa: Type of project(required):' L W-I am a employer with 4. ❑ 1 an a general contractor and I 6_ n New construction employees(fall and/orpazt time)� have hired the sub-contractors T.Q I am a-sole proprietor or partner- listed on the attached sheet t 7• n Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers'comp.insurance. g, [1 Building addition Flo workers'comps ince 5. 0 We tea^- po €iozf arl�1 i required.] officers have exercised tfteir 10.QElectrical repairs or additions �.❑ I am a homeowner doing all work right of ex=ption per MGL 115dPlnmbing repairs or additions myself-[No workers'comp. c.152,§1(4),and wehaveno 12_n Roofrepairs insurance required.]t employees. [No workers' comp.msnrance required] 13.n Other '_`-syr ,�3'^=c..`-7�0et CTZ3"•'c uo=!n2L also 1"YL,'ami EG.se—chan a--'e_^.R`�'!L'b•�-:r wo'.�.�ee moon. j Homeowners vino Submitfnis affidavit indi�g they are dohG all work and- tea hire outside contractors mast submit a new affidavit inaicaiin.-soca tContmctor$=check tbn box must attached an additional sheet showing the name oftbe sub-conhactow andtheir workers`comp.policy info.natio^... lam an employer that is providing workers'cornpensad on insarrance for my employees Below is the policy and job site information. �/,� Insurance Company?dame: y/1-r� / Poliqyt,P or Sem ins.Lic.M. d J?a�0 Expinition.Date: / Job Site Address: `�%l///� C7/� City/State lZip: O��iy, j -4,0� Atbach a copy of tae workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required undem Section*7 of MGL c.152 can lead to the imposition of criminal penalties of a nine up to$1500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against Bre violator. Be advised that a copy of this statement may be forwarded to the Office.of ;nves€iga€ions of the DLk:For insuz-anCe meeragae verification. I do Azrebywi c der a pains mid penalties of p " the informadon provided above is ince and torsed Si2nature.- Date. l7 _ Phone� • d jJacia[use only. 1?o not write in this area,to isecan�by city or town o f zcr'a City or Town: PermitUcense i# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbingDtspector 6.Other Contact Persow. Phone n M, ions usetts General Laws chapter 152 requires all employers to provide workers'compensation for flheir employees. Nlassach �P - . " service of another under contract of hire, an ee•is def red as _.every pes$oa in the s �Y Pursuantto this statute, empty . express or implied,oral or_written. " assn ' co oration or•otherle en' or two arm ore An employer is defined as as mdividnal,parinershup, oration, rp � may, �YY m a joint and including time legal representatives of a deceased employer,or lice of the foreQain 7 fie, . d g association or other legal em employees. However the receiver ortrustee of an mdividuaI,partueasbsp, �', plug `owner of a dwelling house having not more than$nee apartmLents and who resides 1 or.the occupant of the dwelling house of another who employs persons to do mairmemance,construction or repair work on such dwelling,house or on the grounds orWdingg appnrtanantthereto shall notbecause of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or le cal licensing agency shall withhold the issuance or renewal of a license or permitto operate a business or to menstruct buildings in tie commonwealth for any applicant who has not produced acceptable evidence of comnprumce with the insurance coverage required." Additionally,MGL chapter 152,§25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work imtU acceptable evidence of compliancy with the insurance requirfinents of this chapter have been presented to the contracting authority." ,Applicants Please fill out the workers'compensation affidavit completel3r,by checking the boxes that apply to your situation and,if _ necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies all or Imi ted UabhZfty Partnerships(LLP)with no employess•ether than tue members or partners,are not required to cavy workers'compensation insurance. If an LLC-or LLP does have employees,a policy is required. Be advised dial ibis affidavit may be submitted to the Department of Industrial Accidents for ennfizmation of insurance coverage. Also be sure to sigh and date the affidavit. The affidavit should be rimed to the ci�,w tram tat!he application:&r fie permit or' license is b.-:ng requeslyd,not the Derm==a of Industr at Acrid..-nts. mould you have any moons rsgaidmg the Ia.N or if you ere regriined to obtain a workers' conU)ensation polic9,please call rile Department at the number listed below. Self insured companies should enter their self-insn mc;c license number on the appropriate Line. city or Town Officials _ Please be sure that the ofndavit i complete and printed Iegbly. The Department has provided a space at the bottom of the affidavit for you to 01 out in the event the Ofnce of Iuvestigations has to contact you regarding the applicant, Pleambe sure to fill ia the peamMicanse number which will be-used as a reference number. In addition,an applicant that must submit multiple permidlicense 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 localians m (city or town)."A copy of the affidavit drat has been officially stamped or marked by the city or town may be provided to fac applicant as proof that a valid affidavit is on file for bturepeninits or licenses. Anew affidavit must be filled out each Year.Where a home owner or citizen is obtaining a license or permit not related to anybusiness.or commercial.ventiae t"Le.a dog license or pemoit to ban leaves etc.)said person is NOT required to complets this affidavit The Ofuce ofInvestigation would Am i4 thaw you in a&m=e for your cooperation and.should you have any questions, please do nothediate to give us a call. The Departmeafs address,telephone and far.number: The Commonwealth of MassachusmM Department oflndnstrW Accidents Office of Invest i pfieas- Wasbingtog SIrmt Boston,MA 02111 TeL#6-17-727-4900-ext406 or 147' MASSAFE Fax It 617-727-7749 Revised 5-26-05 www-mas&-gov/dia , r OP ID:CHCR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/22113 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(ies)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 endorsemengs). PRODUCER Phone:978-688-6921 CONTACT Macdonald&Pangione Insurance PHONE P.O.Box 428 Fax:978-688-5350 PHONo Ext): VAR R No 104 Main Street E Ma1L North Andover,MA 01845 ADDRESS: Craig S Childs PRODU ER ANDOV-7 CUSTOMER ID M INSURER(S)AFFORDING COVERAGE 'NAIC# INSURED Andover Plumbing Heating Co INSURERA:Utica Mutual Insurance Co PO Box 262 Andover MA INSURER B:Quincy Mutual Fire Ins Co 15067 INSURER C: 4 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 MICATED. 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. NSR TYPE OF INSURANCE BR POUCY EFF POLICY EXP LTR E POLICY NUMBER MMID MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 A X COMMERCIAL GENERAL LIABILITY 4481325 10/26/13 10126/14 PREMISES-DAMAGE rO R occurrence $ 100,00 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GE NERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 X POLICY JER F-1 1130- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 ANY AUTO ALL OWNED AUTOS BODILY INJURY(Per person) $ B SCHEDULEDAUTOS c AFV206229 10/26/13 10/26/14 BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS UAB A CLAIMS-MADE AGGREGATE' $ 1,000,00 48CULP 4141 10/26/13 10/26/14 DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC STATU- O rH- AND EMPLOYERS'LIABILITY YIN ORY OMIT X :R A ANY PROPRIETORIPARTNER/EXECUTIVE 4481326 10/26/13 10/26/14 E-L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? El N I A (Mandatory in and E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Plumbing and Heating contractor CERTIFICATI:HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Plumbing &Gas Inspector ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept AUTHORIZED REPRESENTATIVE 1600 Osgood St Bldg 20#2-36 North Andover,MA 01845 , 7Xzla ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD UE> QCOMMONWS. PLUMBER'=S� ASF ITTE.RS;. - ISSUES TH°E FOLLOW I. tB:=> <i EKs F`" w REG;IS:T:ERD AS A PLUMB I NG COR �r ;a ._ GEORG-E .RL 0 z _'ANOM. ER PLUMB.J:.NG & HEATING CO. IN .; 20 A E G EI%1"i '' " UNIT lO-' M �Ftu MA...o 1844-158:a 2122w . >`'o /o 1/1.6 223403 <;.: »>II>COMMONWbek OF M SSACHUSETT • e e - • o o - > PLUMBER'S P`'Rif SF I TTERS::.> I ISSUES THE FOLL)WI#JG: L,.i�ENSE LICENSE;U AS A MASTER PLUMBER {Q GEORGE R LAROSE ;Lu < 44 OD I LE�';ST MEHUt`N MA..01844-423:3 95 01/1.6.:.;:::.<>:< 223429 3: COMMONWEALTH OF MASSACHUSETTS:::> >:»< D • • • • PLUMBER VASFITTER.S ISSUES T14 _CIC'ENSE.:.. �><> LIGENSEi3 AS A JOURNEYMAN PLUMBER: : �► GEORG R 44 OD I ;.,.:;..MA 01844-42:33" 187;25:;:':::-:'`:::0:5/01/1..6: >,::.> 223428 :<>:::: low Date...?;,AA/"y- ,1 A/"y-.. .... � N I&ORT##, TOWN OF NORTH ANDOVER o3j PERMIT FOR PLUMBING HUS� l This certifies that �..G!.. .Su �c.¢._. ....................................................................... has permission to perform.... vJ ✓.('rr a�;-�- ................................................ plumbing in the uildings of....... .`/..y`/ ........................................................ /e1 / � -/ at... ...'/.....`...G....................... ...................... North Andover, Mass. Fee.k3'— Lic. No. &I ... ... .. " .. .... .. PLUMBING INSPECTOR Check# 16-37a. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY Peon. J 2YL „ MA DATE �SS��y��( PERMIT# JOBSITE ADDRESS TM JL,r �„ j'� �� OWNER'S NAME P OWNER ADDRESS ✓J 0' TEL _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ; j RENOVATION: REPLACEMENT: E11 PLANS SUBMITTED: YES 0 NOMI FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISANDSYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I ( J I DEDICATED WATER RECYCLE SYSTEM I } . _.....J _.—� _j ! ___._J __._j ._.___._{ _( _,.r l _I DISHWASHER I __. _ A= �__! ___# ___� __._.1 ___._� J IL DRINKING FOUNTAIN FOOD DISPOSER .._._J FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) I _I ____i ___.__. .--i KITCHEN SINK _I ._1 - _---__! __-( _ # -I _____E ____I LAVATORY i _LJ _.-AL .___._( ____j _..__.._J ROOF DRAIN I I I _I _ I J _ __.I ._.....J .__._I 1 :I ....... SHOWER STALL I ___D �_�# ._ I __—_.I SERVICE/MOP SINK i I _..__— _—__I _ I —...__l _-1 ---_-._.1 TOILET I __I _ _ URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING I _ I -._... .# OTHER .�Ce I F-71 INSURANCE COVERAGE: hhe a current liab_ ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF 11.11 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW s LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY DI BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 1]l SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinen provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C� PLUMBER'S NAME d C I LICENSE /SIGNATURE IMP JP CORPORATION �PARTNERSHIP D#®LLC j COMPANY NAME (� JF� ADDRESS 1 CITYSTATE ZIP �/ TEL �7 FAX ; I CELL LG EMAIL ROUGH PLUMBING+ IJINSPEC ION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No —� THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES C . The Commonwealth of Massachusetts Department of IndustriqlAccldiints Office of Investigations UT 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): r, L Address: P-0 & 10Z City/State/Zip: C-2ZOVEIA ////J Phone#: 9 Ara ou an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_7 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• 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. El We are a corporation and its required.] officers have exercised their 10.nElectrical 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' comp.insurance required.] 13J]Other *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 CompanyName:. a Policy#or Self-ins.Lic.#: L - Expiration Date: Job Site Address: �7 coTy� Y/ 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 o. 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 tine 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 certo under the pains andpenaldes ofperjury that the information provided above is true and correct Signature: Date: Phone#: �7 7 21 f �� 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#: ` 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 employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,g g � 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 b the city or town may be provided to the Y tY Y 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 burn leaves etc. said person is NOT required to complete this p ) P q p 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 Massacl wetts Department of ladustrial Accidents Office of Investigations 600 Washington.Stxeet Boston,MA 02111 Tel,#617-727,4900 Qxt 406 or 1-877:N1 SSAFB Revised 5-26-05 Fax#617-727-7749 wMass.govaa K • MONW t ; OM EALTH OF MASSACIIS • • . . • • . ME PLUMB AM" G'AS;F::1;TT:ERS:<' : SSU:ES...THE OLL F Wf ..: AS A:<>P:1 VMB I N-G. ,, COP A BURKE SIZ... BURKE SONS'R.LUMB I NG. & H&AT� NG, J 73 WI LE..� srV. rt`A 018 32- 0 COMMONWEALTH OF MASSACHUSETTS • • v 5,61 a Nuel • PLUMBERS ; w ITTERS ` ISSUES 7H'E F.'0LLOWI:;VG; I ttCJSE L l::G:E: N..SE-D AS A MA STER r \ F W r t JAMES: t . A BURKE;:: .:::..:..:.::...:....:::.:. <`73 W ILL<F;f>, '>: HA1fERH I L L MA....01832 apt.>:].:''.::.>;: 104£x; € >< >```` i 05/01/16 ;:>> 223330MMM UP . . ' Date........5.71.6-7-1/V .. NOnr TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Thiscertifies that ............................................................................................................................ has permission to perform , ! C wiring in the building d � � /� ...5 .................................... ` ............................................................... at ./Z/ North Andover Mas . R-.e.................... Lic.No. ................. i ...............................I............ ....... _ LiCTRICAL INSPECTOR Check# 5 4' . j Commonwealth of Massachusetts Official Use Onlygj Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/07] (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 PRINT INNK OR TYPE ALL.INFORMATION) Date: • 16• I "(/ 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) Owner or Tenant FS Telephone No. Owner's Address 541M p Is this permit in conjunction with,�a^building permit? i Yes No ❑ (Check Appropriate Box) Purpose of Building cj dlq• 1'01 1'M YcJ w `I`I1 �j Utility Authorization No. Existing Servicel0o Amps 12O / 2q0volts 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: 1—IRe'h ti 1Mp e $- Q&ffiD PI i 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 eciTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 20 No.of Oil Burners FIRE ALARMS No. of Zones No.of SwitchesNo.of GBurners No.of Detection and E as InitiatinLy Devices No.of Ranges �, No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ..................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW ILocal❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent 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: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: nOo (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:) X certify,under thep ins and penaId of jury,liat the information on this application is true and complete. FIRM NAME:-. ,. ) AIC.NO.: �- Licensee: �(1(�P— Signatur IC.NO.: 2 S C (If applicable,enter ` empt"in the l' ense umber line.) ,A ' Bus.Tel.No.: 44 q0 Address: 1`� 04Alt.Tel.No.: *Per M.G.L s.37-61—,security work regi s 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. 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In 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�e 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 ✓ 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 Chanter 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. EIRu le 8—Permit/Date Closed: ***Note:Reapply for new permit❑ mit Extension Act—Permit/Date Closed: Trench Ins ection Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed(]' Re-Inspection Required($.)❑ Inspectors ComIn s : Inspectors Signature: Date: ROUGH INSPECTION: Pass IM Failed Re-Inspection Required($.) ❑ Inspectors Comments: i Inspectors Signature: Date: 'INAL INSPECTION: i Pass - Failed 0 Re-Inspection Required($.) ❑ nspectors Comme 00or Inspectors Signature: Date: :B WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com _ The Commonwealth ofMassachusetts - - Department of1ndust>riglAccMiks Office oflnvestigations 600 Washington Street Boston,MA 02111 ww1 mass govIdla Workers'Compensation Insurance Affidavit:Builders/Cont°actors&lectr ip ians/Pliimbers Applicant Information Please Print Legibly Name(Business/Organization nd%vidual): �J Address: City/State/Zip: a cJ� Phone#: � +9 056 Zo Are you an,employer?Check the appropriate box: Type of project(required): 1•[( I am a employer with. 4. ❑X am a general contractor and I 6. ❑New construction employees(fall and/or pax time).* have liked the sub-contractors 2.0 lam a sole proprietor or partner listed on the attached sheet.I 7. ❑Remodeling ship anTlaveno employees These sub-contractors have 8. [(Demolition working for mein any capacity, workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised.their 3.[1 I am a homeowner doing all work right of exemption per MGL 11•[]Plumbingrepairs or additions myself[No workers'comp. c.152,§1(4),andwehaveno 12•[]Roofrepairs insurance required.]i employees.[No workers' 13.[Other comp.insurance required.] xAny applicant that checks box41 must also fill out the section be16w showingtbeirv�rorkers'compensationpolicy information. 'Homeowners who submit this affidavit indicatingthey kr doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that is providing workers'compensation insurance formy employees Below is thepoliey andJob site information. Insurance Company Name% Policy#or Self-ins.Tait.#: Expiration Date: Job Site Address: City/State/zip: Attach a copy olthe workers'compensationpolley declaration page(showing the policy number and expiration crate). Failure to secure coverage.as requiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a lineup to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDE$ and a ane of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do Hereby cert urine the pains nafles p ' rY that the information provided above is true and correct. - Si ature• Date: ` f Phone#: 66?::, q, qV <6zo 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#: k> Information and Instrnetions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuait to this statute,an employee is defined as"..,every person in the service of another under any contract ofhire,- 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 j oint enterprise,and including the legal representatives of a-deceased employer,or the receiver or tnistee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant of the dwelling house of anothex 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 lieensing 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 sitaation and,if ziecessary,supply sub-contractors)name(s),address(es)and phonenumber(s)along with their cerrtiliicate(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 au LLC or LLP does have employees,apolicyisrequired. Be advised that this affidavit maybe submitted tothe Department of Iudustrial ' 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 tho appropriate line. City or Town Officials Please be sure thatthe 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 thatrnust 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 maybe provided to the applicant as proof that a valid affidavit-ii on Erle for future permits or licenses. Anew 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 orpermit to burn leaves eta)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, 1 ' please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho CQmrgomeaM of WTassachv._.Setf_ - JQepa t meat offudusWaa Acc%davt Qffiee d1QVedt!gA*n3 60 WaMugtm ftoet Boston,MA 42111 T01#61M-27400 eA 406 or-1-8.7-7•:MASSAM Revised s z6-os `ay, 617-727-7749 Wvtvaaagov'lcha, <COMMONWEALTH OF MA SACHUSETTS:< • . FROM BOARD OF E.L.ECTR I Cl ANS r ISSUES:.THE FOLLOW I N.G';L>I'C JOURNEYMAN. ELE"CTRIX-1- N MATTHEW J STROBEL PO...B:0X;<514 HAMPSTEAD NN 03841-0514" 24984..<E'=`:> `»'0 '/3::11::1:<6 « :< 31296 y,; '► z s -s 162 Date . .q.������ . &.". • TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING A I This certifies that . . . . . has permission to perform . �A— plumbing in the buildings of. . .'r.� , . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . X41 . . . . .SC•. . . . . . . . . . ,North Andover, Mass. Fee (�, . Lic. No. .M . . . `"I . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# 1 .s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK iU CITY NORTH ANDOVER MA DATE 9-16-13 �PERMIT# JOBSITE ADDRESS 14 COTUIT STREET OWNER'S NAME LISA BAILYN POWNER ADDRESS 14 COTUIT STREET TEL 978-975-8169 JFAX� TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL El PRINT CLEARLY NEW:® RENOVATION:® REPLACEMENT:Q PLANS SUBMITTED: YES® NO® FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 _ BATHTUB CROSS CONNECTION DEVICE ::Ij L..E]LEE E]Ei DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM i. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER !_ DRINKING FOUNTAIN p� FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING T 1_ OTHER rI INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY [j 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: OWN ® AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru d ccur e to st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c plian i all P I t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MIKE BURKE LICENSE# 13127 URE MPE] JP® CORPORATION# 2482 PARTNERSHIP®# LLC®# COMPANY NAME I POWERHOUSE PLUMBING CORP ADDRESS I PO BOX 896 CITY ISTATE NH ZIP 103865 TEL 603-378-0020 FAX 603-378-0040 CELL 1978 490 9385 EMAIL j.laurencio@powerhouseplumbing.com Q f� C-4 `4 ' I 1 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES s The Commonwealth of Massachusetts Department of IndustrialAccidents u Office of Investigations ' d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ^ Please Print Legibly Name (Business/Organization/Individual): POWERHOUSE PLUMBING AND HEATING CORP. Address:PO BOX 896 City/State/Zip: PLAISTOW, NH 03865 Phone#:603 378-0020 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 6 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑■ Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. E] Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#I must also fill out the section below showing their workers'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. tContractors 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:HARTFORD UNDERWRITERS INSURANCE COMP Policy#or Self-ins. Lic. #:04WECIT2480 Expiration Date:7-28-14 Job Site Address: 14 COTUIT STREET City/State/Zip: N ANDOVER MA 01845 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 imprisoning,pr, 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 violato2XV ,�ga-veyrication. dvised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ' surance c I do hereby certify un rte a en es of perjury that the information provided above is true and correct. Si nature: Date:9-16-13 Phone#: 6033780020 Official use only. D 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#: a�TOt` �1�. .,atl•;�h�i]✓,�;1�.�� PLUI4ABEQg �leiD GA� +�i'i _ r LICENSED AS 11�1ERS AST,iR PUIMBER ISSUES THE ABOVE LICENSE TO: , a JAMES S LAUR.EV^Ip ; j a•5 HAMPSTEAD R�� 1 ! QANVILLE vi"! 03819-5,1,00 ! 1 X067 163CrG14 .-- .. PLU'P1BERS AND GASFITTERS L1�•� iJSED AS'A JOURN6YiW;AN PLUMBER ISSUES THE ABOVE UCE14SE TO, , DAME , S LAL)REk16 ; Ilk 15 HA.I'STEAD' RD DANVIL. __--NH 03819-510'0 -, 3819-510' • .. E 26341 163603 ' Division of Professional Licensure: License Search Page 1 of 1 f 5 t - The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-2 Topics Home>Division of Professional Licensure> ONLINE SERVICES ............................................................-.....................-..................................................................................................................................................................... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency LICENSEE More... Name:MICHAEL W. BURKE REFERENCES& HAVERHILL,MA RELATED INFO Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS ft GASFITTERS Glossary of License Status License Type: MASTER PLUMBER Codes License Number: 13127 More... Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 1/19/2001 Exam Date: 12/9/2000 School: i This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. i The page above has been generated by the Division of Professional Licensure web server on Monday,September 16,2013 at 10:53:13 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board_code=PL&type class=_M&1... 9/16/2013 Date..........t..�.� 1 .................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �B�+cMus� This certifies that �2 t�S _1 '... . has permission for gas installation ............................................................................ in the buildings o ....... P�\ . ''1� ........................................................................ t at.......... 4......CP.......................................... .............., North Andover, Mass. Fee.. ...r... Lic. No. .A—a1?I...... ......................................................... GAS INSPECTOR Check# `!2 � � ll. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTH ANDOVER I , MA. DATE 9-16-13 —� PERMIT# � JOBSITE ADDRESS 14 COTUIT STREET OWNER'S NAME I LISA BAILYN GOWNER ADDRESS: 14 COTUIT STREET TEL: 978-975-8169 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑■ PRINT rIEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑■ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES Z FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER �^ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEAT R WATER HEATER INSURANCE COVERAGE I hive a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑■ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true n cc the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this appli ' w'tr/un nce with all Pertinent �-- provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: I MIKE BURKE LICENSE# 13127 -_ SIGNAT COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRES PO BOX 896 CITY: PLAISTOW —.-___] STATE: NH ZIP: 0386 FAX: 6033780040 TEL: 16033780020 CELL: 19784909385 71 EMAIL: [—A.tAQRE_NClifOPOWERHOUSEPLUMBINGAND HEATING.COM MASTER❑■ JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑■ # 2482 PARTNERSHIP❑#=LLC❑# Ji \� n ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �'' N° J 7 Date...... .. .. ... .. F �10RTM 3?°;��`` ;•�"°°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that `` / ! . i { has permission to perform ! P :.`.. ....... .`! "y .. wiring incctt�he building off......P... ..!.. ............................................... at....�.1..........(. >..1..c. ...... ......��.� .:............ , orth Andover,Mass. ! ; r * F �0.:.a�... Lic.No//4��jl ............ . i?? ...... / 6:........ ELECTRICAL INSPECTOR � Check # S"i'� r WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only Permit No. R� 7 Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Datex970 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 60 Owner or Tenant 577- FE-VE PA UZ A Owner's Address rin Is this permit in conjunction with a building permit Yes ❑ No 9-"(Check Appropriate Box) s/ Purpose of Building . Utility Authorization No. &0 57694' 1 Existing Service Amps a Voits Overhead ®/ Undgmd ❑ No.of Meters New Service /06, Amps fyp --wits Overhead UP--- Undgmd ❑ No.of Meters Number of Feeders and Ampacity a Location and Nature of Proposed Electrical Work G O yn Sk1J C W 1 s y� 1 o No.of Lighting Outlets Total No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps .Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices No.of D ❑ Municipal ❑ Other Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the re uiremen6ts of Massachusetts efts General Laws I have a current Liability Insurance Policy includin mpleted Operations Coverage or its substantial equivalenYE = NO = have submitted valid proof of same to the Offs ES NO = If you have checked YES please indicate the type o coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) Estimated Value of Electrical Work$ /A.00 (Expiration Date) Work to Start q"'J�}COO Inspection Date Resquested Rough Final Signed unde the Penalties of perjury: Final FIRMNAMEFAV/— y'lCF-wh � Eh GC EC 7-p L OyLT, LIC.NO. /o;;Z�/j Licensee �t vL T Al ri0k Signature LIC.NO..aa t/ ' Address Ow QST'57"Q,�el- Bus.Tel No. 86 � $_ J Alt Tel.No. 9'7 � -,7 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMITTEE $ Location I Na. ' Date i i �jORTIy TOWN OF NORTH ANDOVER Ar Certificate of Occupancy $ + Building/Frame Permit Fee $ { Foundation Permit Fee $ Other Permit Fee $ �p J' ewer Connection Fee $ GcA� ip, er Connection Fee $ TAAL $ Building,tnspector Div. Public Works PE�t�NO. 57 b APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. - PAGE 1 MAP 0. I LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE &NE SUB DIV. LOT NO. TION / 6'vd /1� SPURPOSE'S NAME �G�1?Cr� /� , NO. OF STORIES SIZE ' ✓OWNER'S ADDRESS /�� 6010% BASEMENT OR SLAB ARCH T'S NAME C CJ��7 SIZE OF FLOOR TIMBERS IST 2ND 3RD L--lo UILDER'S NAME SPAN -- DISTANCE TO NEAREST BUILDING '? / DIMENSIONS OF SILLS DISTANCE FROM STREET `7 POSTS DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY Llw'ku ALTERATION l/y IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES >R T. BLDG. COST �Qd j PAGE 1 FILL OUT SECTIONS 1 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EBT. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ATE FILED BOARD OF HEALTH IGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED ff /CON WNER TEL.# TG.�3 PLANNING BOARD CoONTR.TEL.# ✓ 3 19 p2� TRLIC.# 7S' i,•�' "--�` 6� e16 r., BOARD OF SELECTMEN $0 O S �' BUI INO INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. BRICK OR STONE � PINEHARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ '/, 1/t % FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"f"D _ ASBESTOS SIDING _ COMMCN a VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d fIOOR _ K BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) i—LA—T1 A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING -o S own o b n over No. y n 1VEWAY ENTRY PERMIT er, Mass..,_ 19� qoR` PFt�� �I � BOARD OF HEALTH THIS CERTIFIES THAT....................... 7�11wnl. e.0 .... ......................... BUILDING INSPECTOR has permission to pct ... .buildings on ...� . ........ . ..•.. •• • •••••••••• Rough � .. .al Chimney to be occupied as........................ .... ........... Final provided that the person accepting this permit sh II in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office;and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUGTJr' STAP Rough e Final ............ ...... ........................................ . BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner EETNo Lathing to Be Done Until Inspected and Approved by Smsoke Det. Wma" Am Am Building Inspector e , NOME IMPROVEMENT CONTRACTOR Registration 103466 Toe - INDIVIDUAL Expiration 07/08/94 Mr. Allison R. TUrner Allison R. TUrneT 75 WeStjlnSteT Ave. ADMINISTRATOR liaver- MA 01830 I No.:1 Date Of NOR7M 1 �`"_`�_'°•"° TOWN OF NORTH ANDOVER ° A BUILDING DEPARTMENT ' �qS^AC�''�(CHUS Building/Frame Permit Fee $� SA Foundation Permit Fee $ Other Permit Fee $ Building Inspector i I I •� PEWAIT NO. :j4�S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. a LOT NO. '� 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. }1)_m D Q` .� 819 1 p"�Q JC'L41 3�a LOCATION i4 C64oD t S.+ f�1 9 _PIUURR'LP'O,SE OF BUILDING / OWNER'S NAME `(I��I�/1/124 �v�(D /I�oD IIEt/ NO. OF STORIES SIZE OWNER'S ADDRESS✓/`-/t'IGICo IrU IT JTge[f II / BASEMENT OR SLAB ARCHITECT'S NAME 7 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGN TORE OF OWNER OR APTHORIZED AGE T FEE zD PLANNING BOARD PERMIT GRANTED q BOARD OF SELECTMEN A BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY StORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER D _� DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ y, 1/1 1/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE — WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR (� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO g FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC Ist 13rd NO HEATING c � WOOD STOVE INSTALLATION CHECKLIST PERMIT # Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New Used B. Type/radiant ra ivrfA AlwA,, Circulatin C. Manufacturer I TAT1 o Lab.No. 40/w,/',rcen -resin SAL T/67 Name/Model No. C2 $V Collar size 7 r-4a i Dimensions/Height Length a� Width Chimney A. New Existing 1� B. Size(flue area) k' X !0 • C. Other appliances attached to flue(Number and flue size) 001VE D. Prefab(Manufacturer—name and type) MaOOa I- E. Masonry/Lined V-fS -flue liner Unlined �" hype&manufacturer) F. Height(refer to diagrams) �✓dv 1.7 cap No OVER lot I OVER 101 I 12i1 MIN. 7 '+2,MIN. 2 MI 3 MI 10' 10' 3 MIN. 12 MIN. 1$11 MIN. (FUEL/ASH ALG E�ij 51 HEARTH CHIMNEY HEIGHT Hearth & (non-combustible) / // A. Materials id Lk%-_r) B. Sub-floor constructioh C. Minimum dimensions(refer to diagram Clearances and Wall Protection(see stove installation clearances chart) A. Type of wail protection provided B. Clearances(refer to diagrams) 18" all FIREPLACE CORNER WALUCENTER 13 I cap T factory-built chimney C roof support support bracket B — connector pipe non-combustible wall protection `! A connector overlap " A � A woodburning 1„ stove �non-combustible floor protection 12" 12" Figure 2109.4 Figure 2109.4 STOVE INSTALLARON CLEARANCES Combustible . Yz"Asbestos Millboard Concretei Masonry Spaced Out 1 " Stove Components Materibl Spaced Out 1 " 2. Foundation Wall 4" Brick Veneer Radiant Stove 1. 36" — — - - —Front Circulating Stove 1. 24" — — — —Front A. Radiant Stove 3• 36 18" 6" 18" —Side/Back/Top A. Circulating Stove 12' 6" 6" 6" —Side/Back/Top B. Single Wall 18� 12" 6" 8" Connector Pipe B. Insulated 2 2" 2" 2 Connector Pipe C. Chimney Height Three(3)feet above adjacent roof and (Metal or Masonry) two(2)feet above any roof ridge within 10 feet D. Damper If a damper is not included in the stove construction. P it must be installed in the connector pipe. 1. Front:Fuel or ash access side. 2. Non-combustible spacers required. 3. Clearances on each side of a radiant stove with a heat shield shall be measured as if a circulating type. Note:Clearances shall be measured perpendicular to stove body. Laboratory verified test clearances permitted. 12 Location No. Date 8 �oRTM TOWN OF NORTH ANDOVEW F , Certificate of Occupancy $ Building/Frame Permit Fee $ 9-4A�cu a^o ,S • Foundation Permit Fee $ � s�cMuS t n Other Permit Fee $ V Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ' Bu ding Inspector Y'- 10833 Div. Public Works 'ERMIT'NO.� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 —� MAP i-40. 4021LOT NO. (),C70/L, 2 RECORD OF OWNERSHIP JDATE BOOK jPAGE ' ZONE I SUB DIV. LOT NO. rl II LOCATION 'l C 0T V 1�- S ��� � v.,no PURPOSE OF BUILDING 2 ��/t1IJD/� ����j�� S OWNER'S NAME 1 �/�oVe� P4r.(/.a ��Ir NO. OF STORIES T SIZE OWNER'S ADDRESS r - JD A _ BASEMENT OR SLAB ARCHITECT'S NAMEN/4 a©,I,gJIeiLo *: ebb ?l+{ SIZE OF FLOOR TIMBERS IST 2ND SRO BUILDER'S NAME 'JeG Ta.,t CvCf !J_._.e2wQrao: f l yO1 y SPAN DISTANCE TO NEAREST BUILDING Lam-^ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY La f V,,&OLd Re IS BUILDING CONNECTED TO TOWN SEWER C9� Q k -r IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS s PROPERTY INFORMATION . LAND COST w , SEE BOTH SIDES EST. i�. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR !� DATE FILED BUILDING INSPECTOR 81G URE OF OWNER ,AUTHORIZED AGENT I F E E `? �--��T OWNERTEL # PERMIT GRANTED CONTR.TEL.K S-65 y70 ,)?60 61V, (7C) 19 CONTR.LIC.# b b6 -71 11 dor H.I.c.,r � � Lp S3Z ' J BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 11 STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PIASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL IN. B'M'T' AREA _ 114 1/1 % FIN. ATTIC AREA _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ - WOOD SHINGLES EARTH _ I_ ASPHALT SIDING HARDW D ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS.6 FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEOUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK $LATE NO PLUMBING _ TAR & GRAVELSTALL SHOWER _ ROLL ROOFING::::J�lj MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT.HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC lst 13rd NO HEATING ORT Town ofover No. (� o dover, Mass., R LIZ LAKE COCNICME ICK ~Y'�• S BOARD OF HEALTH 3 PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT S T // ..1 — loov i . 1.�+! .....1,�11C. .. ........................................................................ Foundation I has permission to ent.....%S;VM ............. buildings on ..14....0.07 -77.... ..................... trough t0 be occupied as......................................... � �1f NDo�S 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 relatinq.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. ELECTRICAL INSPECTOR UNLESS CONSTRUCTT ST Rough ........... ................ • . Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. . Burner Street No. Smoke Det. iR3fIT NO. i (L APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PACE I t ' MAP 4.40. Li '` LOT NO. d U� 2 RECORD OF OWNERSHIP JDATE (BOOK PAGE i ZONE SUB DIV. LOT NO. I I LOCATION 'L! Ci OTVI+ S /)o, 01rw(.)vef- PURPOSE OF BUILDING �. (�i/L,I�ot� t_ �-X l-le OWNER'S NAME C7ove', 4/•x/_ NO. Of STORIES SIZE OWNER'S ADDRESS j J C D I v,t s,�ln fVO A j BASEMENT OR SLAB ARCHITECT'S NAME N 4 Vat.goem-, It' n6ro 7/4 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 1eGT426"t coo BPA" DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DISTANCE FROM LOT LINES-SIDES REAR - GIRDERS 1 AREA OF LOT FRONTAGE HEIGHT Of FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X 19 BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IB BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY VL&OLL) Ke VLC�C-CI&XIS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 3 PROPERTY INFORMATION. INSTRUCTIONS LAND COST SEE BOTH BIDES EST. 1111111110. COST ' PAGE 1 FILL OUT SECTIONS t - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS I - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. I ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY I ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED I BUILDING INBPKCTOR SIG URE OF OWNER UTHORIZED AGENT F E E `? - �^ OWNER TEL PERMIT GRANTED CONTR.TEL I �0✓ U �6 �. G� 7 ' /B CONTR.LIC./ b b 67/ y H.I.C./ C � �C2- HIT NO. L APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. Lr LOT NO. O d 2 RECORD OF OWNERSHIP DATE (BOOK PAGE ZONE I SUB DIV. LOT NO. 4� PURPOSE OF BUILDING Jy COT 1+ � OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESSc7lq CO 1 V l- Sr (U97 BAf[MENT OR FLAB ARCHITECT'S NAME N/4 Ingo-safef-. A n `lo 7`114 SIZE OF FLOOR TIMBERS f9T 2ND 3RD BUILDER'S NAME .leGTG[-t Co 94' �.�'lt&Qrs,) 0SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET - - POSTS K , DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X 19 BUILDING ADDITION MATERIAL OF CHIMNEY - IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY yL� pLL) Kw- BUILDING CONNECTED TO TOWN SEWER Q k -lam IS BUILDING CONNECTED TO NATURAL GAB LINE 3 PROPERTY INFORMATION . INSTRUCTIONS LAND COST SEE BOTH SIDES EST. rs. cosT _- �r- 00. O1r PAGE 1 FILL OUT SECTIONS f - ! EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED RUI`LDINa INSPECTOR BIG URE OF OWNER UTHORIZED AGENT F E E `er J✓� OWNER TEL I PERMIT GRANTED CONTR.TELf S05 170 -Q?6>0 IS b 6 CONTR.LIC./ b '71 y H.I.C.I 11 O t L( • C ���c�0 5 � -at X00(:1 ! 1s � 10 -t I a El 1 .5h810 11w ,a,anoZpti' � `nom J -12 ON n 4 f � 1 I J )� O1 q I i V v .5hZ )0 AA �S Q� � Ll El i i T fi D .........:.... Dorm SRA .. ..::..::...............r::.:.:::. .................................... 6 196 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION c CATALANO INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. 25 1 BROADWAY BOX 609 COMPANIES AFFORDING COVERAGE METHUEN MA 01844 . COMPANY A HTNOVER INSURANCE CO 'INSURED COMPANY DEC TAM CORP B EASTERN CASUALTY INSURANCE CO COMPANY 10 LOWELL JCT RD C ANDOVER MA 01810 COMPANY I D OVERAGES ;.::.:.: :.;;:;.;:.::;; .;' ::::.:::.::..::::::::............................::.::......_........::............................:::::.......................................... ._:::::::::.... ....... ....... .. ................. 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 iH1S CERi1FiCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERh4S EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRCO OTYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM/DD/YY) I DATE(MMMDlYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE I S COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP/OP AGGI S CLAIMS MADE ❑OCCUR PERSONAL S ADV INJURY I S OWNER'S h CONTRACTOR'S PROT EACH OCCURRENCE S I� FIRE DAMAGE(Any one fire) I S I I MED EXP(Any one person) I S IAUTOMOBILELIABILITY AMN431073203 06/21/96 06/21/97 1, 000, 000 ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) I S X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) S I n PROPERTY DAMAGE S GARAGE LIABILITY i AUTO ONLY-EA ACCIDENT I S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT I S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE I S UMBRELLA FORM AGGREGATE IS OTHER THAN UMBRELLA FORM I S WORKERS COMPENSATION AND WC P 0 0 0 S 9 C 8 12/28/96 X I STATUTORY LIMITS I<'i': i>':::::':? EMPLOYERS'LIABILITY EACH ACCIDENT I S 1, 000 , 000 PARTNERS/EXECUTIVE THE PROPRIETOR/ II---jl INCL DISEASE-POLICY LIMrT $1, 000, 000 OFFICERS ARE: EXCL DISEASE•EACH EMPLOYEE!$1 f 000 , 000 OTHER DESCRIPTION OF OPERATIONS/LOCATLONSNEHICL ESrSPECLAL ITEMS CERTIEICTITE: HOLDE :;:>:,;:>•::>::;:::.<:>:.>:.>:;:::>':;::.:..:::,.;;::.;>;;;'.:.::.;',:.;:,'<::::,;.;.:;.:.:: .. ..:. .....::::........................:...........................:.......................::::........:.:::::::.:.:.:.... .... LLATIn�r.:.:...:::::....................:::.:.:.:::..::::::::::::.: .............................::..:::. ..:. :.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO.THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL VAPOSE NO OBLIGATION OR LIABILITY OF AANY KIND PON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 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Bost-,on, Massachusetl-s 021.08 HOME IMPROVEMENT CONTRACTOR Registration 114014 Expiration 07/27/97 •.•• • Type - PRIVATE CORPORATION ,,� %Ti,,, w•,/i/„j:.// ✓,,,.,,•�i, ; ' HOME IMPROVEMENT CONTRACTOR Registration 114014 (.)EC-'FAM CORP . Type - PRIVATE CORPORATION L_EROY SNODGRASS -� Expiration 01/27/97 10 LOWELL JCT RD ANDOVER MA 01810 DEC-TAM CORP. G�n�oo �4.t�EROY SNODGRASS ADMINISTRATOR 10 LOWELL JCT RD ANDOVER MA 01810 T t 4