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Miscellaneous - 16 FAULKNER ROAD 4/30/2018
16 FAULKNER ROAD 210/044.0-0018-0000.0 I Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION f�. This certifies that . . . ,, has permission for gas installation . . . , , , , , , , , , , , , , , , , , , , in the buildings of. . . nom"-J !. . . c. .... . . . . . . . . . . . . . . at . . . . � :". . . , , , , , . . , North Andove , bass. . . . Lic. No. . 124ty' L�. . . . . . . . . . . GASINSPECTOR Check 8564 r . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 0vC./ , MA. Date: - �'�3 Permit# _ Building Location: 16 F4 U /��/U 2 AOwners Name: Uy 5/fi-� L 0_ c� _ J Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential New: ® Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES LU WY ~ Q m cov m x 0 0 W >. W F- m 0 2 w W zz Z z o o w 2 W W O 1— � > WW C7 O w O Q W = uX. r Cn V W W z x W F- W I" O > V W z O J 1- N O z J 0 LL y x W F- W W Z W �- N J Q Q m w O z 0 H V D o LL 0 O S x J O f]. � � f- > > > � O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR fu--FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 1 n FLOOR Check One Only Certificate# Installing Company Name: —5& ����P � .��. � ❑Corporation Address: y /L X 060 6 City/Town: K67Mrr,.-✓ State: ❑Partnership Business Tel: �l �7` g�" Fax: 'Firm/Company Name of Licensed Plumber/Gas Fitter: �90 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes E No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 419 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 Owner's 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 ❑Plumber Title Gas Fitter Signature of Licensed Plumber/Gas Fitter (� Master 1 city/Town ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑LP Installer d" 7 \� �\"� U�-� V�� "•1 t { f f • I i 't7re C'ptitttid�tive it b, lVfcisr«clitcs�dls �; _ _ beli�rx�ltrr2riCo�JE`1't(tttslE�ttrl.•ll�etlei�fs bQO.��tsltfrrgloit��ift•��! B#Sfarr;MA 02111 ��' �upflt►rrtlss:golrlrlirt '�I... rCreC-011111Clifl1;(EOrrTit$tv4lj1 AfCtl�2��j�.Illtir(tciSlG"onft�nt fo�s�t[e�#Ctsi��tsltf�utiil}�lf� { t111I'icrttt i�tfo2itta(itili _P7i 6skpeiuf) `iC13:' - - i 1�411 ti (t1if;'utcs�Uig,lfiiiiti�nrJltifilidual}� -_ � l�C-/}Q ��L„( �wrj t Ari'�o(r fir e6i l[G}x(?Cilccls Ehcft r 1 i-01) tate box..3 • i. l ' ;. 'I�pi=.bfl»•ojectlrciluTCe't'ij: � I 1�0[Aiutte(nplo}crc�i{f► .. �1• am(Iwilefuleoitirdelornli&I ` ' �, QHC1FCbltstriict[011 c(tipro}ecs�fulCautLforpatttiiuc)� Ctaeeitrrccrtrtostttrcoritraclors 2. 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Shotiltdyoiihaxzaity'buest�onsrcgarditia•tlielaiviii• fy6itarerequiredto•oUtaura�4rorkcrs' 011fAii}ika(ionpolicy,pleasecalILite'D;,jiatiineit>�ttfientitnber:listedbelotu. �e)f-iit§tuc<i.cottipait'iessliotilctentertiteir teff- titmice license number i4e-line tatty,or To Officials Pleaseaffflat'itiscolht lW mid-priu[ed,legibly. Tliebepait»ieittiiasprovicfeciR.slittr, althebtiltout oCtliC,-affidavit for•}'oUd fill otftin theeveitf.tiie Office of Itrnesfigatiens l►as to co»,tncfynu rogaiAui'lhe epplEcanL Ftensebe sura to fill in ihepe�tiiitll ceuse>iumber irltich 4vil 1.rte.ttsedasa:refereuceailuttbet. In aciciitiat,an app)icant 0aafrnusesubinitntitltiplepemiiJticensea licatiotsinau* "� }� i PP }gt4eit3eat,tteed'ati sttUinEf_onesffidavifindicalmgcmrent: .€ policyInfomiation(ifnecessary)Pndiutlei"7otiMeAddress"thoappiieaiit'shouldwrite"aillocalienslti (ci poi j f4ti0i)2'A cppy of(Tte aftidat'itthat hasbeett officially stamped ol•marked by the city or folm uiay be-provided to 1110 ' 01iplicantaspro6fthaeatralulattidat'itisoiiftleforfti[ureperul'itsorlicenses.Atie4v.tiftidavittnustbefilfedouteich t )'Iiereal�oni�ou°nerorc)tizenistibtaii�tug.alicenseoiPernlit notrelated foankbustteasorco»ntiercialvantuie F (f:e_a clog.license or perniitfo barn Eaves etc.)said persott i's Xyyy quv ad to coltipletefitis t!ffdavi€. i t he a�Tice ofIiitie�fiafto*is l4�oiiltl like fti tltati �otrin aitvance for yotu coi at�att gats(stiott)d �otiliai' 0111}�o4tiestioiis, P1(1ise.do.not hesitale,to.give its A call: 3 Tt,O Dep iifi,lent'saddrCss.telep7totie a?tt�fax wtniTier;The�atlitMtits�t���E1>t;�i1��s��fictsetts 1361iaa_-[ittelitOfkdusfria��iccicleiits Y � �Office of Iitvc;;Iifi(colt 600AVashitigtott.Sftect Boston,MA 0211:1 Tol.'.61772mpooest .6 of 1-$"!7 IV�A�SA1<� . , t 7�7=�7'�9 �tm��.i�fuss,got'lc1t� _ f^ f f _ MON. _ AL"R OF.I�C WSACHU,U,' fLUN1(�Fr �' :' 6}dli„ -: LIG•EfV�E � �?��� r�/t�iaTY..�..:,,L[.>rf,1�L�lR�,� � ,.. _ ISSUES THE'ABOVE-'EICENSE TO SALVATOR;M 'CUR RAO �;:` a. N MAIN ,h ,FT f f� NEW TO `�` _ NH 1. 69 05/01/14 •� i�I r , „ w \ y Fold Then Detach kldr g All'fie tions t. j �J "Doug Ludgin"<doug@ludginstudio.com> FW: letter for permitting January 3,201311:46 AM To Town of North Andover Building Department c/o Sal Currao, I am writing to relieve my plumbing permit previously obtained in 2010 by Doherty Plumbing and Heating. Mr. Doherty has retired from practice and he has preformed 90%of the work to date that was included in the permit scope.Therefore, I am contracting with Mr. Sal Currao to obtain a new plumbing permit and complete the remainder of the incomplete work, as follows: 1. Master Bath- Extend rough plumbing in shower controls wall. 2. Master Bath- Install all plumbing fixtures and finishes for shower controls,2 lavatories,and 1 water closet. 3. Guest Bath- Repair leaking shower control valve Sal is also seeking to pull a plumbing permit for an additional scope work. For this additional scope to be described in his permit application, a Building Permit has been pulled, but a Plumbing Permit has not. Respectfully, Douglas Ludgin Homeowner and Building Permit applicant. 16 Faulkner Road North Andover, MA 617.869.4782 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY A)0� MA DATE I— d-9— 15 PERMIT# JOBSITE ADDRESS �(� A A U&nIftk WC1 OWNER'S NAME '00 0 IAS GtJc�g«/ POWNER ADDRESS S 'm C TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑. EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ 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 DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ✓ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET r URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IA NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY,INSURANCE POLICY 92 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 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 compli ce with all Pertinent provision of.the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. q PLUMBER'S NAME ��"( CC���/�–� LICENSE# �3� / y SIGNATURE MP A JP❑ CORPORATION ❑# PARTNERSHIP❑# LLC❑# COMPANY NAMES G Z1y,� �i ADDRESS 00 Q 801C aDa G CITY M(-75 %t,� STATE/n/9- ZIP 6 X Y TEL FAX CELL9j&6 /9 EMAIL ROUGI-1 PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ U FEE: $ PERMIT# '. 45 PLAN REVIEW NOTES rN I ID a t • i E 'tYrCprtjiart�r+eci(1li p, ITti%�frclics�lls �; _ �beti�ii�liueirt+o 'litcfcsCrrc[lteciclirfs ' i�%lO;��rslc�i�gfoir��5Yr4et� _- � .tfQstorr,?YftLQ�r.IX �`- NiPil�.►trpss�ot�/Ifrc AIN �SI�kTcci:'s�Cgnt1�tii5�it�ni �trsitirnit�cA1'ticlit��i� Btifct'crslL'onftrEtrto�'s.3[e�f►'ici��tsT�'�titii�e1i� f !»aiib»tt€1[itt'otitutfidit _ - .:pleas :t�itinE:)G>:�Iwy 141tt1e;[I3yj$utc�,�r0igtltii�itTeRtlui]ividuaT}` ���. ���dip ���,�t�✓� , r Mdress. �v•O ' At•��otr0itentir[oyxt•?C(tecTrfhenpj»•oy{•in(eGdz: • ' . . �, ''�''�-bf inti ecE•et'uYeei: i l:D idntltelttplo}cr014 - rT.[ [Bill ngeltctttleoitlractormittl `' �, cttiColistiiicl[otl cIll cess dru dforttiif tiuic);= itat'elt6t{itTlesuL corit►aclor& 2. X(till asoreproprfetororpaqu.r.- listetlotitlie{tUttclietl�ige{,� `� dncmotfeling s11iyratltl'11ivo»oe111piopes viesp.61b•coli[rnet61-Shaw Dallolilioit xiotki»g...fat_iucP�tnnycnl�ncit}t �voC•kera com}�;ttsitrn►tce, ' .i�, [(:�jii'ittiiitgndditiatr t {I�ateoi cts�coiit�:.itlstnattco �:[l*"oe-ecoipora)ioltand t(s ii�itft tF.j oftcershave,Oercised 11ieIr IQ, ': r[eclr;rnlizltairaorotidi[ioiis: 3.d Titnt.tihotticotrtiertton>stilttgotl: ugfifofe�eanptionpelMC,L 1, �'TinuttLlg Irsoraddhiottr pt3�elF[Nai4brker�coluft, 'C..t52r11(4),iin{Ttccli�i�eSto _. ' (2;Q;n90frei)aus E itisumnccrcgairetlj} 010pfoco.[ O—workci's' coutp.;nsur4ntccregutrgctj 1�,Q`O(Tter. - - it�li}'f1)QtC�1l{(inr<fE;�ts(+.cfl uuc;lrl;ofill'r•a{tk25�Cfii+4ir1o4csts�t4uigtt�eirurrt;.rs`C�lit}ciL:,lionp�lity'1EiCaiittilie '- i 4Sii•rn.atslt;iS�nc�+3¢iYEULttItiC{IfirSl7l[!lO{fi`.tiu lcc}�rwrtAig Itis•.i[:rr:dltt:nhirctintsi6�ceulr,:aai_utn;Isu;+:itiintit4tipY�i�tciliadi.�7nEysu�tr. ' i pClrui :bi:cllelttrt.�fdfi,il•�ti>;ftti:[a:raaxdanra�iiiigt.�lsF.t�•ts4tiu5i�lkcruntt�flit�Stilt•i��Etlrt•.{�kitr:dllr;iftii�iF:cr <.+i: dlii fnfinutlir�arW'�� lritt#nr[ertrpJr,tic=rtlirrlfsltvt�lrllUg rr�vrlers'cvirr/rrrrtsnllnirUcrrrrartref6r•rnpeir�tvt'rc�s 13eimtrlrllreErerrlet�•auri�plrslf� . � � Ir(nritrrrtlart: � ' lltstlraucc.eo»q�a(O��itiiie ..< ` . . . i Policy+lForS`elE=irts.t;ic,1!_ �xjiifitt�ittlinte- _ _ _ � 's` - t Job SitecTitreSs:� G� t`'a.y� �(N`��i ec[ iISt3tclZi�i�. c>A>Lc� rfL: lLitnctin colik.bl cota11eilsiilloitZzoliOg��eclntntiotrpnge f81toufiTg tliotiolicy�fii(ritiret nittl t E�ifi iliniFitit[ejt { 1 iihirc[astGur. •tti�eiitgensregnitzcflntifet`S@ctioti25/4o mbf,�o.tSx-cdnjeacltotltcipipasltionpfcriruitinllifinafticsQ a W10lip[o:SI,S0000audloioiie?yeariutpriso»ntelli;.ast+,eltits civifpelialtics.fit 11Sefortof-it STOP:iI'QItK01t©1;[tirin{Ii< ir1 t ftlpfopl o5250.00acTzy+{r�fifllS(((1Gv olhlot. 13etrclt�isciTllttfitcopyaFlTusstatEmelftitta}�Gi fonvariiecl( e-Of6ceoC f tutrestiga(ion�oftfie))J1i<•foriasumlicecoterrrgeti�etificatiom. - - --- - - - - -- - - - XtlrrtrerrtL��eer[��rrrrr t•Irepatve rtrlpr�rrtrCtieso�''pelitr{rlJtttlNrr.=Iri(oixUtrFlolr.l�rb-t�iFc=it'n�io>•�lstrtrR[iirrledt�ecl. •� - .rf'iotre • fT,�'zTir`xcsc.=.acre►RJ�ar1nE{taiirc:Ftrtiri�rrrerr,ivGiearrllil�lei?Li�c7�%dr•tairto,JjtcFril:LL ��� -- � _ f � �tj�bt-[bii7<< •1-tetni1[1L;egiiself - - � lisslifti�liii[[iori[=t:(citireoitel . !.l3Garctofffeait6 2.ilni[diuglJegortinertE 3.Cifyll'ouiiCiettt 4.Cfsc[cicaalltspe+`(ur i l'InptUluglns}ier[oL 6.Ufhet� Colif<tctl'ei-¢o{r;; ['fioti�f!": t 9 MQNW � QF. SACHUSETI`S i N:LUTO i w LICENSE+ `T.€ ' L41i�,? EtF 1 � .. +"' 38 r.:'•*_ � ,-tri,t ,5,,�-�""'� � I - -ISSUESrTHE'ABOVE°LICENSE SALV`ATQRa~ CURRAG € a N MAINTT NEWTON N Fi7. +fx L7�.3�.7�y{,►1.D� • .� y{i�:'7�';\L(;yYil •`\. Fold Then Detach Aldrig All I�erforAtions •. F 09769 ' Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . .S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .01. . . . . , . plumbing in the buildings of. . . . . . . .`. . . ...". . . . . . . . at . . . . . . . . . . . . . . . . . . North And vey, Mass. Fee.A& Lic. No)Rl,,.`�.�. . . ' I . . . . . PLUMBING INSPECTAR Check# / ,a Date . 11+1p. . . . . �n TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING e� e� � This certifies that . . . . . .! f�.��. . . . . . . . . . . . . . . . . . . � has permission to perform 1."fi .!�;V:'! Z� . wiring in the building of�. . . . . u� cQJI R-. . . . . . . . . . . . . . . . • • • • • • • • at . . . . . fi :Q� Q.!� •. . ,AN, Andover, Ms. MFee �� . . . . Lic. No21�Q . . . ELECTRICAL INSPE OR Ch,Ck# 11393 ,r commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services 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 C),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: 1 City or Town of: NORTH ANDOVER To the Inspectr of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1�o e xotYirls."x- Rn Owner or Tenant o0 3 ; Lvc� r Telephone No.l (ol"7S(og y7$a Owner's Address 1 to U mot+ R-+r- (Yl Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building QLoAiaq Utility Authorization No. - Existing Service C� Amps l�c_�Volts Overhead� Undgrd El No.of Meters �_ New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �� �� 3 LcSq o Completion of the following table may be waived by the Inspec Total r of Wires. No.of No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA Generators �A No.of Luminaire Outlets{� '—' No.of Hot Tubs k AboveIn- o.o Emergency ig tingNo.of Luminaires Swimming Pool rnd. � rnd. Battery Units lFIRE ALARMS No. of Zones No.of Receptacle Outlets No.of Oil Burners No.of Gas Burners No.of Detection and �j No.of Switches Initiatin Devices No.of Air Cond. Total No.of Alerting Devices ot No.of Ranges No. Heat Pump Number..Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting,Devices Q, Municipal Other 3 No.of Dishwashers _ Space/Area Heating KW Local❑ Connection ❑ Heating Appliances KW Security Systems:* k No.of Dryers No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or E uivalent " Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent " OTHER: Attach additional detail if desired,or as required by the Inspector of Vires. Estimated Value of Electrical Work: 00 .OD (When required by municipal policy.) Work to Start: a, 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. i INSURANCE C RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless -11 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: � o. r' LIC.NO.: 2)6ca-P< Licensee: � ature LIC.NO.:Si (If applicable,enter "exempt"in the license numb er line.) Bus.Tel.No.:9"7� Address: I S- L(3"bk �h - AQP rtethi�1 0o •O L830 Alt.Tel.No.:�7�919 —� *Per M.G.L c. 147,s.57-61,security worVrequires Department of Public Safety a 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/AgentPERMIT FEE:$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.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.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if 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 entity stated 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. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Co ents: Inspectors Signatu e: Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comme s: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 1 The Commonwealth of Massachusetts Department of IndustrlqlAccidints Office of Investigations UT 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractorsf Electricians/Plumbers Applicant Information Please Print Le0b1Y Name(Business/Organization/Individual��� I t l Po1(ryW Address: ►E Lp _o4 City/State/Zip:.fto,x)ah1\\, Okg3 C) Phone#: 3(00 ` Scl a Are/you an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with 1_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have Hired the sub-contractors 6. E]New construction 2.El 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, VElectrical [No workers'comp.insurance 5. ElWe are a corporation and itsrequired.] officers have exercised their10. repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions ti myself.[No workers' comp.' c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other 4*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. s 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 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:_ NO(A \ k-y", City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Fpilure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fit 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 an a ties of perjury that the information provided ab ve is true and correct. Si ature: M Date: 1 Phone#: 118 3G Q ��/2 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#: v' 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-contractor(s)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. 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 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 of ladustrial Accidents Office ofInvestigations 600 Washington Street Boston.,MA.02111 Tel,#61.7-727-4900 ext 406 or 1-877,7MASSA.FB Revised 5-26-05 Faze#617-727-7749 wwwmv ass.gov/dia 10083 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 has permission to perform . . � . . . . . . . plumbing in the buildings of at . . �. . 1. . . . . . . . . . . . . ,North Ander, Mass. . . ./I. . .. . . . .`a . . . . . . . PLUMBING INSPECTO Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS �r n / n Date Building Location r'� `/f� I G� Owners Name �/ca tl g fps$ L�9 ty✓ Permit# Amount Type of Occupancy New Renovation F1 Replacement Plans Submitted Yes No FIX'T'URES z W U cr O U � a O � Ln w E A 'mow y a &0 V) O En O A 9 O A U SIMM q q fi491VFNI ]SB FLOQ2 � M FLOCIIt R OC" h (Print or type) / Check one: Certificate Installing Company Name /�2f�t ! ./« e; ❑ Corp. Address ,-r- 6 Partner. Business Telephone ® Firm/Co. Name of Licensed Plumber: ,�� ( e f Insurance CoveragE. Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other-type of indemnity ❑ Bond F1 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 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 S P bing C lie and Chapter 142 of the General Laws. By: Signa 0 irNnse ` Title Type of Plumbing License City/Town 67q icenseINUMDerMaster ® ❑ APPROVED(OFFICE USE ONLY Journeyman Y((�,4\0 The Commonwealth of Massachusetts Department of IndustrialAcciknts Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatiorAndividual): 5 ( 4,, Z A-14 /` Gt r Address: ;e City/State/Zip: gi1+0 r$'Ltr Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 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. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.®Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑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. Homeowners who submit this affidavit indicating they a're 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.Lie.#: Expiration Date: 6l� Job Site Address: ../ Of Cc+ 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 certify under thepains and penalties of perjury that the information provided above is true and correct. Signature: s/�J i Date: 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.PIumbing Inspector 6.Other - - - Contact Person: Phone M. Information and Instructions ctions 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 employeiis 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. 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: Tho Commonwealth of Massachusetts :Department of Industrial.Accldonts Office of Investigations 600 Washington Street Boston}MA.02111 Tel,#617-7274900 oxt.406 or 1-877rMASS.AFB Revised 5-26-05 Faze#617727,7749 wWW.mass,9oV1dia M1�R�t �I2 �I2o��, U t'� LkW5 a /r. TOWN OF NORTH ANDOVER Office of the Building Department °� N RT Community Development and Services ,t2 'V'- s'° 1600 Osgood Street, Bldg. 20, Suite 2035 ° p North Andover, MA 01845 978-688-9545 �9SSACHUS���� Donald Belanger—Inspector of Buildings September 20, 2016 To: Douglas Ludgin Fr: Donald Belanger Re: 16 Faulkner Road, North Andover, MA—Addition of Home Office, Full Bath & Hall Dear Mr. Ludgin, We received your Building Permit application on September 14, 2016 and it is being returned to you as incomplete. Per the Town of North Andover Zoning Bylaw Section 4.122 (4) (d) calculations must be provided to ensure the proposed addition adheres to the guidelines as outlined but not limited to in the section above. Additionally,your permit was returned for the following reasons: 1) Proposed plans have the appearance of a family suite. If this is not accurate, a notarized letter stating the aforementioned is not a family suite as defined in Section 4.122 (22) (a-d). 2) No cooking facilities allowed. 3) No separate living quarters allowed. 4)A completed DBA form for a Home Occupation completed, and included with the Building Permit Application. 5) Project cost must be provided on application. If you feel that you have been aggrieved by any actions that I have taken or failed to take,you have the right to appeal to the Town of North Andover Zoning Board of Appeals or the State Building Code of Appeals accordingly. Sincerely, Donald Belanger Inspector of Buildings Zoning Enforcement Officer TOWN OF NORTH ANDOVER Office of the Building Department NORTy o L%D , ti Community Development and Services 2 `�?- 6'` °A 1600 Osgood Street, Bldg. 20,Suite 2035 North Andover, MA 01845 mob° 978-688-9545 y . �� * A0AATeo I. .�y SS^CHUS� Donald Belanger—Inspector of Buildings September 20, 2016 To: Douglas Ludgin Fr: Donald Belanger Re: 16 Faulkner Road, North Andover, MA—Addition of Home Office, Full Bath & Hall Dear Mr. Ludgin, We received your Building Permit application on September 14, 2016 and it is being returned to you as incomplete. Per the Town of North Andover Zoning Bylaw Section 4.122 (4) (d) calculations must be provided to ensure the proposed addition adheres to the guidelines as outlined but not limited to in the section above. Additionally,your permit was returned for the following reasons: 1) Proposed plans have the appearance of a family suite. If this is not accurate, a notarized letter stating the aforementioned is not a family suite as defined in Section 4.122 (22) (a-d). 2) No cooking facilities allowed. 3) No separate living quarters allowed. 4)A completed DBA form for a Home Occupation completed, and included with the Building Permit Application. 5) Project cost must be provided on application. If you feel that you have been aggrieved by any actions that I have taken or failed to take,you have the right to appeal to the Town of North Andover Zoning Board of Appeals or the State Building Code of Appeals accordingly. Sincerely, r Donald Belanger Inspector of Buildings Zoning Enforcement Officer TOWN OF NORTH ANDOVER Office of the Building Department � NORT1� q O , ,y Community Development and Services L - - 1600 Osgood Street, Bldg. 20,Suite 2035 North Andover, MA 01845 978-688-9545 Arno4 ��SSACHUS Donald Belanger—Inspector of Buildings September 19, 2016 To: Douglas Ludgin Fr: Donald Belanger Re: 16 Faulkner Road, North Andover, MA—Addition of Home Office, Full Bath & Hall Dear Mr. Ludgin, We received your Building Permit application on September 14, 2016 and it is being returned to you as incomplete. Per the Town of North Andover Zoning Bylaw Section 4.122 (4) (d) calculations must be provided to ensure the proposed addition adheres to the guidelines as outlined in the section above. _ Additionally,your permit was returned for the following reasons: Y ���`/_��� �© 1) No cooking facilities allowed. stJ2) No separate living quarters allowed. 3) Proposed plans have the appearance of a family suite. If this is not accurate, a notarized letter igg heaforementioned is not a family suite as defined in Section 4.122 (22) (a-d). 4)A completed DBA form for a Home Occupation, completed and included with the Building Permit Application. 5) Project cost must be provided on application. If you feel that you have been aggrieved by any actions that I have taken or failed to take,you have the right to appeal to the Town of North Andover Zoning Board of Appeals or the State Building Code of Appeals accordingly. Sincerely, Donald Belanger Inspector of Buildings RAU J- 1 /V& - JAA047-4- - 4 IAIII A, eQt,,' c ��° ^-��_� ��,, oP-�- wOree-, 417,- 0Q, l7 V- -7W/S *#/_ T VA SQ FF _ , e Date... ..� ! ...... NORTH pf ��ao ,e1ti0 TOWN OF NORTH ANDOVER o • - PERMIT FOR GAS INSTALLATION SACHUSE� This certifies that . . . . 1. �. . . . . . .!.' .�. (. . . . . . •. . . . has permission for gas installation . . .4/ '4e. . . . in the buildings of . . c�!�!��. . . . ,lt�.�t./..t. . . . . . . . . . . . . . . . . at . . . . . . . . . . . . .��.�, . . ., North Andover, Mass. Fee.4/Y%570. Lic. No.J L.0.�. . . . . . . 4/4 .GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Mo&71 J�i2/,Oo! a_ MA. Date: 0 Permit# Building Location: /,/ /iLAR&! ,,a RD Owners Name: " _/9oU g 4002//y Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES Z H Y 2 W Q m x ()0 LU J v w ~ N 0 2 W w z l- g z 0 W W a O H O W U) W m 0 ~ a H o 0 w X W U W Q ( LL W7 J W ? N W O N = Z W Q: > W Z H P 0 Z J (7 LL W H W z W >- W U) J Q Q m W 0 z 0 ~ F— U 0 0 iii C9 (9 x x 0 d W FW- > > > 0 SUB BSMT. BASEMENT / 1 FLOOR -i'FLOOR 3mu FLOOR 4 1H FLOOR -5'FLOOR -i'FLOOR 7 FLOOR 8 FLOOR r� Check One Only Certificate# Installing Company Name: ,�1��—T ,(i„y,/-f//-,12 _ El Corporation Address:L-)9 Coy�/2y y City/Town: / /j,"2/// z4-State: T ❑Partnership Business Tel: Sn0 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: 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 *vl c Owner Agent ❑ Signature of Owne r Owner's Agdnt 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. Tya of License: Byumber Title Gas Fitter Signature of Licensed Pit, r/Gas Fitter ❑ aster City/Town Lojourneyman License Number: //D-77 APPROVED OFFICE USE ONLY 0 LP Installer Date. f 4 NORT4 3?°,',.��•'„•,�+o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . .. . . :9.V �.� . . . . . . . . . . . moo . . has permission to perform . . . . . �.`. . . . . �. . . . . . . . . . . . . . . plumbing in the buildings of . AY). . . . . . . . . . .�. . . . . . . . . . . . at ._j . . . . ?�. !�. . . . �--. . . . . . , Nort-h nd.py 7 ass. .j Fee".InU. . . .Lie. No..�.�(? �. .� . . . . . .�� . . . . . . . . . . PLUMBING INSPECTOR Check MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:�/0/z�i� ��y�j�/!��_ MA. Date: Permit# Building Location:/Z 15UIIOwners Name: MX j�ey �6/,07 IAI Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:K Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED w Z SYSTEMS z 0 �n > Y U = W Z h = N Ln iA D: Z Q W (' a. QW Z �. Q R: Ln = y Q y�j ? F- W Z F" {A Z </7 h _a O �=. Q W Q W = 0 = W Z W J _Z U a LL J Q a Y = 0 = Z ~ LL Ln ...1 a = W W o 0 H W Q ~Q y H Q F. _ 0 0 0 Z Q Q Q = 0 In W Q H a m m o o LL s Y 3 g Ln Ln = 3 3 3 o a 3 SUB BSMT. BASEMENT 15T FLOOR / 2ND FLOOR 3RD FLOOR 4TH FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Check One Only Certificate# Installing Company Name: �/��T y ��fj�/��yv ❑Corporation Address:, 9LDU�II%2Y/�i�LC1 y/awn:,12 1 ,(1/jj4L State:1.9711 El Partnership Business Tel: 9'1;734/8 �JS 7 ' Fax: ❑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 ner's A en I hereby certify that a 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 OC Type of License: Title ElPlumber Signature of Licensed Plumber City/Town ❑Master /f0 APPROVED OFFICE USE ONLY) ❑Journeyman License Number: �o 7 6 7'4 Date.. "!y/. � /. ..... MORTM Of of TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION CHUSEt This certifies that . . .`Owirz' ? . . . .(3 t eQ. . . . . has permission for gas installation . . . .Uh&'�C .v.!� . . .�. ' in the buildings of . . . .. I.0 I . . . . :U .t.+� . . . . . . . . . . . . . . . at �. . . . . .��.����tz: . . . : .: ., North Andover, JMass. Fe 30.,IX). Lic. No. - . ;1� G&IN�'�ECTO� Check# aJ i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) u Mass. Date__ �( i City, Town Permit # y Buildingi Owner's AT: Location Fau) jtn t, Name Type of Occupancy:_ S;rqk New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ i Y W y y Z x F CC i-J N fY 0 Ic CLU N H cif S J N W FO- U m H x N N Z C W F Q >- Z Z 0 0 M W 11 Q W W O d IC W F b N t7 Z Z 1•- N > Q W W N J Z Q Y ft W W W W F- W Z Q W Q 0C ~ W r y 0 > W Fa V J 1N. W v L tC Z Q IL aa < Q W > W O 0 W cc 0 W H t it x 0 cc > p p t- 0 � g SUB--BSMTa )t BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check One: Certificate Installing Company Name ToyAMsenrl 0j 1 !'n Tuc ® Corp. Address _ 27 Cherry Street ❑ Partnership Tlan = rG, MA 01 923 ❑ Firm/Company Business Telephone _ 978-777-0701 Name of Licensed Plumber or Gasfitter IOspz h G,icrgE 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. ❑ By TYPE LICENSE: Title Plumber ignature 'censer Plumber&'Gasfitter City/Town ® Gasfitter L' APPROVED (OFFICE USE ONLY) El master ❑ Journeyman License Number y . / �-COMMONWEALTH_OF MASSACHUSETTS • FST=ERS LICENSED AS AN LP GAS INSTALLER ISSUES THE ABOVE LICENSE TO: j JOSEPH F GURRY III 3 JOHN ST yC m APT. 8 METHUEN MA 01844-5051 . 885 05/01/12 788338`\ N° 1 6 5 3 Date. f NORTH 1 3:;•_`;�``° "�O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSAcmUS� This certifies that ....... .........� ;.. Y'.. .tR. C ................................ has permission to perform ..... S e.�2.�?�..4.?..........C.. sc.�*3�.Q, ................ wiring in the building of....��.L..,, at t :� F.r'......�4 North Andover ass. >_ ..... .. .....!�.cs.t,�. . .....................` Fee.. ..: .. Lic.No..fW ........._ .... . ........ ELECTRICALINSPEC 0 C 73 05/12/99 11:21 35-00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer OtNce Use only t G,4r &=niumith Df 5miar#mitts Permit No. W 3glar=znt t]f�91Ihlir -*ztfztq Occupancy& Fee Checked SOARQ OF FIRE PREVENTION REGULATIONS S27 C-IR 12:00 3M (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts E.ectrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _- ;X or Town of NORTH ANDOVER To the Insp4ccr of wires: The udersigned acciies for a permit to perform the electrical work described below. Location (Street 3 Number) lB Owner or Tenant Cwr,,er's Address Is this per-mit ',n cccnlur,=icn with a building permit: Yes — No (Check ApOrOpnate Box) urccse Cf 2-Llic;rc Utility Autronzati0n No. Exosang Sarlfce lO_ Amos { --z-1/0 vcits Overreact Uncgrnc I No. of Meters L_ t10V= �ctts -no Set-Ace mos . No. of Meters �t Numoer ,:f Fsecers arc Amcac::y — Z �zCa.,.-„ arc Na*,--;.,e z:0 7rC:csec _ec _i .1C_x �.✓/If ib/�1 Tota? ::! 'ransformers KVA ACave— NO. r :n- Swimming aOt grrc. _ amc. — Generators KVA:t LCrt:r4 =Xrt:res No. at Emergency ugnnrg a NO. of Cil ou:.^•ers ; Barer. Units Nc. .f ___-. c:e .,..:vets No. of Swoon Cucets No. or Gas 3_rrers I =iPE ALARMS No. of =ones Total No. ct =etecnan arc NO. of Rances No. of Air -zr!c• ;ors Initiating ::avices � -eat TOtai Tatai Na. :t -isccsais i No.ar Pur..cs :ons ('%f I No. of Soune:ng Devices No. at Sett Containea SeaceiArea �eaur.g owec::onrSeuncing -evtces No. cf -�snwasners - , I Munlc:=al —Other No. of �-•fers ilea::.-c Covices CN ..--cat _ Cznnec::Cn No. or No. a I Lzw voltage Na. of '.nater _eaters KV1 I Sicr.s 3aiiasa Nir:nc N0. :jvcro .�tassace mos No. of Metcrs Totai +P OT• .n. INSi:RANC= E?AGE Pursuant :o the recuirem.ents ct aassacnusens ;enerat Laws — _ i ?lave a current Laciuty Insurance ;-:tic,, nc:%==; '-amc:etec Ccerauens :..average or -is suostantiai eeuivatenf. YES _ NO - nave 54amtrec vaitC .Oat of same to the �;Niae. !ES = NO = t you -ave-�c��^ecxso "E:. tease inoicate :ne type at coverage =y checxtng the accmcr:ate oox. �.2Ati.tt'L�y / .Yv INSUR1,NCc X BONo = 01 SEP = tPtease Sce:y) (Exctranon Dater s:tmatec vivt,s at Eiec:acai 'NOCK 5 +net wcrx to Star. Inscec::on Da:2 ndC4e5: ecu2C: gr f Signea anter ane Penatue �e ryt ~ /. uC. NO. �= ?IRM NANfE NO. Lcensee C/ �� Sigrature :C. �-- Bus. –et. No. Actress I'rr' `� Alt. —el. No. OWNEa'S iNSURaNCc'NAIVE=+: I am aware !rat the _:pensee aces not rave vne insurance coverage or its suostantiai eautvatent a^te- cturea ov .Massacrusetts Ganerai taws. ano :nat my signature on th:s .errrn accucauon waives :nis reautrement. Own 9 (Please cnecx enes Sd(� siecrcne NO. —PSF;IVIIT FEE 5 v Sicr.ature of C Tier--r wenn �o=== Location ! (� FA u ti��� )P� No'e �� Date %ORTN TOWN OF NORTH ANDOVER O:i .•o ,•1h0 Certificate of Occupancy $ _ s ; ; Building/Frame Permit Fee $ r s,��Mus<�' Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ • Water Connection Fee $ TOTALALCalf, / Building Inspector � 3 U 4 2 04/13/99 13:37 �' 99W Public Works PERMIT NO. t�7 APPLICATION FOR 1'L101IT TO BUILD* ******NORTH ANDOVER, NIA 2. RECORUOFON•NLRSHB' DATE [LOOK PACE SUR MV. 1.07'N(I. I.III ,� ll) -.. lN _ PNNI'OS1:17(:dl)II NTNG /��L ( ] r � (AVNER'SNAME / /' NO. OFSTOME•S ! � SIZE: UIVNER'S ADDRESS // (./S BASEMEN(OR SLAB ND RD _ AM I IIIECI'S NAME L7 SIZE OF PI C"I IM13ERS I 2 3 1l 131111 I)ER'S NAME SPAN (� DISIANCE-JOHLARESI BUILDING DIMENSIONS 01:SII.I.S DIS IANCE I ROM SIRIA:I DIMENSIONS 01:1'OSIS I IIS IANCE FROM LOF LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOF FRONT AGE I IEIGI IF(N:FCRINDATI(N! T1 IICKNE.SS IS BI111.DINO NEW SIZE CN-_I(XII ING X IS BUILDING ADDI IICNI MAI ERIAL CN CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID CIMI LED LAND "Il L BUILDING CONFORM TO REQ 11 REMEN FS OF CODE IS BUILDING CONNECI ED TO TOWN WATER BOARD OF APPEALS ACI ION, IF ANY IS BUILDING CONNECT ED TO TOWN SEWER IS BUILDING CONNECI ED TO NA I URAL GAS LINE INSFUCTiONS 3. PROPER FI' INFORNIAFION LANDCOSI y� a ESI. DI'DG. COST , vAGi: I FII.I.OIFF SECTIONS 1-3 EST. BI-DG. COS I PER SQ. FT. EST. dl D('i. C'tri f 1'Elt R(X)M EI EC"FRIG f lE'I ERS f Il1S f BE ON(NFFSIDE<N B111l.DRJCi �< /Jl/ SEPI IC PERKII F NO. AI-1 ACI IED GARAGES IVIl1STC(NJfoRm FOSFATE FIRERE(i1ILA IINSa. .-►PI'11O\'F:B [11': PIANS MUST BE FILED AND APPROVED BY Ill IILDING INSPEC FOR BUILDING INSPECTOR DATE I=II 1:1) / OWNER-Sl EIA- CON IRAIAH 79I- O l y411 C(NJFit.[.1('11 D i � a O / 1I(iNAItIRI:OFt WNIJtINtA1J:[Ilt IZI: )A(;I:NI' I1 LC.II �0 313 1'I RNIITtIt.ANI1.1) 19 07. geU1 u",A HOME IMPROVEMENT CONTRACTOR Registration 104393 TYP' - Den, j Expiration 07/14/00 - SYLVESTER BROTHERS CO. Don,P. Sylvester - a� Main St, Suite 245 ADMINISTRATOR Waltham MA 02154 I { < ' OEPARTBENT OF PUBLIC SPFEEN LICSE CONSTRUCtION SUPERVISDR Birthdate;. Expires: Number: 01 061951 , 9 CS 016287` 01�D5�199 � I � :. Restricted To: 3 CARPENTER RD Town of North Andover F NORTH O CE OF 3=0`srao ,a°6ti�L COMMUNITY' DEVELOPMENT AND SERVICES A 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number ��S is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: - � � � 'tLl o dsr M 6de0 (Location of Facility) Si4nae of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project throng-h the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 vACIRTH L E D lown of dover COC H11 E \� dover, Mass. AJ /a/ A ' CA7ED � °'�� N OEM& BOARD OF HEALTH rtR I U Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... .. ... ........................... '.. .. ........ Foundation ............... ......... Y 6 A has permission to erect..... .. ........... buildings o . . Rough e ....... ........... ... to be occupied as........ ..IP....... . ........... .......es�...... � Chimney on provided that the person accepting this permit shall in every respect conform to the terms of the application on ile 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 ice PC 14 PERMIT EXPIRES IN 6 MONTHS 1 HS Final UNLESS CONSTRUC-I ELECTRICAL INSPECTOR A AmRough r f ........ .... .... ................................. ......... Service B LDING INSPECTOR . Final Occupancy Permit Required to Occupy wilding GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.