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Miscellaneous - 148 WAVERLY ROAD 4/30/2018 (2)
MA u II Date ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ........... has permission for gas installatioln in the buildings of .... �?O� ............................. at ..... N�htrn7der, Mass. A.0 .... Check # 2 -oz -6 i 104 14 GASINSPECTOR . 8439 MASSACHUSETTS UNIFORM APPLICATION FOR A -PERMIT TO PERFORM GAS FITTING WORK CITYPERMIT # ____I MA DATE_ 1. -1 1 lk JOBSITEADDRESS1 iSdQd jQWwjrSNAME I"Cj G-��C4 JIM OW14ERADDRESS TYPE OR OCCUPANCYTYPE COMMERCIAL 1 MX EDUCATIONALW. RESIDE PRWT CLEARLY NEW-. RENOVATION: IV REPLACEMENT- I -J PLANS SUBMITTED: YES NO[ J APPLIANCES I FLOORS- I BSM 1 2 3 4- 5 6 7 8 9 10 11 112 13 14 BOILER BOOSTER J. J CONVERSION BURNER -LA -i 4, COOK STOVE t, DIRECT VENT HEATER GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HbAT-E ROOFTOP UNIT TEST UNVENTED ROOM HEATER mom mm WATER HEATER OTHER I I Nis . 11 - ... J I INSURANCE COVERAGE I have a current liabiliinsurance policy or its substantial equivalent which meets the requirements of.MGL. Ch. 142 YES !I rv0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND Ij =0 S INSU=WAIVER. I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the uskkts -1.4Q, and that mysignature on this permit application )givn this requirement. CHECK -ONE ONLY: OWNER 1,VJ,"'AGENT.1' OF certify that all tf�he etaft and informa ave submitted or entered regarding this application we true, and accurate to the best of my knwledge that "log, rice! provision all plumbing work and installations perform under the permit Issued for this application %vM be in corn 1P of the Massachusetts State Plumbing Code and Chapter 142 of the General La% -r– r 'Pert' P BE LICENSE ill' Isu NATURE PLUMBE FITTER NAME lm--, A—/jQ-,rnaj1'f1 – - — 11 W Clyl.' MP MGFJ I JP_'l JGFI' LPGs CORPORATION J# PARTNERSHIP 1#1 LLC LP COMPANY NAME.,�-"JADDRESS1 9 CITY 1, -1 STATE I.A-*1ZIP[ ITEL 1.9. 7 FAX — —_]CELLI" %W&MAILJ_ O z z 0 w z •• t z� LU F f z � g w o aw 5 R' N n. 04 ® z 3 ® o m v M CL a x tae E- u. z f z � o H 5 � z x 1 � 2be t:baurtouttralth of Massuchusells Deplrstei:errl of letrlustf lat Acelilelrts Of/ire offinlestigalious 600 tt-WAIuglolt Novel Roston, MA 02111 tvrett►.alassgolA f l :dtet' Coytepcttsllt!©u Ittsttt•tottcc fiflitlit��If: Att!!ticls/Gbtetrmetoys/t(ir�ctegcisottslPlttt»bers 1,110110 0: Ave you an emptoyrr? Check the appropriate Goa. 1 pe of project (regntted): I.Ql t a einplio-cr with, •l. Q 1 am it general contractor mid 1 G. QNew construction _ Ainplows (fat' o"Nor patt-linlcj c 2: jo I out a solo proprietor or partner- have (tined the sub-contrnctors listed on die attached Acet. I I�ry 7• LJ Remodeling ship and have no caeleto)"s These sub-con(taclors have 8. [) Demolition %voikiug forme in any. capacity. tNo, %vorker s' coup. flamenco eros! ere comp. Insurance. S• We are a COTporadon and Its Q. Q Building addition required) officers have exercised IIICIC 10.® Islectrical repairs or additions 3.0 low it houteonraacrdoiug rill crork eight ofC. minion per Mal, Yhunblig t> pairs or additions mysetg [No %%Wkere comp, c. 152, $I(4), and ue have no, 12.Q hoof relt airs Insurance required.] t employees. We Workers! 13.Q Ottrer comp. Insurance required.) •MtnsAAPicaut caadY6a�t41a�nstetsofi[tcxttticscctio�I»tmrsl ntngtle.trawRrrs'matpensationpolicy l"ron"WW& 4Itotwowa:tsWothen tttrcauisl4cmd(adarsatctttsathiitnattrtsffidaritimtir+4ingsent►. rr7rettraz6nstLttcrar<kl6risttt�t t:tataut,amtaeltctiataShut ski" ill? ttettsat;oflhrmulthdruoiLvien+aArattrytAfrnusle�g� I a -in art enapta}-ertlraetsprorfrfing workers.' comixtisadeta insure um forlt(tseatploree& Retom Isthe pal1ctR acrd fobsrre ltiroraralforl. InsurauccContpanyName: L*C GL dc:�P,- Policy fl or Self -fits. IAC, a. ;69i 50301;6-00 mpiration i)atc: Z O / Job Silo Milieu, —7' p fell Citylstalem . / V. T/ lilt 4ye Atlach it eopyof the workety contpend lion policy deciorattton page (showlug the policy inumberaud expiration date). Fatlurc to secure coverageas required under Section 25A of MOI, c.152 can lead to the Imposillon of cdoilua' penalties of a fine tip to S1.500 00 aedlor one-year haprisonrnent, as well as civil penalties in lite form ofit STORNMORK ORDM and a Duo of up to $250.00 a dayagahut rho v iolator. He advised that atopy of Reis statement may be forwimided Eo the Office of Inve-slWtions of the DIA for insurance cowrnge t erification. I tlo feete*lrp C) trijorntaflota ®ff1r1d zsceoltl-: Do trot trrflelra lltlsareo, to be coirr�rleled byel0�oslowl of/lelal. CltyorT oisn: 1'crtnitl[.iccusetl Issuing Authorily(eircle one): 1. Board of ifed(h 7. Building Department I CRyfroarn Clerk d. Electrical Inspector S. Mouthing Inspector b. Other . Contact V A � ormatiori and Instructions Massachusetts GdncW La%VS cligpler f 5 regititirs l erapjayer,_j. provide Pursuant to this stahi '" air en or0ilder any coil"O OJAM e-ncess orimplied,omtorwrilleop AnAVIO.sw1s; defined as "ail indiffithial.-parluersl4p. association, corporation or ogle, legal catiw,. or any w6aawre Of 'Ile foregoing engaged in legal representatives deceased Ora billpid t" , I deceased . I , *, or file 'eceiVerOr[Stcobtartind ividpApadner4up. assoelationiorotherleiii critity'. emplo5y,logemplayees, Holveverthe, owner ofit dwelling house having not more thau twe apattmeitts and i4ho resides thereK or the accultant ifthe dwelling home of another-Vdie, ejaploYs persons to do illaintenwiM. Collsin Jtortse at oil the grIDURdtor building appurtenant thereto shall not beculse 0rsa ch CHIPIOVnent be deemed to be an employer.,, 111GL chapter 152, P5C(6) also slates thatqej,.c,-yst6te or local 11mWi lk� , gelleY Shall t4ititl,ottl the IsOlouLi or renewal of license Or POrailt tO Operate a WISIRCSS or to construct buildings in the continolliviM[fh fol pity -applicant who has not p, vduecd acceptable evidence ofcomplinuce, -14(h1he frisurtuleje covpr;agd requ Ired?, Additionally, MGL chapter 152. - §25CM states -bleither the commonwealthnor any or its political tubdivisioni Adit enter into any contract for flit performance of public Ivalk-1111111, fimplabie evidence ofcompliance lvidtthe insurance requirements of this chapter have 6MM presented to lite contracting authority.,, Please tilt otic: lite tvoikers' ooJnpe,r�fion affidavit ct5mpletely, by eheckitg fhe boxes that appl)f to necessary, supply itib-con(lader(s) "OHIC(S), addrft§(e#and yotir-shuadon and, if phone RIOI19 with their cedificate(s) ok insurance, Limited Liability Companies (LLC) ot-Litnited Llibilityliakinelshipt (LLp) Vill, 110 en lljloiyeesotfier than Iiie. ruclalict's or partners, are Not required to carry workers' compellsatiollinsurance. Iran LLC or' - LLP does have , employees, a policy is required, Be advised that this affidavit may besubmittedto the Department of 'Industrial Accidents for coulaillation of insurance coverage, Also be sure to sign and date file affidavit. 111caffidavifiltould be returned to the city or town that file application for the pennit or license is being requested, Not the Department of Industrial Accidents. Should you have any qubslions regarding lite law or if yon are i-equired to obtain a workers' compensation policy, please call file Department at the Number listed below. Self-jusuledcompan*lshould self-insurance license numberan theas' wwr;nipi.— es -10 City Or ThWit Officlats Pl6aw b6 sure that the affidavit is complete and printed 109iblY. The Department has provided a space at the bottoint of the affidavit for you to fill oldin, the event- the Ciffoo of investigations has Please be sit to c0lititof you regarding the applicant. le for"' in lhel'unrittlicMeftuniberliNch will be used as a refMilceiiiinuberi Tuaddition, anapplicant that must submit multiple Permi(Aicense applications in any given year, Need MY submit one affidavit Indicating cutrent policy infOyMali011 (if necessary) and under "Jo'b Site Address?' the applicant should Ivrild,,alt 10 lio (city or affidavit thathas been Officitilly0amped or marked by tile city or toxvjl maybe provided to the (OWRY'A copy orthe aW ca ns In. applicant as PrOcif that a valid affidavit JS'ori file for future permits of licenses. Aitett' affidavit must fie(died iDitteach year. Where a home Owtierorcitizen is obtaining a license 0 (1,.e. a dog lice= Orliarnit to bum )ca%vs c(C.) said r Permit not related to any business'or commercial venture person is NOT required to complete this affidavit. Tile Office of Ifives I iga(ions would I Me to the Ok YOU At tiolva me for Y51lir CO qPefa! i0q. a i ld slidu ld you have any questions, please do not hesitate to give us a call. 71tc Department's address, tekVione and fox nitin*cF. Md OCITMOgivealt1i Of las" chusetts Depar(niont of IndustrialAccidditts Office of hwesligAttont 600 Washingtoii'att ' t Bostout MA 02111 Tel. # 617-727-4900 Oxt 406 or` 1477-MASSAr-B ReWsed 526.o5 Aoxf6i7-7277749 11MY-mass.aciv/dia i 1 i I Ul "D Q7 J L �° D a I ;�h T 77 rrt 00 i; � r .. 3 w_ z c? w me O o . 71 o -i ;D c: mW Z T d z >;D cn U) m �� m M L m DZ r _ o ,,.o LTI m z • ° 5'0 p D t-+ 3 D H m D ci n o D • p,, D n -qD D o Z` o Z z cn mCA M m n v In o F oo -mi ° ?91 D d y ` o y e x N .. j � • � � •' ,, In -�-I N 1� ,1 Signature �.. 1 Date.. 77-17 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... V�5 ........ has pennission to periorin wiring in the building of ..................................... at . r6) ... W,44-ee-,V� ........... North Andover, Mass. "I Lic. No..,5.44).-7./;F ....... Fee -TN �4-1 ELECTR� CAL INSPECTOR! 41 Check # qt2 7 S1 10961 10 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Onl Permit No. Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 01 I n -- / ,�Z_ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perf the electrical work described Belot Location (Street & Number) d L�b K) a -e� c,;t Owner or Tenant Owner's Address 1 oC Is this permit in conju tion with Purpose of Building Rer�C Existing Service AgO Amps New Service 0® Amps F1 i 1/evolts / OVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4 tnl�d t ex vd I hal. W►'� Cil_ Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead Undgrd 11No. of Meters Overhead Rr Undgrd ❑ No. of Meters $�C ls;D Wav 94, wlrr1 U ' & I Completion of the YollowinQ tahle&ay he waived by tlfe Incherit%r of Wiro.v No. of Recessed Luminaires 6 No. of Ceil: Susp. (Paddle) Fans No. of.. Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. `of Receptacle Outlets �� No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches l No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. f Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW ........... ..Detection/AlertingDevices No. of Self -Contained No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Other Connection No. of Dryers Heating Appliances KW Security ystems:* No. of Devices or Equivalent No. of Water KW Heaters No. of o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: LP00 `00 (When required by municipal policy.) Work to Start: b 1 1�, IU In pections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) -/ 1 PpW,$- F� I certify, under the ams and penalties of perjury, that the information on this application is true and compleie. FIRM NAME: � I i Ji LIC. NO.: Licensee: `2-/ �eg A'&Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: C . Address: Alt. Tel. No.: *Per M.G.L c.-147, s. 57-61, security work requires Dephrtment of Public Safety "S" License: Lic. No. OWNER';; INS WAMR. I am aware. tltat the Licensee does not have the liability insurance coverage normally 1111 by 1aW: below, I hereby waive this requirement I am the (check one)❑owner 0 owttelr's at. ownwAra% t T�►> .No. �EI-`�i PERMIT FEE.- � y zz o _ r psi C, f 9492 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING R-py 6 #1 -7, ��� Ll. ..................... This certifies that ......... 1. .-. . . has permission to perform4T,,-,],-k4re�> plumbing in the buildings of ..................... q!7 C..0 ... C*. at ....... �J. 4". 0 orth nd ev Mass. ov ZV MFee ......... Lie. No . 210��4 ........ PLUMBING INSPE TOR Ched, .r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 4A=' City/Town: .. ® o �,,����✓ MA. Date / ® ? permit# Building Location: /S'0 W fz\vR Owners Name: V Vy% oL_'C,,,� . pType of Occupancy: Commercial ❑ Educational ❑ Industrial 7 Institutional ❑ Residential''f/ - New:Alteration: u Renovation: ❑ Replacement: --i, 1 Plans Submitted_ Yes i iso i DEDICATED Z O. I I I SYSTEMS I of W Ln 5 h Y Z ;nQ Z F"' A Y cn ¢ ,n J U� H w 7 O CI z 2 a w z w Z z n wN Z C cc G y o I I F-4 Ln oc 'r ¢ - O i a z' ?� Z. w I o f oOc ° z w Z H LLI cn J Z' v z a z LL I x J a O w 3 3 LU u ¢: vxi vi pl F- v� �; r- j O p :n a O J Z Z �I ~ f = oa D I a } v a m ¢ < Ji O I LI Y cc JI a J O Q' 2 ,n a C ¢, a ¢ F- v a or al SUB BSMT. BASEMEN` ST FLOOR j 12N0 FLOOR -- - - --j --� 3p° FLOOR L44T FLOOR S'" FLOOR b FLOOR ---I -- - T.— 7T" FLOOR T" -y—� -- — _� -- I - -I-- .� - --- ' 8 FLOOR - I unecK une only certificate # Installing Company Name: JVb1 1 � I , Chi � `le j _ �� I ❑ corporation Address: 1 fF /City Town: t, _ State: ❑ �i`� Partnership Business Tel: '� L WFOax: APlFcP e irmlCompany 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, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Othervtype of indemnity E] Bond F]OWNER'S INSURANCE WAIV : 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 Owne s Agent I hereby certify that all of the details and information I have submitted (or Knowledge and that all plumbing work and installations performed under Pertinent provision of the Massachusetts State Plumbing Code and Chap By Title City!Towr _ APPROVED OFFICE 4L1 0 Type of License: ❑ Plumber J Master ourneyman fired) regarding this application are true and accurate to the best of my permit issued for this application will be in compliance with all of the Generai Laws. Signature of Licensed Plumber License Number. I � � 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. F-1 Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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 S. Plumbing Inspector 6. Other Contact Person: Phone #: INON TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that. has permission for gas installation ........... R -P QL--f- in the buildings of .......................................... at .... ....... UNort Ando S* 21"A k erp Fee 253� ... Lic. No.. . . GAS INSPECTOR Check # 8256 UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown: N4 k) -o -e -V � %� v1O'i �: Date: Permit# �' bj)bPVt�tAjBuilding Locatia" � Owners Name; Type Of Occupancy: Commercial Educational' Industrial' Institutiona! Residential New:.,X Alteration:Renovation: Replacement: Plans Submitted: Yes No INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL. Ch. 142 Yes No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity. Bond. OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General taws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Wner's Agent Owner OAgent By checking this box []; I hereby certify that all of the details and Information i have submittod (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 Pi bing Code and Chapter 142 of the General Laws. By Title Ciiv."own Type of License�Of - Plumber Gas FitterSignature Licens Master Journeyman cr,yur - License Number: f'tumber/Gas Fitter �`�) 6 DATE: TO 'WN 1 RE i Inspectional Services City Treasurer Confirmation all taxes are current n 7 C)t/ic'c o f _InspcChO111+1 ser111c113¢ Cii� 1 ia11 • 375 M(minlack Street, Rm D� Lowell, \I;\ 01� i': 9_/8.970.4036 • 1 97-,.-4-46.7103 As requested, please be advised of the tax status of the above listed property: Property Owner: Property Address: OTHER: OFFICE USE ONLY Taxes are current on the property Customer has made a payment plan and is current on payments Customer is in TAX TITLE and has NOT made any payment plan with the Treasurer Water and Sewer are current on this property Parking Tickets/Excise Tax on this customer are current 11* The Commonwealth of 14assachusetts ` Department of Industrial Accidents Office of Investigations 600 fl•ashington Street Boston alai 02111 lt!1VIV.111aSS.-oI/Cha Workers' Compensation Insurance .kffidavit: Buil(tens/Cottt•actot-s/Electi•icitllls/Plumbers ,Applicant Information Please Print I egibl) �dtilC t13"1 ll' j 0rzalliratio.- ;nc:: Address: Cite/State/Zip:------- ----- ---------------- Phone ':: Are you all employer? C11ec(< the appropriate box: --- —----------- - -- --- -------- I . ❑ [ am a em love; \vitt p q. ❑ I and a `ge enerai contactor and I Type of project (required): _- _ —_— employees (full and or part-time). have hired the sub -contractors 6. ❑ Ne\v Construction 2. ❑ I and a sole proprietor or partnel' listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have S. ❑ Demolition world!!« for me Ill Qtly capaclt\. elllplo\;ees and have workers' [No workers' comp. insurance C0111) IIlSUI-allCC.: } . 9. ❑ Building addition I'Cgllll'eCl.] _ e are a corporation and its 10.0 Electrical repairs of additions .i. 1 all' a homeowner dolli- ail work Officers have exercised their 1 i.❑ [ lum�in:7 repairs or additions myself. [No \\'orkers' comp. insurance right 0fexemption Per VIGL 12•❑ Roof repairs required.] c. 112: §1(-1): and we have no eillpl0\'ees. [No workers* I3.711 Othel-___ Collip. insurance required.] I `Any applicant that checks box _- i must also fill outthe section belotc silo cI , their icoikers' compensation polio' ii :formation. Honleo� I'm echo submit this ai'ficln it indicatine they are cloin, aii tcork vol then hire outside contractors must submit a neic affidavit indicating such. Contractors that Check this box must attached an additional sheet S110\\ 1112 the name of the sub -contractors and state chether or n01 those entities hai'e employees. if the sub-cont:actor haie en;ployees. they must pr0ride their \corkers comp. polio' number. am all ernplol-er that is providing workers' carnpensation insurrurce for /11Ycorp/o1 ees. Beloit, is the po/ic1 rural job site in%or•rnation. Insurance Company Name: Police '= or Self -ins. Lic. Job Site Address: Expiration Date: City/State/Zip: _ Attach a copy of the �N°oricers' compensation Policy declaration page (showing the police number and expiration date). Failure to secure coverage as required under Section 21A of \/iGL c. 112 can lead to the imposition of criminal penalties of a tole up to S 1,100.00 and -or one -v ear imprisonment. as well as civil penalties in the form of a STOP %FORK ORDER and a fine of up to S210.00 a da;against the violator. Be advised that a c0PN of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I Ito IterebY certifi• under the pains and penalties of perjury that the ili ormatiou provided above is true and correct. Phone Of ficial Ilse on/Y. Do not write in this area, to be completed hr city or town n firficial. . . City or Town: Permit/License h Issuing Authority (circle one): I; Board of Health 2. Building Department 3. C'►ty/'roswn Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: 011 Information and Instructions M8SSacllllsetis (J ell'f21 Le1\'s chaplet t !'egill;'es all �i11D10\'l'l'� l0 }JI'0\'td� \\'oI'l pis Clllil})C;1sat10il tOf tiicll' till}JIO\'ecs. PLIi'snant to tills Statute. 2111 employee Is deleted a5 ..... e\"cl'\' })el'soll ill the service ofallothei' under ail\' contract ofilll'e. express or illlplied. oral or written." \n enrpinrer is defined as "an individual. partllershiu. association. corporation or other legal entity. or ally two or more of the foregoing engaged in a joini enterprise. and incladin` the legal repl'esentatiyes of adeceased enitJlo\ e1.. or ;I've recei\'er 01. trustee of an iniivIdual. Partnership. association or other legal entity. enluiovin employees. 13o\\'e\'er the owner ofa d\\elling house haying not more than three apartments and \\'ho resides therein. or the occupant of the dwelling hoose of another who enlPlo\ s Persons to do nlaintenance. construction or repair \\ori: on such d:\\'elling house or on the grounds or huildin� appurtenant thereto shall not because of such, elllPlo\'llleilt 't,e deemed to be an emPlo� e1.. N-IGL chapter i 52. §25C(6) also states that "ever\' state or focal licensing agency' shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the connuon�1'calth for any applicant .rho has not produced acceptable evidence of compliance with the insurance coverage required.` Additionally, \1GL chapter 1 �2. §25C(7) states -Neither the comilloll\\'ealtil 1101. all\• of its Political Subdivisions steal! enter into am 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 apple to your situation and. if necessary supply sub-contractor(s) name(s), addresses) and Phone nuulber(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (L.LP) with no employees other than the members or Partners. are not requited to carry \workers' compensation insurance. If an LLC or LLP does have employees, a police is required. Be advised that this affidavit ilia\• be submitted to the Department of hldllstrlal Accidents for confirmation of insurance coverage. Also be sure to sign and (late the affidavit. The affidavit should be returned to the city of to\\ n that the application for the Permit or license is being requested, not the Department of IndusU'ial Accidents. Should you have any questions regarding the law' or if you are requited 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. Citi' 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 �•ou 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 \\'ill be used as a reference number. In addition. an applicant that must submit nulhiple Pernlitr'license applications in any given veto. need only submit one affidavit indicating current policy information (if necessary) and under',job Site Address" the applicant should \\'rite gall locations ill (city 01- to\wn)." A copy of the afficlavit that has been officially stamped or marked by the city or town nlav be provided to the applicant as Proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fiIICd otit each year. `Vhere a home owner or citizen is obtaininga license or Permit not related to any business or conlnlercial 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 \yould 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 Cotnmonw ealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston. MA 02111 Tel. 4'' 617-727-4900 e o stir, or 1_ -277 -NA �ACC_A FT: Revised 4-24-07 Fax U 617-727-77=+9 www. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Punt or TWO � -233 CW NORTH ANDOVER, . Masa. Dais //- aa to �� Bunding Permit f!' Locstlon L� �U 9 Owner's Al4W,00V<, Name 6rya New O Renovation ❑ Replacement Plans Submitted: Yes ❑ No. ❑ FIXTURES Check one: CartNicate Installing Company NameT�i�/ll �c9� _rd ,-, /Jl ❑ Corp, Address OR' fqr f"aC e c t O Partnership 6 0,✓P 1 a: o l f- I— / WFirm/Co. Business Telephone .-d8Ll) Name of licensed Plumber TOO , 7 hL yre f� ►T INSURANCE COVERAGE: Checx one 1 have a current liability Insurance polity or Rs substantial equivalent. Yes Q1 No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box. A Itabllty Insurance policy Cther type of indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 112 d the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: SionOwner ❑ Agent ❑ sluts o er a OwnN s arae I hareby certify that all of the dalafls and Information I hays submitted la entered) appReatton are true and accurate to the best of my knowledge and that all plumbing worst and Installations performed under thePe lot thio application Mn7 be in partfnanl provisions of • Maasadensatts State Plumbing Cade and Chaptert of the al compliance with ail 11"nature ortkensed Plumbw Trite J- M/Town "Saber I �.� V s Type of Plumbing Ucanse: Master ❑ J PFIID%TD (OFFICE USE ONLY) Journeyman w ►- w ti w s w s O V s h 1: r M- w M =w w s a w '4L, e0� L Y w:IP ws U161 sa rw s w IL si -12 a< W. 1,- . t - `o r =— oo0 to. u s e i s si ►- e. wo ►' s s w W At W 3 s• N i O r44 o o w s at v i i� w i a o ! °s i s sua—ssMT. aAsassarsT IST PS -004 fINO FLOOR 5110 FLOOR ITHFLOOR STH FLOOR STHFLOOR TTH FLOOR STH FLOOR — Check one: CartNicate Installing Company NameT�i�/ll �c9� _rd ,-, /Jl ❑ Corp, Address OR' fqr f"aC e c t O Partnership 6 0,✓P 1 a: o l f- I— / WFirm/Co. Business Telephone .-d8Ll) Name of licensed Plumber TOO , 7 hL yre f� ►T INSURANCE COVERAGE: Checx one 1 have a current liability Insurance polity or Rs substantial equivalent. Yes Q1 No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box. A Itabllty Insurance policy Cther type of indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 112 d the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: SionOwner ❑ Agent ❑ sluts o er a OwnN s arae I hareby certify that all of the dalafls and Information I hays submitted la entered) appReatton are true and accurate to the best of my knowledge and that all plumbing worst and Installations performed under thePe lot thio application Mn7 be in partfnanl provisions of • Maasadensatts State Plumbing Cade and Chaptert of the al compliance with ail 11"nature ortkensed Plumbw Trite J- M/Town "Saber I �.� V s Type of Plumbing Ucanse: Master ❑ J PFIID%TD (OFFICE USE ONLY) Journeyman dPal v�G'� poi",✓� iw�o (a�ed a-e c� 4Uvf if el e1 /ro-/o v 2 �j' �jvU . �... Rv4 M �.� '..1 � h'e•• - L si r3 ',y {- fti ^�-� � >� r �'.'^ ri .Y: J •-?I. ' .- «*,' S-g�yc`�"�,,.""Lv���`^��„'^"-"eA�t�`x«we'."vc.fv�, .r. t.� �p °� �' at s F �......>.._ . �.�.« _.w. ._+�•.. .�. _ _.......�......,. .4.. }. .g^+^�'"�.'..-^�ww�x ._..-... +�',i Yt3r nYe�.;u.}eaxei+iA�,liM+`". 55 .. 4�V- •LTi - -P�� -� ... M ^t..i^ " v '"% ' rss• • +d:"' � ..iaidttl N_' y }� y M1 � 1 .m � Y q - .-P i 3, � µ �' S "�� s 1`�` n �» rt. _.ir s ^i W`r P ' �+.++ 'b w �d 0' "..h 'rt- A%2.wr7i��� a4?/y�fw•. .. .n ..r �: • . w�-.�., .'- � ,: :c4. 3 wed�t G�_�'� '.,� .-,: «. :#!�.�"`'. awl' rW� "-'fp.. } A} ' � � '.. "" 'yp y L �, � i � a�4°i�ai:��'i`�i'•L§�.YM+x'� �.�. c.�".' v'Pok .^� t �.: h t4r i9AT TTY2�N•FrM' � f� _as•"F-�Sa ';Swd � N. �7h . "4 r 1 COMMONWEALTH OF MASSa1,i,LlliScTTS '.:. IN PLUMBERS AND GASFITTERS ICENSED AS A JOURNEYMAN PLUMBER 'SSUES THIS LiCENSE TC rl JOHN H FARRELL III aim 28 GRACE STREET .. LOWELL MA 01851-370&- 'I 24345 05/01/96 954751 . �... M �.� '..1 � h'e•• - L si r3 ',y {- fti ^�-� � >� r �'.'^ ri .Y: J •-?I. ' .- «*,' S-g�yc`�"�,,.""Lv���`^��„'^"-"eA�t�`x«we'."vc.fv�, .r. t.� �p °� �' rW� "-'fp.. } A} *9607 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING I'll- WAW�q S CHUS This certifies that has permission to perform ... .. plumbing in the buildin ,gs of . 4 a t . '/J/ ... vaw-OA- ....,#Qqh Arit�ovet; Mass. Fee=2,-�'�.—, .. Lic. No.3.41j. i ...... .... . ..... ....... PLUIVIB�ING INSPECTT� 0333 11/23/9514:53 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File i Town of North Andover E NORTH Office of the Zoning Board of Appeals o Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 CNus D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 N T N co Any appeal shall be filed Notice of Decision within (20) days after the Year 2003 - date of filing .of this notice w in the office of the Town Clerk. Property at: 144-146 & 148150 Waverly Road NAME: Kevin Murphy REARING(S): 4-16 & 5-15-03 ao ADDRESS: 144-146 & 148-150 Waverly Road PETITION: 2003-003 North Andover, MA 01845 TYPING DATE: 05-28-03 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at 7:30 PM upon the application of Kevin Murphy, 169 Boxford Street for premises at: 144-146 & 148-150 Waverly Road, North Andover requesting a Variance from Section 7, Paragraphs 7.2, 7.3, and Table 2 for relief of street frontage and front and side setbacks on two existing lots and a Variance from Section 7, Paragraph 7.3 and Table 2 for relief of the rear setback on a proposed third lot; and a Special Permit from Section 9, Paragraph 9.2 in order to create a third lot from two pre-existing, non -conforming lots in order to construct a new dwelling. The said premise affected is property with frontage on the North side of Waverley Road within the R4 zoning district. The following voting members were present: Walter F. Soule, John M. Pallone, Ellen P. McIntyre, George M. Earley, and Joseph D. LaGrasse. Upon a motion by George M. Earley and 2°a by Joseph D. LaGrasse the Board voted to GRANT dimensional Variances for relief from Section.7.1 lot area and table 2 for 144-146 Waverley Road of 4,797.4 sq. ft., for 148-150 Waverley Road for 5,570.3 sq. 8., and the proposed lot on Morris Street of 2,526 sq. ft. in order to construct the proposed 50'x 28' 1 family dwelling; and upon a motion by George M. Earley and 2°d by Joseph D. LaGrasse the Board voted to GRANT the Special Permit from Section 9, Paragraph 9.2 in order to create a third lot from two pre-existing, non -conforming lots in order to construct a new dwelling according to Plan of Land location North Andover, MA prepared for Kevin W. and Elizabeth Murphy by Scott L. Giles, #13972, Registered Professional Land Surveyor, Scott L. Giles, Frank S. Giles Surveying, 50 Deermeadow Road, No. Andover, MA 01845, Date: December 10, 2002, Revisions: 5/12/03 and on the following conditions. 1. A new Mylar will be provided to reflect the above Plan of Land dated December 10, 2002 and revised 5/12/2003; 2. The foundation will stay within the 50 x 28' .footprint outlined on the above plan; 3. The dwelling will be one family, only; 4. The 48" weeping willow on the northeast Morris Street frontage will be removed, branch, trunk and stump. Voting in favor: Walter F. Soule, John M. Pallone, Ellen P. McIntyre, George M. Earley, and Joseph D. LaGrasse. Pagel of 2 Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 9• Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (918) 688-9541 Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph. 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood and finds that the applicant has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-003. Page 2 of 2 Town of North Andover Board of Appeals, Walter F. Soule, Vice Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 1�. - 1 Town of North Andover No oT" +ti Office of the Zoning Board of Appeals 0 Community Development and Services Division , 27 Charles Street North Andover, Massachusetts 01845 CHus D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 N p b w i . N co Any appeal shall be filed Notice of Decision within (20) days after the Year 2003 date of filing of this notice w in the office of the Town Clerk. Property at: 144-146 & 148-150 Waverly Road NAME: Kevin Murphy HEARING(S): 4-16 & 5-15-03 co ADDRESS: 144-146 & 148-150 Waverly Road PETITION: 2003-003 North Andover, MA 01845 TYPING DATE: 05-28-03 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at 7:30 PM upon the application of Kevin Murphy, 169 Boxford Street for premises at: 144-146 & 148-150 Waverly Road, North Andover requesting .a Variance from Section 7, Paragraphs 7.2, 7.3, and Table 2 for relief of street frontage and front and side setbacks on two existing lots and a Variance from Section 7, Paragraph 7.3 and Table 2 for relief of the rear setback on a proposed third lot; and a Special Permit from Section 9, Paragraph 9.2 in order to create a third lot from two pre-existing, non -conforming lots in order to construct a new dwelling. The said premise affected is property with frontage on the North side of Waverley Road within the R4 zoning district. The following voting members were present: Walter F. Soule, John M. Pallone, Ellen P. McIntyre, George M. Earley, and Joseph D. LaGrasse. Upon a motion by George M, Earley and 2nd by Joseph D. LaGrasse the Board voted to GRANT dimensional Variances for relief from Section 7.1 lot area and table 2 for 144-146 Waverley Road of 4,797.4 sq. ft., for 148-150 Waverley Road for 5,570.3 sq. ft., and the proposed lot on Morris Street of 2,526 sq. ft. in order to construct the proposed 50'x 28' 1 family dwelling; and upon a motion by George M. Earley and 2nd by Joseph D. LaGrasse the Board voted to GRANT the Special Permit from Section 9, Paragraph 9.2 in order to create a third lot from two pre-existing, non -conforming lots in order to construct a new dwelling according to Plan of Land location North Andover, MA prepared for Kevin W. and Elizabeth Murphy by Scott L. Giles, #13972, Registered Professional Land Surveyor, Scott L. Giles, Frank S. Giles Surveying, 50 Deermeadow Road, No. Andover, MA 01845, Date: December 10, 2002, Revisions: 5/12/03 and on the following conditions. 1. A new Mylar will be provided to reflect the above Plan of Land dated December 10, 2002 and revised 5/12/2003; 2. The foundation will stay within the 50 x 28' .footprint outlined on the above plan; 3. The dwelling will be one family, only; 4. The 48" weeping willow on the northeast Morris Street frontage will be removed, branch, trunk and stump. Voting in favor: Walter F. Soule, John M. Pallone, Ellen P. McIntyre, George M. Earley, and Joseph D. LaGrasse. Pagel of 2 _v �_? �n7j_' r ) r� t::) Fr CD U) C" ;j Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 1, Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (918) 688-9541 Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph. 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood and finds that the applicant has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-003. Page 2 of 2 Town of North Andover Board of Appeals, Walter F. Soule, Vice Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 ♦: Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ cp��-, — Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #. 23 3 14.5 7 0 //v Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: n DATE ISSUED: SIGNATURE: �C Building Commissionerfl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Propetty Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ) /l U, PV illi Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: nb a i� Licensed Construction Supervisor: Address 4,0t Signature Telephone Not Applicable ❑ /cJ (p 1/2 License Number Expiration Date 3.2 Registered Home Improvement Contractor 774- kvt? Not Applicable ❑ G fO l L Company Name % d P1,/�u� Registration Number 2— Address / Expiration Date Si nature Telephone 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 buildinE permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: cew/.e SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant " OFFTCIAI USEC3Nhi' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction / r b C9 e 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 DI, 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 infonnation on the foregoing application are true and accurate, to the best of my knowledge and belief Print N /� tc. ,(j Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THABERS i s 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Page of Free Estimates U " 105 Havernlil Street Fully Insured Methuen, MA 01844 THOMPSON' S ROOFING (978) 691-1355 Shingles — Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE DATE Kevin Murghy- - STREET JOB NAME 148 Waverly Road CITY, STATE AND ZIP CODE JOB LOCATION North andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Strip off all roof shingles on back side of house only Renail all loose boards Install aluminum drip edge around roof line Apply ice and water shield 3 ft. up all along edges Apply 151b. felt paper on rest of area Reshingle with a 25 year shingle to match front Waterproof chimney flashing Remove all work related debris 25 year warranty on material 1.0 year guarantee on labor Construction lic. #060112 Improvement #128612 WC 3prOp0511! hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Three thousand six hundred ------------ dollars($ 3,600.00 Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner Auth ri according to standard practices. Any alteration or deviation from above specifications involving Sign re extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our Il control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully Note: This proposal may be .e.e.! V.v Wnhmen'c I'— .... tion 1--n— withdrawn by us if not accented within days. ACLeptante Of ?Propozat —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Signature iF1CATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER PEI.HAM :NSURANCE SVCS INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. :.. 1..:4GE STREET PELHAM NH 03076 - INSURERS AFFORDING COVERAGE INSURER A: The Maryland :;. INSURER B: Liberty Mutual Thomas Doyle INSURER C: DBA Thompsons Construction & Roofing 8 West St. INSURER D: �.1em NH 03079 INSURER E: nATG nr-no-nn /L4UI nr%1 VVI COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N"-, 'THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS �:RTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL: THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION T TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000.000 A I[X] COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S 300.000 i [[ j) C ] CLAIMS MADE [X] OCCUR SCP 34865353 04.15.00 04.15.01 MED EXP (Any one person) S 10.000 PERSONAL & ADV INJURY $1,000.000 ] GENERAL AGGREGATE $2,00^., ^0 6EN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 52,000 000 [ ]POLICY [ ]PROJECT [ ]LOC LIABILITY COMBINED SINGLE LIMIT i -AUTOMOBILE ANY AUTO (Each accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY vON-OWNED AUTOS (Per accident) E PROPERTY DAMAGE [ ] (Per accident) f GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 1 [ ANY AUTO OTHER THAN EA ACC S AUTO ONLY; AGG S EXCESS LIABILITY EACH OCCURRENCE S [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ DEDUCTIBLE S I RETENTION S $ !WORKER'S COMPENSATION AND [ ] WC STATUTORY [ ] OTHER B EMPLOYER'S LIABILITY WC2.31S-314995.019 04.21.00 04.21.01 E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE S 100,000 E.L. DISEASE -POLICY LIMIT S 5CQ.^00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Roofing ULK11r ILAIL nULULK L JAUUIIIUNAL MUKW : INWKW W ItH Don Foss 9 Gumpus Pond Rd. NH 03076 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPjRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR. TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZJ�'D REPRESENTATIVE Page 1 ^`. 2 0 Ca 0 1 43 /� x 0 A CG v ILI \G O w vO U) o 4P64 w O c�4 v C � u C x a1 O a4 C w" Qa v C40 U 0-4 ra+ O w C w" a O w C w W rA d cn C O cn O CD ■ z Q_ O H Q C CD I Ccm O.� CO2 Q 'O O h O O FE m m L- � CD y■+ ID G)Ca Q L m O a a, =a ca caV C � � v y C C C � Q Q Lij C U) LLJ U) w w CCw LLJ U) o m C ;;C O C V o � c* O y fp1 C.3 �a'o �' p, C lC O m C ;,C O :C2 Ea •• m �I ECSM L -- m C E Ica N Lo- N 3 z rr _ m zoo : e C C H R O_ : m O Co CD =,D Y : Z p C! ' dCt m I'll (� -✓i01. p Zp rL O d C � m �• y m C .QQ N H NJ O evt m 4: C •N '!.s oc 'E C.t CW.+ , CODy Z o H C. C m 'O p 'O ` cm C.4=.. cis zip O CD ■ z Q_ O H Q C CD I Ccm O.� CO2 Q 'O O h O O FE m m L- � CD y■+ ID G)Ca Q L m O a a, =a ca caV C � � v y C C C � Q Q Lij C U) LLJ U) w w CCw LLJ U) Date. I/ – / -4 –a 6 ................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 44�7&x k-wf;.?�y og- Thiscertifies that ............................................... ....................................... has permission to perform ...... ia�Tc-/4.rlov.. ................. wiring in the building of .(::� ....... NF/Z.Cez--�o ............................. at .... / ............................... ............. V—'e . ................. . North Andover, Mass. 9-71AF- �e2� Fee. v.� Lic. No.T6 ...... .................... .. c;i� .......... Check # E crRICAL INSP R 6567. 10/19/2004 14:43 9783742337 HAVERHILL HEALTH DEP PAGE 01/01 • ``' ' c rFiiflFfl T L.fi," is t?f i s� � s � 01774;0i Use Only Department of .,Frere Services. P it xo. �o � (� 7 Occupancy and Fee Checked BOARD OF EIRE PREVENTION REGULATIONS ev. 4/051Qeayblank . APPLICATION FOR PERMIT•TO 'PERFORM' ELECTRI'CAL 'WO RK All work M be performed in accordance with the Massachusetts EletWicat Cede (MEQ, 527 CMR 12.00 PLEASB PRINT EV AW ORTYP,L'&,L.BWORMA270h) City or Tow n o€ bNPJW _ A� By this application the undersigned vas nolIticce of his or Location (Street & Number)��._ 5-p W( Owner or Tenant Were( Owner's Address 1�j 5;' I Nj( kMa l IE y - Is this permit is conjunction with a building permi . Date: _ To the Inspector of Mires: taRerGarni the.electrical work described below. Telephone No. Yes U' No " (Check Appropriate Dox} Purpose of Btu'lding-- Utility Authorization No. Existing Service � Amps ---_! . Volts Overhead ❑ Undgrd ❑ No. of Meters &w Service Amps j .... Volts Overhead Lj Un dgrd ❑ No. of Meters Nw nber of Feeders and Ampacity Location and Nature of Proposed Electrical Work:. No. of Recessed Lwninaires -- - No. of Cei1.=Sasp. (,paddle) Fans ...y V" "wrutY ane,(nS c[ara %r'[rsa.% o. o eta Tra�tsfOrMen IWA No, of Luminaire Outlets No. of Hot Tabs . Generators KVA No. of Luminaires Swimming Pool a �] © Butte ency tg No. of Receptacle Outlets No. of Oil Burners FM ALARMS . No. of Zones Pio. of Switches No. of teas Burners o. 0 Detection an Initlaft Devices No. of Ranges No. of Air Con& Toon o. of Aiertieg Devices No. of Waste Disposers itAoaber: ions o. -o�atamedls: Detectioa/A�lcrdn Devices lYo, of Dishwasher: FHeatmp ea Heating KW l ❑ CNo, of Dryers A►ppbt Rces KW stems:ces o. o meters -, °' o. o o.a or uivalent rDats.wh ing:.S• s $a1lsats o, of Devises or nlvalent No. Hydromassage Bathtubs No. of Motors TotalHPommu anx �aangt ' No, of D 'aeiz or alvalent Aaaca aaauiona[ aewu Ydmrad, or as required by the Inspector of Frets. E#itanated Value of Electrical Work: (When required by mwAcq al policy.) Work to Start....InTectrons tube Tamed in accordance with NBC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owtter, no permit for die porformanee of electrical work may issue unless dee licensee provides proof of liability insmvm including "completed opal udoe cov=ge or its substaaitfal equivalent. ne undersigned certthes that such coverage is in i;ome, and has exbibited proofof same to the permit issuing office. ONE: INSURANCE[] BOIL? ❑ OIt ❑ (Specify:) I c¢rti, Y, under &epains end,penaldes ofpoymy,"the ittforma&n on dais app!rcadvn is true and complete FIRM NANX:Ij LIC. NO.: Licensee: F Signature LIC, NO.: 5'D-5 % afapplicaNe, miter "compt" in the beefs nuanbef line) Address: Beta: Tel. No.; Alt. Tel. No: "Security System Contractor License required for this worlq if applicable; enter die license numl2er here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not how the liability insurance coverage normally required by la . By Y Signature below, I hercbv waive this requirenleart. I am the (check on) [] owner owner's agent.. Owner/Age _ Signature 'Telephone No. l'ITres.. $ N N 10119/2004 14:43 9783742337 HAVERHILL HEALTH DEP D'epaHmeni sof .Fire Services. BOARD OF FIRE PREVENTION REGULATIONS PAGE 01/01 0ffici//1 ttsc Only Permit No. CCJslo Occupancy and lee Checked [Rev, 4/OS.j icavc blank . APPLICATION FOR PERMIT T+0 PERFORM, ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN M OR ' MF &,L RWORMATIOA9 Date: City or Torun A fiat M; ULf2, To dw Inspector of Krz res: By this application the undersigned gives notice of Ws or her intention to erform the electrical work described below. Location (Street & Number) I� - + j�,l ( \ ) t% r) (,1 WORK Owner or Tenant �L), I i P Owner's Address 1(41Z— Telephone No. h this permit in conjunction with a budding permit? No Q (t:,7teck Appropriate Bos) Purpose of Building Utility Authorization No. E:dsting Service Amps / volts X_Pl Servilce Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of !Meters Location and Nature of Proposed Electrical Work;. comaledon ofthe f"Itnwtnv rahla mini ho .1.,i by ph. No. of Recessed Luminaires No. of Ceil.=Susp. (Paddle) Fans IN a. o eta Transformers I{VA No. of Luxrnlnaire Outlets No. of hot rubs . Generators ICVA No. of Luminaires Swimmingp ve ❑ © o. o mergency tg g . dL d. B2ttea Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS . Ne. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiuii5ng Devices No. of Ranges No, of Aix Conti. Togs No -of -Alerting Devices No. of Waste Disposers eat runip I IN No. obeff-Contained Totnls: Detection/Alcrtin Devices No, of Dishwashers Space/Area Beating KW Local a utuctpa ©011ier C®nnection . No, of Dryers Heating Appliances ICW secum ex No. Devices No. o heaters o. Sims Neonate of or E nivaient Aata.Wlr9ing: No. of Devices or Fanivalent No, 'hydromassage Bathtubs No. of Motors Total HP 'elecommn cations iring: • No. of De -deer or Equivalent Attach additional detafl fdesired, or as required by the Inspector of !rima. F_dt hated. Value of Electrical Work: (When requited 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 pei'foMance of elms ical wont may issue runless the licensee provides proof of liability insutatm including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in farce, and has exhibited proof of same to tine permit issuing olif'ice. CIIECIC ONE: INSURANCE 0 BOND p O`UI R ❑ (Specify :) Icer*, under the,pains and penalties of perfnry, that the WOPMAdOn on this application 4 true and complem .FIRM NAME: _ LIC. NO.: Licensee: — 1 A- -signature `i G -si ature yr,r_ _�._ , *a '` 1� a � LIC. IY(1.: D-!5 71 1!r. (7fapplicable, mrar "exempt • in the l:e€nse number line) Buts: Tel. Na.• Address: Alt. Tel. No.: *Sccurity System Contractor License required for this word iifapplicable, enter the license nunnller here: OWNER'S INSURANC'E'WAIVER: I arra aware that the Lfcensee- does not have the liability insurance coverage normally rcquircd by law. By agy signature below, I herebv !varve this requirement. I am the (check orra) El owner 0 owner's agent.. U4- her/A,genA Signature 4^w r Telephone No.,`1' / PERM" Lir' $ 1 1 _ t15Vc fl-u� c le, 1�_ 21 C) Z 1 -moo. -SIS ir m Date op TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING-" This certifies that . .1911PA6? ... P �. A/ .................... has permission to perform ..... th .......................... plumbing in the buildings of . . (;�'. 11.1 �!-: .................. at. j -rp 2 .......... North Andover, Mass. 4 Fee.3 I. r'17-�- . . Lic. No. J-(- 15 -'. . . . . . . _. -; . .. . . . . . . . . PLUMBING INSPECTOR Check# 6 116 6957 0 7L MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) NO' AfJdaf Mass. Date S^�!O 0 H 1 2006 Permit # Building Location Owner's L U U al fB W &Jj . Type of Occupancy New ❑ Renovation ❑ Replacement 1 Plans Submitted: Yes ❑ No ❑ FIXTURES B.P. # SEWER # SEPTIC # Name 1,-Q8ers0n1 r " • ME ■MMMMM MEM MNONE MM■ ME NONE NONE ONE MEMO NONEEMEN No N ONO . ... v■®®®®®�®®®®mom ®®MENMEME ..- ®®�®®■®®®0®®®NE®®®®®®EONON Installing Company Name APOLLO PLG & HTG INC Check one: Certificate # Address 1SHATTUCK ST PO BOX 466 M I Corporation 1097C LAWRENCE, MA 01842-0966 ❑ Partnership Business Telephone 978-688-1755 ❑ Firm/Co. Name of Licensed Plumber DONALD DESRUISSEAUX INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 Yes IN No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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 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 ❑ nurevy ceniry met an or the amans ana 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 installation performed under the 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 L Title Signature of Licensed Plumber Type of License: Master X1 Journeyman C.l Cityrrown License Number 8699 APPROVED (OFFICE USE ONLY) z D m m f- 0 O 0 w 0 -n 0 m c 0 m 0 z r, r O D m c m i. A :- m �v o o �t m z i N O m c �t O to z e b z z c o • z 0 v o: r c K C m m f- 0 O 0 w 0 -n 0 m c 0 m 0 z