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Miscellaneous - 1500 Forest Street (2)
1500 FOREST STREET / 210/105.11-0004-p0 1 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.D.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.a.143,.§3L. Permits sball_be limited as to the time ofongoing construction activity,and may be.deemed.by the-Inspector-of-Wires abandoned-and.invalidi£he,. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entitystated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. *ule S—Permit/Date Closed: Note:Reapply for new permit 0 Permit Extension Act—Permit/Date Closed: \ ,98 ! •tf Date..... .z.-.. ...... ......... -i t �aORTN 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that / R;E S �� .................................... ...... .��!... ........................ has permission to perform 6. .. C . wiring in the buildin of at................ North Andover,Mass. &4 ` Fee..:�II,,, Lic.No.� ...S'of�..... . a. ........... 'J ' FCMCA.lxsP�cnx Check # — Commonwea&of Majsaclumetb Official Use Only aUe cc��rr�� Permit No. F/ ., partmenE 4_7i,.cc77 ire�erviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: 1r�� 2y2l(3 City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /S�CJD S%ljh PC•ln�!/t: �� ( to ran yid e Owner'or Tenant ,qQ K C �' S?< s Telephone No. 97e,e6,7, go? 7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 1211 (Check Appropriate Box) Purpose of Building`� �Grh� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: q��,y�ti� -t Comletion o the ollowin table may be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency tg ng rnd. rnd. Batt= Units No.of Receptacle Outlets No.of Oil Burners FFIREALARMS No.ofZones No.of Switches No,of Gas Burners .o etectton and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons .KW.......... No.of elr Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systerns:'F No.of Devices or Equivalent No.of Water No.of o.of KW Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: E No.of Devices or uivalent OTHER: v Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: V60— (When required by municipal policy.) Work to Start:Qb0�.o101D Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including`completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is'in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND E] OTHER EJ (Specify:) I certify, under the pains and Ides of perjury,that the information on this application is true and complete. FIRMNAME: Aries Electrical Service and Controls LLC LIC.N015650a _ Licensee: Nor and Michaud Signatu- _ __ JC.NO.: 34594e (If applicable,enter"exempt"in the license number line.) Bus.Tel.No. T£� 687-0544 Address: 290 Broadway suite 117 Methuen ma 01844 us.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent crf- Signature Telephone No. PERMIT WE: $S� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ,ARIES:rELECTRICAL SERVICE AND CONTROLS LLC Address: _290 _RgnAT)wAy STITT F 1 17 City/State/Zip: s m f-h ll Prl Ma n 1 R 4a Phone#: g 7 R h g 7 0544 Are you an employer?Check the appropriate box: Type of project(required): 1.�I I am an employer with_r 1 4. ❑ 1 am a general contractor and I 6.❑New construction employees(full and/or part time).* have hired the sub-contractors 2:;:z am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no ernpAeyees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp.insurance.$ 9. ❑Building addition required] 5.0 We are a corporation and its 0Ekkiectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself [No workers'comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions insurance required]t c. 152,§ 1(4),and we have no 12. ❑Roof repairs 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. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contactors that check this box must attach 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.#: z42 %2�3 0 Expiration Date: Job Site Address: , 0 5 j]ay)a C 1eq t )-26 City/State/Zip: I< 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certft under the pains and penalties of perjury that the information provided above is true and correct Signature: Date. e9t'y 492,e_- v2,aZ> Print Name: Normand Michaud Phone#. 978 687 0544 1/ 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: 0900 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . ^.! . . .// has permission to perform . .�ll�. .'.!�.�'I�1Jr-'t . Q. .c.c . . . . . . plumbing in the buildings of. . . .. n . . . . . . . . . . . . . . . . . . at . �. Z)!'l sr�. �`.. CX'-.1. . . . . . . . . , North Andover, Mass. Fee . .`. . Lic. No. . . �Z . . . . . . . . . . . . . . . . . . . . . . IR t PLUMBING INSPECTOR :heck r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITYMA DATE PERMIT# JOBSITE ADDRESS c S-t- OWNER'SNAMEIJ POWNER ADDRESS TEL I -306 - 30651FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT: ® PLANS SUBMITTED: YES[]I NO®I FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _I .v.._. ! _i __..._._.l ..___ .a 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM i .._,_.._-( I a _-_._. ! _m! —J _._..__i DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _! ...__ _I ! DEDICATED WATER RECYCLE SYSTEM 1 ! .-..-_._._ ..-........_I DISHWASHER _i .._.__j ____1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR KITCHEN SINK LAVATORY R OF DRAIN i J ! I ! ___J _--__.1 --_-_._I ._._.,1 ._.._J __.--f SHOWER STALL SERVICE/MOP SINK �.! ------ TOILET —1 -- -_I _ � i � _--! _- 1 l - 4 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _{ i 1 _i __._..l _._._! J —I _____i WATER PIPING OTHER .-_--_.--J -----------._f ! I INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[]! NO i IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY Q BOND Q )y OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 169assachusetts General Laws,and that my signature on this permit application waives this requirement. —meq �J1 CHECK ONE ONLY: OWNER 0 AGENT �! SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# SIGNATURE MP E01"', JP EII CORPORATION ..1# _ r PARTNERSHIP 0# LLC U� COMPANY NAME ' ADDRESS CITY STATE ��';;��,,,�ZIP �- 1�� TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �) Y The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 k4jo www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leyibly Name(Business/Organization/Individual): Lccvn c4i e - Address: City/State/Zip: V''L�'l� ✓1 �a- Phone#: (1 —c_k0C- �7 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction ,Amployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. 9 y p ty. E]Building addition [No workers'comp.insurance 5. ❑ 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.E]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they aie 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 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 verification. I do hereby certnder tlt�pai a pe ties ofperjury that the information provided above is true and correct. Signature: Date: �� f Phone#: C, i 3--a3 Ct — �D Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone M. 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 numbers)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 cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new 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 Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston,MA,02111 Tel,#617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax#617-727-7749 www.mEtss.gov/dia i -p'_ -... COMMONWEALTH OF MASSACHUSETTS.` PLUMBERS AND GASFITTERS LICENSED AS A MASTERPoUMBER ` ISSUES.I`HE_ABOVE LICENSE_ � . L'I p,M j- B LIG H 1 36 PE-ASAN.T 5T 4�. �M"A.,02186=4517 .1 s 05/01/14 18b127 - 15 6 43 Date I::... .�� ................ GF NORr#y,h TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING � oma:.,.•• • x,88�CMU5�t1 This certifies that . - .....4-- .° ....................................................... has permission to perform ....``..............................................................................................:...... Aviring in the building of...v.. .�.�vtJ at ......E..6130...:N.W. .�' .: ........................111prth Andover,Mass. c�4 ' -&, /- CAL INSPECTOR Check# ( i t 'A C"Immonwea&of Maijac"etb Official U Only 1JeParfinenE o`�1re�ervices Po �BOARD OFFIRE PREVENTION REGULATIONS cy and Fee Checked . ] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYP IS�IXF��POR4M44 TION) Date: — —City or Town of: V ' To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant C, T Telephone No. V ")o Owner's Address Is this permit in conjunction with a building permit? Yes NoChe _ ❑ ( ck Appropriate Box) � Purpose of Building Utility Authorization No. Existing Service Amps �02� /�y Volts Overhead Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t Completion of the ollowin table m be waived b the Inspector o Wires. r No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA J No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above El In ❑ o.o U its cy ig ng rnd. rnd. Batte Units No.of Receptacle Outlets 1'7D No.of Oil Burners FIRE ALARMS No.of Zones ` No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices V No.of Waste Disposers Heat Pump Number To.n...._.... KW No.of Self Contained Totals: '-""' ������� Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal Connection ❑ Other U No.of Dryers Heating Appliances KW Security Systems:* No,of ater No.of Devices or Equivalent 3 No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: H OTHER: No.of Devices or E uivalent ® Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: �Q. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Er BOND ❑ OTHER ❑ (Specify:) I certify, under the airs andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: ej� PICo Licensee: LIC.NO.: 90 Signature `VZ_ (If applicable, e;err "exe OO he icense�umbe line.) LIC. NO.: �® 01� V\ Address: Bus. Tel.No.: *Per M.G.L.c. 147,s.57 61,securi work requires Department of Public Safety"S"License: Alt Lic' No.� �g� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner ❑owner's a ent. Owner/Agent _ Signature Telephone No. PERMIT FEE. S s T Infor aflon 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 4 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." I Applicants ` Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if F f necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the ybottom 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 permithicense 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. he Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street I Boston,MA 02111 I Teal.#617-7274900 ext 406 or 1-877-�MASSAFE .. -- - - _ . .- i - ::OMMOgWEA.LTH OF NtA : `• • •. ELECTRIC:IA' AS A REG JOURNEYMAN KEVI14 A ESCOTT cGOLIDGE DRIVE 10 1.259 MA 01879- TYNGSBO'ROU GH g3:1962 07/31/13 50828 E COMMONWEALTH OF f0ASSA-12-HUSETT.4 - REGISTERED MASTER ELECTRICIAN KEVIN A ESC.OTT i 10 CODLIDGE DR :a TYNGSBORO MA 01879-1259 20082 A 07/31/13 8319:61 - I I IIS �G Aare' 1 OOv�A N {� V JN OF N S711, oS �Pl 1 -1OOF FOA GP 001 tON £ F. . .�° O'` s� �.'41 � � ���� , ��+, •,SCS. *M'4SSACHJ�� �• tiO� va,•V e�' �� ,es ira� s cell, JOT ga �G of � �• /t i C�a NSPEc�°a �aS 4e dings �P.`7 LP . GNS '013N -zo Fee' Che°� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE . PERMIT# JOBSITE ADDRESS _J,�G Do si �OWNER'S NAME GOWNER ADDRESS TE TPR O OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL[ RESIDENTIAL CLEARLY NEW,® RENOVATION:[ REPLACEMENT:® PLANS SUBMITTED: YES[ NO APPLIANCES 1 --FLOORS- BSM 1 2 3 4 5 6 7 8 g 10 11 12 13 14 BOILER } BOOSTER CONVERSION BURNER COOK STOVE l _ - - - --} DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE I ! ^� GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ - - - --- - —� TEST �_.__l(� J _ € UNIT HEATER {. -- --_-_--- -____-- .. NVENTED ROOM HEATER I .,...-..__I _......_ I ,n...�_ ._....._._€ WATER EAT R _r J l _. _J _1! -__I OTHER x � _ - J INSURANCE COVERAGE have a current liability Insurance policy or its substantial equivalent Ich meets the requirements of MGL.Ch.142 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY . OTHER TYPE INDEMNITY f-j- BOND , OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance wi all P t pro e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER•GASFiTTERHAME . SYcr LICENSE#1 i2Dg €GNATURE MP L._J►'1 MGF . _ 'JJP L"J El J GF(j LPG[® CORPORATIONE]# Z t 7 2 c-1 PARTNERSHIPE]## L COMPANY NAME:_ __� �}. 11.� ^ ADDRESS �T ti. 7 U n, CITY - ----- - - STATE ZIP OL TEL FAX -?j- `-�. CELL �7JS11 EMAIL --- The Commonwealth of Massachusetts fA! Department of Industrial Accidents Office of Investigations 600 Washington Street VU'; Boston, MA 02111 www.mass.b'ovldia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): J Address: ' _fir �- City/State/Zip: 0 ty,ZZ Phone 7Y 7.3 ill 6 q Co Are y an employer?Check the appropriate box: Type of project(required): l. tam a employer withI2 _ 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on.the attached sheet.t 7. ❑Remodeling ship and,have no employees 1 These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required, officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL i LE] Plumbing repairs or additions myself, [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infnrrnation. 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. Lie.#: 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 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. I do hereby cert' u� e pains and 's of perjury that the information provided above is true and correcx Si nature: Date: s� Phone#: on 77 4) t Z t�cial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• 7 5 Date.�az�� / ....... NORTMI o? TOWN OF NORTH ANDOVER , p • PERMIT FOR GAS INSTALLATION.,,'- SACH S NSTALLATION,'SACMUS .. ° This certifies that . .ei has permission for gas installation . . ,T1 .D. . . . . . . . . . . . . . . . . . . . in the buildings of . . � /C. . s4 i. . . . . . . . . . . . . . . . . . . . . . . . . . at .7 . , North Andover, Mass. i Fee. . ? MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: / A © MA. Date: Permit# Building Location: 1 00 -7L Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: Iteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES Cna CnW Cn Z � N U = W Q F- m = O W W V N H O = W Z F ~ Z J } W Z W O H V) w W m° o a a o W° W x W ' V) L) LU Z W ? = W o W 0LL ofix > 0 W Z O "I F— P O Z —t 0 LL N w W W W O W LU M a R W W O 0 ga 0 H > Z W O U 0 0 u_ 0. 0 2 = SUB BSMT. BASEMENT -i'FLOOR 2Nu FLOOR 3 FLOOR --4'FLOOR 51HFLOOR 6 FLOOR -i'FLOOR F—FLOOR / Check One Only Certificate# Installing Company Name:LG!` 14jd N f �L d o T/U�" (/# nrporation T Address:��' /4c/� /°(� City/Town: 1/��D�. 1 State: c� ❑ Partnership Business Tel: � " —�T`1G� �1 � Fax: /` .S-T/- &c/e1 ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: 1 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 ,�/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By EHnf:'mber TitleEJGas Fitter Signature of Licensed Plumber/Gas Fitter LI-AIF-ster q City/Town [:]journeyman License Number: 9ea'7 APPROVED OFFICE USE ONLY ❑ LP Installer Date. . 87bO TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING oe S cs4us This certifies that . ... . . . . . . . . . . . . ..!�. . . . . . . . . . . . . has permission to perform . . . ...13.F . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . at . . . . . . North Andover, Mass. U <i Fee—�D. Lic. No.!'ZO. ' Izll . . . . . . nnam,c INSPECTOR Check # 7 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:A�VQ0VE2 , MA. Date:��C -7110 Permit# Building Location: Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES Q DEDICATED SYSTEMS � z z in Ou > z LnUj H 2 in vi p LLJ H a z Z H Y Q an Q Q v~Wi Z ¢ oe W Z H = N Q W Z fL41 W z in H 2 O G r Q w r ~Q C Q W O Q OC z OC OC z !A VN1 U Z d LL = Q 3 LU 93C! W W J W 3 Q U x = a o 3 2 z Q - 3 a Y z w f- W o of ¢ > N W Q F N V1 O F > > O O O z Q Q Q F u Q C a Q + a m m c c LL ox Y g 3 o°c 'n L 5 SUB BSMT. 1 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR / Cu ZZ11V4AJ 04- CO- _ Check One Only Certificate# Installing Company Name: !T �/V C � �`p oration ��^�o S—(4IF0VoEZl RJ AM or W Address: � City/Town: JQ dV� State: b �t El Partnership Business Tel: 7r�— / 7/9 Fax: S/4{Ntl� ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,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 Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title lumber Signature of Licensed Plumber Cityrrown Journeyman License Number: APPROVED OFFICE USE ONLY `• • • -e a :e •• • �f�-PL17�111'BER'S a1VD-G%�SFITTEFtS` LICENSED AS A°MASTER PLUMBER ry ISSUES THE ABOVE LICENSE TO:': a 'MI.CHAEL '`F CULLINAN t� 5 WENDELL RD " ;.m NAHANT, MA. 01908-1126 . . ; 9029 05/01/12 784583 Fold,79,- ^ach V All Perforations a Location bD No. `Alz Date 5 16) `Q a �oRTM TOWN OF NORTH ANDOVER � a Certificate of Occupancy $ r IT, CHU t< Building/Frame Permit Fee $ JAMUS Foundation Permit Fee $ u Other Permit Fee $ _ TOTAL $ " Check # oo/ 56 / Building Inspector TOWN OF NORTH ANDOVER. BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLINGMa BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Comoner/I or of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �1VILJCSJCJ L!I a A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re red Provide RegWred Provided Regiured Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zane Outside Flood Zane ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record _16-00 1 Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ c-k yo�871� Licensed Construction Supervisor: O iLicense Number Mn A ress 1 1 l �y�� s q 2 / IY °L2� ExpirAtion Mte ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address 11 " Expiration Date Signature Telephone V, SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned 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: V-e wou e, OA �becU,, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be USE Completed b ermit a licant 1. Building (a) Building Fee �Q • 00 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT =X D as Owner/Authorized Agent of subject property Hereby authorize (—Cuda r- J"ic c LD 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, 'e l00' d- t 3 EYP CJC C r as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief if Cr /L I J 2 of f4 d C. C- � Print Name Si ature of Owner/A ent Date f NO. OF STORIES SIZE i BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DMIENSIONS 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 FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANTS '�OVA evee-s PHONE "Sr 96t , -)' ASSESSORS MAP NUMBER W C E 7)LOT NUMBER -1 SUBDIVISION LOT NUMBER f_*1e st '� 5T STREET STREET NUMBER OFFICIAL USE ONLY2.ewio RECOMMENDATIONS OF TOWN AGENTS '4 2 e P(AC Y_ ,Ao, 11 >c a�� X )3c`©P D DATE APPROVED Mzz-) I CONSERVATION ADMINISTRATOR -DA,�t DATE REJECTED COMMENTS i DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-_HEAL DATE REJECTED 2 DATE APPROVED 41—Z a SE IN CTOR-HEALTH DATE REJECTED COMMENTS �2 � 3 !� ? Sc5 5�� �•••, PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North AndoverNORTH o� (%.to 16�ti ? O o Building Department ti _:Z � 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 9SSACHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: es4 6 77 'J vc-.-s f Facility location PP Signature of Applicant g Date t NOTE: A demolition permit from the Town of North Andover must be obtained for this project through,the Office of the Building Inspector. t o p / RESIDENTIAL REAL ESTATE " HUNNEMAN ' & COMPANY j _ ® is a Listing Broker: - Charlotte McElroy Office : 887-6536 Home : 887-2946 ADDRESS: 1500 Forest Street TOWN: N. Andover PRICE: 329, 900 OWNER: Pearl Directions : End of Stonecleave Rd. ,' Boxford Style : Colonial Land Area: 1 . 24 Ac . Sq. Ft . : 3 , 000+/- Rooms : 9 Fnd: PC Age/E : 1989 Sump Pump:No Color: Beige St . Wd: Dbl Glaze Roof : Fibergls FLOOR PLAN B 1 2 3 Exterior: Clpbrd Bsmnt : Full H Water: Oil (Sep) Floors :HW/WW LR: 20 X 13 X OO/R: Owned W/D: H/U Fuel : FHA Heat : Oil DR: 15 X 13 X Cost : 2000 +/- Wiring: 220 per year Plumb: PVC KIT: 15 X 22 X Driveway: H. T. Water: Private Garage : 2 Car Und Sewer: Private FR: 12 X 22 X Zoning: Res Micro : Yes Fence : Yes AC: Yes Bedrooms : 3 Pool : No Fan: Yes Assessment : $259, 600 Refr: No "Bathrooms : 2 Ann. Tax: $3 , 417 . 62 Disp: Yes Date : 1994 Stve : Yes 1/2 Baths : 1 Bk: 3279 Pg: 142 DW: Yes Nursery/Office X Comments : Central air conditioning. . Jacuzzi, 3 marble fireplaces, family Library X room with tongue in groove cathedral ceiling, central vac, security alarm Underground sprinkler system. system, skylights, & track lighting. I Hunneman & Company Coldwell Banker 10 S. Main Street Topsfield ***If there is a private sewer system on the premises, the buyer should consult a qualified professional regarding its condition i and compliance with applicable laws. NOTICE TO PROSPECTIVE HOME BUYERS: , All Brokers/Salespersons represent the seller, not the buyer, in the marketing, negotiating " and sale of property, unless otherwise disclosed. However, the Broker or Salesperson has r an ethical and legal obligation to show honesty and fairness to the buyer in all transactions. Regulation 254 of the Code of Massachusetts Regulations section 2.05 (15) Except as may be otherwise noted,specifications with regard to the property described above were provided solely by the seller(s)without verification thereof by broker(s)and,therefore, broker(s)accepts no'responsibility for the accuracy thereof.Offering is subject to prior sale,price change,or withdrawal without notice. .�. : �i DECKED OUT INSTALLATIONS TO Q�f--K c-- t mk�j .Q R S '� (� L �© ob a ADDRESS C�eq"-z Y3o� S1 TEL (H) CI L`Z q 19_ (w) l» — q(o - 1 ol-W N - Co _ DIMENSIONS 13 X Q Z 6 FLOOR HEIGHT r MATERIAL 1Pr-C-s3 u.st t ea e� STEPS r') RAIL �U� 1 v �/Z r= y LATTICE JOIST Z.X H SEPTIC DECKING SET BACKS POST `1k SIDING C 1 \f oA5 FOOTING PERMIT i t t 'A� 1 R 25'-0" Qd, CA-` 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name Location: e7 Of City Phone 0 1 am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity F711 am an employer providing workers'compensation for my employees working on this job. Company name: C>Qr-L LAU1 Q C> �tOcn Address C9 cm n� Ci!Y l� Q Phone#: J Insurance Co. Policv# Companv name: Address City' Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION I . ocation of L ch ng Pit - x \0. Septic C5� Back of Dwellinc AS-Built Plan for 3 bedroom 1500 Forest Street °We"'ng North Andover Based on an inspection conducted on 3125195 by Peter M. Mirandi, R.S. STEWART'S SEPTIC TANK SERVICE ESTABLISHED 1956 -STEWART'S , 1 STEWART'S 47 RAILROAD STREET BRADFORD, MASSACHUSETTS 01835 Telephone: (508) 372-7471 NAME \ DATE :57,-2 ADDRESS TOWN / V //7�I/ �✓� G' //l7 J` SERVICE PERFORMED APPROX. SIZE OF TANK J CONDITION OF BAFFLES LEVEL OF CONTENTS IN TANKO/ SIGNS OF SEWERAGE ON SURFACE �� IS SYSTEM WORKING PROPERLY AT THIS T,4E � 1 CNED BY, DR ERl FOR EWART'S I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property: 1500 FOREST STREET,NORTH ANDOVER Owner's name: JEFFREY&KAREN PEARL Date of Inspection: MARCH 25, 1995 PART A- CHECKLIST Check if the following have been done. Y Pumping information was requested of owner, occupant and the Board of Health. Y None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Y As-built plans have been obtained and examined. Note if they are not available. Y The facility or dwelling was inspected for signs of sewage back-up. Y The site was inspected for signs of breakout. Y All system components, excluding the SAS, have been located on the site. Y The septic tank manholes were uncovered, opened and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum. Y The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. Y The facility owner(and occupants if different from owner) were provided with information on the proper maintenance of SSDS. Depth to Groundwater: Groundwater not encountered. Method of Determination of Groundwater Depth: Test pits conducted by C.T.Assoc. in 1989 (Data on file at the North Andover BOH)recorded no groundwater at depths of ten feet(10') beneath grade.No other evidence indicates that this information is inaccurate.In fact,surface water/seasonal pond located approx. 1/4 mile from site estimated to be well below 10' of existing grade; Building site sits on the top of a rise-the high point of this subdivision. A4, rl V 1 y, 4 1 I t _--' A 1 mlI •I A, r • l t r , , e t F 4,,[,�r � In . i . � F..�Ygf• - � :�il�i�` _ �7 � �. 7b�Y 't'k� °.kylYj-•.1.`7�� f .� J 7 1.E 4 Sy � r t r?a e 8 . job I z oo.ee N aw �. ti L Q ro' 2ST 3 .4 7 a ' n w N ` 41 ti A C. 0 s ,00.00 s _ 1••rp _ , a4 zS FOREs - ST MORTGAGE LOAN INSPECTION SCALE: 1 IN.= •¢D FT. DATE: SEAT. iB/9d7 PLAN REFERENCE: BEING LOT ON A PLAN BY EssEr .sa«X SEL(i/LE DATED RECORDED IN ESSEX ti' ZL REGISTRY OF DEEDS BOOK_ i279 PAGE - 2 , I HEREBY CERTIFYTHATTH E BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GRO HOWN, AND CONFORMS TO THE ZONING.LAWS OF THE TOWN OF NORTH ANDOVER I CERTIFY THAT THIS LOCUS DOES NOT LIE GCGRG� / r {y ✓' WITH THE FLOOD HAZARD ZONE . .QS L / � o � fc � I/z Nis. _Lt0 :NIATED. N MAP • 'I/-,. - - ,r -�t r -SC: 'EYASS - zIc- COMMUNITY 2sO0 9R 'L____ 76 NEHOIDEN ST. NEEDHAM � (R �E,�o� THIS PLAN NOT MADE O FROM AN INSTRUMENT SURVEY, NOT TBE'USED qw0 S�� .FOR FENCES, ETC, FOR USE OF BANK ONLY, NORTH Town of Andover No. Z gIL o = `A -o dower, Mass. s-�� �d COC MIC KE WICK ADRATED S BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... m.. .. ............... .......... ..5................................... ............ .............. .......... Foundation has permission to erect...��.......as.............. buildings on ......JS Rough to be occupied as... ..���.. .13'.....oP��V....D�.C.ks...../`ear......�.E....S�I rvc`��.�`"�.... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M j V S Q p y `� �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough ........ ........ .. ....I............. ................................ .......................... Service BUILDING INSPECTOR • Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 12999 �{"? Date. .. .. .... a MORTN TOWN OF NORTH ANDOVER 0 a � `p PERMIT FOR GAS INSTALLATION SSACMUSEt This certifies that-.-:.`C:. 1'!? z .�._.�'J. ' .:..,.,k. �'`-. `gig;• has permission for gas installation in the .... . . . . . . . . . . . . . �f at !. .: . . .- . • • • • .. . North Andover, Mass. Fee./-'.: .a. . . Lic. Nol�' 11 . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . GASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer No.: Date.// TOWN.OF .NORTH ANDOVER ° A BUILDING DEPARTMENT A"° Building/Frame Permit Fee $ - sSACMUSE _ - Foundation Permit Fee $ Ot er P. mit Fee $ , /d, 3. - -—Building Inspector 11/12/9 2:24 40.00 PAID MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 19 City, Town p p a•. Permit BuildingOwner's 7 AT: Location_f o��C1l�f f-S` r Name—� C��q W - P/E .r.; t. Type of Occupancy: W UGC{ )eel ��1 ! �/ S+C :tM•. ti New Renovation ❑ Replacement ❑ t ' Plans Submitted Yes El No � C•; N W cc t/7 Y W (A UCC cc to cc N ¢ O to y F W J N w O U H x N tV Cr i. t Z Z f z O W C O w A m N t- `t cc O O Z F to O W Q x z 1 y ¢ > W C� N cc W z U W W W •¢ x H p CW7 H Z ~ z ~ W w O 0 > LL H FN- w x a W > x w z Q arc fQn m z 0 z o IX s 0 0 7C W 7 3 In Cy J U Cr > o a IW O SUB—BSMT. BASEMENT; 1ST FLOOR'.1 2ND FLOOR` ryy.y 31 1 V ' P 3RD FLOOR " 4TH FLOOR . '.; bTFI FLOOR; nK2I• 6TH FLOOR' I•`,z`,'. p 7TH FLOOR STH FLOOR Frr 7 i ERy . (Print or Type) Check One: Certificate r� Installing Company Name Corp. Address — an /26X EPIC < — — ❑ Partnership S 14 G /`f 6 ❑ Firm/Company Business Telephone /Z��_ Name of Licensed Plumber or Gasfitter I hereby certify that all of the details and information 1 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 Massachusetts State Gas Code and Chaoter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. x � d y Signature of Owner/Agent ----- i3 .'1 have a current liability insurance policy to include completed operations coverage. By 1 TYPE LICENSE: fiellY t,94 __ y r; 4 Title ture i nse� ❑ Plumber fiG s, r lumber or Gasfitter. ! , City/Town ❑ Gasfitter APPROVED (OFFICE USE ONLY) ❑ Master �.y.•,,-.. ;:.: —' ❑ Journeyman License Number n Y,, t(' ''•'`` FORM 1243 HOBBS 6 WARREN,INC.1989 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS mumm . . BOARD IN PLUMBERS AND GASFITTERS IMPORTANT NOTICE PL LICENSED AS A JOURNEYMAN PLUMBER PERMITS FOR PLUMBING AND GAS FITTING ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE TYPE THOMAS R GAGNON OFFICE OF THE STATE BOARD. -J g PO BOX 8860 SALEM MA 01971-8860 m ? 572487 18597 05/01/00 572487 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD IN PLUMBERS AND GASFITTERS IMFORTANTNOTICE s PL LICENSED AS A MASTER PLUMBER PERMITS FOR PLUMBING A50 GAS FITTING ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE THOMAS R GAGNON -M N PO BOX 8860 SALEM MA 01971-8860 a 572485 1■�01366 05/01/00 572485 V) r. Fold,Then Detach Along All Perforations Y Fold,Then Detach Along All Perforalion:: J COMMONWEALTH OF MASSACHUSETTS BOARD IN PLUMBERS AND GASFITTERS IMPORTANT NOTICE e m PL REGISTERED AS A PLUMBING CORP: PERMITS FOR PLUMBING AND GAS FITTING ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE THOMAS R GAGNON -C g PO BOX 8860 wSALEM MA 01971- 8860 572486 1524 05/01/00 . 572486 Fold,Then Detach Along All Perforations fie �omvivwreusP,a/� o�,/�,cr�aae/uc;telld ,-,•� rs P; �, ,� 1 r DEPARTMENT OF PUBLIC SAFETY Restricted To: 00 SPRINKLER CONTRACTOR LICENSE Number ' Expires: Birthdate: SC :i'-002265 08131/1999 08/31/1957 Restricted Tod 00 I asa PO BOX $ab0 SALEM, MA 01970 pf NO oTM 1'b 3? °` 6 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACMUSESl This certifies that . . . . , .�,. . .S k' �.lr�h -- �. . . . . . . . . . . . . . . . has permission for gas installation . . . 1! . . . . . . . . . . . . . . . in the buildings of . . . . .1-71 P A, r at . .!S. �.�. . : r. /� nFore r,* ViasK Fee. . ?. Lic. No.. 1 .3 �. . . . . . . . GA6INSPECTOR Check#�% > � 4521 I c� 106 0 MASSACHUSETTS UNIFORM APPLICATON FOR ERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations 16,6) y 57(M,e-C— /� �� Permit# L14Sa1 Amount$ Owner's Name New❑ Renovation Replacement Plans Submitted rA W OF c u '0 a z o w w ' o x > G � ww C 0 ao A 0 z o 1 SUB-BASEM ENT BA SEM ENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR r 7TH . FLOOR 8TH . FLOOR ortype) �, �,/� ��� � f� �eck : Certificate Installing Company Name Corp.j Address (—b 3L) x V/L � El Partner. —1L c). ✓fi,-,� a .J-P.z- �Lr t /{ , y[ 8 `f (— Business Telephonefo (� D L l7 0-Firm/Co. Name of Licensed Plumber or Gas Fitter 11(-) 5 4e/ -e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes E3' Nor] Ifyou have checked M,please indicate the type coverage by checking the appropriate box Liability insurance policy LI Other type of indemnity ❑ Bond r] 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus toAGasode and C pter 142 of a Gens- By: signature of Licensed Pl ber Or Gas Fitter Title [3-Plumber j City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman 60uo Date.................................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING US This certifies that ........................... .......................................... has permission to perform ....... ........ .................... wiring in the building of......V. .. at...... .-S7.............. 4!!PX7.................... .North Andover,Mass. ... A Fee..Y6-..... Jc.Nogqor ........... ELECTRICAL P1� Check 4 lip 82 -7 t i Commonwealth of Massachusetts official Use only Permit No. Department of Fire Services o ti Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATI [Rev. 11/991 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pbrformed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYP ALL INFORMATION) Date: City or Town of: N Inj9hoig To the Inspector of Wires: By this application the undersigned gives noti a of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant d n Telephone No.� (6-r -7� Owner's Address Is this permit in conju n with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building- 1 �yf �f �/ill _ Utility Authorization No. Existing Service_ Amps ZZc>/ (Zb Volts Overhead❑ Undgrd S—. No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA 1 No.of Lighting Fixtures Swimming Pool AboveIn- ❑ o.of Emergency ig mg r rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No, Zones No.of Switches No.of Gas Burns .o.of Detection an Initiatin eves No.of Ranges No.of Air CTot d. Tons No.of Alertin evices No.of Waste Dis o ers Heat Pu Number Tons KW No.of Self-(� ntained p Tot s: Detection/ lerting Devices No.of Dishwas rs S ace/Area Heating KW Local Municipal ❑ Other p g Connection ' No.of D s Heating Appliances KW Security Systems: 7 No.of Devices or Equivalent No.of W ter KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HPTelecommunications Wiring: !i No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector Qf Wires. 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 cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pai s and penalties ofperjury,that the information on th' a U tion is true and complete. FIRM NAME: LIC.NO.: /G' '�� Licensee: ,�� el Signature a ZZ LIC. NO.: ,jI_ (If applicable,�eemp,�I,� the license ntvnPX liaa.,) 9� Bus.Tel.No..Address: ( �L2�J/� '/�� /�f'S' / �v Alt.Tel.No.:F OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. E Owner/Agent 'e PERMIT FEE: $ � Signature �� Telephone No. i =�- Commonwealth of Massachusetts Official Use Only Floes ' Permit No. 6 CJo(, Department of Fire Services c. ` s Occupancy and Fee Checked ° BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] Leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK- ) All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527-_C-MR,12.00) A (PLEASE PRINT IN INK OR TYP ALL INFORMATION) Date: City or Town of: N oo To the Inspector of Wires: By this application the undersigned gives noti a of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant 0 t4,A OA 16 074Telephone No/up Owner's Address Do Is this permit in conjun with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building( �" �,�ia4,���i �/l>'� Utility Authorization No. Existing Service_ Amps fed Volts Overhead❑ Undgrd[ No,of Meters r^ New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA O Above In- o.o Emergency ig mg No.of Lighting Fixtures Swimming Pool rnd. rnd. E:1 Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. Zones No.of Switches No.of Gas Burn o.o Detection an Initiatin Dev- es No.of Ranges No.of Air C91k Total Tons No.of Alertin evices No.of Waste Dis o rs Heat Pu Number Tons KW No.of Self- ntained p Tot s: Detection/Aerting Devices No.of Dishwas Space/Area Heating KW Local Municipal ❑ Other Connection No.of Dry s Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of W ter KW No.of No.of Data Wiring: Heaters Signs Ballasts I No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors > Total HP/ Telecommunications Wiring: / �i No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 coverW is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 41--� (When required by municipal policy.) Work to Start: - Inspections to be requested in accordance with MEC Rule 10,and upon completion. certify,under the pat s and penalties ofperjury, that the information on th' a lication is true and complete. FIRM NAME: LIC.NO.: Licensee: eZ Signature LIC. O (If applicable, e " e 'mpt- the license numPxx- ue� Bus.Tel.No.l2-;;';i (S,57 G�7y� Address: C `�' .� 72- �//�S' �� /4 4 5 /21L Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signatur �/ U Telephone Na. PERMIT FEE: $ 'I S��G o� �- z�� , ���