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Miscellaneous - 140 PRESCOTT STREET 4/30/2018 (2)
140 PRESCOTT STREET ` 210/092.0-0008-0000.0 T t l � � _ � NORTIi �►c / F q C . Town of _ s ndover No. Z 2O0' el ver, Mass, 0,7 7Dl ro oM1wICK AERATED ►'Pa��S S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • �� ••. •�r���� BUILDING INSPECTOR THIS CERTIFIES THAT I*s... S•'sA41*110pno". ••••••••„ ••••.••••.•• Foundation has permission to erect.......................... buildings on .i{1 �.. .. .S►. •Q •fie • Rough _ wtat ��t� to be occupied as��. i �C � ••, !/�T Ql s•���•• ••�• # Chim__y { F= vided that the person accepting this permit shall in every respect conform to the terms of the application Fin L ? pro p p 9 � 2 on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. ��''r PLUMBING INSPECTOR j6p Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. �A�� ef�l f PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPE OR UNLESS CONST CTIO oug Service .. ... ......... ..... ina BUILDIN SPECTOR GAS INSPECTOR Occupancv Permit Required to Occupy Building Rough Display. in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. j pA- la+ A9 � I �jIvo G �lei6�4✓ G A a i tubing Permit 921037-._x- t Q i" Town of North Andover,MA 4 search... O- A � tx I 21037 "Plumbing Permit-Renovation/Alteration/Addition Fixtures and/or Appliances(commercial or Residential) TIMELINE at�nn lanFit3 Submisslon received — Your request is In progress ® Aug 3,2016 et"Sam we'll let you know of any updates via email.Feel free to check the status at any time by coming back to this page. 0 Plumbing Review to Progress O Oermit Fee Tt " At F1 P,�- p Permit lswanre O ,q � 1'iil � -. eneo are:mibeoope L47 "Ph—t l«noon { Eric Chochrek 140 PRESCOTT STREET,NORTH ANDOVER MA — Loll zl Wednesday,Aug 03,2016 09:08 AM zz— i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I North Andover MA DATE8/2/16 PERMIT# JOBSITE ADDRESS 140 Prescott Street OWNER'S NAME1 Prescott House POWNER ADDRESS 140 Prescott Street TEL 978-685-8086 IFAX —� TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES-1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 1 INTERCEPTOR(INTERIOR) KITCHEN SINK 2 LAVATORY 19 ROOF DRAIN SHOWER STALL 5 SERVICE/MOP SINK TOILET 17 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws and that my ignature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 perforated under the permit issued for this application wicora liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (�_ Xnk PLUMBER'S NAME Richard Ebacher LICENSE# 8926 �`�� SIGNATURE MPO JP❑ CORPORATION❑# 1659 PARTNERSHIP❑# LLC®#0 COMPANY NAME I Ebacher Plumbing and Heating ADDRESS 140 Portsmouth Road CITY Amesbury STATE= ZIP 101913 TEL 978 3884086 FAX 978-3884208 CELL 978-815-8048 EMAIL I r.ebacher@ebachercom an .com The Comnro»lveattli of Massacliusetts i'rint - .fment o Department Industrial Acciderr t .s ! Office e nf lrves7r a trons t 1 Congress Street,.Suite 100 Boston,MA 02114-2017 wlvfi.rnass. otldia Wortcers' Compensation Insurance Affia:lavit: Builders/Contractoi-.s/.IectriciRns/Plutnber-s Applicant Information Please Print Le -ibly Name(Business/organization/individual): Ebacher Plumbing & Heating, Ine Address: 40 Portsmouth Road *P.O. Box 548 City/State/Zip: Amesbury, MA 01913 I'llone 978-388-4086_ Are you an employer?Check Elie appropriate box: Type of project(required) : 1. ] 1 am a employer with 30 4. ❑ I atm a general conuictor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling, ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 D Building addition [No workers'comp,insurance comp• insurance;.# required.] 5. ❑ We are a corporation and its 10,El Electrical repairs o officers have exercised their 3.Q I atm a homeowner doing aIi work 1 l.❑Plumbing repairs o /myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§l(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also•fill out the section below showing tiscir workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing fill 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 nano of the sub-contractors and state wltethwor not those entities have employees. If(he subcontractors have employees,they must provide their workers'comp,policy number. I ant an employer that isproviding workers'compensation insurance for my employee& Below is the policy and job site infornratlon. Insurance Company Name: AON Risk Services Inc of Florida _(see attached) Policy#or Self-ins.Lie.#: W/C 34128410 MA Expiration Date-___U11201 7 Job Site Address: 140 Prescott Street City/State/Zii.. North 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORD13R and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido heret&gEll under the pah&and enalti s o er'ur dirt the I ornratlon provided above is trite and correct. Si ture• /�. Date. 8/2/16 Phone#: 97$-3$8-4086 Official use only. Do not write lit 11ils area,to be completed by city or toren official. City or Town: Permit/License# Issuing Authority(circle ono): 1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector G.Other Contact Person: Rhone it: AC RO L7® CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) os/22/16zr,s 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 Br--LOW. 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 have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services,Inc of Florida Aon Risk Services,Inc of Florida NAME: 1001 Brickell Bay Drive,Suite#1100 PHONE FAX Miami,FL 3313IA937AIC No Ext):800-743-8130 AIC No),800-522-7514 EMAIL ADDRESS: ADP.COI.Center on.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A: New Hampshire Ins Co 23841 INSURED INSURER B ADP TotalSource CO XXI,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 ALTERNATE EMPLOYER INSURER D: Ebacher Plumbing&Heating Inc 40 Portsmouth Rd, INSURER E: Amesbury,MA 01913 INSURER F: COVERAGES CERTIFICATE NUMBER: 1357100 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSF TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MWDD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one son $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY O PROJECT❑LOC PRODUCTS-COMP/OP AGG $ POTHER B AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEC I I RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 061154734 MA 7/1/2016 7/1/2017 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) rc yes,descrioe urger E.L.DISEASE-EA EMPLOYEE $ 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) All worksite employees working for EBACHER PLUMBING&HEATING INC,paid underADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. EBACHER PLUMBING&HEATING INC is an alternate employer under this policy. ' CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 18450 AUTHORIZED REPRESENTATIVE �c>�,�i3k�'etviee�, �ine of�FLotRdsl: ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1012720 '�rw•.,w.w�.J�4.swe-.... .� ._..... _.._-cv�s...rLW�.�s-^.r....�3+ ...7iM.:*i...s]S.'.a'�� ���R l ... ..ajjar.,..+..; y Date......... 9l../, ..... 112319 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ' -/ s3gCMU5� This certifies that.r, 1- f/ 11J......... ... ...... ........................................................ has permission to perform........�. ................. . ..................................... plumbing in the buil Ings of...............................AI�N ...................................... at /�,... ? 1�........ ......................... . ... ndover, Mass. Fee . ..Lic. No./. "a,(.. ' ........... ................................... PECTOR Check# ti MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _NORTH ANDOVER_- ! MA DATE 711012015 J PERMIT# I l JOBSITE ADDRESS 140 PRESCOTT ST OWNER'S NAMEJ PRESCOTT HOUSE POWNER ADDRESS - - __- TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E] RESIDENTIAL E] PRINT CLEARLY NEW:Q RENOVATION:El REPLACEMENT:Q PLANS SUBMITTED: YES E] N0ED FIXTURES Z FLOOR- OBS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM -_- DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN - INTERCEPTOR INTERIOR KITCHEN SINK 0 - J ®- LAVATORY - ROOF DRAIN SHOWER STALL SERVICE/MOP SINK0� TOILET -- - - - - - - �� URINAL WASHING MACHINE CONNECTION j WATER HEATER ALL TYPES WATER PIPING OTHER ---- --- - - � - 1� - - - � -- � - � - - -----100 --� --- --- -- - -- -- 0 - - - ==L--j1 X00 INSURANCE COVERAGE: have a current liabiliq insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE OF INDEMNITY Q BOND Q 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are tru 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 compf� th all nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME JEFF HUTNICK - - LICENSE# 15212 GNATURE MP JPQ CORPORATIONO# 3532 .PARTNERSHIPO# - LLC Q# COMPANY NAME I CALLAHAN AC AND HTGADDRESS 91 BELMONT ST CITY I NORTH ANDOVER - STATE MA ZIP 101845 TEL 978-689-9233 FAX CELL 978-423-6305 1 EMAIL I jhutnick@callahanac.com � ` . .. ;� ,. �� f OP ID: PS CERTIFICATE OF LIABILITY INSURANCE DATE(M1/20 10/31/20 4 14 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 endorsement(s). PRODUCER CONTCT Pete Sullivan Foster Sullivan Insurance NAME� 163 Main St. PHONE 978'686'2266 North Andover,MA 01845 -MA/C IL E A C No):978-686-6410 Stephen Sullivan ADDRESS:psullivan p @fostersullivangroup.com CUOTOMER ID :CALLA-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Callahan A C and Heating INSURER LIBERTY MUTUAL INS CO 23043 Services,Inc. Kate Callahan INSURER B:GUARD INSURANCE COMPANY 91 Belmont Street INSURER C: North Andover,MA 01845 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE D POLICY NUMBER MM/DpYEFF MM DYIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CBP4016154 09/25/2014 09/25/2015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 CONTRACTUAL LIAB PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO BA454403509/2512014 09/25/2015 (Ea accident) $ 11000,00 X ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS (PER ACCIDENT) $ PROPERTY DAMAGE X NON-OWNEDAUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE $ 5,000,00 CU8809334 09/25/2014 09/25/2015 AGGREGATE DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- 0TH- $ AND EMPLOYERS'LIABILITY YIN ORY M S X 10E TR ANY PROPRIETOR/PARTNER/EXECUTIVECAWC586931 09/25/2014 09/25/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 500,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) fax # 978 688-9542 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BLDG.DEPT. 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE BLDG.20/SUITE 2035 NORTH ANDOVER,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 y'f www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Callahan A/C and Heating Services, Inc Address: 91 Belmont Street City/State/Zip: North Andover MA 01845 Phone #: 978-689-9233 Are you an employer? Check the appropriate box: Type of project(required): L❑0 I am a employer with 25 4. ❑ I am a general contractor and I emplo_y�ees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling These sub-contractors have ship and have no employees T 8. ❑ Demolition , working for me in any capacity. employees and have workers' [No«porkers' comp. insurance comp. insurance.t ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g p 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#1 must also till 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. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Policy#or Self-ins. Lic. #: CAWC586931 Expiration Date: 09/25/2015 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: �' - /i" 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#: , OMMONWE14LTH:OF IMI SSA044 SETTS>z- State of New Hamosnire 11#12 us I• MECHANICAL IDENTIFICATION BOA.. VF_-,.w ;.:...... .. PLUMBEtS>< tH`;GASFITTE ,S JEFFREY HUTNICK I NAME: I`S5_UES .TH'E� F0LL0WI`�IDW--_ Ef4SE::» > ufL:k f 'AS A 'MAS CER_PLIIMBERv .,_z; Al, GISTRATION# K. a LICENSE/RE ,.J.Ef�;REY P: HUTN t C1f'`.... s> F u. a r.rc µ'Vi:; : SERVICE GFE0801283 � KI.RuT:i�7 S I ` r:. E"`'o nye{ ':.,.� ...,,: .. �:V; >�;�:`fir,:< ._ iYy.::...1 -:,t•-. .34A 01844-42y6 >:< 19930 ::_ ,,COMMONWEALTH OF MASSACHIUSETTS><< «: ; STATE OF NEW HAMPSHIRE • BUREAU OF BUILDING SAFETY&CONSTRUCTION PLUMBERS<l1PfD"GPSF,I,TT RS-' r' PLUMBING SAFETY SECTION .� ISSUES .THE_. FOLLOWIIG<'t<#CENSE x .. _ ,. NAME: . RE'G;[>ST£R1~D AS A. ;P,L..UtB I NG -CORP` JEFFREY P HUTNICK ; JE;F;Ff�EY p. HUTNICKLIC #:4519 M t'r" .HEATING SERVICE;'` 6o PLYMGUTH'ST z:. ">4`>v<> W EXPIRES: 12/31/2015 .c\V °7EfUE7V ;.tLA` 01844-425'6":* _,.,'. .... : . �.:. .. =��� 11/1�-�s S T.E 1� 353?m '05%0 `204054: Jg<:COMMONWEAL'TH OF M lSSACHOT ETT:S.AFtri F `PLUMBERS ::AND'GASF:a,T :E.RS>: r ISSUES THE FOLLOW NG`C TCIENSE ::;< t.< LIC€<NI}`A5'`>A JOURNEYMAN P : LUMBER::;; J.E;F_F:R.E=Y P H UTN ifg y�> 60 PLYMOwS_T ;MTH.UE�1l; 1;1A`, 01844-4256" 0O 053.218 ,6 , 9 .i Location !a No. /� Date UO . - TOWN OF NORTH ANDOVER S , � • 3 • Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ��1 2895, 54��1/ Z Building Inspector -7-1-1 K BUILDING PERMIT TOWN OF NORTH ANDOVER /�, t APPLICATION FOR PLAN EXAMINATION VL _ ,* Permit NV)k , Date Received A Date Issued: Z 'CHUs��� IMPORTANT: Applicant must complete all items on thispageJ, LOCATION_ `�� ('�2..SC -) ► �'�1' 1l L��Y�j I"�C,� Print PROPERTY OWNER �(� l�tS1�n� YY\Q Cl A� Print MAP NO: PARCELOObkZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer 5+ri P l ) Q on!a Q4 WS 1 f1�I `i , 04 Tx y' u<+er S�'At IO �P1��QS� M,A.k'_` Identification Please Type or Print Clearly) OWNER: Name: Phone: •(091 �ex Address: \40 CONTRACTOR Name: Phone: Address: ` acs kjo\rl mck_ Supervisor's Construction License: CS- C) 1 1W Exp. Date: n Home Improvement License: Exp. Date: o� Nq ARCHITECT/ENGINEER Phone: rt Address: Reg. No. FEE SCHEDULE:BULDINC PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 D (SID FEE: $ lll:br 12- (--- Check Z (---Check No.: :::)D-' Receipt No.: 2 NOTE: Persons contracting with unregistered contractors do not have access to uaranty fund Signature of Agent/Owner Signature of contractor e f ' Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavitsior Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance, of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified'Proposed Plot Plan ❑ Photo of:H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 'All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 OORTH Town of 2 t ndover 0 - - No. h ver, Mass, 2Z COC 1QK mol• 7,9 ASR-4reo ►fP,`�(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect .......................... buildings ons.. ...... . . .... .►F.................................... Rough to be occupied as . �! Q. ... . ....�.......................................................... y ,• ..�:. Chimney provided that the person accepting this permit shall in ev respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ,., UNLESS CONSTRUCTIO T R Rough Service .................... .. ..... ..................... ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. -G. EIN#51-050-33 T 31.3 Haverhill MA 978.374.9224 b&A Reg.HIC#149221 Lawrence M.A.978.687.7339 4 14LA Lic,UCS#78130 Hampton NIT 603,929.9224 60fing F1 0 'n I BB Single-Ply License#1711 &M Hampstead N 603.329.8200, _.- S%tn.cFiZ932 Tall Free 1.888.SOS,ROOF 265 Winter Street Haverhill MAL 01830 'censer/ Kl*Vred •;zFactory Trained s:FactoryCertifje Name: cr% Date- V/1 //4� IVI M Telephone, 1? 10 344.62 Email: B illing Address: -i r-) st city: State: (yi Job Address: -City: State: Scope of Work AStrip and Re-roof 11 Re-roof Approximate Roof Area: • Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected, • Remove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site. • Inspect wood deck,if we discover any rotted wood,.replacement will will performed at*$—�— per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$- I , per SR If individual sheets are found to be rottedfor de-laminated,removal,disposal and replacement will be performed at*$ per sheet If any trim boards are rotted, replacement will be performed at*$� i per LF for new pre-primed pine.Inspect-siding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$ 17- ..If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafters,sweep deck,and prepare for roofing. • Install 8"drip edge to all rakes and eaves.Color kk'i:, • Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or • Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. • Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness, • If upon inspection discover chimney lead to be worn or deteriorated replacement will be performed at t [21 Install anew: Year Traditional Architectural 0 Designer Cafor. • Furnish and Install a new shingle over sty/b ridge vent system —U It Vent system • All debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no circumstances will the watertight integrity of the building b!,corppromised. kte_ r Special Notes CCr-.4,-.r r ou czs; 4oa, 3^ — UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE AWOMIADTH GUARANTEE ORAPERODOFj § IP ARANTE F I � ? YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND7222YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. CKANUFACTURERUPGRADE I *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of:$ Payment will be made according to the following work schedule: $_ _deposit upon signing contract $ _by or upon completion of $ .—upon completion of contract. (Law forbids demanding full payment until contract is completed to both parry's satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the third business day following the signing of this agreement.See attached notice of cancellation for for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES :-,-2 A Lance of the Con act Proposal Home Oxmer(s)Signature(s): Date: VContractor's Signature: Date: 4�_-,Aertroofingxom (Please see reverse side) The Commonwealth of Massachusetts (Department of Industrial Accidents ^ Office of Investigations W rte_. 600 Washington Street W . ,Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/lElectricians/Plumbers Applicant Information / ' Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: F.� Phone#: 7�.3 . r� A e you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with�_ 4. ❑ I am a general contractor and I 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. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp. insurance.f required.] 5. We are a corporation and its MCI 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 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 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. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S or" CQ Policy#or Self-ins.Lic. alA -ooe pq?ns-a-Iy Expiration Date: Job Site Address: ,LAD ?fesCo4 6t- City/State/ZiA)� H1 !S� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under,th d penalti o perjury that the information provided above is true and correct. Signature: Datd: _I q S Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town'!Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . e • CS-078130 RICHARD S LAORRTAOL 26S WINTER STREET' HaverlAl MA 01830 08102=16 Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12!6/2015 TO 246813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. [:] Address F1 Renewal E) Employment [:] Lost Card 3. .�. Date..... ..... .................. = OF NORTry,� '�, TOWN OF NORTH ANDOVER h � 9 PERMIT FOR GAS INSTALLATION t �gSACHU This certifies that ..... ....t. ....Ii- .... vp S has permission for gas installation ... : . ......k...n.A.,P..I............ in the building') of... .9�...... P.RY?.a--.................................................. �, at.........i..`��1....... ..< ..................................... North Andover, Mass. Fee.te.O.-,..... Lic. No. r................................................. GASINSPECTOR Check#73-2,—1 Vs 2 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -CITY- MA DATE(— lS' PERMIT aH JOBSITE ADDRESS N O- P rr 160 1T S T OWNER'S NAME GOWNER ADDRESS TEL — � ]FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIAL ' PRINT CLEARLY NEW:E1 RENOVATION: REPLACEMENT:®'` PLANS SUBMITTED: YES© NOR- APPLIANCES OR-APPLIANCES 1 FLOORS BSM 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 --J1 - GRILLE INFRARED HEATER LAB ORATORY COCKS MAKEUPAIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVE TED ROOM HEATER WAT HEATER I INSURANCE COVERAGE have a current liablilly insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 010 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY ® BOND F 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and aocurate to the best o k edge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ertine pr n f e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � PLUMBER-GASFITTER NAME r SrLICENSE# 15.Y SIG URE MP�MGF® JP® 'JGF D LPOI® CORPORATION .�(.( PARTNERSHIP®# LLC 39= COMPANY NAME: ee_ r ADDRESS S — CITYas-�t� STATE' f�I� ZIP Z f Z]TEL 611- 7 0 FAX CELL s°Qfla6-IgQ`t EMAIL }eeae r� e , . w � I22�0 �� i COMMOfvWE4LTH OF MASS ACH .se PLUMBERS,. SFITTERS THE, FOLLOWING': -- LICENSED AS LICENSE A MASTER PLUMBCR. DAVID W GARFIELD 1 WILLOW ST BROOK TON .` .�. ��.�, y 02 r� .,a � / W 15645 MA 301-1451 '_. 05/01/16 . 226442 FPISSUES NWEALTH OF MASSACHUSETTS. • . • • , BOARD OF. LUMBERS ` ANO Gi45F..ITTESRS THE FOLLOW ING`'LICENSE. REG I'STERED AS A .PLUMB I ,COR �¢ DAVID W GARF I ELD 4� I F:EENEY BRGTHERS SERVICE, .,. 21 WILLOW ST 1�� � BROCKTON MA 02301 ! 3619 05/01/.1.6• 221413 N I � FEENSRO.01 SMORAN CERTIFfC/�TE �F LIABILITY INSURANCE DATE(MMIDDIYYYY)— ---_ 1/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain PO11CIes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 816-2156 434 Rte 134 Me o xt: Arc 877 No:( } South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE MAIC 9 INSURERA:OId Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC IHSURERC: 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION`OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D SBR POLICY HU41BER IPAlOLVIODY EYrr HOMO E P LIMITS A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 CLAVAS-MADE a OCCUR A2CG07501501 02/01/2015 02/01/2016 PREMISES Ea occurrence $ 300,00 MED EXP(Any one Person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 G£N'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000,00 POLICY a JEC M LOC PRODUCTS-COMPIOPAGO $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY - COMalNED 91WGLE LIMIT S Mal ANY AUTO BODILY I NJURY(Per person). $ AAUTOS AAUTOESDULED BODILY INJURY(Per accident) $ HIRED AUTOS L . 1 AUTOSNON-OWNED Per a�TY DAMAGE $ $ UMBRELLA UAB FOCCUR EACH OCCURRENCE $ EXCESS LLAe C�),IS MADE AGGREGATE $ DEO I I RETENTION$WORKERS COMPENSATION I $ AND tPLOYERS'LIABiLIITY YIN X STATUTE I I ERTH A ANY PROPRIETORMARTNERIEXECUTIVE A2CW07601601 02/01/2015 02/01/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERn'10.tSEREXCLUDED4 NIA (Mandatory In NN) E.L.04SEASE-EA EMPLOYEE $ 1,000,00 ITyes,descnbs under DE SCRIPTIONOFOPERATIONSbeaN E.LUSEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ir more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE s ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101):(. The ACORO'name anti logo are registered marks of ACORD 7 5t 0 Date..2 !.! .!....... NOFTM 4, 16 o: TOWN OF NORTH ANDOVER a • PERMIT FOR GAS INSTALLATION E 7SS,ACMUSEI i This certifies that . . . . . . . ....� .. . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . in the buildings of . . .t. . . . . ` �. . at .1 c��: . l!�:. F . . . . . . . . . . . . . . North Andover, Mass. Feel). . . . Lic. No.J.? . . .r. . . . •AS INSPECTOR Check# `� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO QO GAS FITTING City/Town: /�/J�Dl.��/� ,MA. Date: Permit# Building Location: /90 PRa WIT SJ Owners Name: Type of Occupancy: Commercial[]- Educational❑ Industrial❑ Cnstitufiona1❑ Residential'❑ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 0' Plans Submitted: Yes❑ No❑ FIXTURES LU Z ~ m m v = l� L o rn r�i MX x O O J CJ IZ IZ t- N O 2 W W z z ~ M W uQi Lu U) w g m o a f- o IX (aIX > ut w a w o Lu IX 0 ZJ ZO �+ ZZ ul > UJ . W ° aozao :W) 04. 6 > Lu x �0 o Q u © © x o O a a tY 1- > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3Ku FLOOR 4 FLOOR 5 FLOOR 6 FLOOR —77 7 FLOOR Installing Company Name: LLA 6(Lj C f 1-/ G Check One Only Certificate# ❑Corporation Address: -// C���h�ijt'I Cit y1Town:N- &WUM State: ❑Partnership Business Tel: 6 1 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter. `f S U �'G INSURANCE COVERAGE: 1 have current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes D-No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVED 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 Owner's Agent By checking this box ;1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent,provision of the Massachusetts State Plumbing C c7a d Chapter 142 of the General Laws. Type of License: By Plumber Title Q,G3SFitter Signatu icensed Plumber/Gas Fitter City/Town ❑Journeyman License Number.I APPROVED OFFICE USE ONLY ❑LP Installer Date. t"hpR: .�4, TOWN OF NORTH ANDOVER 0 IL 3: PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . . . . .&fl�?!�.k"''. . /�.�. �Lvl � . . . . . . . . . . . . has permission to perform . . . . .��/. q. . . . . . . . . . . . . . . . plumbing in the buildings of . !e.Vo.ff. . .,`'j�C���'`�'. at . / �.� �. j G. . . �� . . . . . . . . . . . . . . North Andover, Ma s. Fe#30. . . . .Lic. No../ /.a. . . . . . . . . . . . . . . . . . . . . . . . . . y/ PLUMBING INSPECTOR Check p y 8357 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING _ City/Town: Aj AN_,___ wo Z t/�/ ,MA. Date: 7 /G Permit# Building Location: / /10 M Gd77— 1 / Owners Name: AI1=5[d /1JUf4�p6A/ T Type of Occupancy: Commercial[�rEducational❑ Industrial(] Institutional❑ Residential❑ New:❑ Alteration:❑ Renovation:❑ Replacement:0�Plans Submitted: Yes[] No❑ e FIXTURES DEDICATED w Z SYSTEMS W Q H > u LU V1 ZN N W G Z a W QZ C Z Vf Z a CQC z a' 4� Q = {Ly Q 3 H = N 5 W N F W Q N p: of � a � a a z e}e C) o: z AA n z LL. F- 3 Q G' 3 W G F G W M W = = 0 Q tt 0. Q Z = W W Q Q N V1 Q H F > > Q Q Q Z Z = Q H W Q Q a m m c c LL i Y g g D 3 3 3 0 a 3 SUB BSMT. BASEMENT 1ST FLOOR Z"D FLOOR 3RD FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR 7T"FLOOR HT"FLOOR � Installing Company Name: C/� 1 —C Check One Only Certificate#�� �� �,� Lorporation Address: �3EL/L7r„►.7 S) City/Town: State:- A Business Tel: rJ6 l/(l9!9,Q 3 Fax: ❑Partnership -----------___ _/G�SS ❑Firm/Company ----_-------- Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes J:J'No❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 21-'r Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only --------------------------------------------- Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 o t e Gen ral Laws. By---—----—------------------— Type of License: ---- Title___ Signa r- �id Plumber ------------------------ ['Plumber cense City/Town _ ester APPROVED OFFICE USE ONLY ❑Journeyman License Number: ____ _— Date....... 4, TOWN OF NORTH ANDOVER 0 Ao PERMIT FOR WIRING 3 CHUS This certifies that .......... ....... ...... **,.�.................. has permission to perform ..... ....................................................................... - R&-S,C,:�:,—/-7- 4,4,C.,_5 -- wiringin the building of....... ......................................................................... E T 57- at.............. ................5..e...0.../................................... North Andover,Mass. Fee.(') <-.........R-a- �.. ... Lic.No.A.gY..V...........,I .................... . ...... ......... ELECTRICAL INSPECTOR Check # 7 7194 �b-\ Commonwealth of Massachusetts vmciai use umy Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed m accordance with the Massachusetts Electrical Code(1vMC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2/1/2007 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) 140 Prescott Street Owner or Tenant Prescott House Telephone No.. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Boa) Purpose of Building Nursing Home Utility Authorization No. j Existing Service 2000 Amps 277/480 Volts Overhead❑ Undgrd® No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Misc.Electrical for renovations for five interior areas and a new exterior canopy. Completion of thefollowing table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 113 Swimming Pool Above ❑ d. El Batte mergency Lighting Rrnd. Un No.of Receptacle Outlets 38 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 15 No.of Gas Burners o.of Detection an 1 Initiating Devices No.of Ranges No.of Air Cond. 2 Total Tons 5 No.of Alerting Devices No:of Waste Disposers eat p umber ons o.o e ontamed Totals: -_.. _..._....__--------.-._.__. Detection/Alertin Devices No.of Dishwasherspal Space/Area Heating KW 12 Local❑ Connnncecttion ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.o Water KW o.o o. Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications inngg. No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. + Estimated Value of Electrical Work: $75,000 (When required by municipal policy.) Work to Start: 1/30/07 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 under- signed certifies that such coverage is in force,and has odaited proof of same to the permit issuing office. CHECK ONE: INSURANCES BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: MAKI ELECTRICAL LIC.NO.: A8481 Licensee: WILLIAM MARTIN Signature ! L LIC.NO.: (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: 508-752-5662 Address: 100 NORTH STREET WORCESTER,MA 01605 Alt. Tel.No.: 508-752-5663 *Security System.Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re- quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent Owner/Agent Signature Telephone No. a PERMIT FEE. $125.00 1 (Z�Zt,�-mss MU-7 i emsP Te( ARCHITECTURE i {- ONE HARTFORD SQUARE WEST . (�-lo.] �i��.�. lli.�'�, �? p.��. INTERIORS HARTFORD CONNECTICUT 06106 Pc, LAND PLANNING TELEPHONE 860 548 0802 FAX 860 249 2531 EMAIL mail@teclonarchHects.com INTERNET www.tectonarchitects.com July 26, 2007 Mr. Gerald A. Brown Inspector of Buildings Town of North Andover Building Department 1600 Osgood Street N. Andover, MA 01845 , RE: Genesis HealthCare— Prescott House New Exterior Front Entrance Canopy and Site Work Dear Mr. Brown: I have made periodic site visits to observe the construction carried out at 140 Prescott Street, North Andover, MA under Permit#402. General Contractor on project, RP Masiello Incorporated, Boylston, Ma., Project Manager Mr. Bill Babin. All required approvals have been submitted. To the best of my knowledge, there are no outstanding violations of the Building Department and said construction has been satisfactorily completed in accordance with plans and revisions submitted for permit purposes, and with all applicable-codes, rules and regulations of the Town of North Andover and the Commonwealth of Massachusetts. Sincerely, David G. Foster No.5389 Principal rigin I Si 'Lure and Seal qd b6 Copies to, Bill Babin, RP Masiello, Project Manager f.Iprojectslgenesislgen53inOl-prescott house interior renovation Idatalconstruction adminlaffidavit.070716canopy-r.p. masiello.doc V40 1"4 '9 Town of _ ; Andover 0 No. C 6100V J o dover, Mass., o COCMICKEWICK ADRATED `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....�... ". W.....#01001V100C. ................. ........................... ................................... Foundation has permission to erect........................................ b 'Idings on ..... ..� �� � J� �� Y ................................................ !rte �N�V » *#!0.! Jto beoccupied as..�W /.�. ....... /4..... ......... . �1..a.. chi e . . . . . .. . ............................... .... provided that the person accepting this permit shall in every respect conform to the term of the ap kation on file inanal - this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Aft ion and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Tff'40Rough 3 &S* Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S Rough ... ....... Service ING INS P R in b � Occupancy Permit R wire C l GAS INSPECTOR Rough Display in a Co ' us Place the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner ---� Street No. SEE REVERSE SIDE J1 Smoke Det. �' � - i GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS;.ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum). Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway . Continuous strip footings for interior columns FOUNDATION: Rebar as required ` Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblook-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. - Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. n Joist hangers-fully nailed w/hanger nails. -1t,45"C7 1WG Sill plates 2-2X6(1 PT)w/sill seal. a _ot- D -7 Girls-solid brick or steel plate bearing at foundations "air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. 6-1ft 0AIF7 9!%6c� Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.2240 w/3'headroom above). ` z Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. of required glaiing shall be openable. ttY Bedrooms required min. 20x24 egress window or door. - _ Vent attic spaces- proper vent", soffit and required ridge vents. �y 3 `f Firecode under'stairs if used for storage !S1- FIREPLACES: Separate permit required. U�( Inspections at Footing-Smoke Chamber-Finish Smooth parging,clean joints,8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. �1 p Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure %ORTH ovm Of _: Andover 0 No. dower, Mass., A4 T o _ LA �. COCMICNEWICK V 7�A0OATED C7 `s BOARD OF HEALTH Food/Kitchen Septic System PERMIT D BUILDING INSPECTOR THIS CERTIFIES THAT .....AA . ......... .............. ..... Foundation iio� has permission.to erect....................................... uildings on .�. � W ` to be occupied as.. iftox...... ...... . .................. .... .. . ............... . 10 1- h• ey provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Fina1 ��� �/"�` this office, and to the provisions of the Codes and ws rela ' to th ncperjion, Alteration and Constru f Buildings in the Town of North Andover. 9 �r��II �I/ 3 • Q PLUMBING INSP CTOR Y � � VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough ��" ` tna PERMIT EXPIRES INZLATHS UNLESS CONS T ELECTRICAL gy. INSPEC )��- ? 0 jZ 7 / ....... .. .................. .... ............. ...........OR ervice INSPECT ina M Ste„ - D 7 Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final " No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ` GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,.ADDRESS, AND PERMIT(COPY 0K)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. WalJs at stair stringers. Windbrace comers and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. , Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). ` Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging, dean joints,8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. Date. S c , c? :14, TOWN OF N, OR H ANDOVER �? ��� _., �• °oma (,/" PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . .F. �. �� . . .� . .� .C.f. . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of at . . . Vo. . ��/3,.'.sf� .7'7`-- . . . . . . . . . . . . . North Andover, Mass. Fee./4..' . . .Lic. No. ? . . . ,,�.._. - - - - - - - IUMBING INSPECTOR Check # 7334 - 06/19/07 TUE 12:23 FAX 5480800 TECTON ARCHITECTS Q004 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BUILDING DEPARTMENT CONSTRUCTION CONTROL AFFIDA 1171• PHASE 3 Ian accordance with Section 116 0 of the 1@rlassaachusetts State Building Code, I, Peter Hentschel being a projaessional engin /architect,certify that I have reviewed the plans dor Prescott house- Interior Renovations-Phase 3:Rooms#113 114, 13S, 135.1 & 137 at 140 Prescott Street, North Andover IKA and to the best of my knowledge such plans conform to the provision o, said code,all acceptable engineering practices,all applicable laws and ordinances. Further,I will observe the construction as specified in Section 116.2.1 and submit reports as required by Section 116.2 2 of the Code. y; .<C�5 Pt4ENlg�,ren CL .30399 CT Yeo Architect or E4& Seal trH OF MP Signature 9UBS CRIBED film S WORN TO BEFORE ME ov THISDAYOF t-/14 A.D.2007 ````,pP��uR rT' �. ......... 2 MY {� _ T"YBL = COMMISSION c J 'Na EXPIRES :U 3131108 MY COMMISSION EXPIRES �• �� �'� F •R.......• ••• a 06/19/07 TUE 12:23 FAX 5480800 TECTON ARCHITECTS 0003 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTHANDOVER BUILDING DEPARTMENT CONSTRUCTION CONTROL AFFIDA17T PHASE 2 In accordance with Section 115 0 o the Massachusetts State Building.� Code,.l; Peter Hentschel being a professional effgkmer/architect, certify that I have reviewed the plans for Prescott Hoarse- Interior Renovations—Phase 2:Rooms#115, 115.1. 115.2. 127.1 & 130 130.1 and 132 at 140 Prescott Street Ngrth Andover MA and to the nest of nny knowledge such plaits conform to the provision of said code,all acceptable engineering practices,all applicable laws and ordinances. Further,I will observe the construction as specified in Section 116.2.1 and submit reports as required by Section 116.2.2 of the Codes ��s, •k'=,� �`�a.� a X10. 0399` o HARTF 0 CT Architect or EagM Seal ` `FgttH� sS°' Signature SUBSCRIBED AND SWORN TO BEFORE ME ON THIS I DAYOF Jui't A.D. 20� ale Z MY `ten OT PUBLIC - COMMISSION L- TA" EXPIRES G 3131106 MY COMMISSION EXPIRES 5-3)- 0 g ''ii�op CQ�C1�G`���\ ���"nnn1111WO`� 06/19/07 TUE 12:22 FAX 5480800 TECTON ARCHITECTS 0002 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTHANDOVER BUILDING DEPARTMENT CONSTRUCTION CONTROL AFFIDAV'7T PHASE I It: accordance with Section 116.0 of the Massaclause°of State Buildirg Code,I, Peter Hentschel being a Professional--mgm /architect,certif,,t eat I have revioved the plans for Prescott House- Interior Renovations—Phase 1:Rooms#139, 139.1, 139.2, 139.3&139.4 at 140 Prescott Street.North Andaver,M. and to the best of my knowledge s¢scla plats conform to the provision of said code, all acceptable engineering practices,all applicable laws and ordinances Further,I will observe the construction as specified in Section 116.21 and submit reports as required by Section 116.2.2 of the Code Architect or Engitsec Seal Signature SUBSCRIBED AND SWORN TO BEFORE ME ON THIS _DAY OF A.D. 201. unry,rrrr,� F_R 2 MY n s N: COMMISSION c OTAR,YPUATC .t . EXPIRES J MY COMMISSION EXPIRES J- 31. 0 97 .,,�rrOF jCr�;N,r1y``�,. I � 3 YCa MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or pmt) NORTH ANDOVER,MASSACHUSETTS • Date 3--o�ci C1 7 Building Location 110 CL-, Owners Name OX,��M / 15-' Permit# -.__ ----- '?33r Amount Type of Occiipaiicy C1me�rc-c�i�� New 0 Renovation [A Replacement 0 Plans Submitted Yes � No FIXTURES Alw 1ISI SiBHW BAS9*HNf 1ST.ROCIt 2%Rfm, 3iD ROCK 4M ROCR SIRRDCR - , 6MROM 7M ROIR M ROCK (Print or type) �(yy� 11 Check one: Certificate Installing Company Name 1�-lJllt `V1i `�' Yo [a Corp. 143 Address P'0 ' :� -) 0 Partner. Business Telephone 7 == Finn/Co. Name of Licensed Plumber: Insurance Coverage- Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 129Othertype of indemnity 0 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 Signaturee Owner 0 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 vrith all pertinent provisions of the M=42ftte 1an hap 142 of the General Laws., Y Signature 57 Licenscu Type of Plumbing License ' Title i !Town - 47�- ty --_ -<_ _ il✓censeNum e� r Master ® Journeyman PROVED co�cE usE oxr.Y ii'l;A_z.'lr.! O<I (JT IN.P.14 Vol f4f)'If W"f"Ilk vi tA cl z -1 Xfl. Lj A)WO 'wnq ljow lo 4im!"'onc,Im-xi"n-c ;!.-.t P/ 77 7" 40, LIPRO"'I".N'll �-C--77"iT,7-M. .77.777 k IAORTH own of 4 over O ....... "` c^ o = E dover, Mass., COCMICMEWICK 7�ADRATED P' �S `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System V � t' -A �,� BUILDING INSPECTOR THIS CERTIFIES THAT....L / ....I.....I'�� ...G 71 .......................... .......tj........ ................ .. Foundation i has permission to erect........................................ buildings on .. ...t'f iC'D ....... ...�.....f. 0......................... Roughj�f,-4-2 CAL to be occupied as.......Pi�rXi� -.. .. ..... ........�..!.................................................................. Chimney provided that the person accepting this permit sh in eve re act conform to the terms of the application on file in � a this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSY,,ECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. O/A ? PERMIT EXPIRES IN 6 MONTHS �0/ UNLESS CONSTRUCTI T TS ELECTRICAL INSPECTOR BUILDING INSPECTOR Final e Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. :� SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,.ADDRESS, AND PERMIT(COPY 0K)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stoneffabric filter/cover and.outlet connection. ' FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat,elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1PT)w/sill seal. Gists,,-"solid brick or steel plate bearing at foundations "air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses-. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish f Smooth parging, clean joints,8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupvina structure. NORTH Town of over No. _- �.C, = �A E dover, Mass., I� COCMICMEwICK 7�ADRATED P'V C7 S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System J P..710��. . BUILDING INSPECTOR THIS CERTIFIES THAT....Jio ate.4....i ,Kr ... <. `.................. ..'. ....... .. .. Foundation I �f has permission to erect........................................ buildings on .. S �.0......................... Rou h(j�; �iwrJ�. -�'•'' .. ^� .. �................... ... g r to be occupied as..:....PI -.. ... ......... ........r�f . ..-.............................................. Chimney provided that the person accepting this permit sh in eve reconform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBIN/G INSSECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. '� I�4r! o ? PERMIT EXPIRES IN 6 MONTHS CF90c 6t1111'T -7 UNLESS CONSTRUCTI T TS ELECTRICAL INSPECTOR fou h� �9�', S, j & m m .............. ..... ..........................BUILDING INSPECTOR f, Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burnerj - Street No . SEE REVERSE SIDE Smoke Det. Date..........a...`................. pORTN e: °`,"'°:•_�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUSE� , y�y f This certifies that/jiUld��Li .. Lr.. ............................ .�}. has permission to perform .r1rW.f.Mla !.G ....... .... -r- wiring in the building of .....^........................................................ : � .'3 +''� ......Qc�rmucAOL Nrth Andover,Mass. ; at...... ................ ......... �............ Feek.................. Lic.No.............. .................... . ........ .... ..... E INSPECM Check # 8 T/ Date��i .�. . . .... .... NORTH ! o� TOWN OF NORTH ANDOVER 41, PERMIT FOR GA$ INVALLATION . AC MusE� V This certifies that . .o. ./�!!H. . . . . . . . . . . . . . . . . has permission for gas installation . . . I?/V . . . . . . . . . . . . in the buildings of . . I. 0c C< .c. . f.. . . . . . . . . . . . . . . . . . . . . . . . at .M'� . . f ! . . �'` . . . . , North Andover, Mass. Fee. . 5. . . . . Lic. No.. GAS INSPECTOR Check# �' 607 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,Mass. Date (O 20& Permit# [,�a 7 F lM �' / Building Location_ JZ SCOT ,� Owner's Name� ���L--SCDT� �U/moi 6 /46- Owner Tel# yp Occupancy C O �// T e of Occu anc New a Renovation 0 Replacement o Plan Submitted: Yes o No 0 FIXTURES 2Uj 91 ,, M z H o U z o W= CO) Zw z Q w J Q ¢ x O ao° ox co Fw(1) g pO = 9 o . WW xH o SUB-BSMT BASEMENT k 1 ST FLOOR 2ND FLOOR 3RD FLOOR e FLOOR 5T"FLOOR 6T"FLOOf: 7T"FLOOR e FLOOR Installing Company Name f Check one: Certificate Address C/z R(_�&4t 05orporation �fG} -ki na a /? 1� 1��Ll a Partnership Business Telephone# �,33 ® Firm/Co. Name of Licensed Plumber or Gas Fitter 14 f,7—/u j c,f7- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes cr"~ No 9 If you have checked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy d'-- Other type of indemnity D Bond o 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 o Agent 0 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 the permit issued i application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene �f BY Type of License: --TEEffi5L;P Signa tu sed umber asT'rtter Title •-Gas fitter f as License Number City/rows Journeyman APPROVED(OFFICE USE ONLY) El Commonwealth of Massachusetts official Use only Department of Fire Services Permit N°. "Z -7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ..� [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION Date: 61-- _;) City or Town of. NORTH ANDOVER ©�� To.the Inspector of Wires: By this application the undersignedgives notice o his or her intention to perform the electrical work described below. Location(Street&Number) - , Owner or Tenant _ 17e ( Telephone No. Owner's Address Is this permit in conjunction with a building Permit? Yes ❑ No (Check Appropriate Box) Purpose of Buildingead Undrd Utility Authorization No.��y* 0,? 7 3 Eidsting Service/" Amps j, / VVolts Overh g g ❑ No,of Meters New Service �`AQQ Amps IAv /AVUVolts Overhead Und rd g ❑ No.of Meters c. Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: 19 of CeiL-SuCompletion of the ollowin table ma be waived b the Inspector o Wires. No.of Recessed Luminaires No. sp.(Paddle)FansNo.of Total . Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In- o.o mergency T g d ❑ d. ❑ Bao- a Units —, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No of Zones No.of Switches No.of Gas Burners No..of Detection and Tot / InitiatingDevices No.of Ranges No.of Air Co d. To (� No.of Alerting Devices No.of Waste Disposers E SP Number Tons KW _ No.of Self-Contained otals: Detection/Alertin Devices No,of Dishwashers /Area Heating KW ��❑ Municipal Connection El Other No.of Dryers Heating Appliances KW Security Systems:* 4 t No.of Water No.of No,of Devices or Equivalent Heaters KW Si s Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires.Work to Star (When required by municipal policy.) Start: j'^ M-1—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: INSURANCk a"BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of piMLu ,th 'the information o this application is true and complete- FIRM NAME: U�Qtc� C �?� License • [�yl! /� �t�� ` f LIC.NO.: t�! Signature (If applicable, enter"erem t"in the license nu ,b line. LIC.NO.: `jam/;to Address: S GI1111 A s.Tel.No.:" 7 Alt.Tel.No..� *Per M.G.L c. 147,s. 57-61,security work requires Departrn 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 Signature Telephone No. PERMIT FEE: $ I!; �k; �� � � � , � ,� r, (� r i . I I I I The Commonwealth of Massachusetts Department of Industrial Accidents 11 Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers At►olicant Information Please Print Legibly Name(Business/Organization/Individual)' ijcy e`�� Address: ,S 7U FTS City/.State/Zip: K L t.J Phone #:_ 31ell",^ YAreeu an employer?Checkthe appropriate box: Type of project(regairet�:am a employer with—�— 4. ❑ 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.x 7• ❑Remodeling ship and have no employees These suit-contractors have 8. (]Demolition working for mei any capacity. workers' comp.insurance. g, ❑Building addition [No workers'comp, insurance 5. [3 We are a corporation and its I�ectrical a * required.] officers have exercised their repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No-workers'comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurancerequired.]t employees. [No workers' comp. insurance required.] 13.❑.Other *Any applicant that checks bo>lr 1€t must also fill out the section below showing their workers'oompensation 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. ;Contractors that check this box must attached an additional sheet showing the creme of the subcontractors and their workers'comp.policy information. I am an employer that is.protading:workers'compensation insurancefor np employees information Below is the paltry and job site Insurance Company Name: &=-PJ 7 4e,4 /j Policy#or Self-..ins.Lie. Expiration Date: ` Q Job Site Address: City/state/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a- fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains penalties ofpe t/sat the information provided abo is true correct Si tore: Date: 6 � 9 Phone#: �7. / CrJ ./ / Of kiat use only. Do not write in this area,to be completed by city or town off al 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 employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a liceuse or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidenceaf 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." i Applicants licants „ I Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to yoursituationand,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of a insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to,cavy workers'compensation insurance. Ifan LLC or LLP does have a 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,nofthe 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 dine. 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 wiII 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 copyof 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 Y 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 lnvestiWions 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 Officeof Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MA.SSAFB Fax#617-727-774 Revised 5-26-(?5 � www.mass.gov/dia