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HomeMy WebLinkAboutMiscellaneous - 145 BARKER STREET 4/30/2018 03 BARKER STREET / 210/035.=�-0000.0 / � I S I I Date......J-0777.1&ez 40RTPI TOWN OF NORTH ANDOVER PERMIT FOR WIRING US This certifies that ................ ......... ............... has permission to perform ..... a.>12 7'1 ?................ wiring in the building of........ (.'' tz).A'rx'zi(.................................. USS at.......... .............................5 r'........................... ,North Andover,Mass. .......... Lic.N .. Fee.. o..I............ ... P .......... /�j ELECTRICAL INSPECTOR Check # 7726 4 r ' Commonwealth of Massachusetts Official Use Only { Department of Fire Services Permit No. 7 '77-4 kip BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives no ' e of his or her intention to perform the electrical work described below. Location(Street&Number) ' Owner or Tenant Telephone No. Owner's Address Is this permit in conjun tion a b 'ding permit? Yes No ❑ (Check Appropriate Box) Purpose of Building t Utility Authorization No. Existing Service D Amps /Z40 Volts Overhead.❑ Undgrd JZ No.of Meters New Service r� Amps �--P) / Volts Overhead�— ❑ Undgrdl,PS No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: d Completion of the followin table ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of r--Total Transformers VVA No.of Luminaire OutletsNo.of Hot Tubs �^ ----- Generators �KVA No.of Luminaires Swimming Pool Above In- o.o mergency ig $-- nd. d. ❑ Batte 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 Initiatin Devices r--- No.of Ranges � No.of Air Cond. Total I Tons d. No.of Alerting Devices No.of Waste Disposers / eat Pump Number To s No.of Self-Contained / Totals: ......._.. . ......._............................. Detection/Alerting Devices No.of Dishwashers Space/Area Heating K M Loca❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of water No.of No.of Devices or Equivalent Heaters Signs Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Ielecommumcations Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lec 'cal Work: (9,a 1) (When required by municipal policy.) Work to Start: 0 t9 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ (Specify:) ❑ OTHER I certify,under the pain an penalties of Perjury,that the information on this application is true and complete FIRM N U 1 e�j' j7o j LIC.NO.: Licensee: Signature LIC.NO.: j (If applicable, enter" pt"in the license nu beer ne.) Address: Q(� 6r'a26 Bus.Tell.Alt.Tel.No.:No.: l7- y�O� - *Per M.G.L c. 147,s.57-61,s ty work req ices Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. <� PERMIT FEE:$ I I t I r ,J I li The Commonwealth of Massachusetts Department of Industrial Accidents Dice of Investigations iyt,I i 600 Washington Street `. Boston, MA 02111 www mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Coatra.ctors/Electricians/Plwnbers Applicant Information Please Print Legibly Name(Business/Organizationlindividual); `Lh6-� �4 Address: �� City/State/Zip: e Phone#: . , 15�F Are you an employer?Check the appropriate box: I am a employer with 4. ❑ I am a general contractor and I Type of project(required): 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.t 7. D Remodeling ship and have no employees These sub-contractors have $. [J Demolition working for mein any capacity. workers' comp. insurance. [No workers comp. insurance 5. 9. Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No-workers'comp, c. 152, §1(4),'and we have no 12.❑ Roof insurance required.]t employees. [No workers' re'atl's comp. insurance required_] t3 ❑Other "Any applicant that checks boO I must also fill out the section below showing their workent'compensation policy information. t Homeowner¢who submit this affidavit indicating they are doing allwork and then hire outside contractors must submit a new affidavit indicating such. ;Contactors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing:workers'compensation insurance formJ'employees: Below is the policy and job site information. Insurance Company Name: AA Policy#or Self-ins.Lie.# / / 3�� Expiration Date: Q Job Site Address: St- 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 c ify a the pains and penalties of perjury that the information provided abeve is and correct Signature: Date: U Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# 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#: i I V 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 timstee of an individual,P artnership,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 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." 2 25C 7 states"Neither the commonwealth nor an of its political subdivisions shall Additional MGL chapter 15 , Y 1Y, P § ( ) enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es).and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city,or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted below. Self-insured companies should enter their self-insurance-license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the penmittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 as a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents C?ff ee of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-977-MASSAFE Fax#617-727-7744 Revised 5-26-05 www.mass.gov/dia Jan 02 08 04:38p J B I 86669094�'r r• � i Kenneth A.Woods, PE Ltd. 18 Temple Street Newburyport,MA 01950 (978)985-6129 i STRUCTURAL AFFIDAVIT Project Name: Medlock Residence Address: 145 Barker St,North Andover,MA 01845 Architect/Engineer: Kenneth A. Woods,PE In accordance with Section 116.0 of the Massachusetts State Building Code, I, Kenneth Woods Registration No.39885 being a registered professional engineer hereby certify that I have observed the work associated with the above named project and that to the best of my knowledge, information, and belief the structural work has been done in general conformance with the permit a-id plans approved by the Building Department and will safely support the live, dead, wind and earthquake loads in accordance with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. This certification is based on regular observations which I or my designated g � representative made at the site while the structural phase of the work was in progress. f Signed: Kenneth A.Woods Date: ` / Z t ozd�-j Stamped Seal: s�/Z''A OF F�ass��y KEnr,V � cyG�V e 1r_n 1 b A.WOODS ^,i► Esc !'v STRUCTr�RAL No.3.9 w' q c, %a I i f i E Date.... .". I NORTN o?�``^��� � TOWN OF NORTH ANDOVER FPERMIT FOR WIRING IL ,SSACMUS� , This certifies that ...............D ................................ has permission to perform ..... Rd7B / �. .............. E,. /alt ,. wiring in the building of.....................!.!'t Q o...................... .................... North Andover Mass Fee..................... C � S 1 Lic.No.............. �. ELECTRICAL INSPECTOR Check # 7591 ¢ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. / f� 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( EC), 27 CMR 12.00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector" of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Num er Owner or Tenant 1° Telephone No. Owner's Address Is this permit in conju ction ith b 'lding permit? Yesry� No L� ❑ (Check Appropriate Box) Purpose of Building / a Utility Authorization No. i Exist Service Amps f 00A Volts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f � nt� ^ is,�l ✓e�24 she_ Completion of the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans,_--- No.of Total Transformers —K-VA No.of Luminaire Outlets <--. No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ Ila— o.o Units ig g rnd. rnd. ElBatte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and s-------- Initiating Devices No.of Ranges 1'— g �--��' No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Ton No.of Self-Contained �— Totals: ......................... ..... - Detection/Alertin Devices Municipal No.of Dishwashers '� S ace/Area Heating KW / P - P g I'°cal❑ Connection ❑ mer No.of Dryers �— Heating Appliances IW Security Systems:* No.of Water No.of No. No.of Devices or E uiva en o�- Heaters Signs Ballasts . Data Wiring: No.of Devices or Equivaknt No.Hydromassage Bathtu "`- Telecommunications Wiring: h� No.of Motors AHP No.of Devices or E uivalent� OTHER: � L Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o Electrical Work: D'2yp,p a (When required by municipal policy.) Work to Start:—N21 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t epai s and penalties o perjury,that the information on this application is true and complete. FIRM N SPS61 LIC.NO.:, 81 90 Licensee: 'I IS{P,S Signature LIC.NO.: 38 (If applicable, enter"exempt"in the license ber,ine Bus.Tel.No.: ?3 82 Address: a �Q e (� U Alt.Tel.No.:6 *Per M.G.L c. 147,s.57-61,secunty work requires Department of Public Safety S License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ i �� � ��-� 2 �� � �� 40 d. The Commonwealth of Massachusetts ki ! Department of Industrikil Accidents Office of Investigations 600 Washington Street i Boston, MA 02111 j www ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Leaibl Name (Business/organizatioMndividual); G Address; City/.State/Zip: /+ �� / = Phone#• . 41121-IMI VVIN? Are you an employer?Check the appropriate box:l.� ' Type of project(required): El am a employer with 1 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.t �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp.insurance. g Building addition workers'comp,insurance 5. ❑ We are a.corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOL 11.❑ Plumbing repairs or additions myself.[No-workers'comp. c. 1.52, §1(4),'and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑Other 'Any applicant that checks bo><#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;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 is providing workerscompensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: of z� f Expiration Date: Qg Job Site Address01�/( Sf City/State/Zip: � D 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 fo insurance coverage verification. I do hereby c un t pains and penalties of perjury that the information provided ove ' true and correct Si tore: Date: �� o Phone#: y0 O fficialse only. Do not write in this area,to be completed by city or town official own: PermitlLicense# uthority(circle one): of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector erson: Phone#• , information and Instructions k enation for their employees, person in the service of another under any contract of hire, Massachusetts General Laws chapter 152 ��r�`aIlemployers to provide workers comp i Pursuant to this statute,an employee is d � express or implied,oral or written' two or more to er is defined as"an individual,partnership,association,corporation or other legal entity,or any An emp y rise,and including the legal representatives of adeceased eeS'However the of the foregoing engaged in a joint entloyer,or the erp receiver or trustee of an individual,partnership,association oreandgwho rresides tliereingor the occupant of the owner of a dwelling house having not more than three apartmentsemployment it deemed to be an employer. another who employs persons to do maintenance,canstivction or repair work on such dwelling house dwelling house of tenant thereto shall not because of such ' or on the grounds or building app state or local licensing agency shall withhold the issuance or MGL chapter 152,>�25C(6)also states that"every in the commonwealth for any i permit to operate a business or to construct ce with the in coverage required." renewal of a license or pe olitical subdivisions shall ' applicant who has not produced acceptable evidence of comp �25C(7)states"Neither the commonwealth nor any of its p Additionally,MGL chapter 152, public work until acceptable evidence of compliance with the insurance enter into any contract for the performance of P requirements of this chapter have been presented to the contracting authority ' Applicants 1 to our situation and,if enation affidavit completely,by checking the boxes that appy Y Please fill out the workers' comp along with their certificate(s)of } sub-contractors)name(s),address(es)and phone number(s) with no employees other than the necessary,supply or Limited Liability Partnerships(LLP) insurance. Limited Liability Companies(LLQ compensation insurance, if an LLC or LLP does have members or partners, are not required to carry be submitted to the Department of Industrial employees,a policy is required. Be advised that this affidavit may artment of Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should ed to the city or town that the application for the permit or license is being requested,to obtain be returnquestions regarding the law or if you are required to es should enter their Industrial Accidents- Should you have any lease call the Department at the number listed below. Self-insure come compensation policy,p ro riate line. self insurance license number on the a p P City or Town Officials at the bottom The Department has Provided a space fete and printed legibly. ou regarding the applicant. please be sure that the affidavit is compffice of investigations ant plicant of the affidavit for you to fill out ill the a numbervent the will be used as a reference number.one affidavit indicating current , Please be sure to fill in the perm applications in any given year,need only submit o that must submit in permit/license app or town may be provided to the I if necessary)and under"Job Site Address"the applicant should write"all locations in-(City or policy informatio ( ed or marked by the city town)."A copy of the affidavit that has been officially stamp tit not related to any business or commercial venture roof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each applicant as p year.Where a home owner or citizen is obtaining license erson is NOT required to complete this affidavit (i.e.a dog license or permit to bum leaves etc.) P questions, Office of investigations would like to thank you in advance for your cooperation and should you have any The give us a call. please do not hesitate to g The Department's address,telephone TJe number of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston,MA€12111 Tel.#617-727-4900 e t 406 or -MASSAFB Fax#61727-774 Revised 5-26-05 www.mass.gov/dia Date.. . � f MORTH TOWN OF NORTH DOVER 1 PERMIT FOR ,GA NSTALLATION . o s :f Q SACHUSE� This certifies that � . . . . . . . . . . . . . . has permission for gas installatiifn . . . . . . . . . . . . . . in the buildings of . . . . .S. . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee.:- .c Lic. No.;-� / f` / -? .. . . . . . . . (� GAS INSPECTOR Check# t) 6117 i MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS FITTING (Type or print) Date I Pi () NORTH ANDOVER,MASSACHUSETTS Building Locations A(1 I S ` Permit# ��/ Amount$ uo Owner's Name New Renovation © Replacement Plans Submitted I U a Wv� a 9 w w o O � °o z Gw x z u W �, z F a p a > w p- w v, ., a x 9 a w � w E~ A H x z w > W f* zz t Fw„ w G7 O > w Fw. w F W j Z O x x O x � 3 a cal a u °a > o a H o SU B-BASEM ENT BASEMENT 1ST. FLOOR Q / 2N D . FLOG R 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR .6T H . FLOOR .7T H . FLOOR 8TH . FLOOR (Print or type) `� Che k one: Certificate Installing Company Name-- .Jaws I�yrt�� P+ �} �o- b Corp. Address S M),C1�G, ( _ {� . T � Partner. Business a ep one TeFirm/Co. Name of Licensed Plumber or Gas Fitter _ INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity D Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the j Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 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 j compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Li nsed Plumber Or Gas Fitter Title M Plumber a-�i L-) City/Town Q Gas Fitter (cense Num6er Master APPROVED(OFFICE USE ONLY) Journeyman j I Date. 2-,7'o . . . . 7 AORTM TOWN OF NORTH ANDOVER '0 PERMIT FOR PLUMBING SAcwUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . at . . ... . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Fee.7V� Lic. No.�3,14-,7- . . . . . . .... PLUMBING�IN41ECTOR Check # /2 el 7486 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS " Date S-CA� �, 01 Building Location 1W), I�A. 1(f Owners Name i n,� �V1 loW,11, Permit Amount Type of Occupancy S� S New Renovation © Replacement 1:1 Plans Submitted Yes No FIXTURES i VA w E~ SLRHM MROIR &�i41VII�II' 2N1 FIDQt l ( i 3MROR 4MROM SIH IIDQt 6M ELOC t 7MFI" 91H ROM I Lt (Print ing Company Name type) Installing iA1 S �yr N� Q+ (� C� y Check one: Certificate J El Corp. I Address 5 M 1 C L,u t L C�.� � Partner.' 1 Business Telephone IV- WI-A El Firm/Co. f Name ofLicensed Plumber- Insurance lumberInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond ❑ El Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in aboveaPP lication are true and accurate to the best of m knowledge and that all plumbing work and installations Y g P $ performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing a and Chapter 142 of the General Laws. Gam- r BYSignature ort—ic—e—n—WriumSer Type of Plumbing License Title 1�� City/Town License Num0W' Master Journeyman APPROVED(OFFICE USE ONLY El I Date a "oaT" TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING s��SSACMUs�th' This certifies that . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . • • i� //6 le t plumbing in the buildings of . . at . /� • • • • • • . . . . . . • • •. North Andover, Mass. Lic. No.. < i/ Fee`!�S,/�,;�.fir.. . r, ?(.. y11 -s . . . . . . . . . . . PLUMBING INSPECTOR Check # 3� 7264 � 1 MASSACHU SETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date Z A NORTH ANDOVER,MASSACHUSETTS Building Locations � 7 � ���/�- 2— Permit# Amount$ ?0. Owner's Name d /© e– New DRenovation D Replacement DPlans Submitted D z H a a F a W Q z a a � d C7 F z F z Ex„ F [azl C7 p > Ow z d w Q a ., m z o z o m a x o x w 3 a .da a > a a F O SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR ! 5TH . FLOOR 6TH . FLOOR .7T H . FLOOR 18T H . FLOOR Print a =� ( or type) ( y� Check one: Certificate Installing Company Name -1 /7 +t��lL�iZ �PL L� Corp. Address U✓� J Partner. 5� 3 ofy71d U J --e2Business Te ep one C�'� !, Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes all' No1 If you have checked Les,please indicate the type coverage by checking the appropriate box. I Liability insurance policy Other type of indemnity 13 Bond 1 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the i Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 instal lationsp rmed under Permit Issued for his app licati will be in compliance with all pertinent provisions of the Massachusetts S e Code a Chapt 142 oft General S. BY: ignature of Licensed Plumber Or Gas Fitt Title Plumber City/Town Gas Fitter (cense Number Master APPROVED(OFFICE USE ONLY) Journeyman 4251 Date.... RT 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHUS ,%- s certifies that .... . .... C CJ . .. ................ ,4ias permission to perform ......... 7 'i - wiring in the building of........ ..................... ... ..... ................... UL at........... North Andove!M Fee....�j Lic.No./—�- N ....... ylMass. . LECrRI Check # ME CONI ONREI LMOFMAMCIUSETI S Office Us on RT DEPAt'1 W0FPUX1CS4FE7Y V ` \ BOARD'OFFMPREVEMONR1;GUTA770NS527CM12...M Permit No. Occupancy&Fees Checked APPLICAHONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS 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 described below. Location(Street&Number) }- Owner or Tenant fte Owner's Address lLff '6at'�C{r 5 Is this permit in conjunction with a building permit: Yes Q No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service 2OU� Amps I-L0/2.YOVolts Overhead Underground M No. of Meters New Service Amps / Volts Overhead Underground ® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of`Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures KVA g g i L- Swimming Pool Above Below Generators KVA J round to No.of Receptacle Outlets Z No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Rspges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons j No.of DiIpposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Di hwashers Space Area Heating KWet No.of Sounding Devices 6�y No.of Self Contained Detection/Sougding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER ti�uanorCovsage.Ptu�totheragmanagsofiV��aclat�tfsGalaalLaws [ha�aamartliabiltlyhmuarrepb}iCcyinc�u�r>gComp��'�Co�e-�eorilss�>b��equivalat YES NO havesttbrndmdvalidtxoofofsametotheOffice YES P1/1 r ffyouhawdmckDdYES,pkmm dica�ihe Wofm�by F*a6m Dale YotktoStait �-4i-02 h�pearonDareRec �2—q UEsbrm�dvat�eofD iglwotl<$ 2ochG. Od :igr@lunder'&Ptr�sofpetjtay. final r'C C O. IKen9eNo. C YO SZS isee ' '6 a t'!1►� Cd,�H Signahue LioerNo E y/ SL S BttvrmTel.No. Lai^2 3e,,.2 G}j Y ddt Ah Tel No. 4103-19,3-.C475, INNERS INSURANCE WAIVER;Iamawate thattheLkwse doesnothavetheirmuarxecovetageori[S,%bsMntialegttivalent as m#edbyN 9%adim is(ierte<alLaws dthatmysignahueonthispwnkapp)i�ft� 'lease check one) Owner Agent ,� f Telephone No. PERMIT FEE$ r 0 Ignature ot Uwner or Agent I r , Location i `No. Date f N°RTM TOWN OF NORTH ANDOVER O' . o :�1ti0 ' Certificate of Occupancy $ J4�M. <�' Building/Frame Permit Fee $ US Foundation Permit Fee $ Other Permit Fee $ / ?D TOTAL $ J Check # 160 '18 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING s rn BUILDING PERNUT NUMBER. 02 3 DATE ISSUED: J _a ,4_ O M SIGNATURE: ,..� Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dia;ic—t Proposed Use I Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RqWred Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name Tint) Address for Service: Sign Telephone 2.2 Owner of Record: Name Print Address for Service: ® j Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Eicensed Construction Supervisor: Not Applicable ❑ f Licens,d Construction Supervisor: License Number mn Address I Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v j Company Name m Registration Number r i Address r Expiration Date /1 Signature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building &I/ Repair(s) ❑ Alterations(s) � Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify El N 16 i FIN k25, 66 t1;FAJ! Brief Description of Proposed Work: EZ&&I A)G 4 II()SU 4- 4T/!()6 Or E032I6IZ Fa)dU L�4UO/OQ4 C.0 S ?)&SCARE-KJr FAVA(L Y RIV, UENTllt 6- x�c'- eC-oS Erl s�' SAA SPOV-6, PtOD1 NG- CFC, CT21C 14i5-A7_- 6ZP CC-'1C �-- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Buildingq� (a) Building Permit Fee Z. ® Multiplier 2 Electrical (b) Estimated Total Cost of Q 0 Construction 3 Plumbing 1 Building Permit fee(a) X(b) 22� � 4 Mechanical(HVAC) /v 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My!!��ers relative to work authorized by this building permit application. Signature of OwnerDate (O� ( � l0 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1> as Owner/Authorized Agent of subject property Hereby declare the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief « Z7Tk&()'_4 /,-- (V signature o er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DiN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BtRDING CONNECTED TO NATURAL GAS LINE 13 'Cp o"o y CLOS G f i LL S� �''� 02 fLs2 3 !30L)K z � E v I NORTH EO f Town of And 0 No. 70 o z A dower, Mass., AV 7074 COC HICH I � ADRATED p �C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System AAA BUILDING INSPECTOR THIS CERTIFIES THAT..A4 .YAP ..... �. ............ : ......IM.c..wa. ..... ... Foundation has permission to tet.. N/.. .......... buildings on ..... y �.RA.�.�..kx t ............... Rough to be occupied as..../......xooIrfI e ......Ago....... .......AA.S%01110 to#V Vt—• Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �F// O� '3 O PLUMBING INSPECTOR VIOLATION 0 TION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR t Rough ew .......... ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Y _ I Location ,� Date ` No. j I NORM TOWN OF NORTH ANDOVER 3? i OL ` Certificate of Occupancy $ _ i �i�b', •'cam Building/Frame Permit Fee $ S Ss�CHU Foundation Permit Fee $ Other Permit Fee $ _ { TOTAL $ a Check # 14- J Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �?SDA � BUILDING PERMIT NUMBER: �/ TE ISSUED: � /. SIGNATURE: Building Commissionerfl for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number (A� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record P i Name(Print) Address for Service: Ag, Telephone 2.2 Owner of Record: Name Print Address for Service: { z Signature { Telephone SECTION 3-CONSTRUCTION SERVICES RVI ES 3.1 Licensed Construbtion Su rviso Not Applicable ❑ Licensed Construction Supervisor: C��C9t '7 7 �� G� 1/f jfGr /� License Number Addr s f �� ,7 7,C ?,3 7 `y Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number r/ I Address r j 1 Expiration Date Signature Telephone t -_- SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yes.......❑ No.......a/ SECTION 5 Description of Proposed Work check au a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIALUSE(}NLY,`° ,' Completed by permit applicant .._. z>'�,..rG 1. Building (a) Building Permit Fee Multiplier " 2 Electrical (b) Estimated Total'Cost of . (� Construction 0 0 3 Plumbing Building Permit fee(a)X tb> 4 Mechanical HVAC �i 5 Fire Protection r 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTH_O . ATION TO BE COMPLETED WHEN OW S GENT OR CO CTOR APPLIES FOR BUILDING PERMIT I,_ as Owner/Authorized Agent of subject property L Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pen-nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my&wledge and belief 1 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS t HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ' `'^ — ✓fie-�orrvmaiuoea�i ��aasacicuaetfa ..� I� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION_SUPERVISOR � i Number-.CS 040392 IiJ ,tl� Birttidate 07!10%1947 ; .' Expires'07/162001 Tr.no: 3223 ;Restricted To: 00 a DONALD L KELLOWA Y, . 47 TEDESCO RD . I METHUEN, MA 01844` Administrator Y 1 F i e V l I I I i i I 177.30. ". — •,t w•'"'r'3Fi�F.� i :?. .5,�wxt`T,Z t�.; .,� i V. � •K.. �, :H.cs L r L ;•• •t. -I tel: _ a _ M 4 1 4 1• 1 t%tk �► co . '4`d . :�.1s ,•`icy'' .. _ � . . � �-.' L� r,:.: - ..`COT^�' I tiny 1-� 3Q• _� �! =4 STI(/yY `SMry uj r s co S r � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name:. .. w Location: sem; Cit�/��'J c�' L) �"Y�' Phone L-/ 0 am a homeowner performing all work myself. j I m a sole proprietor and have no one working in any capacity I I am an employer providing.workers'compensation for my employees wonting on this job. Company name: Address City: Phone#: Insurance Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy�of7s tatement may be forwarded�to the Office of Investigations of the DIA for coverage verification. 1 do herby certify u der the p ins and penaltieof qury that the information provided above is true and con correct Signature i r!' Date Print name` Phone# Official use only do not write in this area to be completed by city or town official' C] Building Dept []Check ff immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone A Health Department Other FORM WORKMAN'S COMPENSATION NORTH Town ofdover O �.. dower, Mass. 11 COCHIC. WICOK %p ADRATED pP��-`� S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......1....�A...R .....l.�l .............../y1 l / ................................. Foundation has permission to eaoet...� ,� .��......... buildings on .......1q5... ,.4�o"..... ......... .......... Rough I to be occupied as....5.. .1.. ! ....... .,5 .�./.."A.......Rr�r.....Of.... !t/�� Chimney � provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. Rough 9 9 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough .............. Service 100 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough I 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 1 Street No. Smoke Det. SEE REVERSE SIDE