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Miscellaneous - 20 GIBSON COURT 4/30/2018
/ O GiCison C©WR-r J - i i h Date. . . . . . . . . . . . .. . d NORTH Of o 1 ti Fj '` p TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACNUSEt This certifies that . . . . . . . ... . . . . . . . . . .T. . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . ..i. . . . . . . . . . . . . . . . . in the buildings of : . . f'! . .':. . . . . . . . . . . . . . at . . . . . . .:{ . . . . . . . . .`. .`. . . . . . . . . . ., North Andover, Mass. Fee. :: . . . . . . Lic. No�. . . .i ?. . ��` - ,,Yc . . . . . . . . . . . . r GASINSPECTOR Check# 7 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT T'0 DO GAS FITTING (Type or print) Date Ai�/2 NORTH ANDOVER,MASSACHUSETTS I� Building / `�Locations S J ` "'sy"' Permit# Amount$ ,�SCf 1V — Owner's Name�� G( �{ Qyt -eCole New❑ Renovation ❑ Replacement Plans Submitted ❑ 0 a SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR- 7T H. LOOR7TH. FLOOR 8TH. FLOOR (� (Print or ) 14 / , n .�_1 �/�� � �� one: Certificate Installing Company Name �' 1 Corp. Addres c t e t e,., 11Partner. Qtt' ef Business Telephone / ❑ Firm/Co. Name ofLicensed Plumber or Gas Fitter Z a b1 irY� I Q INSURANCE COVERAGE heck onp. I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked ,pl indicate the type coverage by checking the apprgxiate bcoe Liability insurance policy Other type of indemnity ❑ Bond ❑ V Owner's Insurance Waiv . I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or tered)in above application are true and accurate to the i best of my knowledge and that all plumbing work and installations perf Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State d hapter l4 the General Laws. By ature of Licensed Plumber Or Gas Fitter Title Plumber i4;� City/Town S Gas Fitter License NUMDer Master APPROVED(OFFiCE USE ONLY) Journeyman MAP W PARCEL 9 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FMING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations ! Cb J D 4- Permit# 3 �A � 1 Owner's Name Amount$ New El Renovation ❑ Replacement Plans Submitted ❑ x � - F x c Z c w r� Date.3 .-.1 - t�!!..... o a > / x x 3J1 w F r O C > A a F O NORTH TOWN OF NORTH ANDOVER 3��ya��.ao ,e,�OOL o PERMIT FOR GAS INSTALLATION 1- A •, a SSACHUSE This certifies that . . " " " " . . . . . . . � CSC one: Certificate Installing Company has permission for gas installation ;.!,:� • !.-T. • • • • • • . • • • • • • ' ' ❑ Corp. . . .� in the buildings of . .�., �. `l. .: .t. ;• `• . . . �- L ❑ Partner. at ' �' f� . . . . . . . . . . . . • • • • •. North Andover, Mass. North ❑ Firm/Co. Fee. .l� Lic. No.. . . . . . ..... . . .�. :.. . . GAS INSPECTOR , t WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked M,please' dicate the type coveragebychecking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waive . 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: [:1Signature of Owner or Owner's Agent Owner [:3 Agent I hereby certify that all of the details and information I tallati, e sub (ore tered)in above application are true and accurate to the best of my knowledge and that all plumbing work and n eunder Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts e C eland Cha to I Laws. By: Signature of Licensed Plumber Ortt Title Plumber City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Date....... gORTIi TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 CHU5 Eth This certifies that .........t..�... 6..........r....... .. .... . .. ... . .�ca..... . ...... .......... ... has permission to perform ....... ............................................. wiring in the building of.....\AJA.Ur ......................... at.. ............ c.7....... ,North Andover Mass Fee gko... Lic.No./&/-,y .. ............ ELECTRICAL INSPECTOR Check # j elMM'.' e, Lh g�,rh�ae�eulsjfs OfticiuI Use Only ..Ue arin�en!o cc77 Permit bio. 3 y'_ k p �..tirs�sruics! BOARD OF FiRE PREVENTION REGULATIONS Occupancy..and Fee Checked A Rev. 11/99] heave 61ank) APPLICATION FOR PERMIT TO PERFOR All M ELECTRICAL. WORK .cork to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00. . (PLEASE PRhVT iN INK OR TYPE ALL iMFORi-VIATION) Dale: Z d Z City or"1'owtt of: Aj, 14 �t_�� To flee hgrflecfor o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical%York described below. Location (Street 4s. Number) — l S' t2 (;;b%K C-4 E Owner or Tenant (,()pW l2.L4 %inn C ��— TelephoneNo. Owner's Address Ao w ad'h6le a04A Is this permit in conjulictiori with a building permit? YesNo❑ LAJ (Check Appropriate Box) 1'urliosc of Building ( {&� K4f.e �fp� Utility Authorization No. Existing Service Amps Volts Overlicad ❑ Und rd g 14 No.of Meters .�� Ncle Sertiicc S�gwIe Amps / Volts Overhead❑. Undgrd ❑ NO.of i'leters. Number of Feeders and Ampacity :P . Location and Nature of Proposed Electrical Work: N a rvicY (� Completion of the fallaIvin. table may be ivaived by+the his'cctor of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans ! o•o '-tat frarisformcrs KVA No,of Ligliliiig Outlets No.of Ilot Tubs Generators K%rA No.of Lighting Fixtures Swimming Pool Above ❑ Lt- ❑ i 0.0 mergeucy ig i nig rnd. rnd. Batte Units i No.of Receptacle Outlets No.of Oil Burners FIRE ALAR.IIS No.of Zones -•� NO.of Switches No.of Gas Burners . o.o Detection and x Initiating Devices No.of Ranges No.of Air Cond. Total Tons No. of Alerting Devices N ,No.of Waste Disposers Flcat Punip _.Number Tons K� .No. o el- ontaincd Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ N uriicipa Connection ❑ Other No.of Dryers Heating,Appliances KW Security Systems: t o. of Nater No,of Devices or Equivalent No.of .`to.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E alent No.Hvdroniassage Bathtubs No.of tMolors Total HP l elecommumcations Wiring-, OTHER: No.of Devices or Equivalent Attach additional detaili desired- f or as r e wire IivSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work Inspector y issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. 1lne undersigned certifies that such coverage is fil force,and has exhibited proof of same to the permit issuing office. CHECK ON'E INSURANCE P/ BOND ❑ 0.1'I-iER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expalio%Dace) Work to Start: 3" 0 Z-- Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjrrg;that lite information oil this application is tare and comp&,&e. FIR.i%I NAAIE:- ' LIC.i\O.:— 1.� k Licensee: �1,1G �.t' �E= Signature �a053t') l a licabre,enter• "errn1pt"in lite license number line LIC.NO.: - �l rn Address: �a� d ' ( O 3 Bus.Tel.No. ' Alt.Tel.No.; $ Y OWNER' INSURANCE WAIVER: I am aware that the Liceruee docs nor have the liability insurance coverage norn3ally required by law. By my signature below,l hereby waive this requirement. I am the(check onc)❑ owner ❑owner's agent:' Owner/Abent Signature 1'elcphonc Nu. P;- rrT r•EE: 5 (� t Date. 0'.",�RT:�tio T )PE OF NORTH ANDOVER p MIT FOR PLUMBING ,SSACMUSEt This certifies that . . . . . . . . . . . . . . . . . . . . has permission to perform r J-4 . . . . . . . . • . . . . plumbing in the buildings of . �J� '.�'.<�? lr'2-�. . . . . . . . • . . . t t � at. . ,��. . . . ,T. . . . . . . . . . . . . . . . . .. orth Andover, Mass. Fee. '. . .Lic. No. 1: �. . ?.i . . . . . . . . . PLUMBING INSPECTOR Check # I 5U � 0 MA$SACHUSEITS UN1MRM APPUCATON FOR PERNHr TO DO GAS FflTNG (Type or print) Date 7 J Iq yL 0 NORTH ANDOVER,MASSACHUSETTS jW q Building Locations V I e � S j� �'4� s 1'`- Permit# / a I /IF Amount$ Owner's Name/ ►Jr d'11 ,/&9 S, (D — New❑ Renovation ❑ Replacement [;T Plans Submitted ❑ � w n W U F vi W W W O. O F x z F C7 W x z F W" > W�W G zW W rn � � � C4 a W � W F A F x C4 C7 F Z WF z W W C7 W C� F UW1 U 9 1 > A F O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or t L r W 1 V Check one: Certificate Installing Company Name I U ��l S � ❑ Corp. Address ° S �" r�G�✓ ' '" ❑ Partner. S Business Te ep oneS'— Firm/Co. 77 S ] ❑ Name of Licensed Plumber or Gas Fitter p( N . INSURANCE COVERAGE Chec o e: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please'ndicate the type coverage by checking the appropriate box. Liability insurance policy o Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the = Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installatio pe r ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S and pter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber / Z z // City/Town ❑ Gas Fitter License Num5er Master APPROVED(OFFICE USE ONLY) � Journeyman Date °f<NO°':'�o TOWN OF N T .-ANDOVER PERMIT FO PLUMBING SgAC1/u5� This certifies that `. . °l b?! . . . . . .' . . .f. . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . �. / . . . . . . . . . plumbing in the buildings of . . .. .(... . . !. !. . .S.1. . . . . . . . . . . at . . . 7. .13. G �.l°-. . . . .c. .�". . . . . . . , North Andover, Mass. Fee.�f1 Lic. No. G.t.� .T. . �- . . . . . . . . . . . PLUMBING INSPECTOR Check ..1 �t j 7035 Date `.��r0� : H 0Q 1 f ,,- TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACHUSEt t This certifies that . . . . . . . . . . . . . . . . .e. . . . . ." ` .f`!. . . . . . . . has permission for gas installation in the buildings of . . .ff rl�4vat f_1/ . .. . . . North Andover, Mass. Fee. .'. Lic. No. �`: .-- . . . . GAS INSPECT04 Check# 6349 MASSAMSEM UNNORMAPPUCATONFORPERMPTTO DO GAS FITTING (Type or print) Date ? © . NORTH ANDOVER,,MASSACHUSETTS Building Locations �f �� t .+a Permit# �'`-�y 9 =�c Amount$ Owner's Name New❑ Renovation Replacement Plans Submitted a Vj c a H H m H W o o -D $ z F w a w = z F a o a > d � F z � C x w a z w > W F, v� m Z O Z p x 3 0 0 .da ° 0 o a o SUB -BASEM ENT > BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOG R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name i Corp. Address `✓� Partner. BusinessTelephone . irm/Co. Name of Licensed Plumber or Gas Fitter _ s INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it' -stantial equivalent. Yes No If you have checked ves,please indica a type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond ❑ Owner's Insurance Waiver: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 13 1 1 hereby certify that all of the details and information I have submitted(or entered)in above application ar true and accurate to the best of my knowledge and that all plumbing work and installations performed der it Issued for s ap will be in compliance with all pertinent provisions of the Massachusetts State Gas C e th Gen aws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber City/Town, 0 Gas Fitter License Number ❑ Mas APPROVED(OFFICE USE ONLY) u'rneyman 1 , Date......... ke................. ' - OF r10RTI1,� o �, TOWN OF NORTH ANDOVER � � 9 PERMIT FOR GAS INSTALLATION °+pit°.f�•l This certifies that , `?` .... ........!� 1.............................................................. has permission for gas installation���� t. rr:. ?�„/ -.................................. inthe buildi s of................................................................................................................... n at...../�............6........!;!? .r..... .................................... Nortih Andover,Mass. Fee....................... Lic. No. 6 t . ........ !................................... • /GA INSPECTOR Check C' 3 � Date....�.�z.�.jl.��......... 00n7 t OF 1.410 7#1 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING 6 � » v' �BACMUS� f This certifies that Aja a L{ ............. / has permission to perform..�.�..r. L/....... - 1 ............................................. plumbingin/the buildings of............................................................................................. at 1 �r-n..iu.C. /North Andover Mass. .. . . ................... . Fee Lie. No. �sb�� '`�• .................... ... r.................................................................... PLUMBING INSPECTOR k +. Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �-�_ MA DATE PERMIT# I JOBSITE ADDRESS = Com•,,,, ��, OWNERS NAME POWNER ADDRESS 1 J2 L)J 6 r�' _ b TEL — FAX j TYPE OR OCCUPAR t TYPE COMMERCIAL ® EDUCATIONAL E.0 RESIDENTIAL PRINT li CLEARLY NEW'j RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES® NO FIXTURES Z FLOOR--s BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB j CROSS DEDICSPECIAL WASTE SYSTEM DEDI .1 ED GAS/OIL/SAND SYSTEM I —JI J DEn-ATED GREASE SYSTEM J _ ---._._E _-..._! —__( _-_A ----j ( ..._...._) ( ......_...( r- ICATED GRAY WATER SYSTEM �i DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _.1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 7 KITCHEN SINK LAVATORY E ------_1 ___ 1 --.-J ROOF DRAIN SHOWER STALL _I -y_I _l I ._-._. __ I SERVICE/MOP SINK TOILET URINAL ( _.._.__ I E � -_--_._` I J ' ._.__.._( ( ........f .__. _! ._...__i _r... WASHING MACHINE CONNECTION WATER HEATER ALL TYPES w �� WATER PIPING OTHER -- i ...__._i _ ( ._J .___—:3 ___: 71 111 111 11 F-1 f INSURANCE COVERAGE: Dave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Fq-51610 IF YOU CHECKED YES,PLEASE INDICATE THE PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW y LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND M OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and curate a best of my kno e and that all plumbing work and Installations performed under the permit issued for this application will be in complianc ith P rtinprovision he (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME EILICENSE# S� SIG TU (VIP e--,JP 0 CORPORATION M1FIi# j PARTNERSHIP[--],'# ;LLC ! COMPANY NAME ADDRESS ' CITY I ,��_ - -- ;STATE L tn,_, J1 ZIP TEL FAX -�CELL MAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INS ,ECTION XOTES S Yes No /Aj //—r THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ lop FEE: $ PERMIT# PLAN REVIEW NOTES i � I CX The Commonwealth of Massachusetts - Department of Industrial Accidie is Office of Invesfigations 600 Washington Street Boston,MA.02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Buffdens/Contractors/Electiricians/Plumbers Applicant Information Please Prim Legibly Name(Business/Organization/Individual): Address: - City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full.and/or part-time)* have hired the sub-contractors 2111 am a sole proprietor or partner- These on the attached sheet. '7. E]Remodeling ship and'haveno employees These sub-contractors have 8. El Demolition working :for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. El We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 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 insurancere employees.[No workers' quired. 13.E1Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section bel6w showing their workers'compensation policy information. t'Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. iContractors that checkthis box must affached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. T 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.#: Expiration Date: i 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 requiredunder Section 25A of MGL o.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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under file pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#• Official use only. Do not write in this area,to be complefed 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#: 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 employes." 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 subdivi'sions 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)andphone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of , Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain,a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)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. Anew afixdavit 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 annd fax number: ThoCA ome'althofMuSSarhwotts Department o.£Zndustdal.A.ccidonts Qfflec ofIuvestigat ions 600 Washiugton Sfreet Boston,MA.02111 tel,#617 727Y4.900 eA 406 or 1-877 MIASSAFE Revised 5-26-05 Fax#617"727'7749 WWW-mass,govAa 13i-N innvvawnvvL-I I%a vwn vINm nrrLtvn nvt• a vn n rLMM I Iv r-LAM vt%m rw1nunry rrv1%r% CITY MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME LLWV iq[aQO S POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCA ONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMEN . PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TY OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW op LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 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 1 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 mpl nce with all PertineMM� the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMELICENSE# I SIG LINE MP CORPORATION[]# PARTNERSHIP❑# LLC❑# COMPANY NAMlfolmes Plumbing&Heating ADDRESS 6 RL',4h Circle (� r f CITY Hnverhil, MA 018�C STATE ZIP TELla�C\ �I „(��-f L)V, FAX CELL EMAIL i r Be Comm4wealth of Massachuseft ,- Depatnint of Indushkj AccU&fs Office of fnvestigi&fiS . 600 pPaskhWonStreet Bastor4 MA 0. 111 www massgovMa j Workexs'Compensat onXnsurance Affidavit:Builders/Contxacto:rdElec xlcixamlfl mbe3ro A.pplkM M rmation Please Prat I.et lv Name(Snsinessl 6 Ruth Circle _ .A.d&esS: HaverhiL.MA c itp/Siate/Zip: Phone#• Are you an employer?Checkthe appropriate bog: Type of project;(regiureq. 1. am a employerwith q•, ❑I am ageneral contractor andl 6. ❑New construction have li ndthe sub-contractors � ployees(fall aad,ror paz�time). listed on fie attached sheet� 7. ❑Remodeling I am a sole prop proprietor or partner- ship and'have no employees These sub-contractors have 8. ❑DemoMion r working forme in any capacity. workers'comp.instrcance. 9• []Building addition fi0 orlaw comp.Jnsmrance 5. ❑We are a corporation and its 10. Electriical airs or additions w � d-] p oficershaveexercisedtheir 3.[]lama homeowner doing all work of exemption per MGL 11.❑Plumbingnpairs or additions Vqself:[No wodMWcomp• c.152,§1(4),and we bave no 12•QRoofrepairs t emplffwark oyees•Eoeis' msmancezecp�ired.] 13.0 Oilier comp.insurance require&] Any spplicanttbaf checks boxil mustabo fluoutthe sectiontxl6w showingtII*wadMI?compmationpolioywMatiom Homeowners who suhmittbis affidavzt indicaimgthey ace doing otwowaadthea hue outside contmotm mmtmbni t a new affidavit indiodlog such. tContracbrs thatcherddtMs bcmmust atWW onadditional sheetshowingtename orale sub-cogs andtheir wodmm'Comp.policyinfomoation. X aha an a W10yerthat isprovirThig Ifgrims,compensadion insurance formy employees Below is 9iepolicy and lob sr�e in,formation. bsumce CompanYName:. I Policy#or Self-ins.U0.#: ExpirationDate: f Job;Site Address- Attack a copy of the workers'compensatioupoliey declaration page(showing the policy number and expiration date). Failure to secure coverage as required-under Section 25A ofMGL e.152 can lead to the imposition of criminal penalties of a fM0 up td►$1,500.00 and/or 0.tLe7-Year 303prisonrment as wellas eivilpenslties in the form of a STOP WORK ORDER.and a fore this statement ma be forwarded to the Office sof ofup to$250.00 a day against the violator. Be advised that a copy of Y Investigations of the DIA for i %UMce coverage verification. fiat fie ira rmador� routed above is and a err: _ Ido hereby derihepauis andpen a,f jury .fh P tore: Date: oars#: Officaal use onk Do trot write in f.Ftis area,to be completed by or town ofd C*or Town: FermitlLicense# Issuing Authority(circle one): x.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumspectorbing In 6.Other AcvRLr CERTIFICATE OF LIABILITY INSURANCE 5/21/14 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTRUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: Q the caartificale holder Is an AD ITIONAL INSURED,the pon*w)n at be endorsed. If SUBROGATION IS WAIVED,Subject to the terms and ca mStions ofthe policy,cerialn policies may ra pire an ardorsemeril. A dabmei t on thiscertiftate does not confer rights to the certHicate holderin lieu of such endor PRODUCER NAME: Barry J. Kittredge Ins Agency PHONE CONTACT Dam I4DOd FAX 81 sauth Main street JAIQ Na 00- 978 374-8400 . (978) 373-136 PO Box 5206 danafkittred-geinsurance.con INS AFFORDING COVERAGE NAICs Bradford, MA 01835 INWRER A:Commerce Insurance Co MUR® InsuranceINSURERS:Commerce Insrance Co Adan C Holmes IMURERC:Associated Employers Ins. Co. Holmes Plumbing & Heating INSURE 0: 6 Ruth Circle INSURER E: Haverhill, MA 01832 1INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. INSR AML SUER MBS PAY NLtWDFPOUYYYY LIMITS SIP LTR TYPE OF INSURANCE A cLENERALLIASILITY BDHVCP 3/5/14 3/5/15 EACH OCCURRENCE $ 11000,000 COMMERCIAL GENERALLIABIUTY DAMAGE-To ENTED $ ZOO OO CLAIMSt�LADE ®OCCUR 0. MED DP(Any one person) $ 5,000 PEISONALBADVINJURY $ 100,000 GENERAL AGGREGATE $ 2,000,000 GEITLAGGREMATELIMTAPPLIESPER PRODUCTS-ODMP/OPAGG $ 2.000.000 POLICY �O LOC $ B AUTOMOSILEIIABIUTV BDDRW 3/6/14 3/6/15 COWBI SI L LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWWO SCHEDULED AUTOS x AUTOS BODILY INJURY03er accident} $ • HIRED AUTOS UOSWNED PROPERTY DAMAGE $ eraocid $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ` E>CESS LIAR CLAIMS-MAD= AGGREGATE $ DED RETENTION `s WORKERS COMPENSATION ti,TCC-500975102014A 2/23/14 2/23/15AND EMPLOYERS'LJASRJTY ANY PROFL21ElOWP� YIN EL.EACH ACCIDENT $ 500 OOO OFPICERMENBE2 EXCLUDE? N N/A (Mandabry in NIL) EL.DISEASE-EA EMPLOY 500,000 ff describe under I O RATIO w -E-L.—DiSEAsE-PoucYumrrI s 500,000 DESCRIPTION OF OPERATIONS l LOCATIONS/VI"CL.ES{Aftwh#CORD 1M,Ad9donal Remarks Schedule,H morespace is regJ red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 7HE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE W17H 7HE POLICY PROVISIONS. AUTHOR®REP4ESENTATIVE H. Dana Mood O 1988-2010 ACORD CORPORATION. All rights reserved. ACOR0 251201 OAST The AC ORD name and tow are reafttered marks of ACO RD MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /_ �/� 7023e Date 145�� Building Location J� VD p Gy wners Name �rlQ� permit# T e of Occu-pancy Amount New ri Renovation Replacement % Plans Submitted Yes No ❑ FIXTURES Q F F a U o xz Q w z w Q Q O U r >a�v>avr Isr ffi R FL" 4M FLOOR sm FIOClIt 6M fl" 71H FLO(lit SIH FIOCR (Print or type) Check one: Certificate cate Installing Company Name Corp. Address 4 1`_k "1-1 de- � Partner. Business Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type 9,Linsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information i have submitted(or entered)in , ve a plication are tru curate to the best of my knowledge and that all plumbing work and installations performed d ermi ssued for this Lica " n will be in compliance with all pertinent provisions of the Massachusetts State Plum de C ap o' neral Laws. By: ignaure of Muciiseuum e Title pe of Plumbing License City/Town tcense umber Master ❑ Journeyman APPROVED(OFFICE USE ONLY Location No. Date MpRTM TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7.-2� i Check # 675 ) Building Inspector G The Commonwealth of Massachusetts State Board of Building Regulations and . TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE.USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: J? 1 Date Issued: C�j 99 —a Q p 3 . l C Sign ature: Building Commissioner for of Buildings Date (� ' SECTION 1.SITE INFORMATION (v 1.1 Property Address: + 1.2 Assesses Map and Parcel Number: Map Number 3 Parcel Number r7 \ 1.3 Zoning Idarmatioo: 1.4 Property Dimeosioos: Lot Ares(sq) Froota®e(8) Zama DistrictUse 1.6 Building Setback R Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided / / 107 water Supply 9M.O.LC.40.4§St 1.5. Flood Zone Information: 1.8 Sow Disposal System: Public 0 Public Primo Zone-0-- Outside Flood Zane a Municipal On Site Disposal System \V 2.1 Owner of Record Name(Punt) Address: 10 Lja.Ah't d e Rd e/ � Signature Telephone q2 (P91 '7093 2.2 Authorizeden: `TNa� (3ur O Name(Print Address Wt.jjtantS 0 W laod*hA W S4nature Telephone p (O � r/ SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN AODO CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q U-0h 1n 1 Licensed Construction Supervisor: License Number ' d 3343 Addr �t 1114.W1s Expiration Date 15 20 Signature TelephoneCo Z� 3.2 Re ' Hoe ement Cc tor. Not Applicable Q . ( Company Name I Registration Number IOV14S Address Expiration Date a-A ("1'7 8- Z 2� 50 �-0 Z-0 Sigmttue Telephone 4 Revised 1997 JMC f SECTION 6-DESCRIPTION OF PROPOSED WORK check allapplicable) New Construction 13 1 E)dst:ing Building Repairs Alterations Addition -Accessory Bldg, Q 1 Demolition 13 1 Other Q Specify Brief Description of Propo ✓1W S 0-P-+- SL 61,Vi gd . T I s In s 9- SECTION 7-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check asapplicable) CONSTRUCTION TYPE A Assembly A-1 A-2 A-3 IA Q A-4 A-5 1B Q B Business El 2A Q E Educational Q 2B Q F Facto F-1 F-2 2C Q H High Hazard Q 3A Q I Institutional Q I-1 I-2 I-3 3B Q M Mercantile 4 R Residential E3 R-1 R-2 R 3 5A Q S Storage Q S-1 S-2 5B Q U Utility Q Specify: M Mixed Use --U-Specify: S Special I Cl Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: I Eicist:ing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 SECTION 8-Building Height and Area BUILDING AREA Existing(ifapplicable) Proposed j Number of Floors or stories include basement levels Floor Area per Floor Total Area Total Height ft SECTION 9-STRUCTURAL PEER REVIEW 780 CMR 110.11 Independent Structural Engineering Structural Peer Review Required Yes Q No Q • SECTION 10a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIL DING PERMIT i Y , I, ,As Owner of subject property hereby authorize 7 �n to act on nze_ _ U t�i Pif^S G. my behalf,in all matters relative to work authorized 6y this building permit application. Signature of Owner Date revised bldg form/state JMC , SECTION lOb-OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized 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. Print Name Signature of Owner/Agent Date SECTION 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to Official Use Only be completed b permit applicant 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 AC �aQ ✓ 5. Fire Protection 6. Total= 1+2+3+4+5 Check Number .. .�� � ......._�.r............,;!�.r�_� tis" .. ___... i V iN WViI.ITn/w.�RMM-�1i'!VNWM'�NV� ` �A O.F,OV�.t,�1. ,G`R�QUh�►TI0N3 Ii {J,Icense: CONSTRUCTION SUPERVISOR {. NumbQR 033843 Tr.no: 19350 �r JOHN T HAFFE 3 WILLIAMS ' WAYLAND, MA 01 Administrator i; � 1 I h , SECTION 4 WORKERS'COMPENSATION INSURANCE AFFIDAVIT[NLG.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- PROFFESSIONAL DESIGN AND CONSTRUMON SERVICES-FOR BUILDING AND STRUCTURES SUWECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 CONTAINING MORE THAN 3 000 C.F.OF ENCLOSED SPA 5.1 Registered Architect: No Applicable Name(Registrant): Address Registration Number Expiration Date Si ture Telephone 5.2 Registered Professional Engineer(s) Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name): Area of Responsibility Address Registration Number I Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone 53 General Contactor Not Applicable E3 Company Name: is Responsible in Charge of Construction Address Signature Te lephone .7 Board of Building Regulations and Standards = One Ashburton Place - Room 1301 i Boston_ Massachusetts 02108 ! Home Improvement Contractor Registration i { Reqistration: 108945 Type: Private Corporation Expiration: 8/27/2004 J. T. HAFFEY BUILDERS John Haffey 3 Williams Rd ----- ---- -- -- ---- --------- Wayland, MA 01778 — Update Address and return card.Mark reason for change. { Address `—' Renewal Emolovment Lost Card i Rj] Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: :> Board of Building Regulations and Standards �y Registration: 108945 One Ashburton Place Rm 1301 Expiration: 8/27/2004 Boston, Ma.02108 Type: Private Corporation J. T. HAFFEY BUILDERS John Haffey I 3 Williams Rd Wayland,MA 01778 Administrator \ot valid without signature • , 1 i.t�'�{�1 'd t ,i ' i4 .eta h�'�` t_ ' The Commonwealfh.'::6f,� a I$ PQ r P ' Department of ln,u t �1 ccldents �. _ Office oft*vesflgratlons a .600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit 'NOR; Name: Location: \0" 1s 9©od R t.Lta e- City: IU o r-t� ('� yidb ve r --Phone# ❑ I am a homeowner performing all work myself. ❑ I am 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: T Address:, 4 3 ujh u�s rO - City: W (a'vtd f 1 t� l-7 Z 9— Phone# SCS s fo 2p'71 k0 8 co. � Q � Policy# W GCo2'�1 3 F =94p— Insurance ❑ I am sole proprietor, general contractor,or homeowner.'(clm/0 one)and have hired the contractors listed below who have the following workers'compensation policies: Company name: Address: City: Phone# Insurance co. Policy# Company name: Address: City: T phone# Insurance co, Policy# Failure to aacirre coverage as.'�equlsi uridef Soctlori.�SA of M(3L;1, 2;catt`� 8�.aotligamp• (tion of crlrrminal penalties'of s fine up to$1,500.00 and/or one year's Imprisonment as well as,civil.penaities in the form of a STOP WORK ORDF.R'and a fidq of$100.00 s day against me. I understand that at copy of this statement may be forwarded to the Office of Investigations of the DIA for coverape`verification. I do hereby certify under the pains and penalties of perjury that the Inforrriatlo0"Po lded above is true and correct. Signature• Date Print name phone Official use only dpot writein this area to be comp"lofvlm officlal . City ortown: nniUllcanse# ❑Building Department E]Licensing Board 4ty,� F Selectmen's Office, check H immediate response is required ❑Health Department coptad person. r),r z{•. x t43 a� f T ' rt.. .'yr / '' / ��..1,1 ri. i a..l it fi '- ti Inyn tti, !` '� rpt ... � !'��f-�}!(�r� ��"�{ y��t�,'•,'T " nq., the 7, 7177,7 'i}Sl d4.t r.j r�j0rt r J-„t�4,t t`,NYS,. 1•7.1.q. (, North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r • AORTH ' E over 0 of _ .. oti..`. 1` No. 0?.3 VL zoc -o?9► -o? o0 ,C " dower, Mass., SRATED P �C� H ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT... 00 t � .....�I ...E......... .... MRS 0. .......................... BUILDING dation has permission to erect . . ... ......... buildings on Rough e A...C. g ..a, ...... ......S.o. v....0 a r► 0 to be occupied as IODOA.l..44- 4o- .4 ill Chimney provided that the person accepting this permit shall in every r4ect conform to the term the application on file in Final this office, and to the provisions of the Codes and By-Laws relating toInspection, Alteration and Construction of Buildings in the Town of North Andover. a13/7 th 047 a0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR s Rough ................................. 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 Street No. Smoke Det' SEE REVERSE SID z Date. . r. . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S MUS This certifies that . . . . . . . . . . --. . . . . . . . has permission to perform. /,1�� .6 ! plumbing,irrthe buildings of � f; !1.x!.1 at/ (.l!��f�� . . . . . . . . . . , North Andover, Mass. Fee��l .Lic. Nc,4, . Xr� . !e t�� fj/�;�_l !t?.: •',�2�: . . PLUMBING INSPECTOR Check # 6384 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building LocationbJopbR i jo Owners Name / eQ Permit—# �S G=t gSCil�1 C OV�� Amount �� r Type of 4 New Renovation Replacement Plans Submitted Yes No FIXTURES rX ' 5[SBfiMC ' 1SJC KOM 3�iHIDQt �d,1)HIDQt 4M IIDM 5M HDM 6M HDM 7M HDM 9M HIDM (Print or type) Check one: Certificate Installing Company Name / ' ❑ Corp. Add ss 5 � - Partner. T "'9o> a usiness e ep one SS ' —p/ Firm/Co. Name of Licensed Plumber: -� (///,, &-//Lso n Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I ubmitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work install ions rformed under P t Issued for this application will be in compliance with all pertinent provisions of the sachuse S Pl�uing o nd Chapter 142 of the General Laws. By: Signature of TAcensea Type of Plumbing License Title / 6 ?3/ City/Town i'L cide Numoer Master Journeyman APPROVED(OFFICE USE ONLY I j 4/26/2016 Date:April 26,2016 20084 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.comt#/records/20084 •s�'TtlLis�' .• - �.�- .� • TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION r. This certifies that Marc Buvair has permission for gas installation Dryer Replacement in the buildings of Jessica Laughner at 21 Gibson Court, North Andover, Massa Lic. No.23540 1/1 4/26/2016 e� A Date:April 26,2016 20084 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20084 • TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a � This certifies that Marc Buvair has permission for gas installation Dryer Replacement in the buildings of Jessica Laughner at 21 Gibson Court, North Andover, Mass. Lic.No.23540 1/1 a F -� (;' �p https:/Jnorthandoverma.viewpointcloud.comj#/records/'20084j39454 �i ::.Apps .�IieWPoint Town of North Andover, MA q search.` 20084 +Add to a project *Gas Permit-Renovation/Alteration/Addition(Commercial or Residential NOT in conjunction with a Building Permit) 77MELINE [naa w--J Submission received q Permit Fee Apr 25,2016 at 12:37pm q Gas Permit Review Minimum single family price appliances/fixtures $25.00 x GReview by departmental staff Total per appliances/fixtures price $5.50 x i 0 Perntlt Fee Payment t Add Fee... Permit Issuance Total Fee Amount: $30.50 Document I i Conversation Aft Merylle Chase O Apr 25th 2016.12:51 pm The permit that was mailed into us for 21 Gibson Court the payment fee is "—� $30.50 and the checkyou sent#286 is for$25.00.Please remit another check in the amount of$5.50 or by credit card via the link from this email. There is a 2.9%fee for credit card payments. i i say something abo che-cK an)ocu i- Sel�} I'1 w C\S 11 Orr e d- n � i l-IU)1) elm o ; l v Monday,Apr 25,2016 12:52 PM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE PERMIT# JOBSITE ADDRESS21 GIBSON CT OWNER'S NAME JESSICA LAUGHNER Po � � u„ OWNER ADDRESSTEL€78 305 0820 FAX me aw TYPE OR OCCUPANCY TYPE COMMERCIAL' EDUCATIONAL RESIDENTIAL d PRINT CLEARLY NEW:__ » RENOVATION: REPLACEMENT:_ PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS- BSM 1 2 34 5 6 7 8 9 10 11 12 13 14 BOILER _..._ _._. BOOSTER �-----� x £ CONVERSION BURNER r ,.. . .-.,.._. .. r._. .... ...,.,, COOK STOVE DIRECT VENT HEATER I ,,,, DRYER '..._.__ _f.. ,.,.,,, _,_...._...i.. . .... , . _,w `............... ....._ ,,, i__ FIREPLACE i FRYOLATOR _ .__.-..- FURNACE ! _ t GENERATORi` GRILLE M m INFRARED HEATER I LABORATORY COCKS r MAKEUP AIR UNIT ( £ OVEN POOL HEATER ' 3 ROOM I SPACE HEATER _ 1 E _E 9 ROOF TOP UNIT TEST L UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER OTHER .,y,»t' YRt.7NYdX7, 5,'47 r £ r- ;. Ir »nmw»uu,.n»wwwvuuuuuu,n.uu,uuwuwu.,u»,uuuunwa`+-+n+-n*,..a»an,wa»,a.a„'n , -.rtt„�,-,^.. _ , •vr+ ;i .-..... »S 1 ua^ ursa�w•x�esvhu�xesesuc::se::>�,.._ ..... �4�{.,...K< ,.,.�€,. :, ��- ..� . .,,,,,-,.;:,,-;.:... 3„ .......» � ,..,.,,.;. ,,. €, .. i ,S ��,. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES W NO Lj IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE INDEMNITY Lj 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 L.J. AGENT SIGNATURE OF OWNER OR 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. � � PLUMBER-GASFITTER NAME M RA C BUVAIR i LICENSE#'23540 1 SIGNATURE MPEJ MGF ,,,,, JPF7,9 JGFD LPGI0 CORPORATION # PARTNERSHIPS_ #; LLC # �__% COMPANY NAME: SYCAMORE PLUMBING - ADDRESS 40 SYCAMORE RD -�...._____.,....,,.� � j � CITY �WRENTHAM S LATE I MA ZIP i 02093 TEL'508-446-6344 FAX _ �CELL EMAIL MARCBUVAIR@YAHOO COM Date.,/ ./l GG. . ...... . NORT/y Orya�..ao ,e ti t 0� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACNUSEt i This certifies that . . . .W.O. . . . . . . . . . . . . . . .. . . . . . . . . . . has permission for gas installation . . ,l*.'•7. . f-� . . . . in the buildings of . . .W. A�.�.�. .�/. rf i�. . . . . . . . . . . . . . . . . . . . . . at . . . S!. ! 3.r -z . . . n. . . . . . . . . . ., North Andover, Mass. --v Fee. . Lic. No. .�; S 17. . . . . -1 �{,,f- - - - - - - . /GAS INSPECTOR I Check# 54ub MASSACHUSEM UMMI FOR PMUTO DO GAS FIT'l% (Type or print) Date NORTH ANDOVER,MASSACHUSETTS 6/ Building Locations DLa Permit# .1 Y� Amount$ r �i19 9114 rr Owner's Name New Renovation Replacement Plans Submitted O WWF p O F ad O• O SUB •BASEM ENT ` B A S E M ENT + 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) C one: Certificate Installing Company NameP 6 ff Corp. Address 6 Ie 11 Partner. IJ Y b � Business a ep one Firm/Co. Name of Licensed Plumber or Gas Fitter jg�"Q INSURANCE COVERAGE Check n . I have a current liability Insurance policy or it's substantial equivalent. Yes No1:3 If you have checked yes,plea e' dicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 0 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pe ed order Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State ►a r 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By: Title Plumber /7 Z City/Town Gas FittericeLse Numb Master ,WPROVED(OFFICE USE ONLY) Journeyman . '► Invoice H. WOLF JOLM NK 41 HEA TVV6 BRUCE NUMBER: WR 10.9 LWOICR DATE: 7-APR-05 P O Box#2229 SALEM, AN. 03079 RANDOLPH H. Of TEL:603-234-9231 MA. MASTER PL UMBEAT # 12299 CUSTOMER: WOODRIDGE HOMES CO-OP TELEPIIOffljff� ADDRESS: 10 1100D8IDGE DR. FAX., crr sTAT&FosTAL conte NO. ANDOVZR,M}F_ 01,645 PO NUMBER: 20 OIBSON ORDER DATE LORI[REQUESTED BYGARY i STA I?T/FND DA TF 0.00 - X0.00 _._ - 300R 05 325,:00 0.00 $0.00 0.00 $0.00 0.00 .$0.00 TOTAL A mArY COST.' FEATSR 0 .WIR 40 AL R LTCB WAM HEAT ft 0.00 J 314CXAi J / xc: $2.50. . t J 3/4C 90 BIAS NIP $3.75 EA. !') 3/4 COP TUBE 'L" $ 1,25 PER %Ou f 50 I'j BLK NIT l ')3/4CSLIP COUP ' 1.I0 U S/4CST 45 2.00 0.00 TOTAL MATERIALS COST: VET, 10 DAYS THANK YOU TOTAL BILLING: ��g0 Invoice Date. .//// !� 1 ".O RTM .4, TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ` S�ACMUS� This certifies that . . . . .ti, 0 . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . 1,4,-1. .�.<.`.( c ... . . . . . . . . . . . . at. . '). o. .(�7r. �. t H . . .C,6 7. . . . . . . . . . . . North Andover, Mass. Fee. . 1. �,4.Lic. No/?.(, S. . . . . . . . . . . . �' �,..� . . . . . . . . PLUMBING INSPECTOR Check # 6774 lI I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS *� Date0. Building Location 0G�ch.SGt. Owners Name ; d Permit# -77YAmount �L)� 'J v Type of Occupancy New Renovation Replacement19 Plans Submitted Yes No FIXTURES a 3 � 3 a Kalem 3 a�w>avr IST FLOCR a�n» 3M1HLOM 4M HDM sM ELOCR 6M Fl" M Hj" SIH NJ" i (Print or type) Check one: Certificate Installin Company pany Name ❑W 2 IV /—A/ 1), 1 /1 12 Corp. Address YO 09Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate he ype o insurance coverag by checking the appropriate Liability insurance policy Other type of indemnity ❑ Bond n L...1 Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations rfo d nder Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State 4A nd Chapter 142 of the General Laws. By: igna ur ic nscu riumver Title Ty of Plumbing License City/Town 29 is nse um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date. "r t 4 .0R':1ho TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING +.�••,,r—•�` S t CHUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .LA,PArC . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . at. . . '� L'. . . r.�:-. . . . . . . . . . .. North Andover, Mass. Fee. .7A )' .Lic. No../. PLUMBING INSPECTOR Check # 6771 tifti Y' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ` Date Building Location y 0, Owners NamePermit# Z7� � Type of Occupancy Amount New Renovation Replacement /(� Plans Submitted Yes ❑ No FIXTURES 3 3 a > w %R RASMW BE NI= MIIDM 3R[IFLO(R 4>HHjo(R 5M IFL OR s>H Hi" P 7II3)HItO�t SIH ELOCR L 77- (Print or type) Check one: Certificate Installing Company Name ZS Corp. Address e ' Partner. Business a ep one Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate-.1ho Indicate-.1htype of insurance coverage b hecking the appropriate bo Liability insurance policy M Other type of indemnity ❑ Bondyjl ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ 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 perfo ed der P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State a and hapter 142 of the General Laws. By: 31giiatujapr Licerrseaum er Title TW of Plumbing License City/Town i ense um a �' Master Journeyman ❑ APPROVED(OFFICE USE ONLY r / R. fl. frOLF AOWING d REATLN6 IWOICE NUMBER: W1114 INVOICE DATE: tl 3 JULY OS P. 0. BOX # 2229 SALEM, N.N. 03079 RANDOLPH& WOLF TEL: 603-69$-6505 HA. MASTER PLUMBER 12299 PAX:SAME CALL AHEAD CUSTOMER: WOODRIDGE DOMES CO-OP TELEPHONE: ADDR£ss: 10 WOODRIDGE DR. PAX: CITY,STATE,POSTAL CODE: NO. ANDOVER,MA. 01845 PO NUMBER: 20 GIHSON CT ORDER DATE GARY., O . ® START 1 DATE t RANDY 1.50 $90.00 13 JULY 05 135.00 0.00 $0.00 .. 20135 t TOTAL ACTIV"COST: $165.00 MATFIZIALS OTHFIZFXPF-qSES , 2) 1/2C COUP REPLACE WASHING MACHWE 0.50 2) 1/2C 90 VALVE 0.75 2) 1/2C ST 90 1.00. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL MATERIALS COST: NET. 10 DAYS THANK YOU TOTAL BILLING: $137.25 Invoice Invoice Date. . r NaRr: a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �Sg,4C14USE� This certifies that . . . . � L �. . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .64. F .1 .4 . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . �. . . . . . . . . . . . . . at. .2.0. . L, .c ' .7. . . . . . . . , North Andover, Mass. Fee. 3 .==- .Lic. No. ?. � 5`i. . . . . . . .J 1.�.! x .... . . . . . /PLUMBING INSPECTOR Check # 6760 y� i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS , 0,654, 0 + Date Building LocationOwners ep— Name �'e t # 1 nl �" Type of Occupancy Amount New 0 Renovation ReplacementOf Plans Submitted Yes No FIXTURES Y «F FSI 3 3 SLI Is>V 1FLOCR ZM]IELOCR 3MFLOOR 4M FLOOR 5M HDM 6M FLOOR 7M —gM H JOM +177 (Print or type) / Check one: Certificate Installing Company Namezo/lj)d 14 �1 Corp. Address l l I` J * Partner. S 3 Business I a ep one c Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate ype of insura ce coverage by checking the appropriate box: 4zLiability insurance policy Other type of indemnity 111:1 ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installation erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett ng de and Chapter 142 of the General Laws. By: 1gn 1cN%eQ Flumoew- Title Type of Plumbing License City/Town i ense um Master Journeyman APPROVED(OFMCE USE ONLY I ,/// R- If WOLF ELWANG d H-FAT11MO INVOICE NUMBER: WR1:35 INVOICE DATE: 27-SEP-05 P. O. BOX # 2229 C A L£M, N.R. 03079 RANDOLPH H. WOLF m9N TEL- 603-898-6505 NA. �6 ASTER PLUMBER 1x'2'99 FAX:S"E CELL AHEAD CUSTOMER: WOODRIDGE UOM£S CO-OP T I'IION ADDRESS: 10 WOODRIDGE DR. FAX: CtTY,STATE,POSTAL CODE: NO. ANDOVER,MA. 01845 P0 NUMBER: 20 6IBSOP CT ORDER DATE GARY: i t DATE IiNDY 5.00 $95.00 27/2$ SliI'T 05 415.00 0.00 $0.00 TOTAL ACTIVITY COST: � . 1) 7COE TIPPER WASTE 17 0A. BRASS REMOVE/IIJSTALL TUB 55.00 3) 1/2 C 90 DRAIN/SHOWER VALVE 1.05 2} 1/2 CXM 2.00 2) 1/2 C COUP 1.00 1} l%2CX E DROP 90 6:25 10`) 1/2 COP TUBE L 10.00 3) IAC MIL]RANGER 4.50 5 3) 1/2C CLIP 0.45 »)SYMONS S=96-2X 130.00 0.00 TOTAL MATERIALS COST: $$1?ES NET. 10 DAYS THANK YOU `r0'1'aelzL BILLI1Vti: $092: 5 Invoice to Date........6 .... N- I / 6 1 - `. NORT/, TOWN OF NORTH ANDOVER = p PERMIT FOR WIRING �,SSACMUS� This certifies that has permission to perform ........ ...... L S ........................... wiring inthebuilding ottf--....... ................................................ pit.........c .. . ...�!�.ti..7 � rn C-. . ' North Andover,Is7 Fee.....3f-40 Lic.No.. "P(............. ?R' ECTRICAL&SPECCOR '/�fd' 14:21 35.oo PAID WHITE: Applicant CANAR ui ing Dept. PINK:Treasurer V V I' � I J. 1 _� The Commonwealth of Massachusetts Office °5e Only id Department of Public: Safety Permit NO. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 Occupancy b Fee Checked_ cleave Dlank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be Per6rmed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town ofJQ�f�yUe,r' To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant __<1U//I V Gam` `-' Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of BuildingUtility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No, of Transformers Total No. of Lighting Fixtures Above In- KVA Swimming Pool grnd, ❑ grnd. E] Generators No, of Receptacle Outlets KVA No, of Oil Burners No. of Emergency Lighting No. of Switch Outlets Batte Units No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heats Total Total Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Beating KW No. of Self Contained Detection/Sounding Devices No, of Dryers Heating DevicesKW Municipal '-'---- Local❑ Connection❑Other No. of Water Heaters KW No, of No. o Si ns Ballasts Wirinoltage ..... No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO ❑ I have submitted valid proof of same to this office. YES❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box• INSURANCE ® BOND ❑ OTHER 0 (Please Specify) Estimated Value of Electrical Work $ 3_1�� Expiration Date Work to Start Inspection Date Required: Rough Final Signed under the penalties of perjury: FIRM NAME AMERICAN ALARM & CO M N IATIONE, I, IC, N0. 12 _ Licensee_RTCHARI) T entuvenaT Signature Address 7 CENTRAL STREET ARLINGTON MA 02476 Bus. TelLIC. N0._ . No. 7R1_f,&1_ 000 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have theAlt.insurance coverage or its-sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature of Owner or Agent Telephone No. PERMIT FEE ,