HomeMy WebLinkAboutMiscellaneous - 163 OLD FARM ROAD 4/30/2018 163 OLD FARM ROAD
J 210/035.0-008aooc3D:o
1 Date. .. ..
NORTH
1 OF'..ao
o� TOWN OF NORTH ANDOVER
' 9
4 -
. % PERMIT FOR GAS INSTALLATION
10
h
S^ACeNUS
This certifies that . .a.Sn~. . r. . . ��" . . . . . . . . . . . . . .
has permission for gas installation . . F{i': e. . t n c.
in the buildings of . . .43. .O��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ar�
at . . ,. , North Andover, Mass.
Fee. ` Lic. No.. LPta.l0 . . : 71o2i µtilt �----
pZ GAS INSPECTOR
Check#
4542
I
MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS PTrnNG
�� I
(Type or print) ` : Date 11/25/03
NORTH ANDOVER,MASSACHUSETTS !
Building Locations 1 h 3 Old Farm Rd � � � Permit#
Amount$
_ 25.00
Owner's Name _Joyce Bold
New❑ Renovation Replacement ❑ Plans Submitted ❑
CA w �
w w a a ° H • • it pl ce
d H ° z c w ns rt
a
aG U
z w
>
LA rA 0
o w 3 A o
SUB-BA SEM ENT
BASEMENT
1ST. FLOOR
2ND . FLOOR
3RD. FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
(Print or type) Check one: Certificate Installing Company
Name Eastern Pro-anP CTaS ❑ Corp.
Address 131 Water St. , Danvers MA 01923
❑ Partner.
1 800 322 6628 ❑
Business Telephone Finn/Co.
Name of Licensed Plumber or Gas Fitter 86A 0 6A,u
INSURANCE COVERAGE Check_4j e:
I have a current liability Insurance policy or it's substantial equivalent. Yes U No❑
' Ifyou have checked yes,please'ndicate the type coverage by checking the appropriate box
Liability insurance policy Other type of indemnity ❑ Bond ❑
i
Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and ha ofthe General Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber Com/2�e
City/Town Gas Fitter License Number
❑ Master
APPROVED(OFFICE USE ONLY) Journeyman
Date...
f NORTH,
"O0 TOWN OF NORTH ANDOVER
o . PERMIT FOR WIRING
{
CHus�
Thiscertifies that ............ ......... .....................................................................
has permission to perform ............ .... .... ......................................................
wiringin the building of.....r.............................................................................
at...'//'3........ .....�e ..h .........,North Andover,Mass.
Fee..................... Lic.No.............. .../ .; ?.a...- �..................
``ELECTRICAL INSPECTOR
Check #
5 "i
52
Official
Use Only
Permit No.
WE C09kfW0AWEALW OAF'911,4SSA SE27S
Department of�Pu6Cu Safety Occupancy&Fee Check
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 5 CMR
(Please Print in ink or type all information) ate ��' C- Q
To th inspector of Wires:
Town of North Andover
The undersigned'applies for a permit to perform the el
ec
trical work desbelow. l
Location(Street&Number (J3 CJ �I �C11
Owner or Tenant
Owner's Address b�
Is this permit in conjunction with a building Yes No heck Appropriate Box)
Purpose of Building �'l2 LAUtility Authorization No.
Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgmd 0 No.of Meters
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above 0 In 0
No.of Lighting Fixtures Swimming Pool gmd 0 grnd 0 GeneratorsKVA
No.of Emergency'Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
b Heat Total Total
No.of Di sal .No. Pumps Tons KW No.of Sounding Devices
No./of Self Contained
No.of Dishwashers SDaceJArea Heating KW Detection/Sounding Devices
0 Municipal 0 Other
No.of Dryers Heating Devices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW Signs Bailases Wiring
No.Hydro Massage Tuds No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES n NO o
have submitted valid proof of same to the Office YES C, NO C% If you have check YES please indipte the type of vera by checking the appropriate box
INSURANCE t, BOND C, OTHER 0 (Please Specify) ffZ'
(Ex i n
Estimated Value of ectrical WorkE
Work to StartMr
Inspection Date Resquested Rough Final
Signed underthe ffenatties of pedury:
FIRM NAME v �) --d�f1 LIC.NO. c.JJ
Licensee U Sig/nature L� LIC.NO.
Elus.Tel No. r� Ger
Addresses Alt Tel.No.
OWNER'S iNSU CE WAIVER: I am aware tha he Licenses d es not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE $ "
(Signature of Owner or Agent)
z a The Commonwealth of Massachusetts
Department of Industrial Accidents
' d Office of Investigations
w~ Boston, Mass. 02111
°+M 5�lb Workers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
city Phone #
F] I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
0 I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
Ci : Phone#:
Insurance Co Policv#
Company name:
Address
Ci!y: Phone#:
d
Insurance Co Policv#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00
and/or one years'imprisonment-as_well as_civil.penaltiesin3hefamjofa_STOP WORK ORDER.and a.fine.of_(.$1DO.DD)aiday.against.me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
V
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date
Print name Phone
official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
❑Check if immediate response is required 0 Licensing Board
Selectman's Office
Contact person: Phone#. ❑ Health Department
Other
Location
No. �r Date
Mo^Th TOWN OF NORTH ANDOVER
Certificate of Occupancy $
23
s''•°''I Building/Frame/Frame Permit Fee $
s4cNust 9
.4 Foundation Permit Fee $
Other Permit Fee $
TOTAL $ /a 3
Check # /
553 3 Building Inspector
i/
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEyMOLISH A ONE OR TWO FAMILY DWELLING ■®v■
BUILDING PERMIT NUMBER. Vo DATE ISSUED.
ic
SIGNATURE: C
Building Commissioner/Ing3ector of Buildings Date
SECTION 1-SITE INFORMATION O
1.1 Property Address: nn 11 1.2 Assessors Map and Parcel Number:
10 OLD ss- 9(!�:>
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided ReqWred Provided
Q
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n
Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
/63
Name(Print) Address for Service
6g3- L(1�i
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone 90m
SECTION 3-CONSTRUCTION SERVICES
Licensed Construct on Supervisor: Not Applicable ❑
Licensed Construction Supervisor: S D d
19 Nq (� . J
, License Number on
Address M.
on
M— �35Expiration Date ic
Signa re Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name b U
\� V�� �� M� Registration Number
�a v� U.J J I tt
-Address _
�l O R q` 6 35-3 Expiration Date nZ
Signature Telephone ®'
SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work(check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work: \
d- t...J
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)X (b)
4 Mechanical HVAC /
5 Fire Protection
6 Total 1+2+3+4+5 0 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, ,as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
CTI N 7b OW R/ UTHORIZED AGENT DECLARATION
h as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Pr m
Signature of Owner/A ent Date
NO. OF STORIES SIZE f
BASEMENT OR SLAB
SIZE OF FLOOR TMERS IST 2 ND 3KO
SPAN
DM ENSIONS OF SILLS
DM ENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUULDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
000521
THREE SONS HOME REPAIR FROF`UaA�L
18 Munroe Ave.
Waltham, MA 02154
Page No.—of
_ Pages
DESCRIPTION OF JOB
781-899-6353 MA Reg #118807 ARCHITECT DATE OF PLANS
PROPOSAL SUBMITTED TO: JOB
F . ADDRESS
...
........ ..I.........
CITY S E ZIP
....... ...... . .. .
..................................... PHONE................/VDA��(/,
.. ...............................I.......................... ......................................
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
............ . ........ .......... ...... .... .......... .... ........
O \00 ....... ......YPi P,
................... .................... .................................. ............
a
C . too
./....... �.r.�M........... ............... ...................................... .........................................................I..........................................
9 'e7-� -7',r'�n ,
e ..........
NA �t� 5�.
.. ....................IN............................... ..... ....... .......... .....
........... ....... .... .... .. ......................
7\...4 ... ......................................................................... .
..
....... GVks>'i C' W�% . ........Opp
......... ...........
.......
. ........... ..............:......... .......-.........I..........................................................................................................................
(
.. ............i...........VZ-.'.L0'.e.........P ........ .. .......L--1-- 11\ 0 .......
.... .........
.......... . .......
............9.........�-o RV-N Vj Vj,
............................................................................................. ......................................................
..............
5.............t ....... ..a ,....................................................................................................................................................................
.................. .....................I.....................-......I........................................................................................................................
...........N-1......... ......................... ..............................................................................................................
We hereby propose to finish material and labor, complete in accordance with above specifications, for the
pQ
sum of dollars($ I q, qq0.
with payment to be made as follows:— -VL'f'j co r'\
40A)
All material is guaranteed to be as specified. All work is to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from specifications Authorized
involving extra costs will be executed upon written orders, and will become an extra Signature
charge over and above the estimate. All agreements contingent upon, strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be withdrawn by us if not accepted
insurance.Our workers are fully covered by Worker's Compensation Insurance.
within days.
Acceptance of Proposal - The above prices, specifications and cond-
tions are satisfactory and are herby accepted. You are authorized to do the 0,J)
work as specified.Payment will be made as outlined above. Signaturpe
-
Date of Acceptance: & Signatur I
u"
CNA
For F`7 C--d--t,
nR r uMohz
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC RO 00 01 ( Aj
POLICY NUMBER: (6S59UB 725X472 7 02 i
RENEWAL OF I6S59UB-725X472 7 011
INSURER: C:ONIINENIAL CASUALTY COMPANY
NCCI CO CODE so381
1.
INSURED: PRODUCER:
NUTILE , PAUL DBA SELECT FINANC',IAL INS AGY
THREE: SONS HOME REPAIR 1579 WASHINGTON ST
18 MUNROE AVENUE HOLLISTON MA 01746
WALTHAM MA 02453
Insured is AN INDIVIDUAL
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy periods from 03-22-02 to 03-22-03 12V A.M. at the insured's malting addresss..
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:.
MA
_ B_ EMPLOYERS LIABILITY INSURANCE; Part Two of the policy applies to work in each state listed in
°-� item 3.A. The limits of our liability under Part Two are:
® Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 policy Limit
Bodily Injury by Disease: $ 100000 Each Employee
C_ OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here.
SEE ENDORSEMENT WC 20 03 06
i
:
D. This policy includes these endorsements and schedules:
`— SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
+
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
Plans. All required information is subject to verification and change by audit to be made ANNUALLY Y .
DATE OF ISSUE: 03 01 02 we ST ASSIGN-. MA
OFFICE: CNA o4,1
S I I L,I(`FP4: F7N ,n4r`Tn TN' r.r .lF "7�Y')n
i
s',, �� �J09fVlltO?tfl�Pfilflf.
I Board of Building Rtguiatio s fdr� .
-- ✓llC 10Pf)L?ltOltllJ!-'CL/�IL O�/1�1t8+1ClQItfL6ClI6
I .BOARD OF BUILDING REGULATIONS
HOME IMPROVEMENT CONTRACTOR f License: CONSTRUCTION SUPERVISOR
1 Registration: 118807 7
t
ExptratiQn: 04!2512003 yNumber: CS 080626,` _ '.i
Type: DBA 1q I " Birthdate: 10/13/1961
Expires: 10/1312005 Tr.no: 80626
THREE SONS HOME REPAIR `J'• _ Restricted:
00
PAUL NUTiLE x ,_ PAUL E NUTILE
18 MUNROE AVE. 18 MUNROE AVE
r % ALTHAM,MA 02453 - .' WALTHAM, MA 02543
Administratgt t + Administrator
� NORTH
Tof
own y R L -Andover
No. STO
dower, MaSS.
T O '-- LA E 1
COCHIC HEWICK
ADRATED P `2
1 H BOARD OF HEALTH
Food/Kitchen
PERMIT . T D Septic System
S O� O BUILDING INSPECTOR
THIS CERTIFIES THAT........ . ' .... .................. ......... .......«....
................................................. Foundation
has permission to erect....`f Y1.................. buildings on ....Aj....0/`;.... 7few...... .... Rough
................
all �t �� W.1-V 10Q W Chimney
tobe occupied as....................... ...Q6... r ........................................... . .. ...............................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Lawsrelating t the Inspection, Iteration and Construction of
Buildings in the Town of North Andover. 3i V Q /p� �� PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIONST TS Rough
........ .................
............................................................................. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building. Inspector. Burner
Street No.
r
SEE REVERSE SIDE Smoke Det.