Loading...
HomeMy WebLinkAboutMiscellaneous - 145 SOUTH BRADFORD STREET 4/30/2018 (3) 145 SO BRADFORD STREET / 210/103._ 0-0030-0000.0 e Town of Andover 0 No. 1-7 A o dover, IViaSS., ap • COCHICMEWICK ��. '4ATED BOARD OF HEALTH PER IT T D Food/Kitchen Septic System . 111L Jr �� � � BUILDING INSPECTOR THISCERTIFIES THAT...... .. ..................11�0... ..... .......... ........ ......................................................... ........ Foundation has permission to erect........................................ buildirips ons.I.Tr.........M............ ... .... Rough tobe occupied as........���.!!r ......... ..... .. ........ ................................................................................... 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 tot Inspection, A ration and Construction of Buildings in the Town of North Andover. � of 0#00 PLUMBING INSPECTOR VIOLATION of-the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS I ELECTRICAL INSPECTOR UNLESS CONSTRLJ S TS Rough .......... .................................................................................................... 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. 4 tilassachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License r License: CS 44201 Restricted to: 00 3 y ROLAND A DOMINIQUE 25 GLENNON AVE DRACUT, MA 01826 K-1 ('ummissioner Expiration: 4/20/2012 Trt#: 20647 Office of Consumer Affairs&B Hess Regulation License or registration valid for individul use only o VHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 151738 Type: Office of Consumer Affairs and Business Regulation Expiration:- 6126/2012 Ltd Liability Coipe, 10 Park Plaza Suite 5170 DINIQUE'S CONS R-U-- t#jN-LLC. I Boston,MA 02116 ROLAND DOMINIQUE: / 25 GLENON AVENUE 6, vQ DRACUT,MA 01826 1 Undersecretary Nol-valid wit on signature . r Aca cl CERTIFICATE OF LIABILITY INSURANCE 8/17/2010 PRODUCER GEORGE GATH INSURANCE AGENCY,INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 703 CHELMSFORD ST ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LOWELL,MA 01851 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 978)454-7728 (978)45&M INSURERS AFFORDING COVERAGE NAIC# INSURED DOMINIQUE CONSTRUCTION LLC INSIIRERA:i tiIe Mutual G 25 GLENNON AVENUE INSURER B. DRACUT MA 01826 DISURER Q INSURER D: ENSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD MDICATED.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.AGGREGATE LIMrrs-6HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. pNSR POLICY POLICYEMAIW POLICYNUYBBt KIL Lam GENERAL LIABD TY EACH OCCURRENCE ; COMMERCIAL GENERAL LIABILITY DAMAGE E3 aa�uD e ; c;AIMS MADE MOCCUR M®EXP ane erem) ; PERSONAL aADV04AM ; GENERALAGGREGATE $ GEWLAGGREGATE L UT APPLIES PER: PRODUCTS-COWlOP AGG S POLICY PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO �fNGLE UMTf $ ALL OWNED AUTOS SCKEDULED AUTOS BODILY D&nA;rf (Perp—on) - s HIRED AUTOS BODILY INJURY NON-0wNE DAUTOS (Pet $ PROPERTYDAMAGE(per Gooldent) $ GARAOELIABNYAUTID LIABILITY AUTO ONLY-EAACCIDENT ; A OTHERTHAN EAACC S AUrD ONLY: MGC ; E KCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE ; RETENTION S ; A ��aVERSCNS WC2-31S-35973"10 7/412010 7/42011 �/ STaru- OTH- BLITY YIN ER ANY FE IMEM�BER E)=UD I OFICCD E.L.EACH ACCIDENT $ 500000 (Mandatory i`NH) L. _ — E. OISEASE-EAENPLOYE ; 000 0 - 99=ROYESWNSOalm ELDISEASE-POUCYLDDT ; 500000 OTHER OEStER PTMnILOCATIMIVBUCLESIEXCUMMADDMiffENDORSEMMISPECIALPWiMMM Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA. CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHEABOVEDFSCMBEDPOLICIESSECANCE LLEDBEFORETHEEXP1RA710N T DATE VIEREOP,THE ISSUING DISURER WILL ENDEAVOR TO MAIL 10 DAY WRITTEN T WMcETO THE CEB nmATE HOLDER NAMED TO THE LEFT,BUT FAILURE To DO so SHALL 1 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR D REPRESENrATIVES. - AUTNORIMD REARFSBNTA7IVE Jeff Eldridge G ACORD 25(2009101) f . ®1988-2009 ACORD CORPORATION. All rights reserved. CBR!NO.: 8054076 CLIEW CODE: 1359739 Anne Chandler 8/17/2010 5:25:02 AN Page 1 of 1 e Dominique's Construction, LLC 25 Glennon Avenue Dracut, MA 01826 978-957-6308 Apri 12, 2011 Kristin Hollenbeck 145 South Bradford Street North Andover, MA 01845 978-b81-1894 _ . uote --- - - Roof Over Front Steps • Homeowner to supply building permit • 5 -8"round fiberglass columns • Plastic top&bottom plates • Drill into granite&install 4 slugs for PT base • Build new roof w/curve ceiling inside as per plans • Use Azek wood trim moldings • Use Azek crown molding • Use 5/8"roof plywood • Use weather&ice membrane on entire roof • 8"white drip edge • Shingle roof(Note: Homeowner to supply shingles) • Use white plastic wainscoting on curved ceiling • Replace trim moldings on front door w/Azek wood • Remove&install existing siding • Dispose of all debris Total cost: $5,950.00 NOTES: 1. Fluted side boards for front door-extra$220.00 2. If homeowner removes siding - save$250.00 3. If homeowner installs siding- save $350.00 I accept this bid Kristin Hollenbeck Contractor.Roland A.Dominique Dominique's Construction,LLC 978-957-6308 N°- 7 }n; Date.E a�.."q Ot.'o1DrM��O o: o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHUS Thiscertifies that . ..................................................................................... has permission to perform-..,.---, perform.-:- , .., ����. !..,............................................... ...... ............ ...................... wiring in the buid. .nf � . .......: ..Q� ... ..,.... . North Andover,Mass.at.ZAe... ..... ..... e-r �:.. i Fee..................... Lic.N . .:S.!'l 2.. ............................................................... ELECTRICAL INSPECTOR U/20/98 10:13 15.c* ��IA WHITE:Applicant CANARY: Building Dept. PINK:Treasurer �\ Dills. 0►s a.lr The Commonwealth of Massachusetts ' r...lt sa. Deportment of PubUc Safety t �W— t4r.p•n•j L l•e O.ec�•• DOARD OF SSE PREVE1171011 REGULATIONS S27 CMR 3/90J3; tl,a.• �t•.►I APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD AA.nk so lK petfonmad in sccerdancc willwthe mauscl.wetts 0ictrlcai Celt, S27 0111 12:00 (PLEASE pRI11I Ili INK OR ME ALL I11FORIEd21011) • Date. City or Town of t I.A�•1o./ A- To the Inspector of Wirest IL,ee undersitned applies for a permit to perform the electrical uork described below. Ltration (Street L Member) 14'S r 8 ar O:ser or Tenant R. 1AOt-La&" 9=4e, omer's Address • [PI'S S. $QAUFn2A Sr. Is Ithds permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Pa-rose of building woma UtUity Authoritstion 110. k'8/4 Edating Service 200 Amps 12.0 / 2.40 Volts Overhead 19 UndErd❑ flu. of lieters. kw SerTiee 200 Amps IU- Volts Overhead 19 Undgrd❑ 11o. of deters Tocber of Feeders and Ampacity ,.�,•-I lacatfon and Hsture of Proposebilectrical Work eiwme, + •vicar f),goiC.w KAs i)oLL-co L � Ho. of Transformers Total Jo- of Lighting Outlets Ho. of Hot Iubs KvA In- tia_ of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators KVA FBa m- of Receptacle Outlets Ito. of Oil Burners BEmergency Lighting atteerr y Units Fa_ of Switch Outlets No. of Gas Burners FIRE ALAPJIS iio. of Zones Fa. of Ranges No. of `A1r Cond. Total Ito. of Detection and tons Initiating Devices la_ of Dir osal$ Ito. of Rest Total Total tlo. of Sounding Devices P Pumps • Tons KW 3a_ of Dishwashers S ace/Ares heating KIl iio. of Sel� Contained P Detect Lon Sounding Devices Am.'of Dar ers Heating Devices KW [Local ElConiclpal ❑Other 6 y nnec[lvn No, of o. o Low Voltage Fo_ of eater Heater: Sims 5211asts Hiring ' We Flydco ttassage tubs Ho. bf Motors Total H? t i2:IItER: • rMSURAIICE COVERACEt Pursuant to the requirements of Massachusetts Ceneral taus I have a current Li ilii Insurnce Poitcy including Completed Operations Coverage or 1/s substantial e-gttivalent. YES[ I10[i aI have suhnitted valid proof of sane to this office. YES[_ 110 0 F! you have checked TES, please indicate the type of coverage by checking the appropriate box. } USURAIICE e- BOM ❑ 0111EP ❑ (Please Specify) • --jxp rat on ate Estimated Value Qo-f Electrical Work S irk to Start o /0 e , Inspection Date Requertedt Rough - Final 0116'&? under the penalties off1-et j.-7tt,p E11t}I..KAI. ��/C S C�C•fl��E Lam[/. ���• LTC. 110. . -Licensee (//i(/ _EKE �• --t-�7�/�' S Signature VA ".LIC. 110. iw*ress1B-a-u. �S'�&+•/ S1� ho Dec,�e., Q ���f,/S' Btt:. Tel. rlo. Ate. Tel. r1o. 011HER'S INSURAIICE UAIVERt .. I so aware that Cha Licensee doer not have the insurance coverage or~ is su - / stantial equivalent as required by Ilassnchusetts General laws, anTthat my stgnsture on this permit �pplieation waives this requirement. Owner- Agent (Please check one) _ PERIILt' FEE Telephone No. ° S ..J SLsnaty,,e of Owner or gent • .1 Location No. (,L/ `> l .3 Date Z le >/ NORTH TOWN OF NORTH ANDOVER o?oma t•``D /•,�0� ' oA Certificate of Occupancy $ 41 + Building/Frame Permit Fee $ J '04 CH a cMustFoundation Permit Fee $ 04 5TofiF - UD Other Permit-Fee $ Sewer Connection Fee $ t g?e Cbnnection Fee $ ` 7 1 991 TOTAL �� $ &JY(N©� � r"Q�{ Building Inspector ii.. , Div. Public Works Location No. Date �aRT� TOWN OF NORTH ANDOVER O�• �te y1ti O? •' - • Ooh A Certificate of Occupancy $ 41 Building/Frame Permit Fee $ 4'� CMUS Foundation Permit Fee $ + Otho Permit Fee $ Sewer Connection Fee $ ��I�Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works PERMIT NO. WIS- 13A APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP +JO. I LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE — ZONE SUB DIV. LOT NO. 'LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE c OWNER'S ADDRESS /t�.0 S /B,ieiSbGFORAL•I35T BASEMENT OR SLAB b�yS�/YI�yT ARCHITECT'S NAME �/ SIZE OF FLOOR TIMBERS IST nLx(, 2ND 3RD BUILDER'S NAME ovm, r t'JOLL6A18FCK SPAN -- DISTANCE TO NEAREST BUILDING ,00 DIMENSIONS OF SILLS --- DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR "" "" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY :r Tove rl110E IS BUILDING ALTERATION Woop STo VG /NSTR 'CR T70III IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y,6-< IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 3 PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES EST. BLDG. COST ZOO PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY r ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED,{ pANDAPPROVED BY BUILDING INSPECTOR DATE FILED / 7/ BOARD OF HEALTH SIGNATURE OF OWNER dR AtfTHORIZED AGENT FEE �` PLANNING BOARD PERMIT GRANTED c� 19 f \^\ BOARD OF SELECTMEN BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ d I 2 13 CONCRETE BL'K. --II PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T AREA _ Y. 1/1 3/4 FIN. ATTIC AREA _ -NO B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD")D _ ASBESTOS SIDING COMtAC:N VERT. SIDING ASPH. TILE —I{_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR (� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I f HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT H SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 13rd NO HEATING Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption .(Please print) DATE__ JOB LOCATIONS �RRD(-"021 SI, Ntq umber Street Address Section of town ! "HOMEOWNER" 01� G o�lEi(IBECX 69/-/89 � Name 7� (0 22/_ Home Phone --- Work Phone PRESENT MAILING ADDRESS ¢5 s. ---�— tQ2ADFOIZp ST � 100 vG--j2, City Town MA State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeown engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code Sect DEFINITION OF HOMEOWNER: ion 109 . 1 . 1) Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be , a one to six family ing, attached or detached structures accessory to such use and/orfarmwell- structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" to the Building Official , on a form acceptable to the Bolding shall lOfficsubmit that he/she shall be responsible for all such workerforme building permit . (Section 109 . 1 . 1) p d under the The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and . regulations . The undersigned "homeowner" certifies that he/she understands the Town North Andover Building Department minimum inspection procedures of nd requirements and that he/she will comply with said procedures and 'r requirements . HOMEOWNER' S SIGNATURE 'APPROVAL OF BUILDING OFFICIAL s . Note: Three family dwellings 35 , 000 cubic feet, or lar er will required to comply with State Building Code Section 127g0, ,Constrbction Control . f �r WOOD STOVE INSTALLATION CHECKLIST PERMIT # �3z 1 Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New Used ✓ B. Type/radiant _ ✓ Circulating C. Manufacturer JOYy L Lab. No. Name/Model No. TOTU L # tdo2 Collar size 5 r� Dimensions/Height '24#1 1 ength 1810 Width 1I Chimney A. New ✓ Existing B. Size(flue area) 14.63 SA ►MCNES t' WR'- C. R:C. Other appliances attached to flue(Number and flue size) _. NONE D. Prefab(Manufacturer—name and type) E. Masonry/Lined Flue liner Unlined (type&manufacturer) F Height(refer to diagrams) To BE DE7MMIKIt=n AFTER rNs•rgw A77oN cap YES OVER lot OVER IOt I 12t( MIN. T 2 MIN, 2 MI 3�MIg to' to, 3 12" 't MIN. 18`f MIN. (FU EL/A-c4 ACG E�ij 41 HEARTH CHIMNEY HEIGHT Hearth(non-combustible) A. Materials GOrJCILETE wrrH SLATE oR R56E5Tc9 MILLSOARA Wirt/ 71Z-4- B. //-EB. Sub-floorconstructioh 2x6 wrri4 PLYWOOD (CARPET/Nk SNHLL BE CUT AWAY ( C. Minimum dimensions(refer to diagram) UNPERNEA-rH 14EART+I Clearances and Wall Protection(see stove installation clearances chart) A. Type of wall protection provided 4" 891cK KNEC-1Z o A R5'8ESTo5 M/l.LBo 9AD W/rH T/L-C B. Clearances(refer to diagrams) i FIREPLACE CORNER WALL/CENTER 13 • cap factory-built chimney C roof support support bracket B connector pipe non-combustible Nall protection connector overlap A A A V' i i woodburning / stove q non-combustible II floor protection 12" 12" Figure 2109.4 Figure 2109.4 STOVE INSTALLATION CLEARANCES Combustible 1/2"Asbestos Millboard Concrete/Masonry Spaced Out 1 " Stove Components Materi8l Spaced Out 1 " 2. Foundation Wall 4" Brick Veneer Radiant Stove 1. 36 ' — - -Front Circulating Stove 1. 24^ — — - -Front A. Radiant Stove 3. 36» 18" 6" 18 —Side/Back/Top A. Circulating Stove 12" 6^ 6" 6 —Side/Back/Top B. Single Wall 18- 12'" 6" 8" Connector Pipe B. Insulated 2" 2^ 2'" 2" Connector Pipe C. Chimney Height Three(3)feet above adjacent roof and (Metal or Masonry) two(2)feet above any roof ridge within 10 feet If a damper is not included in the stove construction, D. Damper it must be installed in the connector pipe. 1. Front:Fuel or ash access side. 2. Non-combustible spacers required. 3. Clearances on each side of a radiant stove with a heat shield shall be measured as if a circulating type. Note:Clearances shall be measured perpendicular to stove body. Laboratory verified test clearances permitted. 12 ORTH � Andover Town of 6 uw 0 n No. AO 'FP over, Mass., 07 A 40 Maio BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... 14 R OLG..' ....�.1.. ....... �.i .. �� '..................................... Foundation has permission to weet...Rl�f ............ buildings on .... ys.... .IQi4 a .00�.........�.............�•••• Rough G 10A 1/404040 �� �� �« � F T*jS 64 Y4 ISI J3A S t IM Chimney tobe occupied as............... ................................................ M......... provided that the person accepting this permit shall in everyrespect conform to the terms of the application on file in ��� q/ this office, and to the provisions of the Codes and By-Laws relati to the inspection, Alteration and Construction of Buildings in the Town of North Andover. L ��dow PLUMBING INSPE(EO-i VIOLATION of the Zoning or Building Regulations Voids this Permlt. � in PER, EX iDIREIN 6 MON-THS p _ ELECTRIC/AyL INS C 7 L';'VL� S CONSTR 1 i 10N IS—TAR. IS Rough /0 .. ....4........aw .(...................................... . Service ... . BUILDING INSPECTO..R... '._`CCLtbClJ1(.'`, Peri ,; ?,equii C"a o : JJJJ Date:!.. ... .c(....•• r NORTH TOWN OF NORTH ANDOVER p T PERMIT FOR GAS INSTALLATION N 9 i • ,SSACNUSEt This certifies that . . ��.!� .?r; ?�r• • • •� ° has permission for gas installation . . . . . . . �� . . . . . . . . . . . . . . . . . . in the buildings of . .r. . . . . . . . . . . . . . . . . . . . . . . . at .�.��.5 s . . ./�/.�!`?�r`�'. . . . .,,Worth At{dover, Mass. Fee. ./?. .: . Lic. No.. . <. . .�. 1 . . . . . . . GAS INSPECTOR v WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ' /� (l 1/E tL , Mass. Date_ .20 0 Permit # Building Location__ /4.f �� ,��e>�,�Fd� Owner's Name Type of Occupancy i'eS New ❑ Renovation ❑ Replacement ❑ Plans Subm Yes❑ No ❑ N cc x W N N N v z a: U) o: N ¢ o: x O (W7 J N W H V a ]S vl z x F Q >- z o r w (A H N C~ W O V W x H z Q a O G W W W N J x Q x a it W a W 1- W �- Z J Q f. H >- N O 0 z W J W Q W z W z o z 4 otu x 'i o d uUj '. 3 c d v C y n a o SUB—BSMT. BASEMENT I 1ST FLOOR 2ND FLOOR r 3RD FLOOR 4TH FLOOR y STH FLOOR 6TH FLOOR IE 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET D3 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery 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 j es, please indicate the type coverage by checking the appropriate box. A liability Insurance policy JK Other type of indemnity❑ god ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accu�pte to the best of my knowledge and that all plumbing work and Installations performed under the permit Iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (j i Tg of Ucense: Title Plumber Signature of censed Plumber or Gas Gasfitter Master License Number 8697 City/Town Journeyman APP O IC S_ONLY I. BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING `'. NAME TYPE OF BUILDING -;, LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE.__��9 GASINSPECTOR 1_' s Date......... NORTH A TOWN OF NORTH ANDOVER 0 # PERMIT FOR WIRING SA NU This certifies that ...............!...`..I.:............. ...... ................................. has permission to perform ....... ........!.............j........... ...................................... wiring in the building of ......................................... at............................................ ..............-..C.............. .North Andover,Mass. Fee.;7(),..CV.... Lic. ........................................................... ELECTRICAL INSPECTOR 7�%C�) H-,j i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File q � I The Commonwealth of Massachusetts office us Only 7 Permit No. _ Department of Public Safety 1 9-ff . _� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy 8 Fes Checked r 3/90 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AN work to ba partomnd In aocord.na with 0»Maasschusanf Elecrnw Cade,527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date City or Town of /V-W&-04 c!c v To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 8 Number) Z1 ,5_ So �&,qrl X S T" Owner or Tenant X21 t7!nr e`/ tToi Ili Owner's Address— Is ddress Is this permit in conjunction with ayb'uilding permit yes 1 j no C] (Ch--;k Appropriate Box) Purpose of BuildinC_d� I /tf— TIP ZZ-5 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts OverheadL I Undgrd J No. of Meters Number of Feeders and Ampacity /// Location and Nat a of Proposed Electrical Work_ w r�L /1VJ 7.v 1 No. of li htin Outlets No. of Hot Tubs No. of Transformers KVA J TOTAL Above In C No. of Lighting Fixtures SwimmingPool rnd.❑ rnd L_1 Generators KVA No. of Emergency Lighting No. of Receptacle Outlets JJ No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones TOTAL No. of Detection and No. of Ran es No. of Air Conditioners TONS Initiating Devices s� HEAT TOTAL TOTAL No. of Sounding Devices No. of Disposals No. of Pumps TONS KW No. of Self Contained No. of Dishwashers J Space/Area Heating KW Detection/Sounding Devices Municipal No. of Dryers Heatin Devices KW Local � Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. of Hydro Massae Tubs No. of Motors Total HP OTHER: GINSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES C NO 1 heave submitted valid proof of same to this office. YES C NO W If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) CC) (Expiration Dere) Estimated Value of Electrical Work $ dS 00 Work to Start 1/0"— 6 Inspection Date Requested: Rough (o 3 d Final Signed under the penalties of peoury: FIRM NAM C //46S t.C.✓ LIC. NO. Licensee C 'a✓ tis _4 `s r v s- Signature LIC. NO. 3 C Address 14 // I'►j Bus. tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. and that ny sig Pdture on this application waives thiss requirement. Owner Agent (Please check on �)� _' _. �..�.... Tnl@phOrlg No.— �` (U �PFHMIT FEE S oe Date.. . . . . ..... R NpRT1, pf ­to "1tip ` TOW Z0FRTH ANDOVER o O PERMI NSTALLATION ,SSAC HUSE1 This certifies that . .J. . . . . .G !�. ! has permission for gas installation . .�� . :.„ . . . . . . . . . . . . . . . . . . in the buildings of . . .H: . !:.�, c, at �.!'. . . . . . , North Andover, Mass. Fee. . . . . . . . . Lic. No.. ! ; .Vi . GASINSPECTOR Check# ) 7 6014 J MASSACHUSETTS UNR'ORM APPUCATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date ��10 7 NORTH ANDOVER, Building Locations /T J ord az/f g A4l Permit# K0 Ly 9Amount$ Owner's Name R/ S74,I Jul' /.► New D Renovation Replacement Plans Submitted z ` H °° Z a Z 8 x w �G z H z � � � � o� W � a A xx O > SU B-BASEM ENT BASEMENT o IST. FLOOR �. 2ND. FLOOR 3RD . FLOOR n 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR ` 7TH . FLOOR IST H . FLOOR r (Print or ty,,- 0 A) ( � � 4 � C k one: Certificate Installing Company Name �''') �,J t /�'�2 `/ '� Corp. Address L j Partner. Business Telephone 77 Firm/Co. Name of Licensed Plumber or Gas Fitter fi, 70 IQ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No®� If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ED Other type of indemnity 13 Bond 13 Owne s AInsueWaiver: I a a are that the licensee oes nothave the Insurance coverage required by Chapter 142 of the Mas Gs,a hat ly t n h's a application waives this requirement. ` Check one: ! ig ture of Owner or Owner's Agent Owner Agent ereby 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 agd installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Si re of Licensed P/lu �r Qr Gas fitter Title lumber / ,[rj Z City/Town Gas Fitter (cense Number ter APPROVED(OFFICE USE ONLY) Journeyman C �s Com G� �1 iL L!.