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HomeMy WebLinkAboutMiscellaneous - 152 GREENE STREET 4/30/2018 152 GREENE STREET 210/033.0-0050-0000.0 Date L1.2.4 kH...... 1 tJ , ) oF'.'�RT"'tio TOWN OF NORTH ANDOVER * PERMIT FOR PLUMBING . 8`4�cHUBE ..... This certifies that..... .. . `, .... �:.. .. .......................... .................................. has permission to perform...........��, .: ... .�-'. .r�r.�. . ......................... plumbing in the buildings of..... !n^, .....................................I......................... at.....1. .. ....... p.P :....5. ..:....... ................ North Andover, Mass. Fee Lic. No. 1I.5.9.... PLUMBING INSPECTOR Check# < MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY J MA DATE ( PERMIT# JOBSITE ADDRESS S ef17, OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIO RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:© REPLACEMENT: PLANS SUBMITTED: YES© NODI FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM I _1 _ _J J � __1 —_J _-. I DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I __..__.J _._._._J .! J .__. -1 __J DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER I - - FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) __ ( ___-__i .___ J ___._ i ___.J .__1 _____I KITCHEN SINK - -I --! -- -----I ---! -----I - - I __ I -- __JI ---J --- J LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL I .._._i __J _._-_! I== ____J _._-1 ------ ____ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ! I 1 I I __J WATER PIPING ......J .. ___I F __I INSURANCE COVERAGE: / 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESD-No b IF YOU CHECKED YES,PLEASE INDICATE THE TYPE 0:COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY DI BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q 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 po5pn of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S AME (LICENSE# �I SIGN UR MP _ JP© CORPORATIONM#M�p PARTNERSHIP 0# LLC COMPANY NAME ADDRESS CITY (STATErJ ZIP TEL J ' FAX ( CELL Jfj�7S.�� EMAIL _..------- ------._---- ----- . _ .._ __..---- -- -- - - I.. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY / FINAL INSPECTION NOTES OF G Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Invesfigations kvi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual).� A-14 e�/-- 77;�_t�� Address:/ zn/� SD City/State/Zip: y/1G S SU�y y�r C, �l Phone#: Are you an.employer?Check the appropriate box: Type of project(required): 1.U,I�a employer with_ h 4. ❑ I am a general contractor and I 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] T am a sole proprietor or artner- p P P listed on the attached sheet. Remodeling a ship and'have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers'comp.insurance. p 9. El Building addition [No workers' comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.]t employees. [No workers' 13.El Other comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T'Homeowners who submit this affidavit indicating they ai-e doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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 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 under the pains a enalties ofperjury that the information provided above is true and correct Sip-nature: Date: �F Phone#• Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone 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 carry workers'compensation insurance. If anLLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 CoMoonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston,MA.02111 Tel,#61,7-727-4900 ext 4 06 or 1-�77�MA _ SS.Ak'E _ Revised 5-26-05 Fax#617-727;7749 �vww.znass,govfdla. COMMONWEALTH OF MASSACHUSETTS LICENSED AS A_MASTER PLUMBER ISSUES THE A60VE LICENSE T0: /,•� 1J. ! SCOTT R TAFT ,1 a 12 LARSON AVE , TYNGSBORO�� MA�01879- 1121 11579 05%01/14 142840 �� Date..."`1.2....... . ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU This certifies that ...... .......�.4Gtnj..................................... .......................... has permission to perform, 4 AmL-,3 v-, ................................................................................................. wiring in the building of......�.V16le............................................................................ at ]" Z ..................... orth Andover,Mass. ...). ........... ........... Fee..�........ .....Lic. No? .... .... ........ ... ....... N ELE ICAL SPEMR ChOk# 12135 (�P -�`� 1��1 (f.nlnlanrUOa LU1 a/Mallac/irUcttt Oficiall Usq,,Only I _ 2','a,•lment o� iro Sory ced PertniENo. iii Occupancy and Fee Checked. BOARD OF FIRE PREVENTION REGULATIONS rRev.1 071 (leave blank) APPUCAT8ON FOR PERMIT TO PERFORM ELECTRICAL WORM All woilc to be performed in accordance with the Massochusetts Electrical Code(MEC),537 C1vrR 13.00 (PLEASE'PRFJVTJNflV `ORTIIP�EALL�ORALJTT0 Date: �-tb Z� 2OA City or Town of: 1 g-kiv— To the It7spectol-of fit•es: By this application the undersigned gives notice of his or her intention to perform the electrical tivork described below, Locntion (Street& Number) 152. Gmt\ STIP' Owner or Tenant �A< Telephone No.��c(�1��1Z Owner's Address X.C5 Z � Is this permit iu.conjuncti``on with a building permit? - Yes No El (Cliecic ApproprinteBox) S Purpose orBuilding `y0Mt�_ Utility Authorization No. Bristing5ervicekDO Amps (?,0 / zdValts Over hctd Undgrd ❑ No.of Meters ^ New Service .Amps / Volts Overhend ❑ Undgrd ❑ NO. OlMeters Number ofFeeders and Ampacity Locntion and Nature of Proposed Electrical Wor•lc Com lelion of the fb1loivinq fable malr be warred by the Inspector of f• No. afRecessad Luminnires 4�-k No.afCeil.­Susp.(P:iddia)Fn ns No. of Total Transformers ItVA r No. of LuminnireOutlets No. oft lotTubs Generntors ICVA i Above In- 114a.o �mergencyLig ting No. ofLgminnires 75 Swim Ming ernd. 0 arnd. ElBnttc Units rj No.of Recepincle Outlets (Z. No.of Oil Burners ALARMS No.of Zones Jr No.ofSrvitchasNo,of Gas Burners No.ofDetection and InitintinE Devices No. orRnnges t No. arAircond. Tons Tobl No.of Alerting Devices No. of Waste Disposers 1 BeatPump Number ITons I CV_V No.of Sell'-Contained Toinls: Detection/Alertine.Devices No.afDislrtivas{tars 5 ace/Area Rantin 1t=W Loyal❑ Municipal p' g Connection ©Alter llentin A lances Secul•ity Systems:= Na.ofDryers g pp ]CIN No.ofDevices or]; uivnlent Na.of Wnter Itl� No.of No. of Dota Wiring: ] Heaters H n l l as is Signs No.of DevicesarT; u' e tv�l nt No.Hydramassnge Bathtubs No. of Motors Total ITP Telecommunications Wiring: T Na.afDevices or'r uivnlent 1 07RER: 5• �_��p�C� AUloch additional detail fdesired, or as required by the Inspector Jr Estimated Valu;�=Lk Ln Work: (When required by municipal policy.) r4 Work to Start Inspections to be requested in accordance with NBC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance ofelectriml Nvork may issue u the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalenL 'I undersigned certifies that such coverage is in force,and itas exhibited proof ofsame to the permit issuing office. CHECKONE' fNSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cerlI&,rtiltler the pnius antl j)enties ofperjriry, tal lite itrforntulion air hits applicnliorr is-trite raid coniplettw - FIRM NAME: q 011 LIC.NO.: LicenseSignature I_.3C.NO_:A7_�RSL(- (Ifapplicable,enier "es pt' in I lirensep berlipeJ u5.Tel.No : .- Address �-� �F . t�a�ty` 1"`�">� v` jt� • AlL Tcl. No.I� �Z *PerIvI.G.L.c. 147,s,57-61,secu `ty work requires Department of Public Safety"S"License: Lic.No_ OWNER'S INSURANCE WAIVER: I am aware tint the Licensee does not have the liability insurance cover-age norm: required by law: By my signature below,I hereby waive this requirement_ I am the(circle one)❑ owner ❑owner's.T -0N ner/Agent Signature Telephone No. PERI 17T FES:�-r' F t����•1+'. hi 4 7 ��'^•' yl 1V.[ASSACHUSETTS BELOW FOR OFFICE USE ONLY PLAN RMEW NOTES ELECTRICAL INSPECTION NOTES ELECTRICAL INSPECTION NOTES FEE: PERMIT# RDUGH FINAL 1 INV" !,n7lc)rr))jr:frr✓rjp r7?r fU'ftid"1!grjjlj'�ilp r iir�•llJygl-1^rl ttil '!1✓:p 1rj�, �Ji1 1 r N�. 1 jllf f1 J nu,l I r•. r r �+�t�(flrl(/rl/rr11r,1/li�t: ...1�Ni7i�er/r�N. i! '1 r 11lI ! 'r! 1kr: 'il(1Jpih rJui:j/r„port 1 tlli(r! (+ • r 7j'ur 1(14��i(G!�'r/.I�ifs; r1 r Ira. 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M a I� ..ice• � d�I�'j � � �PG �--� �� \ � � 2� � �' O��tti'� � \ � I • W W E7rs_^ j` ti WLL LA z M Q` • IQ W yyI. O� o�+sem I W C9 w WOx] W s I � � � � `f' � I .t w� ,m>t ti t C��, ,tit\C`\l \�'•`\ '"� ► a, `� I I � • ,,�;t\�`,�,1 y�; \�.\, .i\�1I"1\�,�i�"11�1 :�LL � � 1 ,, t:����'��11��}:!�',��li 1 '�I� - r� t • '(rrI���rrCC • .C:Y, r,,r/1./i.;:�,T+r /�G lf, r J r ; r rn t , �hl•�.•,r err 'r(J/lllIr������( h{✓nr;lI1�.It7 r. 1 ;ulji,,lie��r�.r ra J r I {Ey(� s I�jlf 111 .�]t/� +i,li I ` i 11t l ',. -��. ,�1� 1 i�1 1,l.li�i � �S;I+{!j'�l"��V!r I�r�i f'r ii: I 1MI•t , \1�t\,t�ll�; ���;n� \t�j�`t,. �5 I tt. . ii t t: ,t t: I �, rr s• , 1 r ; ,`�,,• ,a•1�,'' r ,'�t;..,�` ��1 � t l rii � t,,i ,i I I'r ! I i i 1 i� i ���i'1 i i`i� �ti`• � �` '11 ;i ,;1;I , ,I !. tl!,�I1 ,.tl� yII)►�t111) !i1� I •i r�1. 1 ;1 I 1 ! t 1; r, �• ,� �, ,,,. rri r I Ir�''l!;I�r�+i1 r11!,�11,}iy I!. jly{� I l � ,I ,r 1�11.r/!� �1�,���;;�i!I 1 1,- .���11•�r�� t ,, lay", r,,r;tr I rr��,lrr,t!.1lJl,,tr�.><�lil;r�llr =t1trr7lr�,r��Ifr�I,:r�.1rl��rl�. � — f Division of Professional Licensure: License Search Page l of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... LICENSEE Name: RICHARD J. BEAUSOLEIL REFERENCES& Business: RICHARD BEAUSOLEIL EL CONTRACTORS RELATED INFO LOWELL,MA Disclaimer Regarding NEW SEARCH i Website License Searches "This Licensee has additional Licenses,click here to view them." Enforcement Process Glossary Licensing Board: ELECTRICIANS Glossary of License Status Codes License Type: MASTER ELECTRICIAN TYPE CLASS:A More... License Number: 7554 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 6/24/1974 Exam Date: 6/4/1974 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday,February 25,2014 at 7:26:51 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board_code=EL&type class=_A&li... 2/25/2014 ALDEN WEBSTER ASSOCIATES �u�1 ,r3,4�, I S CATES / SOB 7- Structural Engineering Services AJV,Q7-Y4 A„JMoVee� X4A-0--- , 113 North Street LEXINGTON, MASSACHUSETTS 02420 SHEET NO. SC --OF (781) 861-6513 CALCULATED BY ALPV 2'? • DATE M&M rillnm;; erg leis: : I ' i .R 1a- -'t' - - -- ,,St x;44` Az Ae- -- �, as�s9c . --- AL D--N L. tiG' WEBSTER - + - - _ - STRUCTURAL Cn .3102 4 F V' 3 I k 4 — -- — `�c- 1725� 0., 7 4� y txze ACA4•4.0VeR`tiw m rzNt '�P•tc:� ,�(®ccs Pi Lev 41p/ vt � J Date...... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING $S CHUS This certifies that ......... . .............................................................................. has permission to perform ....'A.Vpe"�.a...A&T ..................... wiring in the building of........ Aevf................................................. /�2— e5ZCmAj ............/) at........................................................... North Andover,Mass. - - Fee..,:5.��.77.. Lic.No..7�y*........... Check # 8954 (.omtnnnwra(!�o////al0ach�edeH.! offikal We Only AArC�� Permit No. partment o1 Jtrr services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07 leaveblank C APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance wide the Massachvsctts Electrical de(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE_AL INFORMATION) Date:_ ,(1. 2n City or Town of: R— To the Inspector ojWirea- By this application the undersigned gives noti of his or her Iform the electrical work described below. Location (Street do Number) 15 2- �� tsz22� Owner or Tenant Telephone No. Owner's Address Is this permit in conjun tion with a building permit? .Yes No ❑ (Check Appropriate Boss) Purpose Utility Authorization No. Existing Service 160 Amps (20 /ZOF-�, Volts Overhead 011�­Llndgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Comp/Trion o the follnwin tabla mo be waived b rhe Inr ector o Wirer. No.of Rcceseed Luminaires No.of Ctil.-Susp.(Paddle)Fans No.° oto s Transformers KVA No.of Luminairt Outlets No,of.Hot Tubs Generators k'VA No.of Luminaires Swimming Pool Above ❑ n- o.o mergenc lg ing end. d. � Battery Units No.of Receptacle Outlets �7 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches l No.of Gas Burners o.oVetection an InitiatingDevices No.of Ranges No.of Air Cond. Tone No. No.of Alerting Devices No.of Waste Disposers Hest ump um er ons K o.o Se - ontasn.ed Totals: ._.,......._._.. ......_.,...»,...._...._�...__ Detection/Alertin evlces No.of Dishwashers Space/Area Hosting KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances 1 fir Security Systems: No.of Devices or Equivalent No.o pieror . Data Wiring: Heaters KW o Signs Ballasts No.of Dzevices or E uivslcrit No.Hydromassage Bathtubs No.*of Motors Total TIP relitcommunicationsWiring: oTtrER: No.of Devices or E uivalent Zbtx? 0 o Attach oddirlonal detail if derlred ar as regr.lrcd b), Estimated Value of Electrical Work: I (When required by municipal policy.) rhe/ntpector of Wires Work to Start: s I, ZAO 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.I uranee including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove c is in force,and has exhibited proof of same to the permit issuing office. CN.ECK ONE; INSURANCE BOND ❑ OTHER ❑ (Specify;) 1 certify,under thepa/ns and pcnaltle1r njperjury,that the information nn this appttcation is true and complete. FIRM NAME: I.1C.NO.: Licensee: &-r hard )3ea tl.g o-/et / Signature LIC.N0.• ^�S"S ({/applicable.enter"exempt•'in the 11cenre number line.) Address: 7` LQ we!/, /7Q O/�,�o .Bus.Tel.No.; Alt.Tel.No.: 'Per M.G.L.c. 147,s.57.61,sect my work requires Department of Public Safety"S"License: Llc.-No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage a normally required by low. By my signature below,l hereby waive this requirement.*I am the(check one owner owner's agent. Owner/Agent Signature Telephone No._�__! PERMIT FEE.•5 �� � �� � � � � � }��r ��i � i���/�� �. r �. Date.. °ftNORTM,�O TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING . o ,SSACHUS� This certifies that .��� . . . . has permission to perform plumbing in the buildings of . .M.ltf'. . .,��/?.p�"�"'�. . . . at . . . �12-e�!? . ./`r C .... . . . . . . . , North Andover, (M,asss. Fee.'�`^d �.Lic. No.. . .(.I..l. . t. . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check 7 J7 8178 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location /�-k ("'3 r pp n e- JE mle,Owners Name OVA'!zIff Permit# Amount Type of Occupancy des New Renovation Replacement Plans Submitted Yes No FIXTURES rACA Z Lnw w A w Q w o ,� SIM BE FLOM M 3M HIM 4IH R M sm)FLOCK 6M H-0011 - 7IMOOR SIH)FLOCK (Print or type) Check one: Certificate Installing Company Name �a� Address "r_ nn Ay-e Partner. Business Teleptfone — _ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the ins a coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and acctw4te 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 MassachuseV State Plumbing Coded Chapter 142 of the General Laws. By: lig„aLwc vi Lacenseu rlumoer Title Type of Plumbing License City/Town 9 lcense u Master Journeyman ❑ APPROVED(OFFICE USE ONLY The Commonwea&k of Massachusetts )t Department of Industrial Accidents t ! Office of Investigations 600 N'ashinb pton Street Boston, MA 02111 t? www nwssgov/din . Workers, Compensation Inskrance Affidavit: Builders/Contractors/Electricians/plumbers APPficant Information Please Print Leeibly Name (Business/organiza5on,4ndividual): Address: City/State/Z,ip- !��—fX.L� Phone Are you an employer?Check the appropriate box: 1.Q I am a employer with 4. T�of Project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have mired the sub-contractors 6. Q Now construction 2.0 I am a sole proprietor or partner- listed on the attached sheet.2 7. ❑ Remodeling ship and have no employees These sub-contractors have workingfor me m g• Q Demolition any capacity, workers' comp.insurance. [No workers'comp.tasurance 5. ❑ We are a corporation and its 9' ❑ Building addition 3.Qre9m ] officers have exercised their 1Q•Q Electrical repairs-oradditions I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myseI£[No-workers'comp, e. 152, §1(4),and we have no insurance uired, t 12.❑Roof repairs req ] .employees. [No workers' I3.❑Other COMP, insurance required.] 'Any applieerrt that drecks bo>l+#I must also fill out the section blow showing their workers'compensation policy information. 1 Homeowner;who sohmit this ei}idavil indicating they are doing an work and then hie outside con 4contractors that check this box must attached an additional sheer sho moots mustwbmit a new affidavit indicatiq loch. wing the name of the sub-cortnctots and their workers•weep,policy irfomiation. 1 am an employer that is providurg workers•'compensation insurance for my mrjoyees: Below it the policy acid job stir information. ; Insurance Company Name: Policy#or Self-ins.Lie. #: Expiraion Date: Job Site Address: CitylState2ip. 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 MOL c. 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonment, penalties and of i Y pnsonmertt,as well tis civil penalties in the form of a of up to$250.00 a STOP WORK ORDER day against the violator. Be advised that a copy of this statement may be forty a fine Investigations of the DIA for insurance coverage verification. y forwarded to m of I do hereby certify under the pairs and penalties of perjury that the information pmt7ded above is tragi and eons Si tore: Date: Phone#: r 4f, lcud use o*. Do not write in this area,m be conrkred by city or town offic w City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Tovvn Cleric 4. Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3 oyers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and includirig the legal representatives of a de zased employer,or the r=iver ortnrster of an individual,partnership,association or other legal entity,employing employees. 'iioweverthe ownerof a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empbyer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shag withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'coverage required." Additionally, MGL chapter 152,§25C(7)st$tes"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 coaltract'mg authority." Applicants Please fill out the workers'compensation•affidavit compie✓tely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)aind phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)witb no employees other than the members or partners,arc not requiredto carry workers'compensation insurance. Ifan 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 iicetrse 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' oompensation policy,plem call the Department at the nusa►ber listed below. Self-insured corrpanies—should v++er+hp r self-insurance license cumber on the*appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed hgibly. 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 permiVlicense number which vvilI be used as a reference number. In addition,an agpikInt that must submit multiple permidiicensc applications in any given year,need only submit one affidavit indicating mirrent policy information(if necessary)and under"Job Site Adds-e:ss"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 applicxrit as proof that a valid affidavit is on file for fit= permits or licenses. A new affidavit must be filled out each year. When 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 Industrinal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL# 617-7274900 Ext 406 or 1-877-MASSAFE Revised 5-2645 Fax 74617-727-7749 www.mamgov/dia t 4 ALDEN WEBSTER ASSOCIATES STRUCTURAL ENGINEERING SERVICES 113 NORTH STREET LEXINGTON,MASSACHUSETTS 024241929 781-861-6513 Desjardins Construction LLC August 19,2009 5 Carlisle Lane Pelham.NH 03076 Project: Dunbar Residence 152 Greene Street North Andover,MA Dear Mr. Desjardins, This report letter is to document my findings and recommendations made to Tim Oriole at our site meeting today. The project consists of adding a full shed dormer on the rear of this traditional cape styled home. In framing the new shed dormer,you have installed a new full length ridge beam composed of 2 1 3/4"x 18"LVLs. Although the new ridge beam extends full length of the home(32 feet), you have installed an interior column at one side of the existing stair. Effectively,the new LVL ridge beam has two spans-a 19 foot span and a 13 foot span. Structural computations indicate the new ridge beans is correctly sized and satisfies the requirements of the Massachusetts State Building Code. However, the computations also indicate a substantial new interior column load that requires some column reinforcing. The enclosed Sketch, SK-1, shows our recommended method of reinforcing the existing column and the existing first floor beam. Please call with any questions regarding this report. Sincerely, Of Alden L. Webster P. E. �� cs �' � ALOE10 L. G� WEBSTER STRUCTURAL No. 310 8 9f01 ST E BONA E �`r y �! ' ��� ' � I I Ai '� �' ^� .� 1, ,t ` Y � 7�- gyp,{' / ',' /r� .� ALDEN WEBSTER ASSOCIATES /5-2- /5 2 CRA M ' s ewzr= - Structural Engineering Services --- . ,QD�tI�� A e.4• 113 North Street _ f� LEXINGTON, MASSACHUSETTS 02420 SHEET NO. ��� of �j q (781) 861-6513 CALCULATED BY AinYl/ DATE alldl v r - WEl3STE"— :^ -- — — — — whhlC1 '' �A1C/ �" ��► -- <-? STR[J�TURAI-- I CrI-�"d{J/M ------------ No. '---No. $102 - � I ' FG(STE 1 r i ' ._ �.. .. _•._.. I i ' ' ' I I i ----� -; --- - - ; 11 i : i 1 11 j I : : r � I I V 60. 0 x%A -- ✓lh � D' C1d�JDLA.L j r7ja it ALDEN WEBSTER ASSOCIATES STRUCTURAL ENGINEERING SERVICES 113 NORTH STREET LEXINGTON,MASSACHUSETTS 02420.1929 781-861.6513 Desjardins Construction LLC August 19,2009 5 Carlisle Lane Pelham-IVH 03075 Project: Dunbar Residence 152 Greene Street North Andover.MA Dear Mr. Desjardins, This report letter is to document my findings and recommendations made to Tim Oriole at our site meeting today. The project consists of adding a fwl shed dormer on the rear of this traditional cape styled home. 1n framling the new shed dormer,you have installed a new full length ridge beam composed of 2 1 3/4"x 18"LVLs. Although the new ridge beam extends full length of the home(32 feet), you have installed an interior column at one side of the existing stair. Effectively,the new LVL ridge beam has two spans-a 19 foot span and a 13 foot span. Structural computations indicate the new ridge beam is correctly sized and satisfies the requirements of the Massachusetts State Building Code. However,the computations also indicate a substantial new interior column load that requires some column reinforcing. The enclosed Sketch, Sl{.-1, shows our recommended method of reinforcing the existing column and the existing first floor beam. Please call with any questions regarding this report. Sincerely, l�U tN Of M,trr_ Alden L. Webster P. E. $ "' ALDEN L. WE9STEP SMKTUML #lo_3102 S UL ALDEN WEBSTER ASSOCIATES Jog— Structural Engineering Services 113 North Street - �, l LEXINGTON, MASSACHUSETTS 02420 SHEET No. of (781) 861-6513 CALCULATED BV 4 DATE lqcv�110,1110fl _ _LYV� ETV j: l X090 'SEC � - - .. 4 _ 1 I- II I r- .. FT I BOISE' Doub.(6 1-314" x 18" VERSA-LAM(E) 2.0 3100 SP Roof Beam1RB01 BC CALC®2.0 Design Report- US 2 spans No cantilevers 10/12 slope Thursday, July 16, 2009 12:58 Build 284 File Name: BC CALC Project Job Name: DUNBAR Description: RB01 Address: 157-GREENE ST Specifier: City, State, Zip: N ANDOVER, MA Designer: Customer: Company: Code reports: ESR-1040 Misc: 12 19-00-00 13-00-00 BO B1 DL 1,740 lbs DL 4,688 lbs 62 DL 861 lbs SL 5,663 lbs SL 14,408 lbs SL 4,088 lbs Total of Horizontal Design Spans=32-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib 1 Standard Load Unf.Area(psf) Left 00-00-00 32-00-00 15 50 14-00-00 Controls Summary value %Allowable Duration Case Span Disclosure Pos. Moment 29,532 ft-lbs 55.0% 115% 193 1 -Internal Completeness and accuracy of input must Neg. Moment -32,819 ft-lbs 61.1% 115% 3 1 -Right be verified by anyone who would rely on End Shear 5,943 lbs 43.2% 115% 193 1 -Left output as evidence of suitability for Cont. Shear 9,014 lbs 65.5% 115% 3 1 -Right particular application.Output here based on building code-accepted design Uplift 582 lbs Na 193 2- Right Total Load Defl. U459 (0.496") 39.2% 193 1 properties and analysis methods. „ o Installation of BOISE engineered wood Live Load Defl. U583(0.391 ) 61.7% 193 1 products must be in accordance with Total Neg. Defl. -0.106" 14.2% 193 2 current Installation Guide and applicable Max Defl. 0.496" 49.6% 193 1 building codes.To obtain Installation Guide Span/Depth 12.7 Na 1 or ask questions,please call (800)232-0788 before installation. Cautions BC CALC®,BC FRAMERS,AJSTM, Uplift of 582 lbs found at span 2-Right. ALLJOISTV,BC RIM BOARD-,BCI®, . For roof members with slope(1/4)/12 or less final design must ensure that ponding instability BOISE GLULAMTM SIMPLE FRMING SYSTEM®,VERSA-LAM®,VERSA-RIM will not occur. PLUS®,VERSA-RIM®, For roof members with slope (1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND®,VERSA-STUD®are surcharge load. trademarks of Boise Wood Products, L.L.C. Notes Design meets Code minimum (U180)Total load deflection criteria. Design meets User specified (U360) Live load deflection criteria. -- 1. n� :. 1/2 intermediate bearing v Connection Diagram �b d a c a minimum=2" c= 14" b minimum = 3" d = 12" Member has no side loads. p9pelctarl are: 16d Common Nails Location �a No. ► I/ /S5_17/T_ Date { �oRTM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ + = ; Building/Frame Permit Fee $ on Permit Fee $ Y Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ (01,j/ Building Inspector 7865 Div. Public Works PEBliff NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. °-PAGE 1 ,MAP q40. LOT NO. 2 RECORD OF OWNERSHIP iDATE (BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRES cBASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN ---- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES la EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED'AND APPROVED BY BUILDING INSPECTOR - DATE FILED �/ 3 T� BUILDING INSPZCTOR SIGLNATURE OF OWNER UTHOR ZE AGENT F E E ��OG /� // 83 OWNER TEL.# PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# H.I.C.# Al 33 17 BUILDING RECORD 1 O U�� 12 �` SINGLE FAMILY V STORIES THIS SECTION MUST SHOW EASI�WF O QQ���O� 1 NCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMBAGiNB'81. � HES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLq ., CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH �',``���\�� CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA 1/1 1/7 1/1 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ A HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIV D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO-ON MASONRY _ STUCCO ON FRAM BRICK ON MASONRY TIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ ± SUPERIOR POOR ADEQUATE _ �! ADEQUATE NONE 5 ROOF 10 PLUMBING f GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.( _ FLAT I SHED WATER CLOSET ASPHALT SHINGLES LAVATORY Z WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 F G 11 HEATING WOO _LESS FURNACE FORCED HOT AIR FURN. r� TIMBER BM L — STEEL BMS. C S. W'T'R OR VAPOR \ " WOOD RAFTERS _ AIR CONDITIONING VIT,INT H'T'G EATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC ist 13rd 11 NO HEATING own of � s rL , over i � QNort� Aridover, Mass., 19 g6- p - i.n K E ' A- r CH ir trt wrt n �1' U �` BOARD OF HEALTH PER ILD Food/Kitchen Septic System T T BUILDING INSPECTOR THIS CERTIFIES THAT........... .... . Foundation •••• Rou h has permission t buildings on,*"....... .. ..... ... g to be occupied as...... ...... ! 4�,,,... imn y Ch' e provided that the person accepting this p it shall in every respect conform t e 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. Rough Final PER-N/I T F./J.�� i.; i I 1 Ivi�`?I f _J J ELECTRICAL INSPECTOR UNLESS C01 1`�`T Rt'-1tAI.� �I�1 1.r� 1�"�'�; Rough !... ... Service L B DINAU/14 SP�E6 Final Occupancy Pem-tit Regi1i. -cd to OCCitj)y Btil'IdilIg GAS INSPECTOR Display in a ConspicuousRou Place on the Premises — Do Not Remove Finagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. gW/PR /IA/ATFR FINAL DRIVEWAY ENTRY PERMIT —