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HomeMy WebLinkAboutMiscellaneous - 176 CARTER FIELD ROAD 4/30/2018r �� Date .... Z.i.,JPJA ........ 10379 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1 This certifies that.................t.W.........1 ......................................................... u, -&A c. -,z - has permission to perform............................................................ plumbing in the buildings of. - a"a ................. at ..... A.J..'P........ Q '2 �. PiL - k. -...q.. :....... North Andover, Mass. Fee ..� .Q..':" ' Lic. No. 103.0.1 ....... PLUMBING INSPECTOR Check # r P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY. —�I MA DATE QLIIPERMIT# JOBSITE ADDRESS OWNER'S NAME I ' % (} OWNER ADDRESS TEL FAX E OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL © RESIDENTIAL EA NEW: 01. RENOVATION: El FIXTURES Z FLOOR- BSM 1 BATHTUB _( CROSS CONNECTION DEVICE ( _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I Y DEDICATED WATER RECYCLE SYSTEM I DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) (_. .. KITCHEN SINK LAVATORY I ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET I URINAL WASHING MACHINE CONNECTION ^I ATER HEATER ALL TYPES I WATER PIPING I I— REPLACEMENT PLANS SUBMITTED: YES 0 NOEL 2 ( 3 ( 4 ( 5 ( 6 ( 7 ( 8 ( 9 ( 10 ( 11 ( 12 ( 13 ( 14 INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESJ, NO �1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY© BOND M 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 ON SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this ap lication are true and that all plumbing work and installations performed under the permit issued for this application be in comp�j Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMt� t w��j<< — LICENSE # f�,61 1 MP,R JP Q CORPORATIONZJ#PARTNERSHIPD#� COMPANY NA h ADDRESS,,L CITYi STATErkqw (ZIP Q ( f TEL FAJID ( CELL ( EMAIL .___ � � b Y: OWNER 0 AT 10 r e t est of k wl dge t prow n t SIG URE LLC 00 H z O F U W a w � o El z ) ❑ F W a 4 Z u LU 1- a CO O aa R; w O w w N a O z a a w a � U J a Q� � w = w F LL F O H F U W P, a a 0 a Date ... c9j ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thatf �;� ,� .................................................................................................................. has permission for gas installation ... 6: P 1 nc r ,.< ................. in the buildings 9f -110 1 at Al ......... 7 ................................................................................ . North Andover, Mass. 0 !� Lic. No. ........ A.�44 . . ..................... Fee.Ad. ............ ...... ................................. �qIK GAS INSPECTOR Check# 9098 F" �-� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE _d/ PERMIT# 0 JOBSITE ADDRESS , � Q✓it— F, x r� P 0 ER'S NAME � V r_1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER TER HEATER INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES JONO F I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY0I OTHER TYPE INDEMNITY ® BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives thisjequirement, CHECK ONE ONLYi, 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this applicati are true and accur and that all plumbing work and installations performed under the permit issued for this application will be in ompi ce with Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAM G- b _ �j LICENSE # 03e l.. ( SI MMGF El JP] JGF LPGI CORPORATION A# PARTNERSHIP ® _ COMPANY NA . Lf. 0�__ - ADDRESS CITY STATE _-4 ZIP QC `l TEL FY -76T-- FAX 671 CELL 7LEMAIL LQp LLC ®# G . OWNER ADDRESS TE FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL�jJ EDUCATIONAL RESIDENTIAL Rr CLEARLY NEW: F-1 RENOVATION: El REPLACEMENT: Rf PLANS SUBMITTED: YES 0 NOE] APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _ �1 FRYOLATOR-- _T FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER TER HEATER INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES JONO F I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY0I OTHER TYPE INDEMNITY ® BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives thisjequirement, CHECK ONE ONLYi, 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this applicati are true and accur and that all plumbing work and installations performed under the permit issued for this application will be in ompi ce with Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAM G- b _ �j LICENSE # 03e l.. ( SI MMGF El JP] JGF LPGI CORPORATION A# PARTNERSHIP ® _ COMPANY NA . Lf. 0�__ - ADDRESS CITY STATE _-4 ZIP QC `l TEL FY -76T-- FAX 671 CELL 7LEMAIL LQp LLC ®# w z 0 F U a � rA W z O N W } � ~ w H a Z Uw �* F - w Aq 3 ¢ w w W � CO 0 a P, a J F a IL � w I w F- LL. H O z z 0 F U W C7 P4 i The Commonwealth of Massachusetts - JI Department of Industrial Accidents Office of Investigations 600 Washington Street UV Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers City/State/Zip: I v(� . �"- Are you an employer? Check the appropriate box: 1. - I am a with employer 4. I am a general contractor and I � El Type of project (required): ` 6. New construction ❑ employees (full and/or part-time). � have hired the sub -contractors El Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 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. El We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 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. T -Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. ("1 Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: .P0 . J+_4' City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to and/or one=year imprisonmenais!ediat as civil penalties in the form of a STOP WORK ORDER and a fine of up250.00 a day ainst the violator. Be acopyof this statement may be forwarded to the Office of Inve t� iaations of the DIA rinsAnce cever e n. Ido hereby that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # �I — Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees., Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone 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 Industrial Accidents Office ofIavestigations 600 Washington Street Boston., MA. 02111 Tei. # 617-727,4900 oxt 406 or 1-877 MASSAFE Revised 5-26-05 Fax # 617-727.7749 wwwmass.gov/dia 11w (,UMMUNVVVALJH U1111MNMUH1J3t;11N Office Use only DEPARllll WOFPUBLICSVEN Permit No. Q DOARDOFFMPRE'VFMTON NS5VCMR12.VO Occupancy & Fees Checked 0 APPLICATION FOR PERNRTTO P 2�MELECTRICALWORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC RICAL CODE, 5.27 CMR 12:00 ,EASE PRINT IN INK OR TYPE ALL INFORMATION) Dat �?'Z' o ` wn of North Andover e undersigned applies for a permit to perform the electrical work�es/ribed below. cation (Street & Number) vner or Tenant vner's Address _ I To the Inspector of Wires: this permit in conjunction with a building permit: Yes L—\-J'No u (Check Appropriate Box) rpose of Building A {'S 1 C �� ' L� Utility Authorization No. � .isting Service Amps I Volts Overhead Underground ED No. of Meters .L Service � Amps .�QVolts Overhead Underground No. of Meters amber of Feeders and Ampacity ,cation and Nature of Proposed Electrical Work to. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA lo. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground lo. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units To. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones 4 tr v enges No. of Air Cond. Total Tons tu�:nsposals No. of Detection and No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices To. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other Io. of Dryers Heating Devices KW Connections lo. of Water Heaters KW No. of No. of Signs Bailasis lo. Hydro Massage Tubs No. of Motors Total HP CHER• warneCoverdo�. PUMUX tlDftmqukeme tsdTvbssachuMCia=WLaws neaanra�tLiabt7rtyhaaalaePblr,yir�ctrdrlgCole� Corer�georilsrialegrivala�t YES u NO ivesertmiWdvafidptodofsanetodeOffm YES � ffycutumdniWYES,pleas niCatefte peofODWWby '�RANftCE ' , J/ BSMWboDL OND p OTHER p ) 1u� FonadValtrofE Wodc $ w st xt 7J DaRao (AA -U— CA -t. -t Fit Lxerse% f V1 ✓LSJ�3 ae(`^lC,tlA-(�C�l✓� Signaaae""�'� �— qqe� lioaiseNo (6---t-7 Yl�� Bt sk=TelNa bO ?j 6�-t 2 - 3 6irj _ S71-0 -v M4 Alt Tel Na .g ) Y 2576- -o £r6 Z_ .0 ;DiSURANCEW IamavvaedlattheLiom9edamnothavedr,r urdneooveragzar,aiAaMegltivalaltasregttitedbyMassadimMG=WLam try sigrtaaue on tt>is pemyt app5caaorl waves ttas ragtmana�t check one) Owner M Agent Telephone No. PERMTf FEE $ signature ot Owner or Agent �c�vccL - RTIL-t i . P. o,"Ift &V -Al 73-oo6 rc K Ps 4-1 RTIL-t i . P. o,"Ift &V -Al 73-oo6 rc Location Id /C � ! f f No. 023% Date �oRTM TOWN OF NORTH ANDOVER O: ••�ao :• 1.{.00 • Certificate of Occupancy $ " E��' Building/Frame Permit Fee $ 5c;?, -1 CRUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t�y Check # v5fr 186"10 Building Inspector O Z OW U CD o 0 (n Q m W W<< m �~ NL, Q Q Q Q °o ijz o Z x Np Cpl 0 OW W 3 O a Ey-Am U1 J2 L LLj a Q lY SJ F-- Z OZ O H O 2 W -� F- SUWom 30 W ZO0 �^ a I-� o c J m ON m] 1 :D O z �o Za�Q 0 �� H X1.,0= 5; ZQ< �< W oN� W o O Ln O OW �� OWN O O J ��i - N •- U7LUz O d p�} 70> Z V% o _j 0th �p W mW > >� W II tr Z d zO W W O In�> w Y� N W Q U_ O o m Q W Z^ m d� F -O OZ a =Z '�IIIIII Lli O O �z_ M 0 Ln u-zd>Qn F� ETT 0 A wUQ x�Q <q �Q O 20 SQ y4°a�g W ��� Illllls _ oU ram n� �Z Wp p o0 �i o 99�P www 7 0 ��� cn x Z`1�III m Illh. 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V) c LLI U) U) W W 19 W CA Town of North Andover Building Department 400 Osgood Street North Andover Ma 01845 (978) 688-9545 Fax (978) 688-9542 r T� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 1-6 ��� J , e, () LOT NUMBER 6 SUBDIVISION DATE REQUEST FILED & -/,/) -S DATE READY FOR INSPECTION TEN 10 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE CO - P D WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWEN - ($25.) DOLLARS WILL BE CHARGED IF THE STRUC DOES N ET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY R ni ITIN(T D.P.W. — WATER METER 5l y 14 I�L DATE /0`2 4 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE / PW AUTHORIZATION Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 1...;!..� has permission to perform ........... ................................................... wiring in the building ofa (��� .., (71..� .t�✓G i{ t/�altl, at North Andover, Mass. Fee.11J.: . Lic. NoI%%1Q. ]j ELECTRICAL INSPECTOR Check # 5666 ]HE UUA MUIV Wt'AL1 H UP' AIMMUHUNKI1 N Office Use only DEPARTAlUff0FPUBIICSAFM Permit No. BOARDOFFIREPREVEMONONSS27CW 12W Occupancy & Fees7 1 Checked APPLICATTONFOR PERMIT TO PORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC SSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) i Date ?,Z -r ©�' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work es rib below. Location (Street & Number) 7 ,6 6 &Z'-�t,- 1 L Owner or Tenant -Tom'& L -6t64 -t 1 (�t/�1p`u � � ► C�v�p Owner's Address Is this permit in conjunction with a building permit: YesNo (Check Appropriate Box) Purpose of Building�( ¢�S 6� (; t. (1 vt�C� Utility Authorization No. ► I L3 Existing Service Amps/ Volts Overhead Underground M No. of Meters New Service -L4DO Amps 'aj / -)-q Volts Overhead Underground Ca No. of Meters. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Plumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• h urarneCowrW-Plmmitothetequireln ecfMamd>useits IhaNeahiiwdvandptoofofsametDdrOffim YES,�j ' I dltxtgtheappo box `1 e0valat YES u NO M 1f3u ha%edrdodYES,pk=mdr&thetypeofcowrWby WodcOoStart Z tiv 0<— kzpectimDaeRaquestad Rtxrgtl�d,t� C�4 A- C aileofFJeesaealWodc$ Fuial Ciarptlimr�rtTrFhnalti crtfrwriimr fV MZnA &IBJ \ 11 LimrwNio. ILI ` r� I.ioe 1`^lU.e,4 l�t.•J-'1; ✓ sigtlahue "\1�->�-- .�C 9 e_ 1�-Z�Z Y Os 3 P��S Busk=TeLNoL &0 �) ddm �`�� ` ✓ ICS -'l am AIL Tel No, OWNER'SINSLRANCEW•Iamawa<etudrLimwdoesnothavettCkRW&UOD oriLssubdarroal and ffiatIrysignahueonftpwrntapplicaatim ' thisretltmerrut � �'�Ca>�alLaws (Please check one) Owner Agent Telephone No. PERMIT FEE $ 14 signature or Owner or Agent If Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that %✓ /? L''." .T. .. has permission to perform ...........1..� ... 5 . �1 �!K. v ..................... wiring in the building of .......... f.....�... .I.,X .............................. �f.'. at..... ......7...�..................................... ...............p; North dove d� ass. (0 ee .... ........ Lic. No.......��s 1 ....... ................ .------............................. ELECTRICA INSPECTOR Check # 5240 TBE COAMONR LTHOl+'MAS94CHU,S'E7TS Office Use only DEPARTNIENTOFPUBLICSAFETY Permit No. BOARDOFFIREPREVEMONREGUL4HONS527CMRI2.,Q0 tI Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 / /O (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / ` Town of North Andover The undersigned applies for a permit to perform the Location (Street & Number) %') L,, ( )'C-5- Owner or Tenant Owner's Address Z CA -A- ;-� Is this permit in conjunction with as building permit: Purpose of Building SI .V E-A.�, 6t-(, Existing Service Amps_Volts New Service Amps/ Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets s No. of Lighting Fixtures No. of RecMptacle Outlets y No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters KW No. Hydro ,Massage Tubs OTHER 4 To the Inspector of Wires: is work describedaielow. �f C - i Z -o' =-t) L--t-ems&n r >= No. of Hot Tubs Yes V7rNo 71 (Check Appropriate Box) Utility Authorization No, 7i��rJ Overhead F-1 Underground Overhead 71 Underground tvo. or transtormers Swimming Pool Above . rm-1 Below i-1 I Generators No. of Meters No. of Meters No. of Oil Burners I No. of Emergency Lighting Battery Units No. of Gas Burners Total KVA KVA No. of Air Cond. Total FIRE ALARMS No. of Zones , Tons No. of Heat Total Total No. of Detection and Rough �„y l� L Pumps Tons KW Initiating Devices Space Area Heating 7RMNAME KW Np: of Sounding Devices AA L ✓ _ � l ' icer>�e/ "� L C�i l� tit /�.�4Cl U ignattnE L.N. No. of Self Contained BusinessTelNo. 7j 7��t7iSta�_ Detection/Sounding Devices ✓�� t/� S io v .�. ! AIL Tel. No. HeatingDevices )WNER'SINSURANCE WANFI2, am aware diatthelicsnse does not have the=ancecoverage orits stt&mtialeq valent asregmedbyMacsaclruscusGer reralLaws KW Local Municipal Other CJ ?lease check one) Owner ® Agent ED Connections No. of No. of Telephone No. PEI2MTT FEE $ �7 Signs Bailasis No. of Motors Total HP boar=Cowrage. Prost =tothawgwwientsofMass dmsetts ' Laws [haveaame liab>btybauancePoheyiwb&gCompfete Co verageoritssubsWbalNmalat YES NO [haves[]bnm2dvandpwofofsametotheOffioe YES IfyuubawchedodYES, pleasemdicatethetypeofoomngeby ,heddrig the .bo�x NSURANCEBOND 1—J U" OII-IFR L (Pkasc Specify) FxpnationDate vahueofflechi c$ VotktoSfalt 1- b o � InspemoriDaleRegtx�d Rough �„y l� L Final >ignedunder e esofpetjury 7RMNAME Licer»No. AA L ✓ _ � l ' icer>�e/ "� L C�i l� tit /�.�4Cl U ignattnE L.N. � Z% J6DJ BusinessTelNo. 7j 7��t7iSta�_ n rklircc i L IA- j6 J l)y�� t1 ✓�� t/� S io v .�. ! AIL Tel. No. )WNER'SINSURANCE WANFI2, am aware diatthelicsnse does not have the=ancecoverage orits stt&mtialeq valent asregmedbyMacsaclruscusGer reralLaws -id thatmy signahue on this permit application waives this regtauement CJ ?lease check one) Owner ® Agent e L Telephone No. PEI2MTT FEE $ �7 7707alure oT 77ner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Companv name: Address " City: Phone #: Insurance. Co. Policy # Company name: Address City: Phone #: 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 oneears' im risonment_as w.ell_as_civil..penattiesintheformof-a_STOP WORKORDER.,and_a fine_of..($1DO.DD)_ada t Y p y.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I 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 Licensing Board Selectman's Office Contact person: Phone #: Health Department O Other t Location No. C,�S/ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $.� Building/Frame Permit Fee $ Foundation Permit Fee $ /frr) srri Other Permit Fee $ TOTAL $ Check # a c�,S_ 177U2 '--Building Inspec6r _ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a ' BUILDING PERMIT NUMBER:/ DATE ISSUED: /10 2-4�� A) K AVIR L:�� SIGNATURE: Building Commissioner n for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: �T 6. *1-76 1.2 Assessors Map and Parcel Number: 6-7 ,lam l/�{b�'�—(�� `�•—,' Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Outside Flood Zone 1.8 Se erage Disposal System: Municipal On Site Disposal System ❑ Public Private 0 Zone SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT 'i`'TUt`iLDistrict: Yes ren 2.1 Owner of Record z� fie% l _ rzr Name (Print) Address for Service S nes re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ License Construction Supervisor: D ff 17 License Number Address 45�%v 2f ` Expiration Date Sig e Telephone i 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address 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 buildin rmit. Signed affidavit Attached Yes ...... JV No ....... 0 SECTION 5 Descriplionof Proposed Work check all a Kcahte New Construction Existing Building ❑ Repair(s) 0 Alterations(s)❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: S �P,1 to /XJ `/ lc;:ti J= �r�yC �/ ��e�j / X'7o d /IFN bScK SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com leted by pen -nit applicant &3IPF, FCIAL ISE 1. Building -229 ' (a) Building Permit Fee Multi lier 2 Electrical 7-1 (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 49 Check Number SECTION 7a OWNER AUTHORIZATIO& TO RE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 2Xas Owner/Authorized Agent of subject property Hereby authorize_ to act on My bein taters relative rk authorized by this building pennit application. /f) ZlZ S' ire of Owner Date ION 7b OWNER/AUTHORIZED AGENT JOCLARATION I, ., as Owner/Authorized Agent of subject proper y Hereby declare that the statements and i rmatio . on the foregoing application are true and accurate, to the best of my knowledge and belief Print N Si ature of Owner/Aent / ! Date NO. OF STORIES 2 SIZE X BASEMENT OR SLAB S SIZE OF FLOOR TEVIBERS 15T 2 NDZ 3 SPAN J %ILI DRAENSIONS OF SILLS Z DIMENSIONS OF POSTSLL- DIMENSIONS OF GIRDERS Z jj HEIGHT OF FOUNDATION Q � THICKNESS _ SIZE OF FOOTING >> X '>� MATERIAL OF CHIMNEY' -ARE► C L 0� IS BUILDING ON SOLID OR Fr1LED LAND IS BUILDING CONNECTED TO NATURAL. GAS LINE /� FORM - U - LOT RELEASE FORM INSTRUCTIONS: This forme is used. to verify that all necessary approval /permits from Boards and Depamnents having jurisdiction have been obtained_ This does not relieve the applicant and or landowner from compliance with any applicable requirements. //. fSoon .Now APPLICANT ���� � LSD I LL C PHONE 4779- 697-Z63r ASSESSORS MAP NUMBER (oZ LOT NUMBER Z + I Sa SUBDIVISION CLI LOT NUMBER STREET GG2I ct/ _ STRF'GT NUMBERam wom-an r b .OFFIC AL USF REQ lF TOWN AGz"' �` r ......... ............ soon, ■a.l.*.a IED G d� CONS& cONRVMN �- U \/ TOWN rV CONMEt FOOD INSPECTS S T 1 COMMENTS PUBLIC WORKS - SEWER, DRNEWAY PER MT FIVE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR �\9 �� � � (z� � � � FORM _ U - LOT RELEASE FORINT INSTRUCTIONS: This form is used.to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Ir.iRwrrntw■■wrwrntw.......... ■R-RrwRrw-Rw.rRwrwR RRRRw R RR R� R.iw. R Rr■ APPLICANT ���� 4, L//w/w/rrrwrR wRRrrrB,LL C PHONE 979= 6g7-Z63�' ASSESSORS MAP NUMBER (oZ LOT NUMBER Z + IV SUBDIVISION CGI Fl PTI LOT NUMBER STREET CC rtl- T' 1 CIS 4100 STREET NUMBER , b �wrr�wrwrwwrrwrr..rw..r.Osman was -so wwwwwrwwwwwwwwawnt■wr.wrw......rwntaarw.waa■ OFFICIAL USE ONLY ...*.wawa wwa.wwr.■amono man" ■.wfntraawntrntwRwww.ntaawaa.awaww.w■.wwwntww wants .......■..a REC �t ATIONS OF TOWN AGENTS Www■ •wawasaar.■ntwww..wwrw■santwwwwa..a.rRawwwwaw.wwwra.wrraa.a wa-"w'.wa.a.wr■ DATE APPROVED CONSERVATION ADMUM4?1ATOR DATE REJECTED TOWN CONMIENTS FOOD INSPECTO BEALTH S T R - CONRVIENTS _ G �_ ✓ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED t t DATE REJECTED CONDAENi'S ......... . CENED BY BUILDING INSPECTOR DATE GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as reques d below. 7� e,,� "A J�3 y e, Permit App cant Property address Map / Parcel q7F-677--Z6_-3, _� Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building. permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit forthe enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units' for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved bythe planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Develop ent Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE BUILDING PERMIT IS ALLOWED AN E) FURTHER I UNDERSTAND THAT THE S CHECKING OFF OF.A ABOVE EXEMPTI NOT IS G-tOUNDVOR REFUSAL BY SIGNATURE Y OF THE INFORMATION PROVIDED AND THAT THE ATTACHED AS CITED ABOVE. OF MISLEADING OR INACCURATE INFORMATION OR THE DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR 1G DEPARTMENT TO ISSUE A BUILD G PER IIT. 16 ��2V DATE TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION The Commonwealth of Massachusetts Department of Industrial Accidents Ofce of Investigations Boston, Mass. 02111 , Workers' Compensation Insurance Affidavit Name Please Print 17 City !Wco , v'L l o `7 Phone 0 I am a homeowner peiforming all work myself. �j I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone * Insurance Co. Policv # R 1. Corrivany name: Address Failure to secure coverage as required under Section 2 or 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment.as_vac l_as_ciAl.penatt* �mefa.STOP WORK_ORDER..and..a fine of.($100.00).attay against me 1 understand that a copy of this statement may be to ed the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pal and penalties of a , that the information provided above is true and correct. Signature Date �U Print nam Phone #1�6 63� Official use only do not write in this area to be completed by city or town official - City or Town Perm!ULicensin I] Building Dept ❑Check if immediate response is required [] Licensing Board C] Selectman's Office Contact person. Phone #: Health Department Other MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename: C:\Program Files\Check\MECcheck\Lot 15 Carter Fields.cck TITLE: Carter Field Lot 16 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 10/05/04 DATE OF PLANS: June 25, 2004 PROJECT INFORMATION: Carter Fields COMPANY INFORMATION: Tara Leigh Development LLC COMPLIANCE: Passes Maximum UA = 600 Your Home = 593 1.2% Better Than Code Ceiling 1: Flat Ceiling or Scissor Truss Wall 1: Wood Frame, 16" o.c. Window 1: Vinyl Frame, Double Pane with Low -E Door 1: Solid Floor 1: All -Wood Joist/Truss, Over Unconditioned Space Furnace 1: Forced Hot Air, 90 AFUE Air Conditioner 1: Electric Central Air, 11 SEER Furnace 2: Forced Hot Air, 80 AFUE Air Conditioner 3: Electric Central Air, 11 SEER Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA 2018 0.0 38.0 50 3572 0.0 19.0 245 584 0.340 199 35 0.340 12 2018 0.0 19.0 87 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building, and the cooling Standard Design Conditions found in the Code. Tl be no greater than 125% of the desijd load as spe5 Builder/Designer if appropriate, has been determined using the applicable JAC equipment selected to heat or cool the building shall in Sections 780CMR 1310 and (J4. . Date ��� MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 10/05/04 TITLE: Carter Field Lot 16 Bldg. Dept. Use Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 continuous insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 continuous insulation Comments: Windows: 1. Window 1: Vinyl Frame, Double Pane with Low -E, U -factor: 0.340 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Solid, U -factor: 0.340 Comments: Floors: 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-19.0 continuous insulation Comments: Heating and Cooling Equipment: 1. Furnace 1: Forced Hot Air, 90 AFUE or higher Make and Model Number 2. Air Conditioner 1: Electric Central Air, 11 SEER or higher Make and Model Number 3. Furnace 2: Forced Hot Air, 80 AFUE or higher Make and Model Number 4. Air Conditioner 3: Electric Central Air, 11 SEER or higher Make and Model Number Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I Materials Identification: [ J I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufachuer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ l I Insulation R -values, glazing U -factors, and heating and cooling equipment efficiency must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table NAT 1. I Duct Construction: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 °F must be insulated to the I levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 Insulation Thickness in Inches by P jW Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Temperature ( F) Up to 1„ Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) CA m m m CA m CA F) Lq < z In mc o n a X ro I Z � C) o aj M ° y 'D _ RI -a � y m o N aM m 0 � rn ('=� 3 a T m� 0 � O O ? N O� O = O C =. m Q 3 a M co '� 0 -' C 13 m o �7� C Q D M T,o f1 O m '� O aa'CL '" c tn '~ 0 E o o * To - Q aCL )Val j ti Do° ;1 CL 0 M me O n � z � � :� � m D E m + Z = C Q a 0 .�M. 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O _ O. q -S o-$. a -L �..�� ► o -1 I N CD L °1-6 a-1, v --Z O -L NSI "1 d Z100 -1S QN o -D 3S 10 IK L� A d - O N ;x Aiwa N � � 0 �A�Qp H d - O A N Aun 't w�QH� 0 NQ�a:Y)Vl\a ACAS IRCW8 O A N f■+rl Z o � o �Aoogp OO��o a z�Hz C t o OZ °-22 °-h t A j N c ;s "r N 0 0� r I o -h � o 0 z e a $r � 99 e � J y in °'_ 0.01 0 a S 9 M 4�tx o-9 o_QE a9 a-9 �t d' O � O -ZZ o-�l O—pZ A W W � U a d kn ZNt TY Q TL �o t4 o �AaGQp �c w 06 okkz��� 70,, l� o1x2 •0 u 1- 1 k :c a Q- 0 2 �1M{fij� �00'1� QfV o7�S o a� � ' a - M N y i t � a; 7 1 &0 kZ H 7Q�,91®o�k2 1, H N V) 1 y� r c. o w 1J O D. M (_1 C Yt� QLr) a GAJ k CDCD Gzc 2 W z � Q a Q Jtp C\f 1 1- o� OOc%LE"'`Z r . nl LP Lil X X co 4 � a x x �� �y x �I �r :� F9 �� N ✓1 3 m O M c o N O 8 p v N o Q 12 N M N M � r•y.. r � `� U)°J n P M M N U1 Jy lM— r qxZ Cv 7 T Q c s y co lP lP M 1 V N I • � t ULu N n (AJ 4� 1 y� r c. o w 1J O D. M U_ M Yt� QLr) a N Gzc 2 W z � Q a a Jtp 1 1- qxZ Cv 7 T Q c s y co lP lP M 1 V N I • � t ULu N n (AJ 4� 0 LJ - Q y� r c. o w 7 O M U_ M M QLr) a Gzc � W z � Q a OOc%LE"'`Z 0 LJ - Q y� r c. ro ? w 7 U_ M 0 LJ - Q Date.. TOWN OF NORTH ANDOVER o : A PERMIT FOR PLUMBING 41 This certifies that ..� l .t!►A� .<.'f C / /5 .............. has permission to perform ... )A,.f."� �/.C. `.............. . plumbing in the buildings of ... I /-? `A lam ................... at ..,%.?G . Fl: -.',I. t.......... , North Andover, Mass. / GS��� Fee.0/79 ".. Lic. No. z ........ ........ i.1.......-^.�.......... . PLUMBING I SPECTOR Check # ) 2) S 6366 w MASSACHUSETTS (Type or print) NORTH ANDOVER, Building Location New d APPLICATION FOR PERMIT TO DO PLUMBIN f Owners Name of Date (r Permit # C Amount Renovation Veplacement13 Plans Submitted Yes ❑ FIXTURES No ❑ (Print or type) Check one: Certificate Installing Company Name (l;(/ - m ! n � ❑ Corp. Address S FlPartner. Business e ep one — El Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent n I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac usetts t >�lumb.nd Chapter 142 of the General Laws. By:Sign re o i enZZ�se Piuin�/ er �p f Plumbing License Title City/Townice1-nse 1NI er Master ❑ Journeyman APPROVED (OFFICE USE ONLY Date. 3-. /.>-.. ". Via..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . AAl. ................. has permission for gas installation . /t. t .tn .. P. :-:1 ......... in the buildings ofh............................... . at . J.7. /—/7......., North Andover, Mass. Fee./G�.�.. Lic. No. �.?.Y t. t_� -, ...... AS INSPECTOR Check # 5G65 MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSA Building Locations �/ /1n r New Renovation ❑ FOR PERMIT' TO DO GAS FfITNG Date 3 "/r' aY Yi; Owner's Name Replacement 11 Plans Submitted 11 Permit # ..d Amount $ Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. Partner. Firm/Co. INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No0 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01 Other type of.indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:1 Agent 0 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 nd Chapter 14,2 9f the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber (— g L/a El Gas Fitter Liceffise Numb7 aster Journeyman • Fir ,j6w No AST. FLOOR ,6TH. FLOOR Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. Partner. Firm/Co. INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No0 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01 Other type of.indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:1 Agent 0 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 nd Chapter 14,2 9f the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber (— g L/a El Gas Fitter Liceffise Numb7 aster Journeyman I Date....`'-.5�. �.�. TOWN OF NORTH ANDOVER o� PERMIT FOR GAS INSTALLATION �9SSACMUSEtt This certifies that ...........k-!. 2'te,..... �!. has permission for gas installation,.<:-,.T.,-.—;-�L2 in the buildings, off ...- at Fee. s a .. Lic. No . X193 Check # Tl q S 5C`80 ............ `.., North Andover, Mass. /,GAS INSPECTAR� • , MASSACHUSETTS UNIFORM APPLICA (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 1 Tara Lei Lei New � s�{ $30.50 Deve Renovation ❑ SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD . F L O O R 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. F L O O R 8TH. FLOOR FOR PERMIT TO DO GAS FIT nNG Date 3/24/05 er Fie4d Rd Zot 16, permit# Q�5-7,90 Amount $ ent per's Name 978 687 2635 Repla / nt11Plans Submitted ❑ x U w a uner — ro U H li e o z o w H 0 C � st b w o A N 1W I w x aU w m 4 d x x W x U w a uner — ro U H li e o z o w P mb rs Q st b w o A N (Print or type) Eastern Propane Gas Certificate Ch k one: Cercate Installing Company Name i Corp. Address 131 Water S t . ❑ Partner. an mars MA nl aP� Business Telephone pp �)❑ Finn/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check I have a current liability Insurance policy or it's substantial equivalent Yes ^ No ❑ Ifyou have checked yes, pleEf dicate the type coverage by checking the appropriate box 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 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 Ccoe, and Chapter 42Aof hee General Laws. By: Signature of Licensed Plumber Or Oras F' e Title Plumber City/Town Gas Fitter cense Number— Master um erMaster APPROVED (OFFICE USE ONLY) ❑ Journeyman