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Home My WebLink AboutMiscellaneous - 145 FARNUM STREET 4/30/2018 (2) 145 FARNUM STREET 210/107.A-0047-0000.0 i Date........:..Z '.. ......��............. NORTH OF��.ao TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....� �.. �V....... .. .. ....... . ......... ....... ... .. ... ..... . .............. i......`.�. has permission for g s installatio .... ��-�✓ ... �(?,l., i inthe buildings of ............G`..... ..1 -,.............................................................. `t at.....:......... .......... North Andover, Mass. FeeU.�`�:. Lic. No. `. ..:. 'M...�. ................................................... �� GAS INSPECTOR Check# 9812 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE PERMIT# v ' JOBSITE ADDRESS 145 Famum St. OWNER'S NAME Chuck Kasabula GOWNER ADDRESS I Same as above TE 978-686-1944 FAX N/A TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES[j NOE] APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 . 6 7 8 9 10 11 12 13 14 BOILER BOOSTER ® Q CONVERSION BURNER. 0 COOK STOVE 1 `� DIRECT VENT HEATER DRYER ®® FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST Q UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER T Gas Pi in 1 3 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the -9' Massachusetts General Laws,and that my signature on this permit application waives this requirement. ..ts 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 performed under the permit issued for this application will be in compliance with all Pertinen vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Timothy F.Cossette LICENSE# 1356 J SIGNATURE MP El MGF® JP® JGF® LPGI 0 CORPORATION D#F3-296-----1 PARTNERSHIP®# LLC®#� COMPANY NAME: Titan Plumbingand Heating Inc. ADDRESS 11445 Main Street CITY I Tewksbury I STATE MA ZIP 01876 TEL 978-851-2486 FAX 978-851-2535 CELL N/A EMAIL Te amTitanPlumbing@yahoo.com i Jan 28 1511:54a Titan Plumbing 19788512535 p.3 a ' .1'he Cornn2onwea7th of1!2'assachUSLWS ' - Depar WentoffidustrialAceldents ' ice of fwafigations 0o wash w9lon S't'reet Boston,MA 02.111 UT wWP Hanes g0V1wa ' Workers'Compensation)[usurran.ci A�#"xdfavit:)3uffder°sfContradoris&locixlciaals lit' tbexs A lieant Information please Fr nt Le Name(Biasf nrs[0.rgan1%affonffhdj:v1daa1) an . Address: 'n Czty/State/%i)?: Are you an employer?dLeek the appropriate ox: Type of project(required): 1. I am a e-rployer with� _ 4• I am a general contractor andl 6, �]New Onsbrwtion employees( ll and/ox pat time). ha lojiiredthe sub-contract xs 7. n Remodeling 2111 am,a sole prroprietor or partner listed on the attachedsheet- ese sub-contractors ship and'luve nonsub-contractors Kava S. ElDemolition worktng forme in any capacity. workers'comp.imwauca. 9. ❑goilag addiflon ]No workers' comp.insurance 5• We are a corporation and its 10 ElBlectr cal.repairs or additions aequired.� officers have exercised.their ri ht of exem.tion erMGL 11f]Plumbiugxepairs or additions 3.El am a homeowner Ping all work g and we have no 12, Roofre airs myseif[Taworlcexs'comp. a.employe e69.E [] p irenrancerequi�[etI.�� employees.�No-workess' 13.�],Othex comp.insurance required.] xA.uYapuliomit-thatcherlsbox0Imust also fill outthssectio belowshovvragibeirwbrkem'oompensa6O]L licgimfamiaiioa. pllomeownerswhasIbmitihisan, davit indicatiagthey kedo all Work and ffim aoutsidacontraotorsn�utsvbmitanewaf�davi:indica ngsucb. �?Gbn ractorstfiat ehc ct8is bo must attached an additional sh4etslowingi r name ofthe sub-eordraetors andibkwodera'comp.polioy infcm ation. X ail an employer that is provialing woxlterM'cola erasation insurance formy employees Betow rs thepolky andjah site information. . Insurance CornpanyNarne:. ! c Dxcl �q gyp- � f�1 policy ox Self-i s.LiC. �O �l zta ionDafi�;e:�t Job Site Address; Attach a copy aftlie workers' comp ensationp o cy rteclat anon page(showing tTie policy number and expiration date). - failureto.seemeinaye-tageasrequizedvnderSecia az25-.ofMGLo. 152 can lead to the imposition,of:cxbninalpena7tiesof — - ne up=to$1,500:08 and/or-i> -year i*dsonrnen as welX as ern1-p� aloes zri a form STOir 101tK oRpER_an_ a'. _e — fiof up tq$250.00 a day against the violator. Be ad "sed tliat a copy of this stafem.ent maybe for Marded.fo the 0lfice of[ Investigations ofthe DIA for insurance coverage vorlEcation.. r X do Iter eby cepfa" uric%P tT2 j)LtIF1s S- rtliies a`perlaliy tliat alis i72,j�or=tion providedl aiiove is tr a and�'orrect ate• � DafeI 2� � Of}Iciar rise 0217Y. Do not write in this area,to a complefed by city or tort officiaF City or Town: I'exmiflLiceuse# issuing Authority(circle one): 1,Board Of Health 2.BuildingDepartmend 3.Czty/ToVM Clerk �.Electrical Inspector S.Plumbing Inspector 6.Other f"nr�Ea ef.PPS:CnT1: � Phoned: Jan 28 1511:54a Titan Plumbing 19788512535 p.2 PA s 1f..COMMONWEALTH OF MA5.SACt1U 5. ::== r • - • • ozoi, <A BOARD`OF PLUMB ERSt.`A.R G7ASE1T[;E�S - y ISSUES TtIE FOLLOW)NG L=ICENSE.;: ;ti:G:IpW& AS A MASTER PLUMBER` ,¢± _TI.M(IT14Y F COSSETTE LW 16 HORSt"GE Lbliq -DERRY_..` :;N;H O3053-44(W =`b$;%0l✓ Via ` :s: 221 117 :4 . . :,:-W.,::GOMMONWEALTH OF MAS$A> Ht3SETTSS st-> BOAR1130W PLUS]6Ef :,Rtia!'uRSF.I.TTE'€1-5_1.-` ISSUES THE F0 .L0W1Ko-°`1ACE4SE,�;<:. y. . L I GEls'ED �C A JOUkNEY:t'1AN PLUMBE z' T.4.MOTis`Y`J F COSSET - 16 HOR5IH&J -L&r ;u ` flNI3'OND ERRY;. .,,=f°-NH 03053-440,0' i '.. 25b5.2_-:1---__J7 0O1_/l.0:::::.?:: 221118 v:;OOM1AoNwEALT}i OF MASSACHIJ Mi",71 LM,P.,raMM:T97 1111 BOARD OF PLUMBERS AND GASFITTERS•" ISSUES THE FOLLOWING LICENSE,,' REGISTERED AS A.. FLUME-ING CO P a a - T°li11UTH-Y COSSETTE ° T I TAN P:L.UAB 1.9GHEATING.-INC 1 445 1iA N-ST is SuIlTE:-x7 TEWKSBURY ,.i4iA 01876 210041 9624 Date....... ... .. .. ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... . .......V's has permission to perform ......... ............... wiring in the building of..........t��4:5a...&!m4..................................... at........... ........... .............. North Andover,Mass. Fee.Y�7ea.. Lic.No. .7�?47 ............... ..... . .... ... ELECTRICAL INSPECTOR Check # 2012 Massachusetts EIectrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§,3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed" " on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shaibe limited as to the time of ongoing construction activity,and maybe.deemed_bythe,Inspectorof_Wires abandoned_anddr valid.ifhe— or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installi�ng.Qntity stated on the,permit application. .. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending"through August 15,2012. ❑ Rule 8—PermitfDate Closed: 16 /4/ Note:Reapply for new pel ❑Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. a Occupancy and Pee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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 PRIATT IN INK OR TYPE ALL INFORMATION) Date: City o Town of: r(o/�e, Ak,dove d To the Inspector of Wires: By this application t e undersigned gives notice of his oi-her intention to perform the electrical work described below, Location (Street& Number) lq]!� f-a-1Z r(tj M Sfi OwnerorTenant ckc ,,ie.� KaSo. btilc� Telephone No.aj–�(�,,6fob–ee��l� .Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No X BLDG PERMIT #_ Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install low voltage security system at above location Completion of the following table may be waived by the Inspector of iTires. No. of Recessed Luminaires No. of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above ❑ In- E:1o. o mergency Lighting g rnd. rnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. 'TI'onsl No. of Alerting Devices No. of Waste Disposers Heat Pum Number Tons J.K.W No. of Self-Contained p Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ My unicipal Other No. of Dryers Heating Appliances KW WT-uritNo.}of Dtems'evi es or Equivalent 1 No. of Water No. of No. of in ; —0011 Heaters KW Signs Ballasts No.o evi. urvalent 4 Bathtubs No. of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of[Tires. Estimated Value of Electrical Work: S6O•Dc� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains turd penalties of perjury, that the information on this application is true and complete. FIRM NAME: Broadview Security LIC.NO.: 7067C Licensee: David Holton Signature Off, 6LL� LIC. NO.: SSCO 001352 (Ifopplicable, enter "exempt"in the license number line.) Bus.Tel. No.:--978-657-0443 Address: 155 West Street, Suite 6 Wilmington, MA 01887 Alt. Tel. No.: *Per M.G.L. c,.147,s. 57-61,security work requires Department of Public Safety"S''License LIC. NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee sloes not have the liability insurance coverage normally required by law. By my signature below, I hereby\naive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PF1Z11 fIT FEE: $115=00 9987 3- v73- / f ' �rDate............. ........ . h NOR7M TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSAC"US� This certifies that ........... ..... �D/71[ has permission to perform ......a"" . ... G2!'L ............................ winng in the building of........ ............... .....: . 1 ;. at...1..!/s......./��SLI.. ...4 .......!1y.7-............ .North Andover,Mass. Fee.. ...... Lic.No. SS2 ... �< ,� ELECT AI LINSPECTOR -� y1110 Check # _ 2012 Massachusetts Electrical Code,Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L,c.143,§.3L,the 1 -_Eennit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed- OR the prescribed form.Atter a permit application has been accepted by an Inspector of Wires appointed pursuant to M.01 c. 166,§32 an a electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shalLbe limited as to the time of ongoing construction.activity,and maybe.deemed_bythe.Jnspector.of_W4res abandoned_and.iavalidaf-he—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created liy Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development of reai property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending through August 15,2012. ❑Rule 8—Permit/Date Closed: Note:Reapply for new permj� \ ❑Permit Extension Act—Permit/Date Closed: pp// Official Use Only //�� C,ommonwea& of Ma.-aacLjeltj I, � cc�� 7 Permit No. y 2eparEmenl ol.}ire.Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYP ALL INF RMATION) Date: � City or Town of: /,Yp � 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) A,/11VP--7 Owner or Tenant �,S'� �d�a Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters tir Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones of No.of Switches No.of Gas Burners No. InDetection and Initiatin Devices No. of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.o Self-Contained P Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: Y No.of Devices or Equivalent No.of Water KW No. of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent � Telecommunications Wiring:' No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 1 Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 57017 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the}jermi issum office. CHECK ONE: INSURANCE [[BOND ❑ OTHER ❑ (Specify:) �/�L, ��t� >a/ �/� I certify,under the pains and enal t ies o perjury, at the information on this application is true and complete. FIRM NAME: / � �� /�� i!/% j c�L�r/L� LIC.NO.: Licensee Signature LIC.NO.: (If applicable, ever " empt"in the license number li}e.) Bus.Tel.No.: Address: f1 /1eG✓Ol7d �O�c� Ale,-,,;," Alt.Tel.No.: 9 *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ Z),00 Signature Telephone No. The Commonwealth of Massachusetts Print Form �► el Deparbiieitt of Industrial Accidents Office of Investigations a -A0 µ.L n� vv r, Ljhiligton.street ;.. Boston, MA 02111 wf+w-mass.govIdia V►�orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �Please �Print Legibly Naine(Business/Organi?atienilndividual):_1!/`�G�� Address: jJLo d� o City/Slate/Zip: �/�j D3D�� Phone#: Q - Are you an employer? Check the appropriate box: — 4. 1 am a general contractor and I Tl'Pe of project(required): 1. I am a employer with ,�,�mployees(full and/or part-time—).* have hired the sub-contractors 6. ❑New construction to 2.2 2111am a.sole proprietor or partner- listed on the attached sheet. 7. EJ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' S. ❑Demolition [No workers' comp. insurance comp, insurance.t 9. ❑Building addition required.] 5. [j We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am.a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12•Q Roof repairs employees.TNo workers' 13.❑Other comp, insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors 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-contactors have employees,they must provide their workers'comp.policy number. I am art eiitplover that is providing workers'cnntpensatioit insurance far my eniptoyees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: ��. / �=r1�1��/ City/State/Zip:�i'7fi 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 imprisotunent, 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 fornvarded tc die,Office cmf investigations of the DIA for insurance coverage verification. I do itereb cera under »(rias n /tin 1. t bo isr/n J r a id p na._ s o,)p jur, t.ta.the in,ormation providcd above is true and correct. Siernature: Date: Phone#: FF only. Do not write in this area,to be completed by ciO,or town officiaL n: Permit(License# hority(circle one): health 2.Building.Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1 son: 7 Date. . � a...... . HpRTM ,: F? �p TOWN OF NORTH ANDOVER,S • PERMIT FOR GAS INSTALLATION lo . � •`ty . AC NUSES Y t1 This certifies that .�iL��. . �. . . . . . f�?� has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . s� .� !q. . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . INo _Andover, Mass. Fee. v. Lic. No..1 ?. .t. . �: t /1. . . . . GAS INSPECTOR Check# I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 07 City/Town: �J`y"U' ✓? �� MA. Date: / 1 ag l Permit# Building Location: p r� �n� (( -� Owners Name: C.0IL61.�1 ' Type of Occupancy: Commercial ❑ Educational ❑ Ind ustri I ❑ Institutional ElResidentialc� I New: El El Renovation: E] Replacement: Plans Submitted: Yes ❑ No❑ FIXTURES V) W co W Cd FW- N U x W W0 w w v 0) H O x W w Z F J } Z W O H O W w W O w z W w m 0 Q a ❑ w x > z w Q W x w I— a W LLI W Z y x W O W Z W > U W Z 6 J H H O Z J U' LLCl) x W W W z w >- W N J Q Q m W O z O W F- Z H U o a LL 0 0 z z � O a0 � W H > > > O SUB BSMT. BASEMENT j 1 FLOOR 2 ND FLOOR 3 Ro FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: ✓ " pliL� rtiS • ��✓�' j� ❑Corporation Address:Zj �r 4404-54 City/Town: State: 4nN ❑ Partnership Business Tel: 46,/-2 _69Pr— �s Fax: VflFirm/Company Name of Licensed Plumber/Gas Fitter: Z�10A nj B&--- A INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Y No❑ If you have checked Yes,please in icate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 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❑;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 Chap er 142 of the General Laws. Type of License: By ❑ Plumber Title ' ❑Gas Fitter Signa re of Lic ns d lumber/Gas Fitter El Master �` Cit crown ❑Journeyman License Number: y APPROVED OFFICE USE ONLY ElLP Installer �ry �r I L3 w1 .NORTq f O .0 1h TOWN OF NORTH ANDOVER PERMIT FOR PLUM BING ,SSACNUSE� ',This certifies that . . ", 7 . �c.�". F n U .f. . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .si . � at . . .1. . . . . . . . . . . . . . , North Andover, Mass. Fee. .3a . . ..Lic. No.. I).t �. . . . . . . . . . . . . . . . . . . . . PLUMBING INR Check # -S 7 L f i I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: / DI-A hJO lam( , MA. Date: �� Permit# Building Location: y S �r^rn`� �6' Owners Name: �p SG Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residentiap New:❑ Alteration:❑ Renovation:❑ Replacement:h Plans Submitted: Yes❑ No.❑ FIXTURES DEDICATED SYSTEMS z Z Z Ln O O W H Cn a U. F- W oC Z . LA a o: Z H Y w a a Ln Z w FW - Z N = L Q w Z w Z H w O a Q r a C O m N W ~ N cc cc W Z to Z U d LL = 3 3 U. H a N C a W 0 0 W Z J Z OC OC p' Oi! O H a x = 3 0 0 3 s Z a LL 3 a x a s W W W r a >. I-- UUj a o a > > o = o Q a a a u a a a m m 5 5 LL x be Ln SUB BSMT. BASEMENT JST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR �f � ) ��S Check One Only Certificate# ./V(� Installing Company Name: -�('� /�1'(�S' r /1• � /� ❑Corporation Address /V h AAL), S� City/Town: State: V ❑Partnership Business Tel:( i ' �'� F x: 'rm/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 No❑ If you have checked Yes, ple se indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only 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 142 of the General aws. By Type of License: Title Plumber Signat a of Licensed/Plum er City/Town Master License Number: APPROVED OFFICE USE ONLY ❑Journeyman I Location No. Date Date c-;7- f NORTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'�s'• t<�' NUS Building/Frame Permit Fee $ AC Foundation Permit Fee $ n Other Permit Fee $ TOTAL $ /,., 4: Check # (� 1� 18631 uilding Inspector // TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAATTc� OR DEMOLISH A ONE OR TWO FAMILY DWELLING �q BUILDING PERMIT NUMBER. ��// DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date x-61 SECTION I-SITE INFORMATION 1.1 Property Address- 1.2 Assessors Map and Parcel Number: 4-00�7 I Map Nu er Parcel Number , Q 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Re 'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: pAlio ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSEE[P/AUTHORIZED AGENT Lfli`triCt: '16n - ,.,10 M 2i;'Owner of ecord Nam Print) Address or Service tgna�e/ Telephone 2.2 Owner of Record: 0 Name Print Address for Service: z M Sixnature Telephone 1 t¢99w SECTION 3-CONSTRUCTION SERVICES R� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 License Number -n Address _ Expiration Date. ic Signature Telephone 3.2 Re 'stered HP a Im rovemen Contra for Not Applicable ❑ � �!/ M Company Name l� Registration Number r l Addre G} l� �L �Q of l y/ � 7j JExpirationODate Si na re Telephone r 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.......0 SECTION 5 Description of Proposed Work check a0 A lieable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other 41 Specify _•, �, ii �i, Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY ' Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection a " 6 Total 1+2+3+4+5 i Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN j a OWNERS T OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner/ uthorized Agent subject property Hereby ithd w to act on My al ,in all n er ative to work authorized by this building permit application. f Si rata hofOwder 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 t_n:e and accurate,to the best of my knowledge and belief " Print N UPI 0 Si at of O e A gen Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1' 2 3 SPAN DIMENSIONS OF SILLS Da ENSIONS OF POSTS MfENSIONS OF GIPDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY 1S.BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE RightFax Hartford 1/24/2005 7 : 46 PAGE 004/004 Fax Server _ GEEI : ls �1� �'t,:EA ,.. DATE(Mflf16D411 - �c THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE F,"T—?'-LIZ10 INS CEDCY HOLDER.. THIS CERTIFICATE DOES NOT AMEND .EXTEND CR �5 LITTLETGN ROAD ALTER THE COVERAGE AFFORDED BYTHE POLICIEt BELOW. NJES'ICRD t ? Gi886 COMPANIES AFFORDING COVERAGE COL°ANY �.2 _ �A HARTFORD UNDERSAlRITERS IfdSi:Rr.NCE COMPANY INSURED UMPANY — ---�— ABCO C-O!S TRIJC =CIV COk PANY- Si LG�CMr.PD��W CRT_VE'• C i L WELL 1✓iA 018:2 CUMPAN'r a D COVERAGIES j THIS IS-TO'CIE•RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ICSUED TO THE INSURED NAMED ABOVE FOR THE-POLICY PERIOD I INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT ITO VVHiCH 'HIS CERTIFICATE MAY BE ISSL!ED OR MAY PERTAIN, THE INSURANCE AFFORDED'SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I EXCLUSIONS AND CONDITONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BE EN REDUCED BY PAID CLAIMS. .q0` ^'rTYCE OF'NS - - PCLICY EFFECTIVE POLICY EXPIRATION - - - LTF URaNCE_ POLICY NUMBER DATE(MMTD0IYY) DATE,MWDDIYY) LIMITS GENERAL LIABILITY _ _ - - COMM ERCIALGENESALLIABILI '*' ( PR D C $COQ P.AGG g j CLALJS MADE a OC CLIAP i PERSONAL 3 A 1L IN RY CWNER'S&CONTRACTOR'S PROT. ( EACH OCCURRENCE s -- II i PRE DAMACE(Any one?ire) $ MED.JEXPENSE(Any one{P-:son! g AUTOMOBILE LABILITY { I COMBINED S'IVGLE .ANY ALITO - LIA4'1 ALL OWNED AUTOS BODILY INJURY i i S3HEDUI ED AUTOS. (Par Pereon) $ BODILY INJURY $ , AGN-OM t ED AUTG9 (P9r Amdani) PROPERTY DAMAGE IS 'GARAGE LIABILITY AUTO ONLY E.AA.C3:DENT $ ANY AUTO OTHER THAN AUTU ONL j EACH ACCIDENT {$ 1 AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FOFwi AGGREGATE $ OTHER THAN UMBRELLA. A EMPLOR'WSLIA LIABILITY ONpND 1;D 7v6X6 4-1-G4 05--01-04 05-01-05 STATUTGRYLIMITS EMPLOYER'S LIABILITY' '- I RE WCL Prr^,OPRIET09. EACH ACCIDENT a 10!; i,JUI_I _ 1$ 5:)v JOO PARTNERS.�EXECUT:VE' DISEASE-POLICY LIMIT OFFICER 5'ARE: EX:L DISEASE-EACH eMPLOYEE OTHER i f 3ESCRIPT! r FOP.RATiON5iLOCATIONSP/EHICLES/REST RICTIO SSPECIAL!TEMS! _ . y. THIS REPLACES ANY PRIOR ,"-- T 4 T T'° O - C�R.._.t'�C.._E ..S5U.�C mac. ..FSE CERTIFICATE HOLDER AFFECTING W�;REH-.; COMP !'OZ�c,R.?O:E. CE TfFaCA E NO LDER �AlVGELLATtON SHOULD ANY OF THE ABOVE CESCRISED POLICIES BE CANCELLED BEFORE THE EXP!RATfON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIC 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE ,. LF.F , BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION GR I' I LIAEILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. [ AUTmORIZED REPRESENTATIVE K � ACC 4 23•S Y3i43) ll F+:CFtR Cft3t t993.: _. ,,. fie i�o7x7tio?r�.uea�i oy c.�-�r4G�i'�.�icea�d { Board of Building Regulati ns and Stand;rdS, ` HOME IMPROVEMENT'GONTRACTOR 'I F Reghstration, 108424. . Expirations .8/18/2005 Type DBA ABCO ROOFING-&CONSTRUCTION Joseph Gys � .10 IViEGHANN LANE r . LOWELL,MA 01852i Admmmstrator NORTN Town of _ over �. ! _ No. 31avow _ dover, Mass., COCMICKIWICK 0 RAToo P��g BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System CBUILDING INSPECTOR THIS CERTIFIES THAT............................ ............ .................................... .............. ................... ....................................... Foundation has permission to erect... ........................... buildings on ./V-4 Rough tobe occupied as. ........................................................................................... chimney provided that the person accepti this permit shall in eve respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La s 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION . ELECTRICAL INSPECTOR 1jRough ............................................................ .... .... .. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. NORTft Town of And 0 No. 3/ ~ A LA dover, Mass.,— C COCNIc 14WK:K BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System CL Ad BUILDING INSPECTOR THIS CERTIFIES THAT............................ ............ ...................................................... ........................................................... Foundation has permission to erect... ........................... buildings on .N4............... ......................... .. ................ Rough to be occupied as. chimney ... .. ......... ....... ...... ........................................................................................... _ _ provided that the person acceptl this permit shall in eve respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La s 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONT ELECTRICAL INSPECTOR ��_ Rough ........................................................................................ ...... Service .......... ....... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.