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HomeMy WebLinkAboutMiscellaneous - 146 MIDDLESEX STREET 4/30/2018 J -146 MIDDLESEX STREET 210/020.0-0015-0000.0 i I Date....�D.17 .1`- ..... TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING t oma:.,-• • $3�CHUg� � .. -�... V�..�... ....... .......Flus certifies thaf� .......k� r: �� Fas permission to perform ..: lJ�i ('.ttt•,,�,..,,o.,n,. ` ..� f! .L :....Y +�. plumbing in the �bjildings of.. .. ... .!. ...!.......................................................... at...........�. ......!.'.�..'.. ..�?P,t`.....".j.�..:....., North Andover, Mass. Fee. !�...`......Lic. No. `1 Q�.. ..� ..M..�.................................................................... PLUMBING INSPECTOR Check# N4 e� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t� Off! MA DATE /.(.� : „ _„L�- . PERMIT# CITY ILIO.". .. JOBSITE ADDRESS & M S4-. OWNER'S NAME POWNERADDRESS S ► Vrt TYPE OR OCCUPANCY TYPE COMMERCIAL( J EDUCATIONAL F] RESIDENTIAL PRINT CLEARLY NEW:[I RENOVATION:0' REPLACEMENT: PLANS SUBMITTED: YES F NO..._; FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE r1V DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEMi(-- —(�;(: DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM � _.' ? -' -1(-. DEDICATED WATER RECYCLE SYSTEM (�-.....: `i[ ha['::- I[ ' .. -_.I ...._..._.......I..............__.a ......_..... .._...._..._s ...._.._.... I._...._._.._ ..._.....__.I._.__.._.._: DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER - [-1 �-r [� (�����-.... FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY .:.. .:_,_-II—_I[ ROOF DRAIN E_ I_ �:— � SHOWER STALL I- I�j ;(- ;ri-'J _ 1[—IC . . (�..(r �7C-I--j� I •–S SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES P--++. [ .. r .^r-WARPIPING r-OTHER =� [- ............ - INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[] NO IF YOU CHECKED YES,PLEASE INDICATE THE T OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q 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 Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 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 he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S AME —5. f�!� e....( .�/. ._... LICENSE# I�O SIGNATURE MP�P[I CORPORATION[t/'##rr��.. _ PARTNERSHIPO# LLC # I COMPANY NAME jeftj Ajq j, CZ- S ADDRESS tl CITY[Rai- STATE ZIP Gl377 TEL FAXI CELL I EMAIL Date..d .t............� .............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Bs�cMu5� �f � /C'I ��l This certifies that..::... `..... .......:.................�.I.... ...�................�.�...� 'ias permission for gas installation .3........ �t . .� .5............................ in the buildings o ...., .....,.. .4111? ...................................................................... at....... ... ..... ......�...... .. ?P. ........................ North Andover, Mass. Fee.�4......... Lic. No. 2.��.�.. ...M�.................................................. t�( GAS INSPECTOR Check# 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 1 &0,4 A Ott MA. DATE PERMIT I JOBSITE ADDRESS OWNER'S NAME ............. FAX OWNER ADDRESS: TEL: .............- ........................................................................... [.................... TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:E] RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO FIXUTRES I FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER f 1 BOOSTER @ ej CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR © 0 FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST JNIT HEATER JNVENTED ROOM HEATER NATER HEATER INSURANCE COVERAGE have a current Ekftinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [j NO El f you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E:1 BOND [:1 )WNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Ilassaousetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E] AGENT El ;IGNAT9RE OF OWNER OR AGENT iereby 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 howledge and that all plumbing work and installations performed under the permit issued for this applicap6n will be in compliance with all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. "LUMBER/GASFITTER NAME: LICENSE#V/aO SIGNATURE V '=PANY NAME: ADDRESS: '01TY: 1-bfbl 1) t-OR Ck- STATE: zip: FAX: ...................... 'EL CELL: EMAIL: (ASTER JOURNEYMAN ❑ LP INSTALLER CORPORATION #=PARTNERSHIP❑#=LLC❑# C ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY /FINAL INSPECTION NOTES Yes No CTC THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES e The Commonwealth of Massachusetts - -' Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 kvi www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /* PIease Print Legibly Name (Business/OrganizatiorAndividual): )SA 0 Address: �(o _ � ►'2 Ck City/State/Zip: l dZtl� /�/�- Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with ';Z— 4. El am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.❑Elec ' repairs or additions required.] officers have exercised their 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 12.0Roofrepairs insurance required.]t employees.[No 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. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.M Expiration Date: Job Site Address: l L/& b C.Sr�6 �� City/State/Zip: Al D —4 "t—L)GI�K 2 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 er the pains a p alt's ofpe 'u that the information provided above is true and correct. si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,- express ire,-express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be.sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if-necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depafaent offadustdal Accidents Office ofIn.vestigatiom 600 washington Street Boston,MA 0.2111 Tel#617-727-4900 ext 406 an 1-877-.MASSAFE Revised 5-26-05 Fax#617-727-7749 _WWW-Mass,govIdia r i t t COMMONWEALTH OF MASAfvHISETTS. ojp - o a BOA.Rb`QF PLUMBERS AND' GASFfTTERS ' ISSUES. THE FOLLOWING `LICENSE L I CENSEI) ''AS A JOURN,EyMANSPL MU BE'R � GHARk ES BAILEYP. 462 BOX`FORD RD _'-� W �J BRADFORD #:A 01835 820b ' 041 01/16:_ 4��i7 COMMONWEALTH OF MASSACHl3SETTS BOARD`fir PLUMBERS AND GASFITT:ERS : I SSUF.S THE FOLLOWING L'I CENSE RtGfSTER:ED AS..A PLUMB I NG CO RF� ¢` F WW ENT M KISSEL C:II. BAk:LEY h`SONS PLUMBING HE 1 13 HARTStJQOD" DR HAVERH ILL MA 01830-2282 2.. 1 0 0<:1:: 16 L209807 807 A Date. e Ot, ".��7"'ti TOWN OF NORTH ANDOVER �: ��A "�•� OCL ° PERMIT FOR PLUMBING •'SSACNus� ` This certifies that �..! . .':,�:�r'. . . . L. . . . .. . 7. . . .�(..1..., has permission to perform . �. .� . �. .!^r'.�' Il .G'. :• .. . . . . . . . . plumbing in the buildings of ._. . r %f . �^�./ . . . . . . . . . . . . . . . at. . . . . . . . : .{ . . . . . . ., North Andover, Mass. P Fee!. . . . . . .Ltc. No../ [�.-�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 4 61 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMB IN (Type or print) NORTH ANDOVER,MASSACHUSETTS IMt rdil1rS�� f l Date o? y Building Location / Owners Name+ ,SC' C �'/�l Permit# Amount Type of Occupancy New 13 Renovation ®� Replacement Plans Submitted Yes 0 No ❑ FIXTURES SLR>EM &1g1VII�Ti' � / /• ZD H1 M M H1= aM HJOC R sm)H fm s>xFLOOR 7M FLOCIt SIH)"IDCR (Print or type) Check one: Certificate Installing Company Name J9,4 h/LAS S v.✓ 0 Corp. Address a 6 f7 yG�e— c S'�n C L"� 0 Partner. 01 UG A) 1Business Telephone Name of Licensed Plumber: ]mak uj ✓J /Y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas c usetts tate P Code and Chapter 142 of the General Laws. By: SignaLure of Licenseaum Type of Plumbing License Title /&-US f City/Town License Numoer Master ❑ Journeyman (�� APPROVED(OFFICE USE ONLY L.— t Location J" _a No. 0.S": Date 14ORT01 TOWN OF NORTH ANDOVER b9 # Certificate of Occupancy $ s i a ��J'�^�•E Building/Frame Permit Fee $ �cNus Foundation Permit Fee $ * Other Permit Fee $ TOTAL Check # Z 76s� 1 75 // �'-Building Inspector /f' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING fer lust f rn BUILDING PERMIT NUMBER: DATE ISSUED: /7 a3_O y X C SIGNATURE: ..� Building Commir-q'104ei/I2EeEtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property A 1.2 Assessors Map and Parcel Number: Map Number Parcel Number G� 1.3 Zoning Information: 1.4 Property Dimensions: G Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT i`:°"� L"I''c _ M 2.1 Owner f;Record Name(Print) Address for Service: �J Signature Telephone I - d 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 63.1 Licensed Construction Su rvisor: Not Applicable ❑ Licensed Construction Su visor. 00 ` R` �p��G, License Number an Address q l t J -7 I `� (0/0 a� Expiration Date Signature Telephone 3.2 Registered Home Improvemeto Contractor Not Applicable ❑ v Company Name 1 �-q m Registration Num7/0 r Address ` L_75- J �� Expiration to ^� Signature Telephone V N o SECTION 4-WORKERS COMPENSATION(ALG.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 it. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work(check sIl a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Desch tion of Proposed Work: h 1&q We 5 p 14'!-q 9 CeN Y- c(o u/'S SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a)�O (a) Building Permit Fee , U Multiplier 2 Electrical / OZj (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit 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 knowledge and belief Print Name ip' Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D.G.COl TRACTI G, ll.NC. Kitchens, Baths, Additions, Home repairs, Finished basements, Decks, Excavation work David Gulezian President 428 Pleasant Street, North Andover, Ma. 01845 OFFICE: (978) 689-4797 HOME: (978) 683-0397 FAX: (978) 686-6337 MA Lic.#001821 INSURED Home Imp.# 120199 Bob Sechrist Basement renovation Remove all the plaster lath and studs on the back foundation wall (from the electrical panel to the end wall).Hall by the boiler room, rip carpet up, rip up drywall 2' up, re-sheetrock, mud and tape. (price does not include any further prep or paint on the walls). Remove the plaster in the stairway,re-sheetrock, prime and paint. Cellar bathroom(one with all sinks and toilets), rip out and dispose of all fixtures. Sheetrock the walls,apply 1 coat mud and tape. Cellar bathroom, move one wall, build a wall and create an opening for the gas meter. Sheetrock the walls, prep the walls for paint, paint the walls. Install a suspended ceiling and new door. Create a hallway in the room to the right of the stairs. Put a door at one end. This hallway will lead to a room 15'6"x 11'+-(sitting room)off this sitting room will be a door leading to the utility room(elec. room). Off the other side of the sitting room will be french doors leading to a 19' x 12'+-pool room with a 6' x 6' bump out. All the walls that are common walls to the cellar apt. will have sound board added to the walls. The hallway and 2 rooms will be sheetrocked, painted and have suspended ceilings installed in them. All trim will be 2 1/2" finger jointed primed. Hall door, elec. room door,and the bath door will be solid core molded, baseboards will be 31/2" finger jointed primed. Total of above work"$20,500.00 Electrical for above work: Plugs to be installed per code. Install 6 high hats and 1 pool light in the pool room, install 6 cans in the sitting room, install 2 hall lights. This price does not include any changes to the service $4,560.00 Upstairs bath: Gut per plumbers instruction. Bring electrical to code. Re-finish and paint the walls and ceiling. $3,270.00 Cellar windows: Replace with vinyl cellar windows. Window will have low E insulation. $290.00 per window Core drill thru the foundation and re-route the exhaust fan so it does not go thru the cellar window. $ 500.00 I expect you may spend $ 850.00 on labor and materials on stairs and railings. Lund de is spa . Eleetrier an ig ting. This price does not include drainage, bulbs/light fixtures, fine cleaning, all cellar unfinished areas are to remain unfinished. Price does not include patching if needed on any other spaces for plumbing,any finish work in the bathroom with all the toilets and sinks(walls to be drywalled with 1 coat of mud and tape). Price includes painting in the main hall (stairway), new hallway, new pool room and new sitting room. Price does not include the purchase of the paint(you choose and purchase the paint and we will apply it). Price does not include heat, AC or dehumidifiers or any charges required by town or repairs to hidden damage. A� The Commonwealth of Massachusetts � r d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Sylb Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City ` � Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Ef' I am an employer providing workers' compensation for my employees working on this job. company name: 1� 1r• `� Address (/V t��Y t✓ y Ci : Phone#: � 7 ( s Insurance.Co. Policv# l� C - 3 2� y 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-w-ell-as-civil.,penattles;in-thelorm-of-a-STOP-WORK..ORDER-an.d.-a.fine.of-(.$1.00..DD.)-aAay-against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required E] Licensing Board F-1 Selectman's Office Contact person: Phone#. ❑ Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant � C) ( v Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH i �. Town of . _ - over No. over, Mass., `a 3 COCHICHEWICK V' %d ADRATED PPS\ '`y S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System � L BUILDING INSPECTOR THIS CERTIFIES THAT...... ............... ................. ..q......�►..?.�!.d..�' ....................................................................... Foundation has permission to erect-At et.A............ buildings on.J..T...e........ ./.01o//`..6..:l.Y......4�.... Rough to be occupied asAR.Z414.1'N �u f Roo V40) ..1 00�#J DO R�M.�l.1.......�'3.a�,. f Chimney ......................... ............ ......... ............ provided that the person accepting this permit shall in every respect conform to the terms of the application on file instil final this office, and to the provisions of the Codes and7/65gg'r Laws relating to the Inspection, itey4 ration and Construction of Buildings in the Town of North Andover. .10 PLUMBING INSPECTOR 3 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ............100 0 .. Service BUILDING INSP TOR Final Occupancy Permit Required to Ocmpy 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. Date. . . . . . ..I. . . . ... . . . . NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that . . . . . . ... . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . has permission for gas installation ... . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT114( 1 (Print or Type) NORTH ANDOVER Mass. Date ti(x kuilding LocationA(& Permit # C i Owners Name New Renovation Replacement Plans S'nl 5W FI X1 1 M! Q _ lA ul N ' ' t7f dl (�j x cc t» N Q N cc O D to X Wo tz oLU o �, ►�' x to r x x cc w 4 W w 10-. N a. x y 4 N a to ° v W z m " a Q o to W W (n W z Q x a W f- t- x f- x != z I. W w 0 a > k N w ..i F� Cr z .Q W < cc F' a- to m — o z o N x Q .W > a w o z d x 4 ¢ o o W _ o W t- a w a O ., c� y a ►- o SUQ—QSP.IT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR TTK FLOOR STH FLOOR (Print or Type) p 'r Check one: Certificate Installing Company Name C,t�'�lV�cit� 1 'i t1 (� Corp. Address �� << t ?� _ Partner. Firm/Co. Business Telephone: 3�1- e87-7 Nr~ e of Licensed Plumber or Gas Fitter fl� k"\ Ao"' c "Act („ante Coverage: Indicate the type of i-isurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1-1 Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent F 1 hereby certify that aU of the devils and Information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that aU plumbing work and Installations petfomicd under Permit issued for this application wW be in compliance wl pciUnent provisions of tho hisssachusetts Slate Gas Code snd f]saptet 142 of the Genual Laws. By TYPE LICENSE: Plumber Title Gasfitter i nat re of Licensed City/Town: Master 1 mb�yepr dor Gasfitter JourneymanL_L APPROVED (OFFICE USE ONLY) License IJuniber Date... 7. . .9. .. .Y.. a NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACNUS� This certifies that L ^' L- ................................................nn............................................ has permission to perform .....�`?. `k IC`e �^" C9'� ..t--% ........................... wiring in the building of � `5 ............................. ... ................................................... at....J !A?......I.!`.k. .................A 'Y...S .............. .NortP Andover,Mass. ....357 Lic.No.A�y 1 Fee ..........��............. .......... .�.�.................. ELECTRICAL INSPECTOR Check # 537J 04e Tnmmnnznettitii of Massar4ft-laeffis Office Use Only Department of Public Safety ,�` Permit No. VVY BOARD OF FIRE PREVENTION REGULATIOtJS 527 CMR 12:00 Occupancy & Fee Checked 3/90 (leave blank) i APPLICATION FOR- PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance ydith the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE AL INFORMATION) Date City or Town of N' � " �( To the Inspector of Wires: The undersigned applies for a permit to perform theelectrical wor described below. Location (Street & Number) Ll (0 ML�° Owner or Tenant Owner's Address .$1 0� e. Is this permit in conjunction with a building permit: Y 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 Number of Feeders and Ampacity rn1 Location and Nature of Proposed Electrical Work �,' ` IL to 1' 0 Del TOTAL No. of Lighting Outlets I No. of Hot Tubs No. of Transformers KVA AboveIn- No. of Lighting Fixtures Swimming Pool grnd. 1:1rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 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 Ranges No. of Air Conditioners Tons Initiating Devices Heat Tota Tota No. of Disposals No. of Pumps Tons KW No. of Sounding Devices. p No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KW Municipal Local❑ Co No. of Dryers Heating Devices KW nnection ❑Other 0 No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: Ne 0"t INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability s ce Policy including Completed Operations Coverage or its substantial equivalent. YNO I have submitted valid proof of same to this office. YEW NO ❑ off If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE �rOND ❑ OTHER❑ 6(Please Specify) W (Expiration Date) Estimated Value of Electrical Work $ Ov0r Work to Start 9—Z `j- 0 L( Inspection Date Requested: Rough �3a _ Final Signed under the penalties of perjuly _ /� ,FIRM NAME STA A f E L.I NL L-LEi 6T►Lt L_v4 - G LIC. NO. ricensee ��`I ]��/V N� `t`n Signatur LIC. NO.Q� 3QW SU .Address 1• _/'�AJL_'S� � iPS� M G� Sus. Tel. No.Y ��Q7— �V 2�s�_��/� Alt. Tel. No q)v^ PK- 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 my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent)