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HomeMy WebLinkAboutMiscellaneous - 14 STONINGTON STREET 4/30/2018 14 STONINGTON STREET 210/019.0-6014-0000.0 fi • 4 4 Date. •1�p TOWN OF NORTH ANDOVER : : �» PERMIT FOR.PLUMBING �,SSACMUS�SS . ,�. .�� P This certifies that . . . . . . . `, . . . . . . . . . . . . . . . . . . . . has permission to perform 0,rA-t i.... ... . . . . . . . plumbing in the buildings of . .I'.t: A�A.. . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. lF. . . .Lic. No.1 3.l4 . . . . . . . .Q. .. . . . . . . . LU WING INSPECTOR Check # 2 S y Date... 4 . ` :.2. o..... t NOR7M, '�.."�o� TOWN OF NORTH ANDOVER o { " PERMIT FOR WIRING CHU ' SSf TThis certifies that ...`-... ................ /!'.c. .............................. has permission to perform .... 1 ......A o ^?.. wiring in the building of... '. /.. ............................................ TD gat.............. ..�...... �.W�2. r� ......5/.:.. ,North Andover,Mass. Fee ��. Lic.No..�..2..�. ...... �,,-,2.. .. .. .. /,.. .. .. .....CTRICALINSPECTO�R F liCheck # _ 9304 f Commonwealth of Massachusetts Official use Only Department of Fire Services Pemut No. �y I BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07) Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECT' /� `A, All work to be performed in accordance with the Massachusetts Electrical Code(IvIE�52 ICA�p WORK (PLEASE PRINT WINK OR TYPE ALL�'ORNIATIO City or Town of NORTH ANDOVER Date: 10 BY this application the undersigned gives notice of his or her in ntion to perfo t e electrical workhe ector of les described below. Location (Street&N er) S O i� �{;,,� Owner or Tenant U e ►✓ Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building N° El Appropriate Bog) a� Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd Na.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 ollowin table may be waived b the Ins ector o_{Wires. No.of Recessed Luminaires No,of CeiL.-Sus No.of d p (Paddle)Fans Transformers Total . No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA i No.of LuminairesSwimming pool lumAbove In o.o mer en d• nd. I. Units Ig g --. No.of Receptacle Outlets No.of Oil Burners „ t , 'G R[.,A a.,oe MIS No.of Zones . No.of Switches No.of Gas Burners No.of Detection and No.of RangesTotal Initis Devices No.of Air Cond. No.of Alerting Devices No.of Waste Disposers eat RMP umber IIs ns KW Totals: "'-- — o•of Se -Contained No.of DishwashersDetection/Ale Devices Space/Area Heating KW Local❑ Municipal No.of Dryers. Heating A Connection ❑ Othea b Appliances KW Security Systems:* o.of Water No.of No.of Devices or E uivalent Heaters KW No.of Data Wiring; signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Tel communications Wiring: OTHER; o.of Devices or Equivalent Estimated Value of Electrical Work. Attach additional detail if desired,or as required by the Inspector of Wires. 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 overage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [3 OTHER I certify, under the Pains and nalkes ofP�lury,that the E] (Specify:) �^ p inform FIRM NAME: ation on this application is true and complete. P C Licensee: ° LIC.NO.: (If applicable, enter " em " ' the 'ce ( u er 'ne.) Signature LIC.NO.: Address. .ST Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Oro Alt.TeLicNo. q 7t e - - 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 g Y Owner/Agent ( ) El ❑ owner's agent Signature Telephone No. rERMIT FEE:$ 1 - J II 6 The Commonwealth of Massachusetts k j ' Department of Industrial Accidents t �` ! Office .f Investi o gatio ns i.{i♦ri ; 600 NCashingon Street Boston, MA OZIII Workers' Compensation Inspraace Affidavit- Applicant � d Cc►ntrac Information tors/Electricians/plambers �---� Please print LeQibt Name (Business/ } S 5�—�—Ph'1 • Organization/Individuat : Address: City/State/Zip. G C9��..Z Phone#: . 7 ��'7 0�( Are you an employer?Cheek.the appropr;;ate box: 1•❑ I am a employer with 4. ❑ I am a Type of Protect(required): general contractor and i 2.❑ employees(full and/orpart-time).* have lid the sub-contractors 6 Ne'construction I am.a.sole proprietor or partner_ listed on the attached sheet _ ship and have no employees 7 ❑Remodeiiig These suit-contnetors have working for me in any capacity. workers'.comp.insurance. g' Q Demolition [ workers'comp.insurance 5. We are a corporation mid its 9• ❑Building addition 3.❑ required.] fficers have exercised their l SElectrica) I am a homeowner da' repairs additions mg s11 work right of exemption per MGL 11.❑ Plumbing repairs or additions rgyself, filo workers'comp. c, 1S � 2, §t(•4);and we have no insurance7-required.]t employees. [No workers' 12•❑Roof� comp• insurancc:requirecL] 13•❑Other Y appiicant that chost#I must also fill out the station below showing their workers'iso t Homeowners who submit this affstinvit indicating they are doingall VPmpetssefion policy infotmation. �Contrnators iFrat check this boli must p end then outside conttactors must submit a new affsdavit iadi attached an additional sheetshOwing•the name of the sub.cottrmcrc+.s. a SOS Bch �^'- • -'ay.{iWICY 1aIDrTaallOil. f am an en{ployer that is provirrg:workers'compensation insurance or infor7natiort f int'employees: Below it the policy mid job site InsuranceCompany Name: 0 Y (n O Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: !1 a City/Statelzip: v 1 Attach a copy of the workers''compensation policy declaration porde(showing the policy number and expiration _ Failure to secure coves a as P on date] g 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 ras civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a dory against the violator. Be advised that s copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifii:atiar: j I do hereby ctrl' der and penalties of per � jmY that the utformation provided aova is and conte . Si lure: Date: v Phone#: _ 7— v O j,'cW ase only. Do not write in this area,to be cOmPhMed by city or town ofc;aL City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Otber Contact Person: Phone# MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ` Building Location f 1� �� / S Date lag / f� ) Permit# Owner l/1/b / hh' Amount New ❑ Renovation Replacement. ❑ Plans Submitted Yes ® No FIXTURES S[SH� Ti�41VI+N! ]ST II�OQt / MEL" M IIOM 4IH Ri" l✓ 6IH ELOCR 7IH EL" SIH FLOQt (Print or ,' ) Check one: Certificate Installin g Company Name (�Il/J�//�/ -J� ❑ Corp. Address �- / 1 re-1 11,719 ❑ Partner. Business Telephone 0 ❑ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the oe of insurance coverage by checking the appropriate box: Liabilityinsurance ❑ ❑ Po�cY Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any of the above three insurance lgnat Owner ❑ Agent El I hereby certify that all of the details and information I ha s toed entered) ' b ve appli true and accurate to the best of my knowledge and that all plumbing work and, ons un P t Issue . application will be ino compliance with all pertinent provisions of the Massa S bin o er 4 the General Laws. By: a oT censum um License Title 2i j Cit PRO icense um er Master( �� Journeyman ' APPROVEDto�cEusEorri,� "`---"4�c�Z--ftt The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Leg><bly Name (Business/Organization/individual): - Address: City/State/Zip: Phone#: J tlou an employer?Chee a appropriate box: G-7 I am a employer with 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition c working for me in any capacity. workers' comp.insurance. [No workerscomp. insurance 5. 9. Building addition ' p ❑ 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 insurance required.] t employees. [No workers' 12-El Roof repairs comp,insurance required] 13.0 Other `.".ny applicant that checks box#i min avit indicatinost also fill cut the sectio^below shcwing ih - "L werk� compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding worke s'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: s �j 2— e-�- - �'1 Policy#or Self-ins.Lie.#: Expiration Date: / Job Site Address: / dam/ City/State/Zip: Attach a copy of the workers' compensad 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 ag ' st the violator. Be advi ed that a copy of this statement may be forwarded to the Office of Investigations of the or insurance coverage fication I do hereby cern r the p and p of perju a information provided abov is true an correct. Si ature: �j Date: (/ Phone#: FOther only. Do not write in this area, to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical InspectorLPIumbingector son: 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 employef 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 15.2,§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 haye 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 4 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 reouestxd,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'. compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation-and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents f Office of Investigations ; 600 Washington.Street Boston,MA 02111 Tel. # 617-72.7-4900 eat 406 or 1-877-MASSAFE Revised 5-26-OS Fax#617-72.7-7749 www.mass._gov/dia r Date.. . . . . . . . ... . . . . AORTk pf o? �` TOWN OF NORTH ANDOVER f A • - PERMIT FOR GAS INSTALLATION •' h .. �1gs^CHUSEtt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . .. . . . . .. . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . :: . . .. . . . . . . . . . . . . . . GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING -- (Print orType) t� %✓4c of 2 Mass. Date /2 Permit # Building Location �� =��D����7D� fT Owner's Name Type of Occupancy 43 New ❑ Renovation ❑ Replacement pi Plans Submitted: Yes[] No(( " m a w a X Z Q N WW N N U � }. Z W W r= O V m r 0 2 O W ~ < ¢ Z O 0 < m N F- W W 0 a C y K > < X N t7 W W = = r", N O W W W 9). J Z < z is c � C W F W F•, X V � .Z J H Z F .W WQ > 4 F- W J Z < W < G F' r a m z O _z O H S JX W z z < rz < < o 0 W n O rf r- O<C 'S O c7 S 16 3 G C9 J Cl ¢ > o a H O SUB—asMT. BASEMENT g2 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR /��Installing Company Name �14,�lA/i... Check one: Certificate Address Al 2.,Z ❑ Corporation 1.,114 0/ ❑. Partnership Business Telephone 97 - / rrm/Co. Name of Licensed Plumber or.Gas Fitter znzml-o INSURANCE COVERAGE: I have a current Iia�lt+ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. � Yes 1No ❑ If you have checkedrtes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy L Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner[] Agent ❑ I hereby certify that all of the details and information 1 have submitted for entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued f� Iicafion will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Geng"aw BY— T of License: Plumber o Licensed lumber or Gas Fitter Title Gast' rill ster License Number Qty/Town Journeyman APPROVED 1 I NL 1P t BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTING NAME.A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE -.-19 OAS INSPECTOR Date. = ��. . . . •'ho TOWN OF NORTH ANDOVER 0 1- PERMIT FOR PLUMBING SSAcHUSE� This certifies that . . . " . . :" . . . . . . . . . . . . f has permission to perform._s.. . ,! ; . . . . . . . . . . plumbing in the,buildings of . r . . r . . . . . . . . . at . .... . . .. . , North Andover, Mass. Fee_,., . . . . . .Lic. Nod . l . . < ': .- _ . . . . . . . . . . PLUMBfN,G IN/8PECTOR i Check c MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location S70"1"s;-7o,v Date �� Owners Name �4¢/L�/-/A/ Permit# Amount Type of Occupancy /?&j) t# New ri Renovation Replacement 13--�- . Plans Submitted Yes No FIXTURES u H z H z w w w x 0 z z a W. c d W w a z a a o W H A a s g W A a x W > z � d SW-Bm a a RASav>M NE ILOCIR MIL" M FLOC 4M 5M FLOM 6M FL" 7MFLOM 8M HIM (Print or type) � /1 `� Check one: Certificate Installing Company Name El Corp. Address J0&;'jW" /A✓L 11 Partner. / ���� '-'11hof 35� �. um sess e ep one S56- 7 Firm/Co. Name of Licensed.Plumber; Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1 r/ 4-�— Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undelrs_iglned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ve,rf4rrned under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Eed�a ter 142 of the General Laws. By igna ure ol McenSWum er Title Type of Plumbing License City/Town 4 71 icense um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY 1 Location No. Date NORTH TOWN OF NORTH ANDOVER ot",60. Certificaes of Occupancy $ *�� ; Building/Frame Permit Fee $ E<� Foundation Permit Fee $ sAcNus Other Permit Fee $ Sewer Connection Fee $ 'Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works PEaJtPt NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP +40 LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE Z NE I SUB DIV. LOT NO. �I ...—LOCATION WOPURPOSE OF BUILDING awe �.. OWNER'S NAME NO. OF STORIES SIZE .rr..OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD a•r BUILDER'S NAME r C O 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 1 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST Lt/� PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PE Qc. FT. PAGE 2 FILL OUT SECTIONS t - 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 i DATE FILED '� •��•�yt�fa Y 1LTaY'10.i•�, BOARD OF HEALTH SIGNATURE OWNER OR AUTHORIZED AGENT FEE PLANNING BOARD PERMIT GRANTED i BOARD OF SELECTMEN BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY S-OR1E5 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 I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/2 1/ 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 HARDV✓'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 _ SUPERIORI� POOR . ADEQUATNONE 5 ROOF 10 PLUMBING GABLE I BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STAIL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING' I 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 �' t UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC Ist 13rd NO HEATING WOOD STOVE INSTALLATION CHECKLIST FE;; UT No: sem_ Permit r 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. y ' Stove A. New _Used B. Type/radiant _ 5culating C. Manufacturer �_�' ab. No. Name/Model No. Collar size Dimensions/Height Length Width Chimney A. New rPE-itcisti ` B. Size(flue area) C. Other appliances attached to flue(Number and flue size) D. Prefab(Manufacturer—name and type) E. Masonry/Lined Flue liner rtypeamen�racc�rer► Unlined F. Height(refer to diagrams) cap ovEfZ log C`/F_R ItoI 12u (vAN. Z Mir ;410 MIK3 12" —�- MIN. 18r MIN. � (FUEL;i�Si-� - QLGzS7 y1C� ISI q HEARTH i CHIMNEY HEIGHT Hearth(non-combustible) "A. Materials --FT l� B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wall Protection(see stove installation clearances chart) / A. Type of wall protection provided DER 1.e L 'E learances(refer to diagrams) 11 ji i c`- t FIREPLACE CORNER WALL/CENTER { 13 Date.. . . NORT/j of �` °� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION h y9SSAC'NUSEt� -- f This certifies that . . . J��-�fc J . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . .. . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee? .. Lic. ./3'{:71. . .; .. . . . .. . . . . . . . AS iN�R Check# 4860 Date. . . ... .9 . .� . . N°RTI, pF t,ao ,°91.0 o� TOWN OF NORTH ANDOVER � 9 PERMIT FOR GAS INSTALLATION h �9S SACHUSE�t This certifies that .[: l! c��i . . . . . . . . . . . . . . r . . . . . . . . . "46 has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildin of . j %. . . . . . . . . . . . . . . . . . . . . . . . . . at ., North Andover, Mass. INS Check#C91313 4860 MA�SSACHUSEI'IS UNIFORM APPLI TON FOR PERM TO DO GAS FiT1 NG (Type or print) Date / O NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ 5— 0 ner's Name � �� New❑ Renovation ❑ Replacem nt Plans Submitted ❑ U W o z � o H � Ch U E» z CA E" A F+ CA H z w � . o 0 0 w H g a . 0 0 U 04 O SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR Print or type? / / hec one: Certificate Installing Company ( YRe, f �! (/ Name� o GGGti•'!�!u4• �Corp. Address /S- '� �� Partner. Business Te ep one — Firn�/Co. Name of Licensed Plumber or Gas Fitter 0 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No� If you have checked Les,please indic to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond D Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of teh Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner D Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Ga a ter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter Title Plumber, f �y77 Tit City/Town D Gas Fitter License Numoer aster APPROVED(OFFICE USE ONLY) Journeyman Date. O N�RTh o?�.<' o� TOWN OF NORTH ANDOVER '° PERMIT FOR PLUMBING 40 ,SSACNUSE� t This certifies that . . . . . . . . . . . . . . . . . . . . �. has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . ... . at.,/ - ,,,. �:- -!'. . , North Andover, Mass. �. . ` . PLUM8 G INSPECTOR Check # �3 6193 Date.F�3. . �T NpRTh TOWN OF NORTH ANDOVER 3j •<<�. ++ppL PERMIT FOR PLUMBING 9SSACMUS� This certifies that . . .//. . . .-. . . . , . . . . . . . . . . . . . . .. . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .•. . . . ..... . . `.. . . . . . . . . . . . . . . . E at . . . . North Andover, Mass. —ort Eeev74 Lic. No. . . . . . . . . ... . . . . . . . . . . . . PL B GINSPECTOR Check # 6193 MASSACHUSETTS U7wnersName RM APPLICATION FOR PERMIT TO DO PLUMBIl' (Type or print) NORTH ANDOVER,MASSACHUSETTS > Date Building Location / 'low������^ Permit#--�a Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No 1 FIXTURES ](iAg1VII�TT 1SIC)HIDCR ' 3V�PID(R 4M)H fM 5IH Ra R sIl3 HfM 7II°I FWM 9M ROCR ` (Print or type) Check one: Certificate Installing Company Name Corp.. Address Aoleloll D Partner. Business'Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent • I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S um)}i Chapter 142 of the General Laws. By igna u ens um er Type of Plumbing License Title y 7/ City/Townlcense Num eTi r Master ourneyman APPROVED(OFFICE USE ONLY u I Date..... G NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING T1 •O++r�°���,y4°� ,SgACHUSE� This certifies that " �e?te................�.............. ........................... has permission to perform ....�� �'' to —13e, wiring in the building of........... CJd^'2............................................ at f .... ''`��'�,�� ...... ,North Andover,Mass. 39 Fee........ .......... Lic.No..A.1.5.. .. ...... .........�......................... ELECTRICALINSPECTOR Check # 5495 TRECOMHONWEALTHOFMMSSACHUSL+TIS Office Use o y i DEPAHI�VTOFPURUC �� BOARDOFFMPREVE M ON ONSWCMR120 Permit No. Occupancy&Fees Checked APPLICA77ONFOR PERMIT TOP ORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAS ACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work a cribed below. Location(Street&Number) -t�lar{ 5 Owner or Tenant Owner's Address ' N SSUg�c�n S r Is this permit in conjunction with a building permit: Yes No © (Check Appropriate Box) Purpose of Building ( CN Utility Authorization No. _ Existing Service t ou V � Amps0,W )%(o Volts Overhead Underground MNo.of Meters New Service Amps / Volts Overhead ID Underground 1:3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work W t re- ^e w dao;Lei No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets. No.of Gas Burners J, No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers. Heating Devices KW Local --I Municipal Other No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP I ��' O.l HER' LnwaCloeCOVEzage.Rust]arYmthelagtwaT�SofMassildl>settSGemaalLaWS IhaveaautaltLial»7itYlr�IIartcePblicyinchldQtgCort�te� Coverageoritsa>bslantiatequivala* YES � NO Iha�submddvalidptoofofsamerolheOffict~YES If)Mba�dledodYES,pleasein&* tetype0foovWXby d>adartgthe box �1 LJ INSURANCE BOND OTHER (Please Spetriiy) Date �-a q-Ucf F�mtamavahaeofWodc$ ii S'v'a� WodcboShatt ]ilspectionD�eRegttestd Rough Final Signed undff&Penalties of pajtuy ^ FMMNAME V� o c� ��Cc�r; �,. LimmNo. licensee �av� (�lo.� Sigttatlue Gd& L Ica A BusinmTelNo. 1�l S-31> 5K7� OW-NWS INSURANCE W Alt Tel No. Sd g'39 c -`t(1-2 ANII2;I am aware that the Licatse does not hav>'the insutanoe ooh or its sub�ai equivalatt as tegtt¢ed by�Gertaal Laws and*mysg oontbSpeuTATplitionwaives(Irismgm'a nag (Please check one) Owner Agent Telephone No. PERMIT FEE$ signature-of caner or Agent