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HomeMy WebLinkAboutMiscellaneous - 169 CHESTNUT STREET 4/30/2018 (2) 169 CHESTNUT STREET 210/060.0-0014-0000.0 r IVIH MCHL 1 M VERMONT MUTUAL INSURANCE GROUP--� Lax 89 STATE STREET- PO BOX 369 MONTPELIER,VERMONT 05601-0369 Claims 800-435-0397 SiElcc>!5"�K Property/Liability Claims Fax 802-229-7647 Auto Claims Fax 802-229-8941 E-Mail claimsnvermontmutual.com March 31, 2015 NOTICE OF PAYMENT OF PROCEEDS UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 175, SECTION 97A. NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 Town of North Andover Tax Collector/Building Department 36 Bartlet Street Andover MA 01810 RE: Insured: Herbet F. & Noel C. Hayes Claim No.: HC208034 Policy No.: H010002764 Date of Loss: 27-Feb-2015 Property Location: 169 Chestnut Street, North Andover, MA 01845 Type of Loss: Ice/Snow To Whom It May Concern: A claim has been made involving loss or damage to real property of the above-captioned property loss location which may either exceed $5,000.00 or cause Massachusetts General Laws, Chapter 175, Section 97A, to be applicable. We have requested per the statutory requirements that the claimant provide us with any certificate of municipal liens from the collector of taxes of the city or town wherein the insured property is located. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate, please direct it to the Claims Department and include a reference to the captioned insured, locations, policy number, date of loss and claim or file number. Additionally, the damage to the real property in question may exceed $1,000.00 and this letter constitutes notice pursuant to Massachusetts General Laws, Chapter 139, Section 313. Thank you for your cooperation. VERMONT MUTUAL INSURANCE COMPANY-NORTHERN SECURITY INSURANCE COMPANY,INC. GRANITEMUTUAL INSURANCE COMPANY 2012 Massachusetts Electrical Code Amendments 527 CMR 1.2.00§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 uniforin 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.01 c.166,§32,an electrical permit shall be issued to the person,firrrr or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in MG.L.c.143,§3L. Permits shalL_be limited as to the time of ongoing construction-activity,and maybe.deemed_bytheJnspector_of_Wires abandoned.and-irwalidaf_he_ or she has determined that the authorized worl�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 23 8 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending"through August 15,2012. ^ ule 8—Permit/Date Closed: Vote:Reapply for new permitl�' ❑'Permit Extension Act—Permit/Date Closed: ""\\ rt 0 r Date...........-7 ....... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING CONUS This certifies that ............. T— -:7 .. ..........4:�( . ..! .............. .................................. has permission to perform .......4, ................... . .. wiring in the building of.................k.�'Y.F'S............................................. qq at..... ...... ..................''North Andover,Mass. -7 .......... . ... ........... .... ......Fee..! ................. Lic.No.31�. A7: • Check # CTMECAL INSPEMR Ics C.ccommonwealth o/V1331c414et& Official Use Only a.Ue arEment o ire�ewicel Permit No. P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEAr L INFORMAT701 Date: 2— � City or Town of: /VQ� l t1�g4 VM To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform ,[the Melectrical work described below. Location(Street&Number)_ �� CA C��T'1 � Owner or Tenant ye S Telephone No. Owner's Address S q M 61 . Is this permit in conjunction�'th wilding permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 77 I e KC Q Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: e C C G1 C'P r7 P,-�id.o�Lea -4- P CCa ti c(/til Completion o the follbwing table may be waived by the Inspector of Wires. r No.of Recessed Luminaires No.of Ceil: No.of Total Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.of Emergency Lighting No.of Luminaires Swimming Pool rod. Elrnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and a� ��� Initiating Devices No.of Ranges No.of Air affli Total Tons a/Z No.of Alerting Devices " No.of Waste Disposers Heat Pum er Tons KW No.of elf-Contained p Total : ..... ........................... ............ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: 3' No.of Devices or Equivalent No.of Water Imo' No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent ' OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectrical Work: (When required by municipal policy.) Work to Start: tt-I 14;� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuingoffice. CHECK ONE: INSURANC . BOND ❑ OTHER ❑ (Specify:) V r --� ��'(,(VQ/1 C I certify,under the pains a en Rtes ofperjury,that th in ormation on t ' application is true and completes FIRM NAME: =� LIC.NO.: 7 Licensee: Signature LIC.NO.: (Ifapplicable,enter "exempt,,in he licensenumber 1' e. y� [1 Bus.Tel.No.• Address: I��X `f ��% �/�P ,1 a �/� % Alt.Tel.No.: & *Per M.G.L.c. 147,s.57-61,secuiity work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ s 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. 6Z^\, The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012. ule 8—Permit/Date Closed: _ � �L_— ***Note:Reapply for new permit ermitExtension Act—Permit/Date Closed: Date....?.=�.�-.117 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 75 CHU This certifies .......................... . .............. ... has permission to perform .....a'4'4 ...... wiring in the building of............. ................................................ .......... ............................................ . 0 rth Andover,Mass. F,ee...2.e..C.- 0—. Lic.No...7.7`1 -//,(............ &iRICAL INSPECTOR �'heck # –Wn-e= CC/, , ./r _ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code EC)p7 CMR 12.00 (PLEASE PRINT IN INK OR YEA INFORMATION) Date: //r``((/L�/J_/� City or Town of: k To the Inspector of Wires: By this application the undersigned gives notice' of hi or her inteqtin,to perform the electrical work described below. Location(Street& m Owner or Tenant Telephone No. Owner's Address S Is,this permit in conjunction with a building permit? Yes ❑ No NT (Check Appropriate Box) 'Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: S Leh( -t 14 r Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. ^� CHUCK ONE: INSURANCE (( BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value o El trical Work: (When required by municipal policy.) Work to Start: / 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under th pains nd penalties o perjury,that the information on this application is true and complete. FIRM NA LIC,N0.: M Licensee: � Signature _j a IC NO.: (Ifapplicabl ,enter " empt"in th license n ber lin .) I 1 Bus.Tel.No. Address;_, (1�'1-Vd nil �&dy /VR �� Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $4 Do-0 Date. � . .� :�� . • .... . TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING ,SSACNUS� r� This certifies that . . . . . . . ,.,/. . . . 'a. .... . . `.`�� has permission to perform '. . . . . . .: .' . ' ' . ... plumbing in the buildings of . . . .. at . . . . . . . . . . . .!... n."- . . . . . "�-'. . . .,_. ... , North Andover, Mass. 0-7 Fee- . . . .Lic. No.��. . �: . . . . z.. . . . . . . . . . . . . . PLUMB G INSPECTOR Check N Pt ', 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: f7Z MA. Date: l0 / Permit# Building Location: ( / 1 r ��e, Owners Name: � � /9y�-1 Type of Occupancy: Commercial ❑ Educational ❑ Industrial [I Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: E] Replacement: Plans Submitted: Yes ❑ No(� FIXTURES z z N O Y U in Z N } N d z ~ Z < N Z Q Q N z M rn F- w a z O m v=i W p a Fw- Z �' Z vi t9 V a M Q LL � Q U) W Q w W O 0 w rn L4 —i z W W W Y x = a O N 3 v z Q W 3 a Y Z v=i H W w Q Q U) N - Q O t_- > > O = 0 Q 2 0 0 0 F Q m to a LL C7 x �e g to to t- 3 O SUB BSMT. BASEMENT 1 3T FLOOR 2 FLOOR 3 FLOOR 4 TH FLOOR FLOOR FLOOR •;;� 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Comp ny Name: 6A o��z� / Corporation Address. �1 # City/Town: State: i ri / �} ElPartnership Business Tel:92g 6? CFax: 7 l0 "/�� �/� ❑ Firm/Company Name of Licensed Plumber: !� INSURANCE COVERAGE: 0 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesX No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 'sy Type of License: LAPPROVE—DOFFICE e PI ber Signat re of Li ns d Plumber asterS9 S yrrown []journeyman License Numbe . ! USE ONLY FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSI'I C'I'►ON(S FEE: S PERMIT k I i APPLICATION FOR PERMI•f TO UO PLUMBING; NAME K TYPE OF BUILDING LOCATION OF BUILDING i SKETCII PLUMBER LICENSE NUMBER i PERMIT GRANTED DATE' I i i i PLUMBING INSPECTIOR i a Date. ,ORTH l TOWN OF NORTH ANDOVER o • PERMIT FOR GAS INSTALLATION h SACMUSCtS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING IIIA 1 Cit ITown: /L�jtAi1 f7���D '� Date: �O�/ G � Permit# Building Locatic 1W1q Owners Name: 74 Se; Type of Occupancy: Commercial Educational Industrial Institutional Residentiax New: Alteration: Renovation; Replacement:X Plans Submitted: Yes Nox FIXTURES UJ!Y � Z W Y Vi �. W 0 to 2 N N fn m = O 0 J } W 0 (n ~ con W W o w Q o 0 W W 0 1-- 0 Z � Q N > w Z m O W a. Q = V a X W �- W a uJ to W Z ga W = w 0 woxwww W w > W W Z 0 J P P O Z J (D u' N ~ Z W w w _ O O z 2 g O a � W W > > Vu- 0 0 O SUB BSMT. BASEMENT 1 FLOOR -i'FLOOR 3 Ru FLOOR -4 FLOOR FLOOR 6 FLOOR 7 FLOOR -i'FLOOR Installing Company Name:.Ail � �, ���� check one only Certificate# tV/ Corporation 99 7(� 'City/Town:- SMAtate: t �t 7" 'vE�Y( Partnership Business Tel: �7i -�;` -c�?� Fax: 4 Firm/Company Name of Licensed Plumber/Gas Fitter: �G���r •Jt� �°�� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YesX No . If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information 1 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: -3y _ Plumber a/ �,4 Title Gas Fitter Signa ure of Licensed Plumber/Gas Fitter Master City/Town Journeyman License Number: APPROVED OFFICE USE ONLY LP Installer _ 1 i ` SPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FI'TT'ING NAME&TYPE OF BUILDING LOCATION OF BUILDING ETCI I PLUMBER,GASFITTER,LP INSTALLER LICENSE NUMBER: PERMIT GRANTED EJ DATE: GAS FITTING INSPECTIOR /0 Q Date.. . . . . . .. . .. . ...... . . ,4ORTH 3? TOWN OF NORTH ANDOVER OVveF 49 PERMIT FOR GAS INSTALLATION • s ' SACHUSE� This certifies that . . . . . .: . . . . . . . . . . . . . . . . . . . . . . %, . . . .� has permission for gas installation .! . .' . . .�. . . . . . . . . . in the buildings of�. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `` at . . .'.1. . North Andover, Mass. Fee . ..-..!. Lic. No.. . . . . . . . . . . . . . . .!.-�1 f�'. . . . . . . . . c� GAS INSPEV Check# ;- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: /`bll� Date: �O�/� 9 Permit# Building Locatic AW de-4rN4X1-- Owners Name:�L°� � 415 Type of Occupancy: Commercial Educational Industrial Institutional Residential New: Alteration: Renovation, Replacement:X Plans Submitted: Yes Nox FIXTURES CO W Y Ui Q W N V W m x 0 L W U) l'- 0w w Lu p a � W� w ° ~ OZ = z oi— oa JLLU) > w z a m = w ww w Z a U wZOJHHOZOLL _-� I.-Z W m wO Z N > z U00 WH t=i z 2 O 0- > O SUB BSMT. BASEMENT 1 FLOOR 2 No FLOOR 3 FLOOR 4 TH FLOOR FLOOR -iTff FLOOR 7 TH FLOOR 8 FLOOR tt f( U Check One Only Certificate# V Installing Company Name: E t�Yl 11aC 'a I l e, "Id -� A V/ Corporation T 9 9 7�,, tAddress:/5�Fp��/) > Cit State:State: MA ,�1 Partnership Business Tel: %7 - �f�-C',7� Fax: R-&,,2- ' 270 a / Firm/Company Name of Licensed Plumber/Gas Fitter: / -hat- `Jt r l/ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YesXf No . If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or 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: 3Y _ Plumber Title ✓ Gas Fitter Signa ure of Licensed PlumberlGas Fitter Master City/Town Journeyman License Number: 7 APPROVED OFFICE USE ONLY LP Installer FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER,GASFITTER_LP INSTALLER LICENSE NUMBER: PERMIT GRANTED❑ DATE: GAS FITTING INSPECTIOR Date. "ORT 1+, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING f ,SSACHUSE� 1. This certifies that . X�Y!4:1�!"f`. . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .y '".s . . . . . . . . . . . . . . . . . . . . . at . . !.G. . .���.�. , North Andover, Mass. Fee. )-3 .Lic. No..9 F 77... . . . . . L) . . . . . . . . . . . PLUMBING INSPECTOR Check # / . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: North Andover _ , MA. Date:110/31/2008 Permit# Q� Building Location: F169 Chestnut St� _ _� Owners Name: Herbert Hayes Type of Occupancy: Commercial Educational Industrial 1-71 Institutional - Residential New:l+ Alteration:0 Renovation: Replacement:��/ Plans Submitted: Yes No FIXTURES z z y 0 Y t) N J 2 H W N a IX Z_ F Y N -J0 w O lz QQ H 9 O m y Lu a a W N Z vyi c9 v a K -J W Z d' W N Z V_ a Y = 3 0 0 1•- 3 z °z Q � 3 a Y a W w w W a s y J a o t � � o = o Q W a a a � a m m o o u_ 0 s 4 a rn 1— 3 3 3 0 SUB BSMT. BASEMENT A 1 FLOOR 2 WFLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 -FLOOR 7 FLOOR PT-FLOOR __-� Check One Only Certificate# Installing Company Name: Climate Design Heating&A/C -1 Corporation ,� Address: 5 South Summer St City/Town Bradford State:i,.MA� -��_���,.�_ .� ---- F Partnership � Business Tel: 978-373-5260 Fax: 978-374-4764 � - —• _ � Firm/Company � Name of Licensed Plumber: Glenn Bosteels INSURANCE COVERAGE: 1 have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes•✓ :Nol 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 I I 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 7 Agent n Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)r rding t application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the perm iss 61— Pertinent ppllcation will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 of he eral aws. Type of License: Title[ �! ✓ ; Plumber �} Sign—at u en ica um - —— - -- Master City/Town Journeyman �? License Number: X9875 j APPROVED OFFICE USE ONLY - - Date. ' '! ' ' . . .. .... .. ,AOR TI{ Of 1'b of TOWN OF NORTH ANDOVER PERMIT FOR AS INSTALLATION t ACHUSE�( This certifies that . CL. .er.'� . . . . . . . . . . has permission for gas installation . . . jr-3. . . . . . . . . . . . . . . . . . . . in the buildings of . . .H.!'.`Y� S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . North Andover, Mass. Fee. a�. . . . Lic. No.F� . . J . . . . . . GAS INSPECTOR Check# 2 1 Y& g 1- e / r r uJU MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING b City/Town: North Andover Date: 10/31/2008 _ Permit# .� L r Building Locatia 169 Chestnut St Owners Name: Herbert Hayes �{ Type of Occupancy: Commercial EducationalD. Industrial Institutional Residential New:0 AlterationO Renovation Replacement:? Plans Submitted: Yes C) No FIXTURES W Lu Z N U = m = O W W V U) FN- O = W O J >. WU) O W Q' Z H Q Z W fY O Q H W W W¢W m O Q a t- o W X > Z W Q W = � I.. W O W W Z g = W O LLi ~ O U. > U W Z O J - H O Z -� O W N = W W W W Z W )- fY N J Q Q m W O Z O ~ � > I.- F- _ O Q W W > Q O W Z Z W Q 1.- 00 o u_ o o m m g On. 16- D O SUB BSMT. BASEMENT 1 FLOOR •2 Nu FLOOR fu'—FLOOR 4 FLOOR 5 FLOOR -FrFLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Climate Design Heating&A/C_ �/ Corporation �Z G Address: 5 South Summer St City/Town:jBradford ;State: MA i -- i 1 Partnership Business Tel:k 978-373-5260 Fax: 978-374-4764 Firm/Company --_ Name of Licensed Plumber/Gas Fitter: Glenn Bosteels INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes' '!1.NoD 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 D Bond F OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent OwnerF7 Agent By checking this box❑;1 hereby certify that all of the details and Infownation I haverdh ntered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work agng ations pa permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Code ar 1 o e General Laws. ;pipe of License: By _ _ -- _ -- _ -� i.v." Plumber Title_ Gas Fitter —� ';�_. �i n icer sed Plumber as Fitter - - - -i Master City/Town! Journeyman LP Installer License Number: 9875 - APPROVED OFFICE USE ONLY T �. .. Location No. Date �l NORT►, TOWN OF NORTH ANDOVER 3?0: 0 JL F L a a Certificate of Occupancy $ �SsACMUSE<�' Building/Frame Permit Fee $ clo Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ 7 U r Check # ' Building Inspector TOWN OF NORTH ANDOVER ` BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING y'rc`.?%•> S''��7;"atd�'�'s1�.v°:;���§ �� vis^'�»"",.�r r ,� ..,� �Y'4 r � b it � r �l�I>�"`S��" 4tx.,s3 � �4,i rq??Ssd��,.+. rc P - :.�[3"r BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / e 9 neulnell Ara D W . Map Number , Parcel Nlrnber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided EEawred Provided 1.7 Water Supply M.G.L.C.40. 1.5. Flood Zone Information: 54) 1.8 Sewerage Disposal System: Public ❑ Private ❑ ZOOe Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) 1 r �Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES QO 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O rib p U TD �- p �� License Number Address �l IU �p 1�1�/�J �h mn Expiration Date ic Signature Telephone rM a 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 9 D b (.l.XT tJ ST i i,^6 n VQ E Q, �� Registration Number M A s � J L �S� ! Q1 .��Jb� T Expiration Date Signature Tele hone 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.......0 No.......13 SECTION 5 Description of Proposed Work check au a ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (IIGj, 4.1 Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee X tbl 4 Mechanical HVAC 5 Fire Protection r 6 Total 1+2+3+4+5 d 600.00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 'SAV 1D CA-5,7 " d c_aA/,E ,as Owner uthorized Agen 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 PAVID C Print e ,�J( Si tature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DIMENSIONS OF'SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F ,AUK Itj own of d®ver o = A o dower, Mass., ��40cq COCHICHEWICK ADRATED F �� S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... 4....�� ... . S .............................. y.��"....................... .............. .............. ................ .... Foundation has permission to erect....S-.Q..jP. ..... buildings on........� .6 q...... �s �u V ...... Rough ........... ......... to be occupied asr Q � 4. C' Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating tot Inspection, Alteration and Construction of Buildings in the Town of North Andover. D / rm � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations oids t is Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S T ELECTRICAL INSPECTOR ,i�`�� 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. SEE REVERSE SIDE Smoke Det. �,\ Jlze 1�Joa�vnzaozcuea� o�✓�aanac�zuaetta - .-..__. '1 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104569 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 7/14/2004 Boston,Ma.02108 Type: Private Corporation DAVID CASTRICONE ROOFING,S Favid�astricone { 9 7 Hillside Road Boxford,MA 01921 Administrator Not valid without signature c Town of North Andover ti NORTH o �t�V0 t 4• Building Department to 27 Charles Street ,; North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 * ('00,4 T10 ��SSgcHus�t�y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL ell, sl 50a. The debris will be disposed of in/at: ` V t" Y ` Facility location Qom..... Signature of Applicant C - 42 -o2dd �- Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.