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HomeMy WebLinkAboutMiscellaneous - 181 KARA DRIVE 4/30/2018J C) pCD _ PD D C:) p D b o m 0 Date .//0—,/4..// ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... zomk has permission to perform ..... Add.(.A.01.7 ...... .. . .................. C OSOZIL. wiring in the building of ................................................................. at .... �61 ...... ........................... . 1-�orth Andover, Mass. Fee../%5 ... 07 .... Lic. No. .4�/ .. U.I.fz� ........... ELECTRICAL INSPECTOR Check # 10481 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. Atter 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, 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.C-1. c. 14,9, § 3L. Permits shall_be limited as to the time of ongoing constriction activity, and maybe,deemed by the,Insp.ector.of_Wires abandoned.and.irwalid,iflme_.. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the. permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaiwpermits -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 m effect or existence' during the qual'rfyingperiod beginning on August 15, 2008.and extending through August 15, 2012. fi . ule — Permit/Date CloseNote: Reapply for new permit ❑ Permit Extension Act — Permit/Date Closed: Commonwealth of Massachusetts Official Use only/ Department of Fire Services Permit No. IP 41 / Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL )NFORMATION) Date: / /�% City or Town of: WDQ-TuA)170U (_ti To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 18 ( kA- (LA j i' i i/ Owner or Tenant QY R) CL,.c, A C Telephone N Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: ADO iTie,&/ 'rG j�-s)U ST-iNG'— Completion of the following 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 K -VA No. of Lighting Fixtures Swimming Pool Above ❑ In- E3o. rnd. rnd. oEmergency Lighting Batte 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 Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons 1 KW No. of Self -Contained 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 Kms, Heaters No. of No. of Signs Ballasts Data Wiring: 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. 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 45'0 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information on this application is true and complete; FIRM NAME: Ul {,tJ <-- . A YA,J LIC. NO.: � l i Z Licensee: C3 Al G, (tq,40 Signature LIC. NO.: 2., (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.• 5 -Off � 4 2. 4,5 -CQ Address: Alt. Tel. No.: I KS2, k.�? OWNER'S INSURANCE WAIVER: I a aware that the Licensee does not have the liability insurance coverage normally required by law. By my si ature belo eby waive this requirement I am the (check one) [I owner [I owner's agent. Owner/Agent Signature �,,� Telephone NUi;� 2;- 00PERMIT FEE: $ �I Date. /lk �/�...... . /"- -IN-N TOWN OF NORTH ANDOVER �00 PERMIT FOR GAS INSTALLATION This certifies that . Yea . .................. has permission for gas installation . . 1,4� 14.w. .. in the buildings of ......60. .......... 4 ................ at ..,l6/ ..... • . North Andover,� Aass. Fee. Lic. No.. GAS INSPECTOR Check# U 51-1 7921 0 G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ' &/ffa, , Mass. Date __! 20 � Permit# Building Location 0 l �%LiCS Owner`s Name 66 VF— Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ . No ❑ Installing Company Name-_ Crane's Plumbing _& Heating Address 70 Douglas Street verhill, MA 01830 Check one O Corporation C Partnership Certificate Business Telephone_ 978.771.1155 — ----- O Firm/Co. Name of Licensed Plumber or Gas Fitter Peter Crane INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes 1J No ❑ If you have checked yes. please indicate the type of coverage by checking the appropriate box. A liability insurance policy U Other .type of indemnity O Bond ❑ OWNERS 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 Aaent owner IX 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 the permit issued for this application will be in'If compliance with �I pertlent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By J 6-'� T pe of Plumber ense Title / NI Gasfitter 'Ll Master Signature of Licensed Plumber or Gas Fitter City/Town_ _ ❑Journeyman License Number21805 APPROVED OFFICE USE ONLY)--- -- — _. 0 W U O X H CC CC W 0 W rn W O U m = H = cn z o W I— W Q} WO z O Z o W W C° cn w I— Q = W t– Un o O Cr w H Q W W rn WF- Z Q S CC W WQ W o o I— = cn Z Q z W -J Q W N f— >- cn O Z O F- W J I— W Q W= W> O Cc 0= W u_ Z D� Q W � Q Q O O W(r O W ♦— 0 J U W> � CL 1— O SUB-BSMT. BASEMENT ' 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name-_ Crane's Plumbing _& Heating Address 70 Douglas Street verhill, MA 01830 Check one O Corporation C Partnership Certificate Business Telephone_ 978.771.1155 — ----- O Firm/Co. Name of Licensed Plumber or Gas Fitter Peter Crane INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes 1J No ❑ If you have checked yes. please indicate the type of coverage by checking the appropriate box. A liability insurance policy U Other .type of indemnity O Bond ❑ OWNERS 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 Aaent owner IX 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 the permit issued for this application will be in'If compliance with �I pertlent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By J 6-'� T pe of Plumber ense Title / NI Gasfitter 'Ll Master Signature of Licensed Plumber or Gas Fitter City/Town_ _ ❑Journeyman License Number21805 APPROVED OFFICE USE ONLY)--- -- — _. 0 The Commonwealth ofMassachusetts Department oflndultrialAccidents Office ofinvesagations, 600 Washington Street Boston, MA 02.111 yY www mayssogoy/dia �plicant Information Workers' Compensation Insurance Affidavit: Builders/ContractorsfFIectricians/.Plumbers Name Address: 0 e • City/State/Zi / p'-��� Phone #:- "7 Y 7, Are o -- y u an employers Check the appropriate box: 1 EJam • a employer with 4. ❑ l am a general contractor and I employees (full and/or part-time).* 2. I am a sole proprietor or have hired the sub -contractors listed partner- ship and have no employees on the attached sheet. These sub -contractors have working for mein any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 3. ❑required.] I am a homeowner doing all work officers have exercised their right of exemption MGLmyself. [No workers' comp. per c.152, §1(4), andwehave no insurance required.] t employees. [No workers' comp incur Type of project (required): 6. ❑ New construction 7. ❑ Rem.odeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ EIectrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs ancerequired.] I 13 Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. 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 w�itra n ica g s «.ri. un employer that is providing workers' compensation insurance foP information. MY employees Below is tliepolicy and job site Insurance Company Name: Policy # or Self -ins. Li,. #: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a EMO up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine violator. Of up to $250.00 a day against the . Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D9 for insurance coverage verification. ,ccreu�y cePZyy Under tlle'ains andpenalties ofperjuPy tYtat fixe infoPHlafiOPc pPovitled above is true and correct. —//cciac use 071y, 17o not write in this area, to be cornpletedby city or town official. City or Town: Permit -y'suing Authority (circle one): 2icease a L Board ofllealth 2. BuildingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing 6. Other g Inspector Contact Person: Phone M IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. a Date. TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING This certifies that ..r .e .... l�l �lr-s... j .... ....... has permission to perform plumbing in the buildings of ... ....5e .............. . at .. � i'� . ��U�f .. �........ .'.. , North Andover, Mass. q Fee. a Lic. No.. PLUMBING INSOtCTOR Check # J'7S-3 1151���Iri b rlii &rij+ iti8m�_�: _ � ���� L /7 �'i''"'c CrtL !�'.�� L` Gsi:iiCl Address: ��ls a yity/Town: e� El Corporation C • )` 5t� (� ate: BusinessTel:•�-Q ` ❑ Partnership Fax: Name of Licensed Plumber: �� (�� Firm/Company INSURANCE COVERAGE: I have a current lia_ bi1-i- insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes N If you have checked Yes, please indicate the -type of coverage by checkingthe ❑ o ❑ appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAI ER.1a I am aware that the licensee does not have the insurance coverage required b Chapter Massachusetts General Laws, and that my signature on this permit application waives this requirement. Y P 142 of the Check One Only >i nature of Owner or Owner's A ent Owner ❑ Agent ❑ 1Knowle hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and r .r F Pertinent ge and that all plumbing work and installations perr'ormed under the permit issued for this application will he in compliance with all _provision fhe Massachuse State Plumbing Code and Chapter 142 0; the General Laws. a cGlian to the bass c, my r� Ty e of License: Plumber ignature of icensed P umber y/Town El Master J�� �/ 'PROVED (OFFICE USE ONLY) ❑rn Joueyman License Number: � C i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING n City/Town: X1W1) &;e MA. Date: permit# Building Location_` �`1 � _12 A Owners Name: h I1 (� / S Type of Occupancy: Commercial ❑ Educational ❑ _�© t C Industrial ❑ Institutional ❑ Residential [� New: ❑ Alteration: (jam Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES w DEDICATED 2 w ti SYSTEMS w z a w z 0 m v=i Z y VO z Z v, u zZ a edC in �' w �n ec LU o ❑ p Z O (� d d a v IX a }' Ln m m o❑ O H a.F w aLL �- sus ssnnr, ❑ 3 o 3 ~ a 3 BASEMENT 1sT FLOOR r 2ND FLOOR 3RD FLOOR 4T" FLOOR 5T" FLOOR 6T" FLOOR 7T" FLOOR 8T" FLOOR 1151���Iri b rlii &rij+ iti8m�_�: _ � ���� L /7 �'i''"'c CrtL !�'.�� L` Gsi:iiCl Address: ��ls a yity/Town: e� El Corporation C • )` 5t� (� ate: BusinessTel:•�-Q ` ❑ Partnership Fax: Name of Licensed Plumber: �� (�� Firm/Company INSURANCE COVERAGE: I have a current lia_ bi1-i- insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes N If you have checked Yes, please indicate the -type of coverage by checkingthe ❑ o ❑ appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAI ER.1a I am aware that the licensee does not have the insurance coverage required b Chapter Massachusetts General Laws, and that my signature on this permit application waives this requirement. Y P 142 of the Check One Only >i nature of Owner or Owner's A ent Owner ❑ Agent ❑ 1Knowle hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and r .r F Pertinent ge and that all plumbing work and installations perr'ormed under the permit issued for this application will he in compliance with all _provision fhe Massachuse State Plumbing Code and Chapter 142 0; the General Laws. a cGlian to the bass c, my r� Ty e of License: Plumber ignature of icensed P umber y/Town El Master J�� �/ 'PROVED (OFFICE USE ONLY) ❑rn Joueyman License Number: � C The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers M iCa11f Y'nfnrmaiin„ Name (Business/Organization/Individual): Address: 7o, City/State/Zip:-1.1 Phone #: % ' f�' / �� Are you an employer? Check the appropriate box: ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees(fulland/orpart-time).* have hired the sub-contractors6 ❑New construction2. Iamasole proprietor or partner- listed on the attached sheet.1 7. ❑ Rem.odelingship and have no employees These sub -contractors have 8. 0 Demblitionworking ]i1s for me in any capacity. workers com .insurance p workers' comp. insurance.[No 5. ❑ We are a corporation and itsrequired.] 9. ❑Building addition' 3. ❑ 1 am a homeowner doing officers have exercised their 10.❑ Electrical repairs or ad all work myself. [No workers' comp. - right of exemption per MGL c. 152, § 1(4), and we have 11. ❑ Plumbing repairs or additions insurance required.] f no employees. [No workers 12.0 Roof repairs comp, insurance required ] 1 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my information. employees. Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. hone #: vffrctat use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: /a / 6,/// 4. Electrical Inspector 5. Plumbing Inspector Phone #: Information and Instructions Massachusetts General Laws chapter 1.52 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, orad 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 apartinents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' r 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 or 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: Theol�mouweaj,.th ox �q4assachusefts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston; M 02111, Tel. # 617-727,4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617,727.7749 wwwanass.zov/dia GROW 26 ACORD,. CERTIFICATE OF LIABILITY INSU QC� NEP LIMBI G PRODUCER ■ T A N C E DATE ryMlOD/YYYY) Doherty Insurance Agency, Inc. THIS CERTIFICATE 13 ISSUED A08/26/11 S A MATTER OF INFORMATION P.O. Box 1985 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 21 ov Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover, MA 01810 INSURED INSURERS AFFORDING COVERAGE Peter J Crane DBA Crane Plumbing & INSURER A: Travelers NAIL 8 Heating INSURER B. 70 Douglas Street INSURER C: Haverhill, MA 01830 INSURER D: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 71'.ENI.CAIGREGATE TYPE OF INSURANCE POLICY NUMBER POLICY EXPI ON L u"iIm 6806620H888 LIMRs MERCIAL GENERALlIAKITY 10�11H0 10�11�11 EACH OCCURRENCE $500.000 DAMAGE TO RENTED CLAIMS MADE 91 OCCUR 1300 OQ j_ _� MED EXP one Person) S$ 000 PERSONAL 6 ADV INJURY $500000 LIMRAPPLDESPER: GENERALAGGREGATE Si 000 000 ry 1 1 a n , __ PRODUCTS. COUamD ern .e nnn ..w.. TOMOBRE LIABILITY ANYAUTO COMBINED SINGLE LVOT ALL OWNED AUTOS (Ea aoomm) 1 SCHEDULED AUTOS BODILY INJURY (Per person) S HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Peraaodem) i PROPERTY DAMAGE accident) 1 IAGE LIABILITYIPsr ANY AUTO AUTO ONLY • EA ACCIDENT S OTHER THAN EAACC S AUTO ONLY: ESSNMBRELLA LMBILITY AGG $ OCCURCLAIMS MADE EACH OCCURRENCE 1 AGGREGATE 1 DEDUCTIBLE S RETENTRON S S WORKERS COMPENSATION AND EMPLOYERS' UABR.ITY ANY PROPRIETDRlpARTNER/EXECUTIVE OFFICE"EMBER EXCLUDED? OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Peter J. Crane DBA Crane Plumbing S Heating... Town Of North BHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Andover DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAR Building Department _10_.. oAva IVIIrrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL North Osgood Street IMPOSE NO OBLIGATION OR LIABRny OF ANY KIND UPON THE INSURER. ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. AUTHOftno REP ENTA ACORD 25 (2001108)1 of 2 OS2751 SIM27246 � DML 0 ACO RPORATION 1988 BOARD PL TYPE —J 753953 IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. a LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 -352-2858 cell! 978-502-5921 November 28, 2011 Mr. John Cusack 181 Kara Drive North Andover, Ma 01845 RE: Cusack Residence, 181 Kara Drive, North Andover, Ma. 01845 Dear Mr. Cusack As you requested. I visited the site 11/28/ 11 to review the installation of the .Engineered Materials consisting of LVLs utilized in the framing of the above project. These are shown on plans prepared by G.J. Bruno and Associates A-1 to A-3 Dated 7/17/11 with the framing sheet A-3 certified by me 8/3/11. Based on the above site visit and based on what I could visibly see. I can certify that to the best of my knowledge the LVLs. members utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the8th Edition of the Massachusetts State Building Code for 1&2 Family Residences. All other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections and other details are the responsibility of the licensed construction supervisor responsible for the project. Should you have any questions please do not hesitate to call: Yours truly; iN OF 64ece H. Ogden P.E. Structural 27765 0� � WRENa y Z HMOLD G Ml 7765 Q f'ISTE¢� F4'� fi�S��NAI Ems% Location �Q1 AA � No. HCSQ Date �`fib - Of TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Pool $ qq' TOTAL $ Check # " �? ►' A 15005 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 4 APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ENID— Section for Official Use OnI BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Buildi2 Conunissionerflor of Buildings Date A t'g 11.18 . 1 Property Address: 1.2 Assessors Map and Parcel Number: 91 0k, 100 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(st) Frontage (11) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard RM Yard RegWred Provide LeqMted Provided Reqtlired Provided /0,0 �- /0 /,F z?b -0- /0 zt3 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood'Zone Information: 1.8 Sewerage Disposal Systenr. Public 0 Private 0 zone — Outside Flood Zone 0 municipal On Site Disposal System 0 2.1 Owner of Record J0170 + A)-J1d/-e-J let e*gce �W-, Name (Print) Address for Service igZlp- P( —N 10 Signature - P07) /J Tel 04-1 / lj� +- &-17e) 2.2 Afithorized Ag6nt 6, Le— VL JA P Name P* tAddress for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 70 So Q a C, oto 1.30 Address License Number Licensed Qpristruction Supervisor: e..D-? I 6 Expiration Date 34 M Are Six Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 ( k- -- Company Name'. 310 9y1-z>e—J Registration Number a 44ess `Expiration ���� Date Signature Telephone ic 0 1694, 11y CA I, `^'"® •- as Owner/Auhomed Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury 12. ..` Print Name 6� Signature ofyyOwynye�r/Agent Date yp Item Estimated Cost (Dollars) to be x X Completed by applicant permit 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) �.�/ Check Number .►� ,� r.r?vr:rTk�,.,i3.``; dam. 4.. ¢: s �33 1.✓In, Tr - l.. °!rk :l £,t•-. si4 Jl. Hkaf? 11_l�U 1. f }f'R� C P... .3..r.•.ft �. <V/51I . f'jir Vl N:� S"A fi, !�_. t "?,r�'..1. ':rf� V. +�.,�.;5 s }}l3Fy .�M, .q-id�f dx4. yY�i fy�t .S ..F, 1 4 E s. 4YVe, s^,.. t r}t �'�•��. fL 4 f j�Y y. Y hp S!J,YI �). '.. '✓3; / 4 �. '�'S, iil '�iT 9 -, it¢:t }hi' .f J� Y AuY ,; :� 4, - y,: 's1f ?Y} (>.Sr.S._ S inP2. Si: 1: 2..}}f ✓r.Yi:']a^'ua ^l ^- t}r #/'>..:.} *}j t.. J3 .lf -0: -�:. ,�{: /n Alt;! R. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2 ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS 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 Yx .c -s x,L�' S -N` 'a`''"z.. vF-.y _ r k '�7�s`g' r w.>• c - r .;,. 1� x "'� ^', �t2. t z k ytrF "R " [ F '' k Y. tc7 ::^4�.. .1 Y : 't "`iiw s .✓... ".i �._..y-1 a .} rt. �.: 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 Yea ...... X No ....... ❑ 5.1 Registered Architect: Name: Address a Signature Telephone Not Applicable ❑ Company Name:` Responsible in Charge of Construction Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable '❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Not Applicable ❑ Company Name:` Responsible in Charge of Construction "#`,!► V+%lt`.fk1l7ltsle'-<<: New Construction Existing Building ❑ Repair(s) ❑T USE GROUP Check as applicable) Alterations(s) ❑ Addition ❑ 1 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify A-2 A-5 Brief Description of Propo;e Work: I � j I Z ❑ ❑ B Business 0 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heielrt (R) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �1 LV V,��- Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA IB ❑ ❑ B Business 0 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory ❑ F -I ❑ F-2 0 H High Hazard ❑ 3A 3B ❑ 0 IInstitutional ❑ I-1 ❑ 1-2 0 I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage 0 S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use ❑ 0 ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heielrt (R) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �1 LV V,��- Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date FORM - U - LOT RELEASE FORM -2 . INSTRUCTIONS- This form is used to verify that all -necessary approval /permits from /3p�mf Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .....■■r.■.■rr//.■.r.r�■r.r■.rr..■...rr..rrrr.r�rr...r...r....■.......rrr.r.. APPLICANT J o 1'1 �� �-�. % PHONE q %g—' U k( —M 10 ASSESSORS MAP NUMBER D O LOT NUMBER SUBDIVISION � LOT NUMBER � 9 STREET t l� �"►' t/�-� STREET NUMBER ........- .................................r............ ................ OFFICIAL USE ONLY ........................................................................... RECOMMENDATIONS OF TOWN AGENTS ll.....■......r....r...■■...............r..r.......r.r■ ■....04....rr.rr..0r IVA DATE APPROVED /-• CONSERVATION ADMINISTRATOR DATE REJECTED DATE APPROVED TOWN PLANNER DATE REJECTED COIv1MEI8TS DATE APPROVED F SS ILP C O�HEALTH Vn l SE CINSPECTOR-HEALTH L COIvf CM -s PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECENED BY BUILDING INSPECTOR DATE REJECTED DATE APPROVEDT DATE REJECTED DATE APPROVED DATE REJECTED f-sl- 41. Name. J a✓1 "% z-�S l Location: Ci 9OV'P1✓ Phone.. # p - 64" —l610 I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity WrMA. I am an employer providing workers! compensation for my employees working on this job. I !v names /A�1+�1 i LI t 6D 7o So �:..,. 1 /� .e.)Le�c.r- s Phone #' ®{� `4 eq Clty 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 51,500.00 and/or one years' imprisonments well As.civil, penalties In the farm nfa STOP WORK ..ORDER..and..a .fine.of.(.$100.00).a day against me. I understand that a copy of this statement may be forwarded to the Offioe of Investigations of the DIA for coverage verification, I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. SignatuY� Date .3 re ; ' p Print name (.J� �► L r ' v1 Phone* Official use only do not write in this area to be completed by city or town official' City or Town Perrri i nsi nc Building Dept []Check if immediate response is required [ L/Censing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department 0 Other -• It L44 -1Z fl� LAJ l+.l Q ZI V vwCaxga� 4r h Lki Lt wcaQ Vl 2Z N w+~� WO~ti�4a �+4c�b Q��h •��Q x 20 xp Q ui vSwU O►x.y mina �-4 x x�ghtixq�$ - •�w 0. 49 CS ,r ; `� vxi4 . L* �tSS' 2 g4Ni Z4 QWa-q .h zi �alb tq]UCwx �►.�j til j ti0.0. Q0.2 12� 3 w Lj 1 CN Q E6 LZI �u4E-4 7.56' e-4 Q W FAMILY Pools & Patiarific. Sales • Service • Supplies 47>t f 70 So. Broadway • Lawrence, Massachusetts 01843 Tel: ( ) 688-8307 Fax:( ) 688-1949 NAME 4 rt c' ADDRESS ' '�^ CSL # 010330 HIC # 118204 # 156 7 LIAB # C01 095968 DATE �� LA lU I 20 J CITY ' tt STATE ZIP `{ TELEPHONE 7k - 62- I r O Res. CROSS STREET l 1 4 f Wk. EST. START DATE ry VV EST. COMPLETION DATE • PROPOSAL - We propose to furnish and install one E() 2 i r t c0, �� �! swimming pool for the sum of $ The price for normal installation consists of: `4 Nine hours total machine time including two trips for excavation, backfilling, and rough grading•.atound pool. { Use of one dump truck for six hours for removal of fill during excavation • Installation of pool with filter and wall skimmer, fit` S Thrice does not include: does time over nine hours, additional machine time to be billed at (I -k' Per hour • Any trucking,;over six hours, additional trucks to be billed at ('7,) ) per hour • Any dumping costs incurred for disposal of ledge or faige rocks Re -seeding of grass around pool • Spreading of loam • Trucked in Water • Patio or fence around pool or any accessories, except as noted below • Additional fill, if necessary, for proper backfill or.reshaping of hole • Disposal of large rocks Fuel Connections • Heater Venting • Fuel Storage Tanks • Permits • Damage done to sprinkler systems or any buried items (ex. dry well, electrical lines, cables, etc.) in the access and pool overdig areas. Stumping and removal will be subject to an extra charge. Water or soil condition (ex. clay, peat, live sand. excessive rock, etc.) requiring Min. ax. a stone pack of the hole will be subject to an extra charge of Use of the above will be at the discretion of the job supervisor. Customer is to supply access for all trucks It is the owner's responsibility to obtain the building permit or to assume the costs of►necessary permits. • CONTRACT • l.`Av0l • EXTRAS • Vacuum Cleaner -�� Steps v 1,t ��r, j. Ladder(s) (2(0Filteri/ U✓j S 4 t.. 04L Diving Board Cl `'jt ) With6HP Pumpr'�`'�"'� — Chemicals Liner n to ✓ ( C,CiAn't4.. ) Maintenance Kit c F\..,, Coping Cq ,. (t 1e,,,4 ►% � S �. ,_J � Lifeline Spa Main Drain Miscellaneous r�vJ -uw-� ) P z,.3�y Solar Cover i ) Miscellaneous ( ) Fiberoptic Light Heater ��� �'�'�(� �e �` )C TOTAL EXTRAS Slide { ) BASIC POOL PRICE Caretaker 99 Pkg ( ) Environpool plus Pkg ( ) -7-202 SUBTOTAL $ Environpool Pkg Polaris Vac Sweep '" 5% MA SALES TAX Polaris -retrofit only t+ g� � Inline Chlorinator TOTAL C �( $ ❑ Patio, Electrical, or fence, see attached LESS DEPOSIT 5% minimum . 4 4101 _" .Sri3 d BALANCE OF CONTRACT t-� $ Z Z Sy PAYMENTS: 11/3 Excavation, 1/3 Backfill etx).Staritt� The buyer hereby agrees to pay in full, the total amo IstransAction, upon start up "oTIrstailed pool.You, the Buyer, may cancel this,.lransaction at any time prior t fight of the thil� u n ss day after the date A this transaction. ^� Credit car yments not accept on ct a t_ BUYER SELLERr� `-� �` �' ---i 1 CO-BUYE ,.i v W r OI h C C L Op m M ca CO �E //��� \D w X 8 0 c0.o cm ��a IMO -0 ar r . ��ui o ° Q 1— � 0 S oz N U to d 0 Z'd 66616699L6 ouI s0t4Qd I 9100d RttwQd Q80=tt 10 92 unr Apr 20 01 01:09p family Pools & Patios Inc 97196601949 �4''' ,• •��.. _.Y. �•.. �a,x,ncaaoeall% o`', �/usn�ruulrl Board of Building Regulations and Standards t HOME IMPROVEMENT CONTRACTOR Aeplebation: 118204 Bxplreden: 02/1312003 'type: Supplement Card FAMILY PCIw & PATIOS INC OLEN WIOOIN 70 S. BROADWAY zz IAWABNCE, MA 018!3 Administrator -6m o,: •il�wa���eelle Board of Building Regulations and Standards H0M8IMPR0VEMENTCONTRACTOR Registration: 118204 5� tplretlon; 021tY2003 ? ;Type; Supplement Card FAMILY R,OOLS a;$ATIOS INC OyNTtU1: ow w0b*4JL03 To S. BROADWAY • �,�,. �" ✓ LAWRENCE; MA 01843 Administrator 1 Q%t�e �Ony,eon(aualdG of ::�lnaeatif«ee�lt3 S� Board of Building Regulations find Standards HOME IMPROVEMENT CONTRACTOR Repletratlon: 118204 Eltpirwt W 02/1312003 ;Type: Private Corporation FAMILYMOOLS d FATIOS INC WILLIMIfaUWORdULU5 To 9.0110WAY,.,.,.' IAWRENCEAMA 01843 Adntlniilrator License or registration valid for Indivldul use only before the expiration date. If found return to: Board of Building Regulations and Sinndnrds One Ashburton Place Rm 1301 Boston, ale. 02108 Not valid without sig t •c Y �� • License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, hie. 01108 X 'Not valid witdout sigma Pre License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301. Boston, MA. 01108 � wV Z ... Not va11J without gnntnre p.2 ACORD,N C E RTI F B �����►I�\EST^ WiE 1MMrODn•Vr .. 03/09/2001 617 846-5000 FAX (6173149-5108 Elliot/ Whittier, Hardy A Roy Insurance Agency, Inc. 57 Putnam Street Winthrop, MA 02152 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 000 NOT AMEND, EXTUNO OR ALTER THE COVERAOE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE Slp y Poo Patio Co. , Inc. 92 South Broadway Lawrence, MA 01643 IUSUAFM A Transcontinental Ins. Co. INSURER I' r INSURER INIVaER D. _ _ INSURER E coven THE POLVES OF 111910RANCE [ISIS"FLOIN HAVE BrEN 15901D M FOR THE POLICY MRIODC JI NOI IG ANY REQUIREMENT. TERM OR CCNbITION OF ANY CONTRACT OR OTHER OOCUMENT'MTH RESPECT TO WHICH THIS CERTIFICATE AIA" BC ISSUED OR MAY PERTAIN, THE IN61URANCE AFFOROV BY THE °'JLICIE6 DESGRMED HEREIN IS SUBJECT TO ALL THE TERMS, EY,CLUSION6 ANO CONDITIONS OF SUCH POLICIES. AGGREOATI LIMITS SHOWN IM.Y HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OP IHlUf!ANCR POLICY NUMBERGATT MNmD, E UMITA A GENERAL LIABILITY FAIAL GENERAL LIANk" COMBRC CLAWS MAN a OCCUR 164095968 12/31/2000 12/31/2001 EA.ChO�G;RutpN08 S 50000 FIRE DAMASE (My one lire) I _ S0000 MEo 1X0 (Any ern P0.10n) 1 S0 PER600AL A ADV INJURY I 5000 OENERALA12ORFOATE 1 10000 0!►fLAO TW Elr►�R'A�p�.OPUES FER /OIICY 1rCT LOC PRODUCTS • COMPIOP ACO I 10000 A AM11110111.1 ANYAUto ALL OYMt0AUT01 SCHEOULE0.WTOS HIRED AUTOS I ON•OMMED AU109 1038607 I I I _ 12/31/2000 12 31 2001 COMowaD SINOL: UMIT (IS 43844111) j I 1000 000 J � I WILY INJURY t I (Pu Perin) OODILY INJURY IPG Modenp I PROPERTY DAMAGE I I (Per mwrd) OARAQM LIAOILRY ANY At" I AUTO ONLY • EA AC•CID6ur I OTHER THAN CA AGC S AUTO ONLY: AGOIS Well LIABILITY OMUR a CLASAI MAGA DEDUCTIBLE R1T'ENt10N 1 , CACIIOCCURReNCE 1 AOORZOATE I 1 I I A WORRINECOMFINIAnOMAND" EM/LOYERV UAmrrf 164095968 12/31/2000 12/11/2001 1 r L IreI rill"' C.L. EACH 40^00ENI I 4 L. DISEASE • EA EMPLOYEf I E.L. OLIEASE • POLICY LIMIT I THEM ADDITIONAL INBUREtr INSURER LETTER SHOULD ANY OF THE ABOVI 00t"200 POLF.1It 01 CA)IMLIO $SPORE THE !10101171)4 OAIE'HEREOF, THE IS91J NO CONMANI WILLSNDEAVOR 10 MAIL DAYS WRITTEN NOTICE TO THE CURTInVATE HOLOER NAMED YO011E LEFT, GUT FAILURE TO NAIL SUCH NOTICE $HALL IMPOSE NO 091.10AT10N OR LIAIILITY OF NYHNIO UPON 7H1OHPANY, AOENTI OR REPRIIaNtATTYIG, For Information Purposes Only -.41, ,, '1 iP m UI W C. rzi IH.Z G 'S 78 m r cogor Q� 7 7QOQ��OQ�QOQD� 007 r'C2 0 7 O-� Opdgo ..rV �O o. p d pN�4°T pV tvv �00 p� J. r fn � �oao NOS Q I A-ildl , ot 1 °! I;. I O z W o A u o. O w E U)v v cn o z °z A .� O w O r�G ^C U ci C w a. O u: ro w a O v G a R. z O G z a w O CO ° cn Q cn z 0 w w c� 4 6 0 4 v a CO) h L L A co C.3 M CL CO) 0 CL H 0 cc C cc CO)CL L 0 ts co CO)CL 0 co co 0 Q o a Q. �Q ca ev J •� 0 CO Z CO CO3 C _o U) U) W w ccW U) . c o co C c � o ` C H : O C ' r O i V U CL A C ccN4D � Ea :mom /b: -v C j O d J� ,n "lam CD �J cm WKS bs� E L ca cc C m N m N O C :. CA 'Em v acj ` m r0 cm -i �i� O cm— 'C : `6 (� V: V y O 0. cm c (LD- H m c _ 3o C Nc 0 CD CD Z •tA � F. W .E O.Z C Q � L CD cm � cm C.3® O m� c ar GO C. co � F. O h _ccL- H O rO. O.r=... i z 0 w w c� 4 6 0 4 v a CO) h L L A co C.3 M CL CO) 0 CL H 0 cc C cc CO)CL L 0 ts co CO)CL 0 co co 0 Q o a Q. �Q ca ev J •� 0 CO Z CO CO3 C _o U) U) W w ccW U) N2 13 2 0 5 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ........ ............... has permission to perform....... ................. wiring in the building of ........ X ....................................................... ,at ... /k. -i- ..... Iry W-. W,e`1. ......e.. , North Andover, Mass/ rFee .... Lic. No.��-'` ELECTRICAL INSPECTOR Check# Zy-A x WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPAR731FJV7'OFPVBMCS4FE7Y Permit No. BOARDOFMEPREVEN770NRE6MTIOAN5270RIZO k Occupancy & Fees Checked i APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Date Town of North Andover To the Inspector of Wires: i The undersigned applies for a permit to perform the electrical work described below. Location (Street 1 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes Purpose of Building %'f'S^ /,Ve Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity No (Check Appropriate Box) Utility Authorization No. Overhead a Underground Overhead Underground No. of Meters No. of Meters Location and Nature of Proposed Electrical Work Int_ ���A�csF2,�/ '�,�r�/� ,i in No. of Lighting Outlets No. of Hot Tubs No. of Transformers No. -yf Lighting Fixtures Swimming Pool Above Below Generators g3rofind ground No. ,6f Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery No. 'of Switch Outlets No. of Gas Bumers No. of Ranges No. of Air Cond. Total FIRE ALARMS Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Connections No. of Water Heaters KW No. of No. of Signs Bailasis N, o. Hydro Massage Tubs No. of Motors Total HP OTHER Total KVA KVA No. of Zones ..........�.� ID Oth4r' ka==QmraF Rusuaitbthelegtmeme&dMmdusftGmxiWIaws Iha%eatmaiLmbkyk ratoePbtityat&xkgC Opet bm.CotaaEporitsWjkFtiale*misk YES NO Ihme%hnffadvdWpoofofsa ebthe06t= YES FINO If}cmbmedtadWYFS�pleaserdC*tbCWCfWgrdWbydmdmgthe MURAMT O' OND 0 OU -8Z (PteaseSpecdy) E=tkdVahrdE xhimIWotic $ WotkioSlat hnpectimD*RaWesWd Rough Fitla! SigttadM*rTieR *ej*V/ FIRMAiAME >! t�IY CIr/ /3 J C ea %�iy/ Loa���,��d�Y J7g P Stguttr ._,�� �. i>oa>SeNo Lam/_ O_k _ BtsclessTeLNa `?7�l 36;? '� r4s Aare ,LC / P� .,- S^ �iyt�� /ice v lew /5 /AiTdNo. 2� -% - �a_%7L OWMR'SII,SURANMWAIVFR;I.atnawatetltattheLioa�edoesmt t theit>staauoea o Gss> ►ec�rivalet>tastt uaedby dx>s Gr3taalLaws aod�atmyrnihspeut�tonwai�ihis lett. (Please check one) Owner Agent ® Telephone No. PERMIT FEE $ a 2 3 2 6� NpRT TOWN OF NORTH ANDOVER 14, PERMIT FOR GAS_ INSTALLATION.. • c ^ r This certifies that . has permission for s in allat'n . ....ft'��.� in the buildings ...................... at . AIf ....... , North Andover, Mass. Fee .C,>.7A . Lic. No. {,r .. �pT� ............... % 12i01 20.GAg'rF15PECTOR �. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer -"` MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) !t ,( NORTH ANDOVER Mass. Date kuilding Location '%�/ Awi1 Permit # 2 .� OwnMrs Name -77W/c//�/iii f New '-1 Renovation �j Replacement dans Submitted 0 lo.c (Print or Type) Installing Company Name ANDOVER PLG. & HEATING CO. , Address 571-1/2 SO UNION ST. LAWRENCE, MA. 01843 Business Telephone: 508 685-8383 Check one: Certificate Corp. 2122 Partner. Firm/Co- Name of Licensed Plumber or Gas Fitter GEORGE I ARO- cr 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 coverages. Signature of owner/agent of property , Owner ❑ Agent El i hereby certify that all of the details and information l have submitted (or entered) in above application are true and accurate to the best of mY knowledge and that atl plumbing work and Installations performed under* Permit iuued for this spptiatioo will -be in compliance with all pertlnent provisions of tho Massachusetts State Gas Code and Qiapt s 14: of the Gencul lAws. B PE LICENSE: Y Plumber Title fitter Sign Lure of Licensed Master Plumber or Gasfittier City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number Y • ■rrrrrrrrrr ■rrrrrrrrram e��rrrrrrrrrarrrrrrtrrrrrrrrrr■ ... ■rrrrrrrrrrrrrrrrrrrrirrrr■ . .. rrrrrrrrrrrrrrrnrrrrrrrr■ - • .. ' ■rrrrrrrr MEN rrrrrrrrrrrrrr .. - ■rrrrrrrrrrrrrrrrrrrrrrrr■ .. rrrrrrrrrrrrr FEE r IME rrrrrr■ ... rrrrrrrrrrrrrrrrrrrrrrrrrr .. ■rrrrrrrrMEN rrrrrrrrrrrr' • • ■rrrrrrrrrrrr ■Mrrrrrrrrr■ (Print or Type) Installing Company Name ANDOVER PLG. & HEATING CO. , Address 571-1/2 SO UNION ST. LAWRENCE, MA. 01843 Business Telephone: 508 685-8383 Check one: Certificate Corp. 2122 Partner. Firm/Co- Name of Licensed Plumber or Gas Fitter GEORGE I ARO- cr 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 coverages. Signature of owner/agent of property , Owner ❑ Agent El i hereby certify that all of the details and information l have submitted (or entered) in above application are true and accurate to the best of mY knowledge and that atl plumbing work and Installations performed under* Permit iuued for this spptiatioo will -be in compliance with all pertlnent provisions of tho Massachusetts State Gas Code and Qiapt s 14: of the Gencul lAws. B PE LICENSE: Y Plumber Title fitter Sign Lure of Licensed Master Plumber or Gasfittier City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number