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HomeMy WebLinkAboutMiscellaneous - 15 WOODCREST DRIVE 4/30/2018N° 9 615 Date ./ v`0/ Z1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Vf This certifies that .... ,(),5Plo�'. r `. . has permission to perform .....f.{'!L^"' plumbing int a buildings f ...` L'.'.r`�.................:...... at.. tNl.Ut�� �0�......... , orth Andov ,Mass. 5� c . . Fee' "'� .. Lic. Nol.�?.... �40 ..... f PLUMBING INSPECTOR Check # 6)9-77 v WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I Q MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY'���-�' # MA DATED' 1 p�_II PERMIT # JOBSITE ADDRESSnj d- 4 OWNER'S NAME f® POWNER ADDRESS i TEL _ "'` FAX TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES Ell NO [7-11 FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEMI DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER_...___-.--I DRINKING FOUNTAIN I ._..._..._..E ! E FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR _(. i-.__..._._i t I 1 ..__.Y_. ....---...._.I I KITCHEN SINK LAVATORY ------ I .__.._._ I r_-------_E _--_.._J _'.___-_ ROOF DRAIN I _-- t —_ _I _ — ____ (_.__...� -.__—J ____ I .__ _._ E---..___I ____..__► __. 1 I __.__I SHOWER STALL SERVICE / MOP SINK i 1 l 1 _.._.__.I _ f I 1 _3 TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES DID WATER PIPING _4 I _ .__._ .[ OTHER- ---- - ------ 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 CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q1 BOND 0 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 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 have submitted or entered regarding this application re true and urate t est of nowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpliance all Pe ine provi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE # d SIGNATURE MPx JP Q CORPORATION F] _ LLC ,r COMPANY NAME ar' ; ADDRESS CITY STATE �bt- ZIP1 TEL FAX CELL EMAIL 1.._ _.Q.__. t 011 - - �iI^ANL. W H z° 0 F U W a a e o z z }❑ 'O w W o IL z u _ w j � aco W w co O o a W � W a Pa U J a a � e x w W H O z ev z 0 " H u W a � z " o z �a a O O , ' The Commonwealth ofMassachusetts .Department of Inclustritcl Acciclenfs 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:0 _ ® City/State/Zip: qG -Q C1Wk 86- O LFIJ Phone #: Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors �• E] Remodeling 2. [X I am a sole proprietor or partner- listed on the attached sheet. ? ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. 0 Building addition required.] officers have exercised their 10.E1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ® Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.QRoof repairs insurance required.] 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. 7 Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Job Site Address: 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 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 coveragVerification. X do hereby cert jo undOWhe pains _(0__IW fury that the information provided above is true and correct. Date: A-7-7 Official uWnly. Do not write in this area, to he 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 CIerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other - - Contact ]Person: Phone #: ;:--y: } �� CONTROL# H364872 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address sfiown is changed, notify your board of correct name or'address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and mWst not j q lotaned or assigned to any other person. Keep this' licensb'ori your person or posted as required by law. CONTROL# H364873 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address slbi+i•r§ fanged, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to::your_licensemgmber. This license is subject to the provisions of the General Laws as amended. It isa.personaj; y ivilege, and mu�tpot be lgor e4Cj or assigned to °any'oH'i`er person. Keep this license' on :your i 1 person or posted as required by law. i i i i ,l This certifies that .. has permission for gas installation .Z -1.11/6-'L ................ in the buildings of.... ........................... at ................. North Andover, Mass. Fee, ,f,) .. Lic. No�"�7.... r1_.....„�1 GASINSPECTOR Check # q 8365 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ "Fie AA--, MA DATEI PERMIT# JOBSITE ADDRESS OWNER'S NAME A_- OWNER ADDRESS W►� TE FAX —j TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIAL CLEARLY NEW: E] RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YESF-] NO[a APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER�r._(_ _f ___.. (— ->_ - ....... CONVERSION BURNER COOK STOVE DIRECT VENT HEATER-I DRYER FIREPLACE �— (-_._.J-z..__I, . I L._..-.� II---1 FRYOLATOR FURNACE GENERATORL GRILLE-_I ... INFRARED HEATER LABORATORY COCKS i -__I__j . __ _ ( MAKEUP AIR UNIT !I . ..I�_..___I(-<.. N� OVEN L - --� --- - -.. _. -_= 1.--► I_ -T 1 I_TL 1_ h:�_,_( ..� . ! _ .. l._.=� _ �_,� POOL HEATER .T.__ TI..:.._�) ROOM / SPACE HEATER [ .. L_-_I- (- _ ' �_ --_C,..- - _-z.. ED- L� I-- -.... ROOF TOP UNIT - --!_-_ ---.- - -I .. TEST UNIT HEATER UNVENTED ROOM HEATER ( I. ._. I-._-j.ZZlI_.--iT,._ _ , 11--i I L== WATER HEATER i, I I_ . i !_TI OTHERL i I I 1 ! .......... _ .... . INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES JANO 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY W OTHER TYPE INDEMNITY [] B 0 N D IFJ 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 0 AGENT �I SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and to tot t of my no ledge and that all plumbing work and installations performed under the permit issued for this application will be in kmpliance it 11 Perti t `rovisio o e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMELICENSE # - _ . SIGNATURE MP N MGF Ell JP R-j JGF a LPGI F CORPORATION F PARTN IP LLC COMPANY NAME:_ -- - --� �n--- -- r _ ADDRESS . _._...--- CITY STATE _. g ZIP ©� - TEL FAX CELL % _�I �� EMAIL . oo z �El r W a ui LU U- � The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j�PIease Print Legibly Name (Business/Organization/Individual):Q�s'�c Address: d3 t If, City/State/Zip: e_Ah `k ACs _ 4 05; Phone #: �Z %�r / 0� � �4g 7 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors 7. ❑ Remodeling 2. 04.1 am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g E] Building addition [No workers' comp. insurance 5. El We are a corporation and its 10.❑ Electrical 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.❑ Roofrepairs insurance required.] i employees. [No workers' 13.[i Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 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,Aerification. I do hereby certify unde4he pains that the information provided above is true and correct. Official usWnly. 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. Plumbing 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 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of MTassachusetts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston, M.A. 02111 Tel, # 61.7-727-4900 ext 406 or 1-877rMASS.AFB Revised 5-26-05 Fay ,# 617-727-7749 www-mass,govldia CONTROL# H364372 IMPORTANT If this license is lost or destroyed, notify your Board at the: ,Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address shown is changed, notify your board of correct name or'address to insure proper mailing of next Renewal Application. Always refer to your license. number. This license is subject to the provisions of the General Laws as amended. it is;a Rersonal privilege, and mos nqt 0,,e logned or assigned to any other person. Keep this' licenson -your t person or posted as required by law. V. , ENHi N ., CONTROL # H 3 6 4 6 7 3 IMPORTANT j If this license is lost or destroyed, notify your Board at the: Division of ,Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address sfion is Fanged, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to:.gour lieense:ntlmber, This license is subject to the provisions of the General Laws as amended. It is-a,Personal.privilege, and mustlnotbp;loaTq or assighed 'to'any'off'"er p r on. Keep this'license`on .your i person or posted as required by law. I f, i J I/ Date ... .......... TOWN OF NORTH AND PERMIT FOR AS INSALLATION This certifies that has permission for gas installation r7' in the buildings of ... Xl�f.l �'f.r at . . /. -�.. . Y- . r-. . �. !. 1 ' ' .1 ............ I North Andover, Mass. Fee-4Vp/4-"I-C--Lic. No. GASINSPECTOR Check # MASSACHUSErIN UNIFORM APPUCATON FOR PERW TO DO GAS FrrrING (Type or print) Date /a G NORTH ANDOVER, MASSACHUSETTS Building Locations lsf� OU� Permit # Amount $ Owner's Name ,A � f`�(� New ❑ Renovation ❑ Replacement Plans Submitted ❑ Name or type) . J �Lf'(SP4t V -4"e %�O - if Check❑Co Certificate Installing Company Address 0 tj') X, `U k �L--_g -,V) ❑ Partner. �P*. (o - 6) 6 z Business telephone 13Firm/Co. Name of Licensed Plumber or Gas Fitter d �Q (/j /� 6-e G INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0__� No o If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Or Other type of indemnity 1:1 Bond 13 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 13 Agent 13 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 Massachusatrs�state Gas Code and Chapter IA of the General Laws. By: Title City/Town VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Num er 0 -Master Journeyman UV O H z 5a F z Z F W W O O a p a w F z i N a w H U x z z z CA o ° w $a w �a o o U a > A a H o SUB -B A S E M E N T B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H F L O O R 8 T H. F L O O R Name or type) . J �Lf'(SP4t V -4"e %�O - if Check❑Co Certificate Installing Company Address 0 tj') X, `U k �L--_g -,V) ❑ Partner. �P*. (o - 6) 6 z Business telephone 13Firm/Co. Name of Licensed Plumber or Gas Fitter d �Q (/j /� 6-e G INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0__� No o If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Or Other type of indemnity 1:1 Bond 13 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 13 Agent 13 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 Massachusatrs�state Gas Code and Chapter IA of the General Laws. By: Title City/Town VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Num er 0 -Master Journeyman 4 Q Q J Date...... A10.f�..... i TOWN OF NORTH ANDOVER p PERMIT FOR WIRING t i This certifies that ............... ..5:........�.r............ has permission to perform �` .�< Fr `!.,�!j`i......... ............... ............... . ?wiring in the building of .........1. /.1.. ;� «..4. ................................................... �t ....:..........�....�1(a(� .a'............ ,North Andover ass. S..v..��. Lic. No �../ .............. �s.�,,w../;%...................... ELECTRICAL INSPECTOR Check # v Official Use Only Permit No. ?fig ethylXd3zZf/5,4Z?;?1 09 X45SWIPWS577S VO4V--d oa pu8lte 5410 Occupan & Fee C et O BOARD OF FIRE PREVENTION REGULATIONS_527.CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Insp oro Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number /5 y" u d Owner's Address SGC) '' -� Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of EAsting Service Amps Voits i Number of Feeders and Ampacity Location,and Nature of Proposed Electrical .t Overhead ❑ Overhead ❑ Authorization No. Undgmd ❑ No. of Meters _ Undgmd ❑ No. of Meters _ OTHER INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I ha went Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = submi valid proof of same to the Office YES = NO = If you have � ked YES � j irate the type f by checking the appropriate box NSURANCE — BOND = OTHER = (Please Specify) . V 11 (Expi&fiodDate) Estimated Value f rical Work$ Work to Start Inspection Date Resquested Rough Final -53 Signed underthe P nalties of perjury:' �% %'` FIRM NAME -,7—,)b&-!�/� �« w c �� LIC. No. General Laws. And that my ,signature on this pennit application waives this G.- (Signature of Owner+ 1)ate OF NOp4H A i10% �: TOWH Oa G,pS J%STALI.P► PE Air R a.necre vnef di PERMITTEE $ " f ettif ies that ! nstallatlOn ' ? Mass This c gas 1 nd°vet, a inisslOn jot 'sort. A et f.. h s P buildings °f �( � �; � r.�To y. c 111 the GAS 1NSPE treasurer at � 11C' N° {• uildtn9 OePt• P NKr---�`.��'`'._ Fee' . CANARY 6 WN1tE: APPttoanY Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures ` Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. d Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other Nri: of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I ha went Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = submi valid proof of same to the Office YES = NO = If you have � ked YES � j irate the type f by checking the appropriate box NSURANCE — BOND = OTHER = (Please Specify) . V 11 (Expi&fiodDate) Estimated Value f rical Work$ Work to Start Inspection Date Resquested Rough Final -53 Signed underthe P nalties of perjury:' �% %'` FIRM NAME -,7—,)b&-!�/� �« w c �� LIC. No. General Laws. And that my ,signature on this pennit application waives this G.- (Signature of Owner+ 1)ate OF NOp4H A i10% �: TOWH Oa G,pS J%STALI.P► PE Air R a.necre vnef di PERMITTEE $ " f ettif ies that ! nstallatlOn ' ? Mass This c gas 1 nd°vet, a inisslOn jot 'sort. A et f.. h s P buildings °f �( � �; � r.�To y. c 111 the GAS 1NSPE treasurer at � 11C' N° {• uildtn9 OePt• P NKr---�`.��'`'._ Fee' . CANARY 6 WN1tE: APPttoanY Official Use Only Permit No. qW a0416 ---t°6 ;DS-ddf Occu an & Fee C eP BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 p APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Insp oro Wires: Town of North Andover The undeminnM nnnlies for a permit to oerform the electrical work described below. Location ( Owner or Owners Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of E)dsting Service Amps Vats Number of Feeders and Ampacity Locationrand Nature of Proposed Electrical Authorization No. Overhead ❑ Undgmd ❑ No. of Meters _ Overhead ❑ Undgmd ❑ No. of Meters FA, OTHER' INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I ha went liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = submi valid proof of same to the Office YES = NO = If you have � ked Y �ej icate the type f e by checking the appropriate box NSURANCE — BOND = OTHER = (Please Specify) U ill (Expi&llriod Date) Estimated Value it ftrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the P nalties of perjury:\J 1-5 3J FIRM NAME / 0 ko g/e-aaiC c x, -)LIC. NO. NO. required by Massachusetts $ Telephone No. PERMITTEE (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. & Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other Nc: of D rs HeatingDevices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hvdro Massage Tuds No. of Motors Total HP OTHER' INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I ha went liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = submi valid proof of same to the Office YES = NO = If you have � ked Y �ej icate the type f e by checking the appropriate box NSURANCE — BOND = OTHER = (Please Specify) U ill (Expi&llriod Date) Estimated Value it ftrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the P nalties of perjury:\J 1-5 3J FIRM NAME / 0 ko g/e-aaiC c x, -)LIC. NO. NO. required by Massachusetts $ Telephone No. PERMITTEE (Signature of Owner or Agent) MAP RCEL MASSACHUSETTS UNIFORM APPLICATON FOR PERMnyo'D DO GAS FITTING s or print) NORTH ANDOVER, MASSACHUSETTS Building Locations /J7 (,A/ �) 0 Date /t,//-3 T?ej aD Permit # ,3 " J -C Amount $ AL Owner's Name -� ' 4/ 0.� New ❑ Renovation ❑ Replacement Plans Submitted 333/0 Date ../!A .. `..... ` . �:"... . INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑--' No ❑ If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 12r 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 ❑ 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 ins ns p ormed under Permi72uof ed for this application will be in compliance with all pertinent provisions of the Mass us taJ Code an$ Chaptetneral Laws. own (OFFICE USE ONLY) Signature of Licen' i5d Plumber Or Gas Fitter 0 --plumber, ❑ Gas Fitter License Number Master ❑ Journeyman GORTm TOWN OF NORTH ANDOVER FOR GAS INSTALLATION SU BST BASEEMM ENNT 3? m � p PERMIT. 1L�T. FLOOR r 'y' 2N D. FLOOR y ► oo ,o,... _.�� 1'9.°'""° � 3RD. FLOOR 4 �4 SSACMUgE 4TH. FLOOR FLOOR F L OO R 1 ffTH > %. [�� sF ................. L O O R ! This certifies thatFLOOR �t��.. for gas �................. installation has permission (Print or type) T in the buildings of .. . IL rr-.... North Andover, Mass. Name L �t at ! . Vit:: f , �. Address D Fee.. .. Lic. No.... . ` .. ` . .... :..... GAS INSPECTOR Telephone Business Tele p �II WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Name of Licensed Plumber of Gas`Ftiter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑--' No ❑ If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 12r 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 ❑ 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 ins ns p ormed under Permi72uof ed for this application will be in compliance with all pertinent provisions of the Mass us taJ Code an$ Chaptetneral Laws. own (OFFICE USE ONLY) Signature of Licen' i5d Plumber Or Gas Fitter 0 --plumber, ❑ Gas Fitter License Number Master ❑ Journeyman Location 1`5J w, ode NeS —Pf2 No. 7 Date TOWN OF NORTH ANDOVER - _ t .. s Certificate of Occupancy $ �ss�cMUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # O f �' 15733 Building Inspector - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLI.Nz G BUILDING PERMIT NUMBER: DATE ISSUED: rl ^ 0-� 9f— SIGNATURE: (� Building Commissioner/I for f Buildings Date SECTION 1- SITE INFORMATION, 1.1 Proper^ty' nA/d'd�ress:�/1 l/�' OYL� I , I n�` O g� � 1.2 Assessors Map and Parcel Number: Map Number Parcel umber .. Zoning District Proposed Use 1.4 Pr(veity Di-rpmsi :vs: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R *red Provided 1.7 Water Supply M.G.L.C.40.. 54 1.5. Flood Zone Information: Public ❑ Private a " x Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 11 ECTION 2 - PROPERTY OWNERSE[MAUTHORIZED AGENT 2.1 owner :fMrd A AA /Qtt,/1. S� NamTt / .pAddress for Service Signature P&TIeephe 2.2 Owner of Record: Name Print Address for Service: Snature_ Te ophop n4 _ _ -. SECTION 3 - Ciiiv�'I$7tiC "Ti.OiV aEie`vXE S 3.11 Licensed Construe ion Supervisor: Licensed Con tion Supervisor. Address i 7 t l IpOC (p b Signature Telephone Not Applicable ❑ + License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date` Signature Tele hone M M z O z M 0 ic r M SECTION 4 - WORKERS COMPENSATION (INLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building If Repair(s) . Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �noc�r� Arm �. jT �"F'Fj� U ... dei, il.y ie�:=� i G L�ll['GT;•a iiTV a titd!'i Item Estimated Cost (Dollar) to be� Completed by Permit applicant FCIAI. [ISE'6�NY �x 1. Building `� o o (a) Building Permit Fee Multiplier 2 No 2 Electrical I 0 9 (b) Estimated Total Cost of Construction 3 Plumbing 1 Building Permit fee tel X (b) ale) Q 4 Mechanical HVAC THICKNESS 5 Fire Protection X 6 Total 1+2+3+4+5 (i Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR, CONTRACTOR APPLIES FOR BUILDING PERMIT I, A .d' LI 0 as Owner/Authorized Agent of subject property AHereby authorize :7RAto act on My behalf, in 1 matters relayo w uby this building permit application. t Signature ofwrier Date SECTION 76 OWNEJ2/AUTHORdED AGENT ]DECLARATION v /VVI o `J ,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 beiief i (rtrlrA, (5" V D< V� E "iO f( Print Name '/ `. /// `! 4" / Siature of Owner ent NO. OF STORIES Date. SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1` 2 No 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 NAI URAL GAS LINE _ G a 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 c 11, S 1.50 A. _ The debris will be disposed of in: (7>vm Psi 6y� N 6,0 ,Scab LuA. 5 6 - (Location of Facility) I0 N G /Signature. of Per it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector LU z • e�z,� \\ .§ OD /�. § ! '7 2 $!«� K ° . k \ \ (L �c ■ � .� \z0 Gad %� E§�- �.. wo-=- |to $§k�} m lK52BG �I.— Z § § R o§ƒnro . �D d q § q c 7} 2§ 2_jui n. I ^ cc E x� m . 3 j z& 2< < _� ' \ § / . c LU m . .: . � ..E E 2 $� ^ ; � I LU z • e�z,� � § $!«� K �c ■ � .� \z0 Gad %� E§�- �.. wo-=- |to $§k�} lK52BG �I.— Z 0 z Wo Cd PE i a c v o w V) 0 w A o w o U C x 0 w a o w c w R. a w o_Cd c� cn w o a: c° x A go U)cn O c• O s Z co CL. O y Q C I CCM O•— y Q C H O E CO m CD C2 CD Z O � m CD CL Q L CL Ca Q co C s CL V y cc C C . C 0. H Q 0 Cn ccw w w ;;C O C H _O C L3 C-3 QC cc W ;= O W !t O � 1 E Q o I �L v :aCL o m 0C2 .r c m E fA y ; - r.. C m -O Q� CCfti.o CD 4%-'m a 1'== o 'cc C C y Q 7 CO m V y O �i � •� Z O �•% o .... cm C d O C •O H = O m y O C N MCL a3COD r=.• -y ed •C c Z = o •y O W' H Ll oa v O v O� � C, A m ? g . ` y O =Sa.-m� O c• O s Z co CL. O y Q C I CCM O•— y Q C H O E CO m CD C2 CD Z O � m CD CL Q L CL Ca Q co C s CL V y cc C C . C 0. H Q 0 Cn ccw w w Date. ..—G–-i� �'<� �� •��c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 This certifies that r./lit... ... r`. ...................... has permission to perform .... 14 /,.,; .:'' ............... plumbing in the buildings of 7 .................. at .. ?`....l?`..... , North Andover, Mass. _ l t Fee. .j !�..Lic. No..`l ? . P�l'UMBING INSPECTOR Check # 39 / 5316 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Permit # Amount 5 �' Type of Occupancy New Renovation ® Replacement Plans Submitted Yes No FIXTURES (Print or type) �/ Check one: Installing Company Name- U/ ej- 11 Corp. Address R 0, iia x ayA %% AAAA C ZV V -r . Partner. 018bo ® Firm/Co. Name of Licensed Plumber:/�/aJ /A If ¢;,K1' Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Bond 1-1 ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner n Agent 11 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 Massaeatelum in , de and Chapter 142 of the General Laws. Y: Nignantre oT Licensea Flumoer Type of Plumbing License Title Y3 i ity/TownIcseeRum e'Ti r Master ® Journeyman Q APPROVED (OFFICE USE ONLY 10 „,, 'ADBoise Cascade Building Materials Distribution Division - From: Sinh Nguyen_. Company:� tl �,1n r Date: Phone: Pages: Re: ❑ Urgent ❑ For Review ❑ Please Cornrnent ❑ Please Reply ❑ ?lease Recycle .Notes / Comments: / cc D// �i C1 �{z Izd 1s�,�EC 100 Ranger Way --- Portsmouth, NH Phone: (804) 962-9961 Fax (603) 431.7663 z'd 699LIEV6091 3QH3SH3 3SIOH dSO:ZO ZO 02 2nd WI, 4 BOISE CASCADE - BC CALCT" 2001 a DESIGN REPORT -US Tuesday, august 20, 200214:04 Triple -1 3/4" x 117/8" V -L SP 2900 File Name: Untitled Job Name Customer EASTERN LBR Address Specifier Designer SINN NGUYEN City, State, Zip - Company: BOISE Code Reports - ICBO 5512, BOCA 88-52, SBCC19852 Misc: 56P Ibs LL 13 1 Ibs DL General Data Version: US Imperial Member Type: ' - Floor Beam Number of Spans - 1 Left Cantilever No Right Cantilever - No Slope 0/12 Tributary Repetitive n/a Construction Type n/a Live Load 20 PSF Dead Load 1 D PSF Part Load 0PSF Duration 100 Disclosure The completeness and accuracy of the Input must be verified by anyone who would rely on the output as evidence of suitability for a particular application. The output above is based upon building code -accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions, please call (800)232-0788 before beginning product installatior. Page 1 of 1 T -d Total Horizontal Load Summary ID Description Load Type Ref. start End Live Dead Trib. S Standard Unt Area Load Left 00-00-00 18.00.00 20 PSF 10 PSF 1 Cono.Pt. Load Left 11-00-00 11-00-00 1440 lbs 780 Ibs Na 2 Unf.Lin. Load Left 00-00-00 18-00-00 0 PLF 100 PLF n/a Controls Summary Control Type Value %Allowable Duration Loadcase Span Location Moment 14019 R -lbs 47.00/c 0100% 2 1 - Internal End Shear 2298lbs 19.1% 100% 2 1 - Right Total Deflection U443 (0.487") 54.1% 2 1 Live Deflection 01119 (0.193") 32.2% 2 1 Max. Dell. 0.487" (Limit: 1 "j 48,7% 2 1 Span/Depth 18.2 1 NOTES: Design meets Code minimum (0240) Total load deflection criteria. Design meets Code minimum (0360) Live load deflection criteria, Design meets arbitrary (1") Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". Minimum bearing length for Bt is 1-112". BCI5 and Versa -Lam® are registered trademarks of Boise Cascade Corp. E99G1E111P609T 880 lbs 1534 lbs Dur. 100 100 100 311ki0SU3 3SI09 cIS0:20 ZO OZ Znd