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HomeMy WebLinkAboutMiscellaneous - 19 CANDLESTICK ROAD 4/30/2018 CANDLESTICK ROAD 210/01 106 A-0114-0000.0 L f 4 E i I I I i i I 1 Date..ed..I.Ad...................... F M°pTM� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 88�cHug� M This certifies that ........6(. L.....!... .............................................................................. has permission for gas installation ..�.. ......1..��.,n.................................. in the buildings of.�.,?�1.1�.►,f �7....... ...................................................................... at:... .��....... .`..................��' .!!.. �--.................... North Andover, Mass. Fee.:?)R.-.... Lic. No)5`�. ....... J-.tO....................................................... GASINSPECTOR Check# t ; �743 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: r MA. DATE: 1 PERMIT# JOBSITE ADDRESS:- E r-aAd(e1-1 l OWNER'S NAME: GOWNER ADDRESS: /q )C TEL: V r- ;d Z Y�YFAX:' TYPE OR OCCUPANCY TYPE: COMMERCIAL[� EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:ElREPLAQEMENT:❑ PLANS SUBMITTED: YES❑ N0 APPLIANCES-1 FLOOR Bsmt 1 2 31 4 5 6 7 8 9 1 10 11 12 13 14. BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER a - 03/ - + INSURANCE COVERAGE liabilit insurance olio or its substantial a ivalent which meets the requirements of MGL.Ch.142 YES �0 ❑ I have a currenty.. p y q If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 7 OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the. Massachusetts General Laws,and that my signature on this p rmit application waives this requirement. 1 CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submittdd(or entered)regarding this application are true and accurate to the best of my Knowledge and that.all plumbing work and installations performed finder the permit issued for this application will be in compliance all Pertinent provision of the Massachusetts State Plumbing Code and ChapterX142 of the General Laws. 499 PLUMBER/GASFITTER NAME: A f K, 'C6 LICENSE# 1� %-IGNATLTRE COMPANY NAME: I ADDRESS:3 i�6rt.si r CITY: ZIP: STATE. /17 t A FAX: %3e co G�..cl� TEL: V3G"Z/ 9 3 CEL �936- Z/ S 3 EMAIL: MASTER JOURNEYMAN❑ LP INSTALLER❑ COR ORATION .3°� PARTNERSHIP❑# LLC .o � �`� q j Department;of-Industrial Accidents �t Office)of Investigations ICon ess Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A A C—4 J f,) Lr Q R U�44P,(I! _ i Address:_ ry�A 57— — City/State/Zip: /�Q`<�rJ i Phone#: y C�k-- &-3K'- Z 15 Are you an employer?Check the appropriate box: ; Type of project(required): 1.2 I am a employer with .3 4. R I am;a general contractor and I employees(full and/or part-time). have!hired the sub-contractors 6. El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.* required] 5. We are a corporation and its 10.[] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself. [No workers' comp. right:of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no , employees. [No workers' 13.4 Other S comp.insurance required.] *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ; Policy#or Self-ins.Lic.#: /?`,'V 0!9-3 7 d Expiration Date: 3 a y Job Site Address: lcI 16el h L 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceLft&under the airs and enalties gtee&ug that the information provided above is true and correct. Si ature: _.. I — Date Phone#: 9-3K— Z f; 3 Official use only. Do not write in this area,to be completed by city or town officiaL i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: + s COMMONWEAL :.S a. .. _ '. i TH OF MASSACHUSETTS ,$ BOARQOF T PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE 3 REGISTERED AS A < i PLUMBING CORP MARK MAGN I F I CO ``� MAGN!F I CO EROS PLBSHGT,GAS F I TTI 31 FOREST ST i z t , PF t r MI€ DLETON MA 01949-2015 1` 3266 o5/01/16 204666Wo COMMONWEALTH OF MASSACHQSI;=TTS BOAR PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED( AS A MASTER PLUMBER ; 'ii �t", MARK B MAGN I F I GO g'' # 31 FOREST STREET Si \y:W 141 DOLETON IMA 01949-2015 35.5.9 0'5/01/16 20466 C01MMONWEA .H OF: N"IASSACHUSETTS BOARD OF = PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE fly_ k.. - LIC-- E--N-�-S•�;E.._D{�A:-mS- JOURNEYMAN PLUMBER flARK B MAGNIFICO 31 FOREST ST M I-60LETON Lu A O1 49-201 : iV�23002 05/01 16 04668 rl. f I�K` " xF� R t I .•1:i' F.• r l..if a " Location No. Date NORTh TOWN OF NORTH ANDOVER F - w + • Certificate of Occupancy $ sCNUs c� Building/Frame Permit Fee $ 3 O Foundation Permit Fee $ Other Permit Fee $ r' TOTAL $ 30 a r7 + Check # GI 17092 C/ Building Inspector S TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH-A ONE OR TWO FAMILY DWELLING 777 BUILDING PERMIT NUMBER. V�/O DATE ISSUED. a _ a M ic SIGNATURE: —1 Building Com ' ioner/I for of Buildings Date zSECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / 4 ('aAn aaakh_._ )eoP _106 !/ _/h N,4 -o tZ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record l 1, ag46 ame(Print) Address for Service: �7 � Signature Telephone 2.2 Owner of Record: i Name Print Address for Service: A z M Signature Telephone 90 ECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M 4 - Registration Number Address Expiration Date ^z Signature Telephone Y♦ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Ti AO tS 2e c Z►� t -3 AS-eM—► SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Dollar F: ( UFJF'ICLA.L USE�tNLY Completed b permit applicant 1. Building (a) Building Permit Fee 3� 0 Multiplier 2 Electrical (b) Estimated Total Cost of 3 Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT.OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1> JiPx a4Ukaoas Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,.in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief r Print Name Si ature of Owner/A ent Date 11111111 Nil NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS 1 SIZE OF FOOTING X F MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ` t-.1"e lS FORM - U - LOT RELEASE FORM 4-- INSTRUCTIONS: - INSTRUCTIONS: This form is used to verify that allnecessary 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. APPLICANT PHONE ASSESSORS MAP NUMBER n P LOT NUMBER SUBDIVISION D LOT NUMB.ER _ STREET C�A� �>� 2"l STREET NUMBER I.woos soma.....................,................■..a.......,......,......a....■ OFFICIAL USE ONLY ................c,,..,...........r.............................,........Nunn.man RECOND ENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS s DATE APPROVED TOWN PLANNER DATE REJECTED CONDAEN S DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED (ter' S DATE APPROVED Lie D SE C INSPECTOR-HEALTH DATE REJECTED CO Z4ENTS PUBLIC WORKS—SEWER!WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMA ENTS RECEIVED BY BUILDING INSPECTOR DATE �URTH Town of North Andover p Building Department 27 Charles Street North Andover, MA. 01845 �,ss Area a q; �scwias£ D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. nn DATE �5,/ 1V 1 ZOL JOB LOCATION / I � �-f1 h /✓LIQ "` ��g/ 5 Number Street Address Map/lot "HOMEOWNER �GO � �i{IS N/t t(/L��I ILWJ� q7j &i s - 2 1 z— Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current s exemption for"homeowners"was extended to include owner-occupied dwellings P P 9 of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE - APPROVAL OF BUILDING OFFICIAL } _ TiY i--- M - I I I r.. A o� +t4 '--1 I P-- ir _ S 2 3y�r1 r � I i L � _ P t 4� 4 A.. F ; 1, w *t i r t i I i � ^rVYMftCe� I j IL .y NEW ENGLAND ENGINEERING SERVICES INC ��/ ------/��____.��.n v r�/.-✓Q� /C�'1%"'rte/ �� BOARD EAL F c1�-r-f' FEB 2 3 2004 E .fi e cw tz" kk cam. � I have reviewed the plans on file at the Board of Health and have determined that your existing system has a capacity of 784 Gallons which can accommodate 7 bedrooms. The following information was used to arrive at the above conclusion. Existing system size 1400 square feet Percolation rate from design plans 15 min/inch Loading rate under current title 5 rules 0.56 gallons per square foot Existing system capacity= 1400 Sq.Ft. x 0.56 gals/sq.ft. = 785 gallons All of the information used in making this determination taken from plans prepared by Joseph Barbagallo and revised by Cuoco and Cormier, Inc. dated October 1990. If you have any questions regarding the information presented above please do not hesitate to contact this office. Sincerely, � ca- Benjamin C. Osgo d, Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 .r NEW. ENGLAND ENGINEERING SERVICES INC y rC`-;,qj or.NOB10 ANDD j""� gQp,,RD OF HEALTH February 23, 2004 FEB 2 3 2094 Elizabeth Williams 19 Candlestick Road North Andover,MA 01845 Re: Septic System capacity Dear Elizabeth: I have reviewed the plans on file at the Board of Health and have determined that your existing system has a capacity of 784 Gallons which can accommodate 7 bedrooms. The following information was used to arrive at the above conclusion. Existing system size 1400 square feet Percolation rate from design plans 15 min/inch Loading rate under current title 5 rules 0.56 gallons per square foot Existing system capacity= 1400 Sq.Ft. x 0.56 gals/sq.ft. = 785 gallons All of the information used in making this determination taken from plans prepared by Joseph Barbagallo and revised by Cuoco and Cormier,Inc. dated October 1990. If you have any questions regarding the information presented above please do not hesitate to contact this office. Sincerely, Benjamin C.Zid,Jr.,EIT President 60 BEECHWOOD DRIVE-.NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 ')O� N VV h 1n� .k I- J.st NORTH Town of _ _ 6Andover0 No. -_ C, � i dov r, Mass., LAKE COCHICHEWICK ADRgTED P -`y S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT r V S '...........s. ..b�...........4...............� ........./�r�.� ................................................� Foundation has permission to erect......�r' t*. h......... buildings on ......I..�...... .!V. �'�S. <<� ................. Rough to be occupied as �fC- rd!n w1 /N .......47.4.; a �/1'► `0 AV 4 Chimney ......... .............. a#............. ....................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ` A / 11 Y X30 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough .. ...................................�.. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Rough— Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. K 14 1)P Date. . . .- /. . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUSES This certifies that . . JX ` (.�... ... . . . . . . . . . . . . has permission to perform . �jWf�.y� X fv." plumbing in the buildings of . /�/, f -lir... ./ . . . . . . . . . . . . . at .�l ��. . .t%�l:!�. . . . . . . . ., North Andover, Mass. // fG� Fee.1.�. . . .Lac. No.!•/�?�./. . . . . . . . . . . . . . . : . . . . . . . . . . . . . . J / PLUMBING INSPECTOR Check # U�/ 526 MASSACHUSETTS UNIFORM APPLICAT/Date PERMIT TO DO PLUMBING (Print or Type) N, 4,A/Dd tr'e/7 Mass . C/� 19 City, Town mit 0--f& Building er ' s AT : Location i 72e_s� Z l1412 WIt r Type of Occupant:• :s/ cr6�12-1 New Renovation ❑ Replacement ❑ t Plans FIXTURES Submitted : yes ❑ \I Y a r y zUJ w a a U_ 0 — w F- w to F- U tL Y < N w Z o. UZ 2 ta N N W } < N 0. < d a' 30 x cc < U J 1- C 3 °" U(n = V7 }- Z O C N Y a C x W I 3 Y 1 Q N C O J C F- N u. O a 3 x m O � I SUa—SSMT. I T— B ,ST FLOOR 2N0 FLOOR I I ► I I I I I I I ! I I I I c JRO FLOOR I I I I 4TH FLOOR 5TH FLOOR 6TH FLOOR I 7Th FLOOR I I I I I I 87H FLOOR DOYLE PLUMBING & (Pant or HE Type) ATINf Check One: Ce^uic [e V 209 y Middleton RInstalling Company name °r�� �•iassaCroa d Corp.. Address lusettS 01921 ❑ Partnership Firms Companv Business Telephone _ `lame of Licensed Plumber or Gastitte- I hereby certify that all of the details and information I have submitted(or entered)in above application arc true and accurate to the best of -,c knowledge and chat all plumbing work and installations performed under Permit issued.for this application will be in compliance with ail ;cr.ircn! provisions of the Massachusetts State Gas Code and Chapter lag of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. - Si{naiurc of OWnul A�cm I have a current liability insurance policy to include completed operations coverage. BV Signature of Licensed PluvVber � Title C;[y;Town //gz/ Type of Plumbing License iVlaster ❑ lourne. ar APPROVED (OFFICE USE ONLY) License Number I Date....-... �....... ............ HOR7h °ft"`°-:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��SS�cHusE� This certifies that ..... .........��.-� :��- �.. .............................................. bias permission to perform...,..--�-s--=-=c !-�� ...... . ;-..r7....... wiring in the building of......:...... .............:..:.:.............................................. n �f at...L2... ................... .North Andover,Mass. pp� w b Fee...Q......:.......... Lic.No.............. —''........... .. � ,•................. ELECTRICAL INSPECTOR Check 5657 Permit No. W-F eowaw=FwmwVis s Pea SQA' Occupancy&Fee Cheo - BOARD OF FIRE PREVENTION REGULA IONS 27 CMR 12:00 APPLICATION FOR PERMIT TO PE RM ELECTRICAL WORK All work to be performed in accordance with the Ma husetts Electricai Code 527 C R 12:00/ (Please Print in ink or type all information) Date 3 `5 l d Cl To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to/performs the electrical work described below. Location(Street&Number Owner or Tenant �'/ �1/� 1 1 Owner's Address ]' I Caoc�.(eSbdl— bey . 4 1"V! �U✓�-(� r''I A c�f$Y s Is this permit in conjunction with a building permit es 0 No 0 (Check Appropriate Box) PL(pose of Building Utility Authorization No. , k / Existing Service Amps Voits (0v�ead�a Undgmd a No.of Meters 41 New Service 00 Amps_2010 VQ Vooiits Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i L✓ "sem Gwdnd C JCV /?"0A9 ,-N Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 1 In 1 No.of Lighting Fbdures No.uSwimmd Pool d B Generators 8 Getors KVA No ! r9enaY Lighting of Outlets ///V� No.of Oil B mr�ers Bat er units No,of Switch Outlets ! V No or Gas Burners FIRE ALARMS No.of Zone TOW No.of Detection and No.of Ranges No of Air Cond Tans initiating Devices Heat Taut Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices o NoJ of Self Contained No.of Dishwashers S An3a Heati '/ X KW DetectionlSounding Devices 1 Murddpal 0 Other No.of Dryers Heating Devices. KW Local Connection Sla of No. s Low Voltage Ab CG yv/.�� 1cl) No.of water Heaters KW S ns Bailasus wiring - No.Hydro,Massag e Tuds / J No.of Motors Tata)HP S/'�o/%w 3/?a./ - Dc OTHER: L/� lwle (�X 23 Awn ���v Sl���. G ✓f 7��`r��GCi� h,/V r, INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES=No, have submitted valid proof of same to the Office YES=NO if you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER . (Please Specify) (Expiration Date) Estimated Value of.Electrical Work$ Work to Start .?' Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME q / d��t� r4j V— UC.NO-3/c� �3 3 t(:!Fc� . Licensee / 6 3 � `�y Signature UC.NO. Bus.Tel No. 22 ,F 3.1^Z 8� 9 Address `5 /y �Sh i }Y " Y�cd d"d;/'v Ah Tel.No. _ OWNER'S INSURANCE WAVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature/on this permit application waives this requirement Owner Agent (Please Check one) Fa" v(/ GC C LC Telephone Nd.(/979 665 - /ZPERMIT FEE 5 (Signature of Owner or Agent) i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers'Compensation Insurance Affidavit Please Print Name: x T✓1 t��1 'I l�tJ(I�l( I G(9. Location: city v iWoy- r M C 1SY5 Phone �1� = am a homeowner performing all work myself. ©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. Poligy# 1 .a Company name: u1� �° 2"(/ Address ' PZ - 42 City �- - c �� � Phone#: 9 - 13 Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to theimpositim of criminal penalties of a fine up to$1,500.00 and/or one years'irnprisorrrrent as well as awl penalties in the form of a 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 office of Investigations of the DIA for coverage verification. I do herby certify under the pal' and p7/ties of bry that the information provided above is true and correct Si nature/i /(� or� Date-3L2 Print name ,x 1"^ 'J Phone# x�l 7 S,2 Official use only do not write in this area to be completed by city or town officiar ❑ Building Dept ❑Check if immediate response is required Building -Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone# ❑ Health Department ❑ Other )RM WORKMAN'S COMPENSATION Date/ F/ .. .. .. Of.NORTH ,4, 3? �` 6 6 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 9 �9SSACMU5 i This certifies that . .,-P/. . . . . . . . . . . . . . . . . . . . has permission for gas installation ... .. . . . . . . . . . . . . in the buildings of . .lA...t. .� .{ l.t"-'-. . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . .. North Andover, Mass. Fee. . .3� . . . Lic. No—C-1. . . . . . . .d.., GAS INSPECTOR Check# 6182 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) p .TMass. Date 19 Permit # Building Location �,C��_�-wner's Name ��•�������""� Type.of Occupancy �7 New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No j H N W N G Y Z ¢ N W W N. Cr O V m S 7A c7 J o i ¢ Z p 2 z o W 4 m N r— W W C O N 0. C < cc N d V W = N W t ccF J r z < j z < s < c c w °` o w r ¢ '2 O t7 S L6 3 D O J V ¢- Y D 6 t^ 'O. SUB-85MT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR L STN FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR MILNE PLBG.&HTNG. Installing Company Name onv ana _ ck one: Certificate MANCHESTER MA 01944 eI Corporation ❑. Partnership Business Telephone �—l�6 — `1a�" \ _ ❑ Firm/Co. Name of Licensed Plumber or.Gas Fitt INSURANCE COVERAGE: I have a currenn9j llUity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes IR No ❑ If you have.checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy L-d' 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: Owner Agent ❑ Signature of Owner or Owner's 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,. _ be in with all pertinent.provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge eral T of lJcense: y Plumber gnat a of Licen lumber or as Fitter _ . Title sfitter _ .. u, Title License Number \�- 0ty/Town )oumeyman APPROVED( I NL i w No 15 6 9 Date.....Z11//</...7.... s �aORTM� 3:;.<;�``°.;•�.S TOWN OF NORTH ANDOVER o . ' PERMIT FOR WIRING �,SSAcm This certifies that ..........ar.4.'M+.PS........ �c.�+!v f. ...................``....., 6 / has permission to perform .........`„P.11 ?. .......... J .... �, ,... ........... wiring in the building of....... .............................................. s . at...... c.r ...... ................. .�North Andover, a�. Fee... - .. Lic.No. �.r� y .... �,^s�. / .. LECTRICAL INSkCMR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer t . ... ....._- 771Ei.t/LYI IONN fiLT O iV I..LZLJS l,J Office Use only _ DF?4RTM0VT0FPUBLICSr11= Permit No. - BOARD 0FFMEP,REY=0NREGM770AS527C.MR 12.-00 Occupancy&Fees Checkcd APPLICA TIONFOR FF I? I BHT TO PFJ1 FORMELE=CAL 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 r / Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perfor pork escnbelow. IAP PARCEL Location(Street&Number) �-T - - t Owner or Tenant Owner's Address Is this permit.in conjunction with a building permit:- - Yes= No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service LOO AmpsLaQLJLQVoltS Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No.of Meters Nurnber of Feeders and Ampaciry Location and Nature of Proposed Electrical Work ( n Goi use No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total 'i KVA No.of Lighting Fixtures Swin hung Pool Above r7 Bow Generators KVA -- ground and No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burn=.3 No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones 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 Nelof Dryers Heating Devices KW Local Municipal- Other Connections No,of Water Heaters KW No.of No.of Y Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTBER- lr,s,,=Czy02grRaa�t>xtothezec}m>n�sof lsG�aaliaws NO Ihawa=aIL2btlilyhnas =Polsyurh�gCanO& Co crltaisttJbalecgnvalart YES Ileskrn&dNehdgocfofsawtothe0fficF-- YES Y3,(ula,&cixt�YES,*aemicateartypeofwwrdwbyd,2dmrgt �CE p BOrID GMER ftase ) a/b10o ,;,.,• E�xi'�rII� r,�, r WcxctoStu �( t )1��I7�/ Ti>FccbnLah:�Rf� Rom Sigo�uc��ePa>alties ofp°rjtny: FI�r2MNAME LicaiseNo c � Lb== )y'M P-k I r signh>te Licec�No S 6 1 t, n BtlsinessTal ,b Ll-lulu Alt.Tel I,Ta OWNH1 SINSURANCEWAIVER;IamavwethatttrLimnsedmnatf tgwlr=_ r&-,ce critsahstam-deg�asmgmedbyNb. tsGammiLaws arrltlratmyS=3& Crld isFcm taRDbmticnw,amnthism4maratJJ_(Please check one) Owner AgentTelephone No. PER1vIIT FEE S J)]=Iure of Jwner or Agent, 1C_\ Commonwealth of Massachusetts City/Town of System Pumping Record N Form 4 JUL ''4 2i�1� DEP has provided this form for use by local Boards tfr Mw&. Ul MOW be used, but the information must be substantially the same, thatt Atl this form, check with your local Board of Health tQ determine the form they use. a System Pumping Record must be submitted to the local Board of Health ouotber approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of hou�Right rear of house. Left rear of building. Right rear of building. Address � � � City/Town State Zip Code 2. System Owner: �/�J V Vl. r����✓�-t.� Name Address(if different from location) Citylrown State i, Zip Code Telephone Number B. Pumping Record 7 -9 -/0 �'S 1. Date of Pumping Date 2. Quantity Pumped, Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condit' of System: �� C � LA,. 4r_r�� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: CS -G-- -. Lowell as Water Signature H er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1