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Home My WebLink AboutMiscellaneous - 196 SOUTH BRADFORD STREET 4/30/2018 / 196 SO BRADFORD STREET 210/104.C-0099-0000.0 \` Date......'.�..�.l. ... .............. NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU i This certifies that has permission for gas installation + inthe buildings of..............7.o 5 .................................................................................. at........�. . �. Q .. .....................V.A . .................. .., North Andover, Mass. Fee .` ....... Lic. No. )..9�.. ..... HL)......................................................... I GAS INSPECTOR ! Check# �2 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -- . CITY _Iv. /��.�.G v�e/--.... ..... ........__._._._......__� MA DATE _L 2 _).3J/3 I PERMIT# lT JOBSITE ADDRESS �.5�+....._.._. _.�_..._ :� 4?� ..._-OWNER'S NAME _ A IGS GOWNER ADDRESS _... _._ _ _ _ _ TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL .._MEDUCATIONAL �._,' RESIDENTIAL � � CLEARLY NEW: _......+� RENOVATION: _...3 REPLACEMENT: ...__ PLANS SUBMITTED: YES NO ._.. APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER ..........( .-.._._.__1 .__._ _i ........_-_.... ._...._..._. ........... ------ E ...... .........._...... ....._...... .........._j CONVERSION BURNER ' l :_._..-_._ ..__-.___; ._..____ .._....-.__ ._._.-.___.. ..._........... ....a.___ ......___..__. COOK STOVE DIRECT VENT HEATER DRYER —J-1 1 FIREPLACE - FRYOLATOR _ ._. _...._... _,r...... ._.__ I FURNACE ; GENERATOR GRILLEI INFRARED HEATER I y_ I { _ j MI 1 4 _ ; - LABORATORY COCKS ! I s t i _.._.__.. ....-..._< _ f. MAKEUP AIR UNIT i ....$ ........,._ ... .. ' ......_{ .....f ' ........ ..:._.__.. ........,..... .._......a ..... ,s ... i OVEN i 1 .... ._-3 ... _. , 5 . ; — ........_ ..... a . ._.. ..._. f _ .. _ _..... POOL HEATER _j. ROOM/SPACE HEATER __._, _.i ROOF TOP UNIT ..._._._J .____.J __._i ___A Ji TEST 14 ur_. __ __j UNIT HEATER _ _ ._ _I ;ONVENTED ROOM HEATER _ � i _vi _ __j _� v k WATER HEATER OTHER t __._I _.___} M` _.i ► l ' S , ._..............._....-.....__................. ....-- - . _,.-_: _.._ s ? z f I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER.? OTHER TYPE INDEMNITY _ BOND i.__.. OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ^ Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER _._ AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicationre true and accurate to best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mplianc ith all P rti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMB ER-GASFITTER NAME LICENSE# 10808 1 G MP MGF 4 JP JGF LPGI , CORPORATION 3403 PARTNERSHIP COMPANY NAME: Atlas/Glenmor J ADDRESS 295 Eastern Ave CITY Chelsea STATE _MA IiZIP 01250 :TEL 617-887-7300 07 f FAX CELL 617-721-6059 EMAILV A- t' � (X4" 1 �� The Commonwealth of Massachusetts • Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;ribly Name (Business/Organization/Individual): ATLAS GLEN-MOR Address:295 EASTERN AVE City/State/Zip:CHELSEA, MA 02150 Phone#:800-433-1616 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 120 1 4. Q I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g• Q Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp. insurance-I required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions ---3--DI-am-a-homeowner�doing=ali=Nvork---- -ff is-hakexer�cised their__ 44NT-Aumbiug-repairsvor�additions - self. m ' right of exemption per MGL y �o workerscomp. 12.❑Roof repairs insurance required_]t C. 152,§1(4),and we have no 13.0 Other employees. [No workers' -' comp. insurance required.] *Any applicant thatchecks box 41 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 indicatingsuch- (Contractors 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 thepolicy andjob site information. Insurance Company Name:NEW HAMPSHIRE INSURANCE COMPANY Policy#or Self-ins. Lic.#:258-89-049 Expiration Date: 10/1/14 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify lepainsand enalties (perjury that the information provided ab7/7/ ia and correct Si ature: Date: v Phone#: It Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �OoIIMON tALTF OF IVIASSAGHUSEI' `' � U 6ER5�q XO GA.SFIT S S3'EFiEp A .ic�.PLtJMPi} G COiP , t "f f' ''`•' ISS`UE$THE ABOVEICENSE TO. y3� .ri's1�EiN 'HOGAN f 13URR(`�1GHS + t �tdzT R E'_ MA. 1 18 4 ; ; {Iu il5/0I/14 15.x; 23 COMMONWEALTH OF MASSAGHUSETf�l t PLUMBERS AND GASFITTERS LICENSED'AS A JOURNEYMAN PLUIVi� ER " ISSUES THE ABOVE LICENSE TO. STEPHEN G. HOGAN ._ -.. + 1'09 BURROUGHS _RD**A °BRAINTREE M2184-115 1 + 1 19523 05/01/14 15382 LICENSE NO. EXPIRATION DATE SERIAL NO. COMMONWEALTH OF MASSACHUSETTS " P'":I MlHRS Af4,D GASFtTTtt,S t Lt f-.-SED AS A MASTER PLUMBEFt ISSUES.THE ABOV.E.LICENSE TO: Y j .*OHi -A -- NOGAN \. `I19 BU RCUGHS;`,RD , Bs'AI'N.TVE 11A 20218 t 15. ` - I;080.8. 05/01/14 1533?5 } GENERATOR APPLICATION DATE: ) ?-113113 LOCATION: )�4 S. Rcra J4;loC 57+ OWNERS NAME: l�,r GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: Md as jam. V o r- PHONE NUMBER: &--C> C-) - `1° 33 - 16' 1 ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: o-tr-lc /7GyS�o *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) �-- r *CONSERVATION APPROVAL Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Nathan & Deborah Wentworth Property Address: 196 South Bradford Street Policy Number: HP1656390 Date/Cause of Loss: 12/5/2012, Oil Leak File or Claim Number: 27391-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. // i Signature and Date , ANDERSON ADJUS ,/'re CO., INC. 50 Nashua Ro d, Suite 303 PO Box 1098 Londonderry, NH 03053 Date. ./ �.. . . . . WORTH 0 41 TOWN - 3j TOWN OF NORTH ANDOVER p D • PERMIT FOR GAS INSTALLATION G••'`Sh / SACHUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . ... . . . . . . . . . . . . . . . . . . . . . . at �. :.! , North Andover, Mass. Fee 2�. . . . . . Lic. No��#'5" . GAS IN6 '70R Check# 7066 1130o� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. �G, tc - Date a City, Town Permit # ��° Building ) Owner's AT: Location / �� S - Name kO'` Gn Type of Occupancy: New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ to N W y Y Z >a N H VW F- W N ccN W O V O H x f' ctl O 1 N W M N F" W W O 4 cc C d 0 Z W x W Q ~ V N tY W Z 0 W x N W Q W O O > W .0 a Q W W O O > W I- V J FN- W el Q W > OC W 'n Z Q Q Q Q O O W O W F- , oc x o c� x U. 3 c Gy .j 0 W > o a. t- O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR '%RD FLOOR 4TH FLOOR '5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check One: Certificate Installing Company Name TasMGeiu n;i t'n , Tnr ® Corp. Address 27 Cherry Street ❑ Partnership Tian r A O1 9 G ❑ Firm/Company Business Telephone—978-777-0701 Name of Licensed Plumber or Gasfitter Tnc_pp}] Qirr3Z I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. ❑ By TYPE LICENSE: Title C1 Plumber ignature of nsed Plumber o asfitter City/Town ® Gasfitter APPROVED (OFFICE USE ONLY) ❑ Master L, �! ❑ Journeyman License Number Location ` S• 2A��'v2� Sr No. ':' 612— Date g �L L MaRTM TOWN OF NORTH ANDOVER 0. Certificate of Occupancy $ cMusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4 -3 Building Inspector PERMIT NO. 1U9,- APPLICATION FOR PE I,� IT TO BUILD********NORTH ANDOVER, nIIA MAPNO.� �(� l�� LOT NO. ,C ! 2. RECORD OFO\1'NERSIIIP DATE BOOK PACE ZONE SU13DIV. LOT NO. LOCATION PURPOSE OF BUILDING` + V- � r.�_•f , O1\'NER'SNAAIE NO.OF STORIES l I� SIZE OWNER'S ADDRESS BASEMENTOR SLAB ' C VY\—e. ARCHITECT'S NAME SIZE OF FLOOR TINIBER$' 1 2 ND 31t BUILDER'S NAME !/ l9w � SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIAIENSIONS-OFGIRDERS AREA OF LOT FRONTAGE IIEIGIITOFFOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING IS BUILDING ADDITION AIATERIALOFCIIININEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL DUILDING CONFORM TO REQUIREMENTS OF CODE 1`l�S_c� '_ r 1p r'� Gu w !u" IS BUILDING CONNECTS TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER i• IS BUILDING CONNECTED TO NATURAL GAS LINE 1NSTUCTI0NS 3. PROPERTY INFOliNIA-TION LAND COST EST. BLDG.COST 7 7U PAGE 1 FILL OUT SECTIONS 1-3 EST.BLDG. COST PER SQ. FT. • EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. i ATTACHED GARAGES MUST,CONFORNI TO STA'1'F,FIRE REGULATIONS 4. APPROVED BY' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED' OWNERSTELII �� — ��3- 3 yg� 47gs_ e CONTR.TELH SIGNATURE OF OWNER OR AUll10R12EU AGENT CONTR.LIC11�—_ �Z-� ��'�� I FEE $ PERMIT GRANTED 19 Revised 5/5/99 JAI FORM U LOQ' RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from- Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. t* ** *<** " AP3'LICANT FILLS OUT THIS 6 APPLICANT wo 2 l� �3 �3 �'P n� ' -r PHONE �` LOCATION: Assessor's Mao Number C � PARCEL SUBDIVISION LOT (S) STREET GO �� S T. NUMBER '� "OFFlC1AL USE RECOMMENDATIONS OF TOWN AGENTS: �.,v,sb /�z CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPEC -HEALTH DATE APPROVED DATE REJECTED SEPT] INS OR ALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING ii 1SPECTCR OAT`= Revised 9\97 im NORTH Town of 4 Andover O No. Z = dover, Mass., o C QC MIC ME WICK AoRATEO P' Cl S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ......0.*A4.rd..........,rit; A0tt..+.O.r7''h ......................................... ...................... Foundation has permission to erect.....F;.N�.�.�......... buildings on ........�... ...L....... so.....3N.01. nit.... Rough to be occupied as....3A.4.1 on ip V.�........;%j.r......sf 1/ ...... .r ..�i............................. chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �1 �► Oy PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION jSTAIiTs Rough 5 $ - U4A Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner i 52 Street No. SEE REVERSE SIDE Smoke Det. C a FQ ' �. -�1 •;mar f sOf V-3 a . - N2 62 Date.'....1.9...... ............. NORT1, °�,�``°;•'"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING sSAcHusf This certifies that " .J has permission to perform ..%.....s. '� ....................�......................................... wiring in the building of... ..............c.. '.. t....'........................................ • at/... ........ ,North Andover,Mass. Fee ........ Lic.No&!/-" ............................................. U ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Z 1E00W0NWE4LTH0FMi Ma1a= Office Use only DEPARTMFJVIOFPUBLIC&4= Permit No. BOARD OFFREPM M ONRWM4770AS527CURIZOO Occupancy&Fees Checked �� APPLICATION FOR 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 4 �d Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. `Location(Street&Number) Owner or Tenant /;1/4 rt A S, G.F✓f wd�� Owner's Address 519�'/�' Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building Utility Authorization No. ��- Existing Service Amps / Volts Overhead Underground a No.of Meters New Service Amps Volts Overhead Underground No.of Meters s� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7P-u No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets n No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets / No.of Gas Burners 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 htiating 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 Municipala Other Connections No.of Water Heaters KW No.of No.of Signs Baiiasis - No.Hydrp Massage Tubs No.of Motors Total HP OTHER kp>==Caeaga Aaa=iDtiL-m4mmie:tsdN4mmdxBcmCgraalLam Iba,.eaomatLrblityhtsim=Potirymdud tgCaTpide,�iomCovaaWcritsskstadiaiegtrivalert YES ® NO lhawahnHiedvalidpmcfofsamebtbeOliim YES � NO If}mba%edtedmdYFS,Pfea mdc*thetypeefwmaWbyd�gthe INSURANCE ® BOND ®. OTHER ® fteseSpecify) Date A/ dc� 4 dVAxd17ecrical Wotk$ WC StNt Ov ttspectimD* `ectad Ro# Mac) Final Sigrted urdert"�i�e FIRM NAME / Lioa�seNa /SI�d Licaisee �. ///��/f r✓/�/V �� Sigratiue L=wl o a, ��, ,� '/ Btsutess TeL Na .(.�r��y,is l✓`- 7 Armor Oo –`21�.fes/ , 6" ��fd /!S�7�1 Alt TeL N . 2Z-1-I'521– LIZ Z I OWNER'SPi SURAN .WAIVER;I.amawaretbatthet =daesactt ethein rase trissthUtialegrm1etastegtmcdbyMassadjts sCcnxALam anddAmysigtahaecntbispmr.tvo 'emt mw'mnat (Please check one) Owner Agent ED Telephone No. PERMIT FEE$