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HomeMy WebLinkAboutMiscellaneous - 151 PRESCOTT STREET 4/30/2018 151 PRESCOTT STREET 210/092.0-0001-0000.0 Date..:t 101!x.......... 11082 fir TOWN TOWN OF NORTH ANDOVER 03?• `` •• OOp * PERMIT FOR PLUMBING 8s,�cNuss This certifies that.............�:J�� .1........... ........e...................................... has permission to perform.....1... ....................... R ........................ plumbing in the/buildings o!f.. ✓ � ..........................................................{ at........A:�'A...:....V... ......te'o Com�....s .:..................... North Andover, Mass. Fee..:?Q...—..Lic. No.�`:aD...l..... PLUMBING INSPECTOR Check# J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I MA DATEPERMIT# JOBSITE ADDRESS OWNER'S NAME 0-1 POWNER ADDRESS TEL=_ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: RENOVATIONAV REPLACEMENT:Q PLANS SUBMITTED: YES Q N015f FIXTURES 1 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM -.__A _ f __.__ _ f I _ -J DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER ! .� __._-.j ---.i ____E _ — ._-.- -----J.. _._-1 __..._1 ___._.; ; ---_-._f DRINKING FOUNTAIN I .-__-- __..- I _. ..-.._..--� -__-__f __-..._� __ ( _--__--I FOOD DISPOSER -J ( FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I J _� .—I ! _ E J _ f . [ ._-i LAVATORY ROOF DRAIN. SHOWER STALL ! .___. __. _ _! ; ; ._. ..1 _ ( � ( _ 4 SERVICE/MOP SINK i ____ l ..�._ l ___ _ _`__! �_� ____� _� __.._�...._ ___1 .__._! ___ l ► TOILET - URINAL I 1 1 1 � --------_l= WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES5ZNO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT 1 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 IMPy JPDI CORPORATION #L�PARTNERSHIPQ# LLC © COMPANY NAME -} i ADDRESS CITY x� 1„ �1� -_ STATE A ZIP { _ TEL >t FAX ]CELL Iasi EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY F AL SPECT !ON NOTES Yes No �S THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES y 5 -n LI Date......... .1.1.4e.1.1... ......................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s`SAC4T.0 $4u Thiscertifies that ............................................... ................................ ..................... has permission for gas iitallation ....V&A- ..... 1V\......... f ee, in the buildings of .................... ................................................................ 5 Ri ... at...... .....1................... ... .... .... .......... ...... .. t......., North Andover, Mass. A Fee..!;RP..".'.... Lic. No. .... .................................................................... GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ D. _ I MA DATE 1L ?o ERMIT# lT JOBSITE ADDRESS , LdC OWNER'S NAME G *- OWNER ADDRESS TEL — FAX TYF�E OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES[-._J NO APPLIANCES 7 FLOORS, BSP 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER Z:j L . _.ZQEQEQ_ . I L: .EQ ZQ -.1_ 1 BOOSTER ED__ __. :j ED CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 - GENERATOR GRILLE INFRARED HEATER --- LABORATORY COCKS MAKEUP AIR UNIT -� _. _. _ � -_ - _. �_.,.( _ I OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TESTUNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER _........... q ........................._........ - - -� - - - �- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JVNO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' OTHER TYPE INDEMNITY © BOND FjI OWNER'S INSURANCE WAIVER:I am aware that the I' en'ee 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 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. PLUM BER-GASFITTER NAME LICENSE# I SIGNATURE MP MGF Ej JP 0 JGF LPGI 0 CORPORATION # PARTNERSHIP®# LLC®#= COMPANY NAME: _ JJADDRESSLVa 2nz CITY _� STATE®ZIP 0( TEL MV FAX CELL ]EMAIL EMAIL ROUGH GAS INSPECTION NOTES %HIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i A r ry _ The Commonwealth of Massachusetts - .l Department of Industrial Accidents Office of Investigations 600 Washington Street .0 IN 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: 7 City/State/Zip: A t4,8 VW1,- KA Phone#: 97 • L/70 ► )79 Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. E]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. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g El Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11, lumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 1 Roof repairs insurance required.] employees.[No workers' q �� 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. -Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lain an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:6V_W&o Policy#or Self-ins.Lie.#: W AU-V_, -6-;,1008 Expiration Date: <<61 Job Site Address: _ PAI&scAstt` City/StateMix.W. ►ylll�l�K. 0 ��� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). i 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 wellas 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. Ido hereby certify under thepainsand penalties ofperjury that the information provided above is true and correct. - Sinature: �+_2�/���At.[.[.� * Date: �t L G, 2vi Phone#: 47Y lets ► Zo ty 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#: Information and Instructions �• Y Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employe Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• 4. 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 co4act 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,'telephone and fax number: The Commonwealth of Massachusetts Department ofladustriat.Accidents Office of Investigations 600 Washington Street Boston?M,A.02111 `QL 4 617-727-4900 ext 406 or 1-877«MASSAFB Revised 5-26-05 Fax 0 617-727.7749 www.mass,govfdza i J � x V::COMMONWEALTH OF MASSACHUSETTS. .<.:.< BOARD.OE' PLUMBERS "A''D G'AS.F,I.TT.ERS< ISSUES THE FOLLOWING LICENSE i L I CENSE'D AS AMASTER PL BE•R `.'1 i ROBERT B BLANCHETTE %1 of b y PO BOX'7 2 ' NORTH ANDOVER: MA 01845-0728^ 09923 5 Y 5 Date... . /. : .. ........ "ORT" pf �.ao ,°1'40 or °` a° AL TOWN OF NORTH ANDOV • X PERMIT FOR GAS IN TAI.LrATION 1SSACNUSES This certifies that . . .�� �i. a?. . . .��.c.c .��. . .� �j. . . . . . . . . . . . . has permission for gas installation . . . . . A}!r . . . . . . . . . . . in the buildings of . . ./Z// ex/ ! n.�. ,n . . . . . . . . . . . . . . . . . . . . . . . . at' North Andover, Mass. Fee. . . a. r Lic. No..5-V:7 !. . . . . . . L . . . . . . �AS INSPECTOR J Check# "T v a c Date..5 I-z ...................��..................... ,-40R 0 7- TOWN OF NORTH ANDOVER --ofts, PERMIT FOR GAS INSTALLATION Hu Thisicertifies that l..,C.(7.�q..........gry ............................................ has permission for gas ivstallation ...0.4 4..... ......... in the buildin-gs 4 C of ..............M Ar-j . ................................................................................. .......T at..... ........................................................................................... North Andover, Mass. Feel�........ Lic. No. ..... MA...................................................... GASINSPECTOR Check# 0 : .9.91 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATES y F 5 I PE.R,MIT#lb4 VJ JOBSITE ADDRESS r es F6 s i OWNER'S NAME GOWNER ADDRESS TEr ]F TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL p�T RESIDENTIAL CLEARLY NEW:[Q RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES© NO APPLIANCES 7 FLOORS--� BSM 1 2 3 4 5 6 7 8 9 10 11 1112 13 14 BOILER BOOSTER [-- CONVERSION BURNER COOK STOVE �� T DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR �— GRILLE INFRARED HEATER LAB ORATORY COCKS _ ( MAKEUP AIR UNIT OVEN POOL HEATER I ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER IM 2T P2 ore o INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WO ®' I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY ® BOND F 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 the best o no e and that all plumbing work and Installations performed under the permit issued for this application will be in compiianc ertin t n of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ��v� ,(-Oct£ LICENSE# SIGN R -MP�MGF© JP ® JGF© LPGI® CORPORATION 3:=tot PARTNERSHIP®# LLC COMPANY NAME: ee 8ro4 $Eic v Ce ADDRESS — CITY e�-� _ ` STATE' ZIP Z ( Z?- ftEl- (7/ FAX —� CELL QR EMAILGro e o eeNe YIV, z COMMONWEALTH OF ' • • MASSAC • • . , HUS TTS•. PLUMBER..' ISSUESSFITTERS THt' FOLLOWING.' La CENSE -- LICESEp AS q MASTER p DA G VI LUMBER.... ARFI �4 21 WILLr u OW ST r Q y BROCKTON 1564 MA 0230 05/01/16 226442 COMMONWEALTH OF MASSACHUSETTS IRIS • • . • • gpARD OF. PLUMBERS;:ANtl GASFJTTE�RS' ! ISSUES THE FOLLOWING 'LI CENSE,.: > 1w REGISTERED AS A .P.LIJMBI CORP �sI DAVID D W GARF I ELD i:EENEY BROTHERS SERVICE, C +►1 r eo:.r.•,r J Z 21 WILLOW ST BROCKTON MA 02301 ` 36T9 05/01/1.6 221413 o. oo MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING citylTown: No . Amo iget . —,MA., Date: �'aNo 34.2 1 Permit# Q Building Location: Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional❑ Residential ❑ New: [] Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES N 4 At o y z y M. �. C1' N F- y z F- . :b w w tiC O . Z F- w ui o_ I— 2 t�I). W m � W _ — IY � rn .tJ , Z W W 0 N. 0 LL. F. . W W Z = W .O W tL� W W f1f. N = Z° la W J ..~ ~ m w o z O ~ > Z W N H �, Z' H _ > . O O w z z W t- IL SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOG 6 FLOOR 7 FLOOR en FLOOD CheckOne,t ly Gerfflcate# Installing Company Name: mt-11'i'lM �.1C_. PLt.wr3fN 4 AU- �1—r- — - co..rporatlian .. Address: City/Town: P- State: _ ❑partnershtp Business Tel: 'q7g. 47Da 1723 Fax: tf-70 •/5921 :❑firm/Company Name of Licensed Plumber/Gas Fitter: trP INSURANCE COVERAGE: I have a current llablilty insurance policy or its substantial equivalent-which meets the requirerrients..of MGL.Ch.142 Ye 171 171 If you have checked Yes:please indicate the type of coverage by checking.the appropriate:hox boto.w. A liability In policy Other type of indemnity ❑ i3rid. OWNER'S INSURANCE WAI R:I.am aware.that the licensee es= donot,have the Insurance cpverage required by chapter 142.of the Massachusetts-General.Laws,and that my signature or'rthis periflit application waives this i�equhsment, Check Uhe only Owner ❑ Agent p SI nature of Owner.or owner's A ent By checking this box ;1 hereby certify hat:all ofthe details'and-Informatlon l have:submitted(orenteredflegarding this application are true and accurate to the best of my Knowledge and that:all plumblh'�g$work and installations performedunder the-pormit isgupd,for this application will be in compliance with all Pertinent-provision of.the:Massachusetts State Plumbing Code and Chapter M of the General Laws, Type of Lieeiise: By lumber Tine Gas Fitter Slinature of Licensed Plumbers/Gas l=itter Master City/Town Journeyman License Number: 8S of 7 APPROVED OFFICE USE ONLY) ❑LP Installer Date...... .:......`....: t NORTN 1 "�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA US C ilJ This certifies that ........................................75.?.i,6..r9...�.f.:eg�:o..................... has permission to perform ......?�5 11.�5.!4/.. A� .. el.7............... wiringin the building of................................................................................... at......../.-s..7.../.......... 5.ems.l-T ................... ,North Andover,Mass. Fee....R .. ' Lic.No.1;27f U. ........... 1 /� / f ELECTRICAL INSPECTOR Y Check # Qqj 32gR .: 9 6 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Ll e. Occupancy and Fee Checked kJ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] 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 FORMATION) Date: " 7-ay -,0 ,6 City or Town of: JJ IQ n "r 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 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building�, �k 1�a.�L Utility Authorization No. Existing Service '206 Amps / 4,WiVolts Overhead [e' Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 3 Location and Nature of Proposed Electrical Work: Completion of the followin table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo.of Ceil.-Susp.(Paddle)Fans No.of Total (3 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. El Batter Units No.of Receptacle Outlets t 7 No.of Oil Burners FIRE ALARMS [No- f Zones 1' No.o Detection an No.of Switches ( No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.ofSelf-Contained Totals: I'll, Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.o No.o Heaters Kms' Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 0 No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value f Electrical Work: s(rU 0.or) (When required by municipal policy.) Work to Start: 7-20-0G 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 pe it issuing office. CHECK ONE: INSURANCE [� BOND E] OTHER F] (Specify:) . T17. I certify,under the pains and enalties of, erjury,that the information o r ppli in is true and complete. FIRM NAME: fie% LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, enter+'exempt" fn the,license number line Bus.Tel. No.•`JZr dY.G Address: 1V e, J4 Alt.Tel. No.: t2Z 34Z.,? *Security System Contractor Licenser uired for this work; C applicable,enter the license number here: 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 PERMIT FEE: $ Signature Telephone No. 4 ' r Date/4 Date,l,?� .� .... .. 40RTH Of o TOWN OF NORTH ANDOVER M a PERMIT F R GAS INSTALLATION 5 MUSESS 4 This certifies that . .N �. . .1�'?4:5. . S ' . . . . . .� . . . . . . . . . . . has permission for gas installation r�./! T. .� :J.-. . . . . . . . . in the buildings of at . .�.�?.4!A'-J.llr4e?741?!':! . . . . . . . . . .. North Andover,(Mass. Fee Lic. No 6.3 3 V . . . . . . . . . . . . . . . . . . . . . . .. . . . GAS INSPECTOR Check# 5828 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING c� (Type or print) Date NORTH ANDOVER, MASSACHUSETTS ` Building Locations \5 �C �`'s�-� �� Permit# J L Amount$ �(� z Owner's NameC G.� �C'(1G�a Ne"�E] Renovation D Replacement D Plans Submitted Y Z F iY C7 a a O U F S i z z p H O O a > W a� Z Q 7." C4. a 94 2 -e > -< F- t 'A d m z O Z a O x x x o z 3 c t7 o a > o a0 H o 1 SUB-BASEM ENT BASEM ENT IST. F L O O R 2ND . FLOGR 3RD . FLOOR 4 T H . F L O G R 5 T H . F L O O R 1� 6TH . FLOG R 7 T H . F L O O R 18T H . F L O O R (Print or type) c� `• eck one: Certificate Installing Company Name—- C4��`��� �C�SS�tI.�S �rC,- Corp. 0\q Add ress�a� ,cZb � Partner. Ccs O�q D Business Te ep one -) -11y_--���� D Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Che c one: I have a current liability[ surance policy or it's substantial equivalent. Yes NoO If you have checked Les,p se indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond D 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 D 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 Ma tts State s Co d Ch er 142 of the General Laws. By: Signature of Lice Plum r Or Gas Fitter Title � Plumber `?>'�35 City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman I Date. . . . . . ..�1` NOft TM pf 3 TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION SACMUSES This certifies that ` '^•`-'. . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . Y. at North Andover, Mass. Fee , Lic. . . . . . . . . GAS INSPECT R Check# 5719 ,VIA%Aa1 SEM UNDDRIN1 APPUCATON FOR PERM TO DO GAS HrMG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations S � � � ��� Permit# Q 611 Amount$ LD Owner's Name P ANGI~ New❑ Renovation E� Replacement ❑ Plans Submitted ❑ Oz �" rA x F a w a z 7 o F cnpG C7 C7 F z E~ Z z C ; WCC C x O O W a O W F O x w O A C7 a U a > A a F O SUB -BA SEMEN T BASEMENT 1ST. FLOOR 2ND . F L O O R 3RD . F L O O R 4 T 11 . F L O O R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR 1: (Print or type) Check one: Certificate Installing Company Name NA 10 S'i EIET P 4 4 Corp. Address )0Z k�'41 M ST l 1.1� ,nnt<i 41;L2 Partner. ❑ Misiness Telephone c 7S 4259,-c 2 Firm/Co. :-Tame of Licensed Plumber or Gas Fitter '}�,\� I t 1poa 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑i Other type of indemnity 13 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 aree true and accurate to the best of my knowledge and that all plumbing work and installations performed under Perinit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Co Chapter 142 of the General Laws. BY: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber City/Town ❑ Gas Fitter License Number ® Master APPROVED(OFFICE USE ONLY) Journeyman ❑ Date. . . . . . . . . . . . . ".0 RT:'� TOWN OF NORTH ANDOVER -'•-�•O0 ' PERMIT FOR PLUMBING SACMUS� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . ... . . . . ..... . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . ... . . . . .Lic. No.. . . . . . . . . . . . . . . . . :. . . . .... . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location 5/ 1165CCEt A) Owners Name Date �'ii�N6G Permit Amount 4/i, SV Type of Occupancy New Renovation MV M1 Replacement1:1 Plans Submitted Yes ❑ No ❑ FIXTURES z F W W Z r = U 6 Si�B�IC � IIA93U I' ISI:FLOOR M FUXR 31 111" M FMM SM FL" t 67H FLOOR 71H FUM SIH FLOCK (Print or type) �� Check one: Certificate �1 Installing Company NameAI M S�`� lk ® Corp. Address _-P1 CENTZAL St lf„Zt Partner. 2 Business Telephone 3- Fi rm/Co. Name of Licensed Plumber: S'k) Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ insurance Waiver: I, the undersigned,have been made aware that the licensee of this application docs not have anone of the above three insurance y Jognature Owner ❑ Agent ❑ I hereby certify that:ill ;f the details and information 1 have submitted(.or entered) in above;application:ire true and accurate to the t,cst of my hnowic:ilgC and that atl plumbing work and installations perfumied under Permit issued 10r this application will he in compliance with all (pertinent provisions of the Massachusctts State Pl ing Code and Chapter 14 2 of the General Laws. By: 3 ugna ure(A LICEIT,7=9471-515-7 Title . Type of Plumbing License y X32. Cit ,Town )✓1�ccnse i uni cr 'vlaster APPROVED iOFFiCE USE ONLY El Iournc;-man Location '. No. �? s� Date01 MORTH TOWN OF NORTH ANDOVER ~ 9 ` Certificate of Occupancy $ • i �'�s'•"°'E<� Building/Frame Permit Fee $ AC Mus Foundation Permit Fee $ g Other Permit Fee $ TOTAL Check # C� Building InspIf6,tor k TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT 8EEAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: Cq— DATE ISSUED: m SIGNATURE: Building Commissioner/12sfor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O /moi PR�s��- syr qp, IS Map Number Parcel N tuber D , /�1l� bf1 LIQ � 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use LA Area Frontage ft I� 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RegWred Provide Required Provided RegWred Provided v 1.7 Water Supply M.G.L.C.40.6) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private 0 ZOIIe Outside blood Zone 0 Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT "« rn 2.1 Owner of Record T E.D F-6=&] f47,- A16 A N©a U M Name(Print) Address for Service I Signature Telephone Q 2.2 Owner of Record: N ame Print Address for Service: O Z rn nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 License Number dry M Address > Expiration Date a Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v DAVID CAsTRI c4APrz RE6r r 4 c f s 2 Company Name rn Is IXT TbA / ,L S EV-17-F—F— ��L Registration Number r ss r- 2 �� 1�� z -3 Expiration Date ^ Signature Telephone Y, w SECTION 4-WORKERS COMPENSATION(XG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......0 No.......0 SECTION S Description of Proposed Work click applicable) New Construction ❑ Existing Building fr Repair(s) 0 Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee 9 b Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC f- 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 d I, as Oxvner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, I A V 11P CA STR I C.p Al F_ as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ` PAV Sr ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TUABERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE COJR& GERTIFIG TE OF LIABILITY INSURANCE DATE(MMObNYYY 0 /22/2004 PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION Internet Insurance Agency ONLY AND OONFFP3 NO RIGHTS UPON THE,CERTIFICATE 522 Chickerin Road I HOLDER,THIS CERTIFICATE Dorms NOT AMEND,GXTTiND OR g I ALTER THE COVERAGE AFFORDED INY THE POLICIES BELOW. North Andover,MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: NORFOLK AND DEDHAM DAVID CASTRICONE m:suReR L:; NORFOLK ri.DEDHAM. ROOFING AND SIDING INC, INSQRERC: ROYAL BUN ALLIANCE 200 SUTTON STREET,STE,226 i INSURER D: NORTH ANDOVER,MA 011345 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE 89 13SLIED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED:NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONT CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH PCILICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN R DUCED BY PAID CLAIMS. MUK LTR IN TYPE OF INSURANCEPOLI Y NUMBER LIMITS A GONERAL LIABILITY 804007$ A 05/0612004 06/08/2005 EAcH ocCuRRFNc` i Loao,cpD,aD .f COMMERCIAL GENERAL LIABILITY PR nea 6 50,DOD.00 CLAIMS MADE OCCUR MED EXP Aiy one paraon} ;,5,000.00 PERSONAL&AOV INJURY $1.00D,ODD.00 �,ENERALAG�REGATfn g•1,OOD,000,00 t3EN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMPlOP AGG 11 1,000,OOOAO POLICY kOJECT LOC B AUTOMOSIL11 LIABILITY 4450840q001 08/01/2004 08/01/2005i�q MBINED SINGLE LIMIT' S ANY AUTO I Lh9 aodticnt) ALL OWNEDAVTQ$ I gpDILY IN URY 230,000.hO SCHEOUL6D AVTOS (Por pervun HIRED AUTOS BODILY V�URY 5 50o.o0C.OD NO"%VNFPAVTCS (PuaoW ent)', I (PPe0eooRAMAGF 8.400.000.00 GARAGE LIABILITY AUTO ONLY•EA ACCIDENT 8 ANY AUTO ��}}{ ��HHpp CA ACC AUTO�NLYN AGG Q EXC56GIUMMLLA LIABILITY EACH OCCURRENCE 8 OCCUR 7 CLAIMS MADE A93REGATE i - f DGDUCTIRLE g RETENTION EMPP OW.MPEBH$A'f10N ANO 791 X978 01 09/23/2004 09/23!2005 TnRr Llan ANY FROPRIETORIPAMNERJEXEiCUTNE E.L.EAC t1AOCIDENT 6100,000.00 OFFICERlMEMMK EXC�LLIDCD? Eb.OISEASE•FAEMPLOYE: 8 600,000.00 I1,+es IAL PROVISIONS under E;L.OIBF.ASE.POLICY LIMIT i $PE de PROVISIONS below 100,000A0 OTHER ROOFING AND SIDING. r CERTIFICATE HOLDER CANCELLATION SMUL.DANY OF THE ABOVE=0105E0 POLICIES LSE OANOELLMD OW-ONS THE EXPIRATION DATE THEREOF,TNM 1SCUING NSURCR HALL WCKAVORTO&WL OSO DAYS WRTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FNLUR!TO DO 30 3HALL IMPOSE NO OBLIOATIOr10R LIABLVIY OF ANY KIND UPON T1161NSURER ITS AORNTS OR REPRESENTATIVES. AUTHORBED REPRESENTATIVE i • AGOR02I�(SQ011Q8) ® ., RD;CORr'ORATlON.1988, Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 104569 Expiration: 7%14/2006 Type: Private Corporation DAVID CASTRICO.NE ROORNG,ZSIDING& David Castricone , 7 Hillside Road BWord,MA 01921 Administrator i NORTH Town of 4Andover No. ' LA dover, Mass., I� COCMICMEWICK y1. 7� ORATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 7 Prd ............... ....................................�..................................... ............................... .................. ........ Foundation has permission.to erect. V�N � /........ buildings on .. �� rr r* #-7 Roush . ...... .............. ................ ........................... p P .. y to be occupied as.......S.�.�t N.�........w.......`.......... ..� ..�A.� ...........w t ti�O,f�I � Chimney provided that the person accepting 4 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Roush PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N STARTS Rough A.. .... Service . ...... .... ............... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner � street No. r SEE REVERSE SIDE Smoke Det. i i r Date. i a? „O DT e�tiTOWN OF NORTH ANDOVER p yL PERMIT FOR GAS INSTALLATION j ,SSACHUSEt This certifies that . . .�?� <<: .: ��zi'. :. . . . . . . . . . . . . . . . . . . . I i has permission for gas installation . . .I.!.. t-1� . . . . . . . . . . . . . . . . . . . 1 in the buildings of . . . . :.! Ze .<� . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .(I .). .`. %.'t?::b.�. .f.:. . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . .: . . Lic. No..: .%::r.?. . . . . . . 05/27/99 14;53 25.00 pAjfAS INSPECTOR WHITE:Applicant CANARY:Building Deft. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date 19 //Permit # Building Location •.Sod Owner's Namwgrs ✓V �'JY/ I/'P� Type of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ y y W N Y Z ¢ y y y V ¢ � S y ¢ rn ¢ O y = t— O m S 9q W J W FW- < �• Z Z p } ¢ Z p W < ¢ ¢ O O ,O 2 < m y F O d ¢ s ¢ < WCUJ Wh W Z <W Q to W < ¢ O H = G7 }- Z J F- Z �. W W O O > W }W- WA ¢ Z < W < ¢ Z 0 Z ¢ O #14 S < W >• ¢ W O Z. < ¢ < < O O W O �1 H ¢ s O tl = W O O 0 J 0 ¢ > o o. H O SUB-BSMT. BASEMENT I ST FLOOR Alla 2ND FLOOR 3RD FLOOR i1 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR Installing Company Name 'lie--A►=9 T A . `Affi mA T 0&' Check one: Certificate Address 3 000 C N 1v1 F?fy Lr 1. ❑ Corporation ME 7 H U e fJ 01 rl 0 I.?q ❑ Partnership Business Telephone &�9 -5 9"7 ( 2-'Mrm/Co. Name of Licensed Plumber or Gas Fitter -f 0 jjE ie T A- 5 A M m tATA i-) INSURANCE COVERAGE: I have a current (}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes lid' No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy ' ttY � Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 C1 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 the pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of laws. By T of License: C� Plumber n ure of n u _. or otter Title - Iter er - License Number 8333 City/Town Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING I NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE - 19 i GAS INSPECTOR i