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HomeMy WebLinkAboutMiscellaneous - 190 BERRY STREET 4/30/2018 (2) BUILDING FILE Date. MORTN TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSCMUSE� This certifies that —5.(61 A.U.(A. . . .Xi4}. . . :• �. . . . .. . .vim ,� S / has permission to perform . . . . . . . :.�. . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . .'tit( . . ./1.c. . . . . . . . at . . . . . . . (J. . . . . . . S . . . . . . ., Nort"�h Andoveerr,,.Nass. Fees ��? .Lic. No..�.f. k�. . . . . . 1, 4PL6vBING INSPECTOR Check r _ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: i />N',1I MA. Date: y—/ -1/ Per mit# a Building Location: 763 /Owners Name: l���( Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New: ,Alteration:❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED w Z SYSTEMS r F- z w Y OV j W z O H tY y z IQ-' Y Q Ln .Ja U r"' W K z QH 2 of w H �- w z h H p nz N vai w FW- [O V1 H Q Y y, Q j Q in Q z OG Q W z W J Z U d W C x J_ Q oZS O W Uj z U rx- x a O 3 U Z a p �' a Y z H '��' ` I Q 3 Q Q H H O O f. > > O = p Q Q Q Q F \ O W Q H Q m m a o LL x Y g g u a Q y � � � WFLOOR IST i 3 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR 41I ,/ n r Check One Only Certificate# Installing Company Name:SUS �/tUl G`� (F'�.( I`( IZ��,L�,� �'!/i/� eliv�>Z' . ` EJ corporation Address: City/Town: �/ 'frlYl'�� State:yk.4 ❑Partnership Business Tel: Q 7 Y- 3 X3-4,/// Fax SEirm/Company Name of Licensed Plumber: ( PSV N/S v S �✓�✓C L INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes M-No❑ If you have checked Yes,please indicate the.type of coverage by checking the appropriate box below. A liability insurance policy di' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner El Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title Sign ture of icensed Plumber lumber g Cityrrown ❑Master APPROVED OFFICE USE ONLY) ❑Journeyman License Number: ' COMMONWEALTH OF-MASSACHUS1 TTS` IN PLUMBERS AND GASFITTERS LICEN�EqA,&EgB8R-Y V_MAN PLUMBE' „ DENNIS R SUSLAVICH E 47 VILLAGE WOODS RD HAVERHILL MA 01832-1079 M ftm Fold,-Then Detach Aiong All Perforations i i I i i 7 6 ", C,'` r� Date. !. ... . ...... .. HpR TIy Of ...o of TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION •`Sh MUSEt This certifies that . . .� � �.�ti�� . . . .1'Jf`'�"h. . . . �: `. ./. . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . .� . .� G�� ., t.�C . . . . . . . . . . . . . . . . at i G .�, f �/ . . . . . . . . . . . ., North Andover,,Mass. Feeb '.�. Lic. No.. � �� . . . f.,lG � � G GASiNSPECTOR Check# 06 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:4! �/UI�NdG�I /114 MA. Date: /-/-// Permit# Building Location: lr'J'D / - Owners Name: /%/,w/�6Ak PA,,19 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: El- Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES m LU rn 1w— Cn V = Q m = H 0 W W V N O =W W 0 J N O w p Z g Z O W W w R O Q W Cl) w m 0 a 1- o O W X � > W Z fA (� H W O Q w w = E: W f. W Q W W W Z N = W F- w Z W �' W W Z O J H F-- O Z J O LL N W W Z W } jXC* Fe Q Q m W O Z 0 ~ F- c°� o o � 0 0 _ = g o a 0° � > > > o SUB BSMT. BASEMENT -i'FLOOR t 2 ND FLOOR 3 RD FLOOR 4 FLOOR 51H FLOOR 6 1H FLOOR 7 FLOOR -iFLOOR Check One Only Certificate# Installing Company Name: �!✓ // ❑Corporation Address:IZZ City/Town: °Y4&� State: lit ' ❑ Partnership Business Tel: Fax: ❑ Finn/Company Name of Licensed Plumber/Gas Fitter: K1!?i1S ✓lG INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesAq No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 7�-- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner El Agent E]Si nature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Typ of License: By [lumber Gas Fitter Title Signature of Li e&;;;bZFifter plf aster City/Town ourneyman ❑JLicense Number: APPROVED OFFICE USE ONLY ❑ LP Installer r, 00 i 7 Date. NORTH °��"":•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING 44 This certifies that ................................�:.. ... .-. ..�. ...................................... has permission to perform ......... �7.v �fQ.l�-r. .............................. /y.............. n wiring in the building of........ �..}a .t . l --1 at....... ©.4 �1��.i�.........s .................... .North Andover,Mass. y Fee Lic.No...N<F/.AI5............ .. . . . .. . ..... ......... .... [.ECTRICAL INSPE t Check # 743 -Commonwealth of MassachusettsFOccupaVncy Official Use Only Department of Fire Services � BOARD OF FIRE PREVENTION REGULATIONS nd Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �, City or Town of: NORTH ANDOVER 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)_ 16IQ Beff� VOwner or Tenant _ 4 �Q 14 � Telephone No.q 2?0� Owner's Address q i[f Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building e Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Z ao Amps ,2 lJ _2 �Volts Overhead❑ Und rd g El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above E] In- o.o mergency ig ting rnd. rnd. El Batter 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 Total g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number.._Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of No.of Devices or Equivalent Heaters KW Si ns Ballasts Data Wiring: No.of Devices or E uivalent r No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lec 'cal Work: (When required by municipal policy.) Work to Start: � // Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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:) I certify,under the pains and penalties f perjury,that the information on this application is true and complet FIRM NAME: d 4 C f�v re v X- LIC.NO.: Licensee: �;q,..,aSignature -,_�y (If applicable, enter "exempt"in the lice number line LIC.NO.: Address: 13 ( 13c?1c y (I� S1, ,dr�v/ �/1 f} Bus.Tel.No.: ¢S'2 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License. Alt.Tec. No.No.. `� z�d T-)7 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent )Downer ❑owner's agent. Signature Telephone No. PERMIT FEE. $ ELECTRICAL PERMIT NO. s s ELECTRICAL INSPECTOR—DOUG.SMALL PORT: I.ROUGH SPECTION: Passed— Failed—[ ) Re-inspection requirecT($50.00)-[ ) Inspectors'comments: (Inspectors'Signature-no i itials) Date 2.FINAL INS TION: Passed—[ Failed—[ .I Re-inspection required($50.00) Inspectors'comments: (Inspectors'Signature-no initials) Date -Z�—/ 3.UNDERGROUND INSPECTION: Passed—[ Failed—[ j Re-inspection required($50.00).[ ) 1 Inspectors'comments: CA (Inspectors'Signatur -no initis Date 4.INSPECTION—SERVICE: - DATE CAY,LED NATIONAL GRID: NAME: Passed— Failed—[ ] Re-inspection required($50.00)-[ j Inspecto s' comments: (Inspectors'Signature-no in ials) ate 5.INSPECTION-OTHER: F Passed—[ ] Failed—j ] Re-inspection required($50.00) inspectors' comments: (fuspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLET)OUT AND LEFT ON SITE jF Tf[E AREA TO BE INSPECTED ISNOT ACCESSIBLE,AND ARE—INSpECTION OF$50.00 IS TO BE CRARGED. .t t The Commonwealth of Massachusetts 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 Applicant Information / Please Print Legibly Name (Business/Organization/Individual): Z'W T He u, (-P V �( Address: 13eg C City/State/Zip: SS 11'5 Phone #: 9 9 3 Affe you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I 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' 13.0 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. #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 y employees.insurance or m em to . Below is the .f p y policy and job site information.' Insurance Company Name: h(�S(7 d- L V, 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). N 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 certify under the pains and pen hies of perjury that the information provided above is true and correct. ,,,-2- � � Signature: �' Date: Phone#: Official 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M r 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-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 confn-mation 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 of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia • a • CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building,Permit Number 492-2011 Date: July 6, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 190 Berry Street Lot #3 North Andover, MA 01845 Dings Oak Properties, LLC MAY BE OCCUPIED AS single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Kings Oak Properties,LLC P.O.Box 166 Hampton Falls,N.H. 03844 Building lns ector Fee: $100,00 previously_ paid Receipt: 23804 f ttORTH q Q tLEO 16 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION �,ys Rwr.o�pa��5 BUILDING PERMIT # SACHUS� ADDRESS/LOCATION OF PROPERTY: �� , 9 S� Map Parcel Lot Number SUBDIVISION: AIV DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: �J�y Sf2 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE A Permit Issued to: Address: ROUTING TOWN ENGINEER, SITE PLAN—DRIVE-WAY REVIEW CONSERVATION "p a �� PLANNING DPW-WATER METER m�� �(I �(��l�� ✓n� � ���e SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File:Application for OC form revised Jan 2007/2011 Cehna5 Structural �nqineerinq I LC Phone 978.465.6436 Daniel L. Gelinas, P.E. Fax 978.465.5160 579A North End Blvd. Salisbury,MA 01952-1738 email danlgelinas@comcast.net April 16, 2011 Anthony W. Franciosa III, President Kings Oak Properties, LLC PO Box 166 Hampton Falls NH 03084 RE: Lot 3 Berry St.,North Andover, MA Dear Mr. Franciosa: You have requested Gelinas Structural Engineering LLC (GSE) provide observations of the framing at the above address. On 4-15-11 GSE walked the site, observed the framing, and is it GSE's opinion the framing observed is substantially complete and satisfies the drawing requirements and the requirements of the Massachusetts State Building Code 7h Edition"One and Two Family Dwellings" Please call with any questions, cell 978.360.2562 H of A,,14 2.s1 �1 f P DANIEL L. �� w Very Truly Y o C. No. 33-.3G-4 Daniel L. inas, .E. '` QQ 4-15-11 framing observations.doc