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HomeMy WebLinkAboutMiscellaneous - 20 LINCOLN STREET 4/30/2018F, O0 4 z 600 C) 9D Cn 0 --1 0 M 0m C, m Ll ORTN 0 05 SACHUS This certifies that -.0 Date.. .".. .. 7 . F. . TOWN OF, NTH ANDOVER PERMIT FOR PLUMBING ............. ......... ...... has permis'sion to perform .................... plumbing in the buildings of ...... ............. : ............... at '�') ... N. ........... ortAndover, Mass. .... Lic. No Fe .............. PLUMBING INSPECTOR Check # 7262 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .... . ....................................................................................... has permission to perform-, _'/. _:7� .................... ................................ �. ; - - - wiring in the building of .... ...; __ - .... _", .... ........ ................. ��'r . ..... ....... ............... . North Andover, Mass. •,::........... ........... Fei . ................ _.. Lic. W5124.,L ELECTRICAL INSPECTOR Check # 7162 4 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �/ 2- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: 1-0-6-7 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) d �j�C �►-n S� (0frlLam fimmbi Owner or Tenant Telephone No. Owner's Address ' Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building incz Existing Service Amps /Volts Overhead LJNew Service Amps Number of Feeders and Ampacity Utility Authorization No. Volts Overhead ❑ Location and Nature of Proposed Electrical Work: Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Completion of the following table may be waived b the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- E:1 o. o mergency Lighting rnd. rnd. 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 No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Number Tons KW No. o Self -Contained Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipa El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirin Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE &r BOND ❑ OTHER ❑ (Specify:) /certify, under th�ypains and pena�ties of perjury, that flee information on this application is true and complete. FIRM NAME: �J e e ( LIC. NO.: Al 1' � � Licensee: Signature C LIC. NO.: (/f applicable, ente entpy in the ice/�l nunab� line.) 1 �M Bus. Tel. No.: Q Address:11�"�,. � Alt. Tel. No.: *Security System Contractor License required for this work; if app cable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑owner El owner's g: No. of Devices or E uivalent OTHER: agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ �j /- ,24-,0-7 /* 4-23-0 7 /-I-t/ 1:1 ? Date ..� ....../2.1...... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Thiscertifies that............................................................................................. has permission to perform ... 4 - t^�: .. �'- ................... . I...I ..... wiring in the building of ..`. `^ '�1�-^......................... at .. �A ...... ''P',.✓...- 7 ::............... . North Andover, Mass. r. Fee`: I........... Lic. No B! .�._...............0 t�z ........... ELEGTRicALINSPECCOR Check It tis:3�o U F 7271 4 4 A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS u,p Official Use Only Permit No. �c 2 /07/ Occupancy and 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:�� � � —6-) 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) UL j)' r.QLtn � f . Owner or Tenant AM PF i (,(JI y} 'f r 1171 Tx (A6 �k y Y 13 rt, n lA ) Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Lod 11) No a (Check Appropriate Box) Utility Authorization No. Existing Service a— Amps 1 0/ h.qb Volts Overhead Undgrd ❑ New Service a1_ Amps1� / Volts Overhead © Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Cormletion ofthe following tahle mnv ho waivod by tho 1nvno,-tnr n%Wi— 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 Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump I Number Tons KW No. of Self-Contamed Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW o. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ����I�11 Attach additional detail if desired, or as required by the Inspector of J4,71-es. Estimated Value of Electrical Work: ,0D (When required by municipal policy.) Work to Start: 3 60 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Ltf BOND ❑ OTHER ❑ (Specify:) I certify, under tanti penalties of erjury, that the information on this application is true and complete. Ma ains FIRM NAME: {�__,C�f I LIC. NO.: Licensee: Signature LIC. NO.: ej (If applicable,ffe��,,te "exempt" in the lice se numb ane.) r Address: `� � V) 1 Ll 1 Cll - hVf 111 ) H A - ���� � —Bus. Tel. No.:���� 1 J � p Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 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. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 � M www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors !. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their S. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also till 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 insurance for my employees. Below is the policy and job site information. t Insurance Company Name: Policy # or Self -ins. Lie. #: Job Site Address: Expiration Date: 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 ycertcertify under the pc int andpenalties ofperjury that the information provided above is true and correct. Phone #: _J—) `p �� 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 #: MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 2c Lrn k Date 113 016 7 Qret��r A1'-,•-etcwJ Permit 9 r N ,-\ Amount Ij a 3� Type of Occupancy 2 t S i — New 0 Renovation E3 Replacement 0 Plans Submitted Yes 11 No FTYTTTR F c (Print or type) Check one: Certificate Installing Company NameCorp. Address Z° Lo ti" k S S go -t- '2D Partner. Business Telephone TM L(a 3 6 S 71 Firm/Co. Name of Licensed Plumber. q' Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El 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 11 Agent 11 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 i stallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the sa tate Plumbing Code and Chapter 142 of the General Laws. By:Signalu le 01 LICns um er Title '� L4 �4 e of Plumbing License City/Town wense um r Master ❑ Journeyman APPROVED (OFFICE USE ONLY IZ Alo 10 4 N c OV V 17 3 0 Date ... �//..'. 1..... 0TOWN OF NORTH ANDOVER PERMIT FOR WIRING a This certifies that ... (, e c i k has permission to perform .............................. wiring in the building of ...... e.`r�,. �. s! j ......t ..!1 ................. at ..... .( .... t s. ^.. �. vl u .... ............................... r orth Andover, , sem' ,AwFee . A,: . �J... Lic. No... ?C �% ................. ..�..i'1^� �.. ,.... hh I CAL INSPt?�R sL,l C�JY y WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 10�Permit No. THOF' 1i�r]r CHU= Office Use only MAP n(� DEPARTME7NTOFPUBLIC.4gFETY 17 30OFFIREPREVEVI70NREGUL4770NS527CMR 12 000 PARiCEL ' Occupancy & Fees Checked 14Ct:P,-Y PERS TO MFORM ELECTRICAL. WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date Town of North Andover To the Insp ecor of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes M No [a. (Check Appropriate Box) Purpose of Building Utility Authorization No. r Existing Service 100 Amps /2,SoVolts OverheadAF;J_Underground ® No. of Meters Neeiee Amps / Volts Overhead = Underground No. of Meters Number of Feeders and Ampacity Locatiton and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. cil Lighting Fixtures Swimming Pool Above Below Generators KVA and 1:1eround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. `of Heat Total Total Pumos Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW [71 Connections a No. of Water Heaters KW No. of No. of Sins Bailasis No. Hydro Massage Tubs No. of Motors Total HP 07'r -TER /', ,1 k; r SM ti -XS i N /Ou� 04F- • •• ui:. . i • . ••' • • 1 • iir '.1• • t • • :• :. % • •ir..: i • r .• : s . • :•., .. i MIS Ear Die Estartated Valved Wade S FAII --- . � AIC Tei Na NEl OWZ'SIIvEIJRr1I�CgWAIVER;[anawatetha frl- msetonotlrethe1,arj ecass-ro�itss> letgmrai�tasreytma3byMats la lis laws a�dthatmy ' flBspearri{tisragr (PI e chec one) 64 I Owne t' Agent L.�.�3 Telephone No. PERMIT FEE S 1 Date.. ,ORTM <• •° .otic TOWN OF NORTH ANDOVER 0 AM PERMIT FOR -PLUMBING .�L-00� °+,rm .A,-q`i ,SSACMUS� f' This certifies that . f`r!r !r.`.... . „/.A le. -t. ............ has permission to perform ....�. ............yy............ . plumbing in the buildings of.. at ...� .c�, . /. i.� c ,c. ���"" ... . , North 'Andover, Mass. Fee. .. �. Lic. No.A� . ........ . ar�c'js PLUMBING NS- r. Check y f� r 7703 Date .. l! . / MASSACHUSETTS UNu ORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations k ) `'y'r D / v Permit # Amount $ Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted (Print or type) Name VC Address __� © s t, j Business 1 elephone Name of Licensed Plumber or Gas Fitter i _i� A /I Check one: Certificate Installing Company ❑ Corp. ElPartner. �irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or. it's substantial equivalent. YesNo If you have checked� Vis, please indicate the type coverage by checking the appropriate box. Liability insurance policy®� Other type of indemnity 13 Bond 13 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 Owner11 Agent i herIJ 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 i Ilatio performed and Permit Issued for this application will be in compliance with all pertinent provisions of the Mas %�s� as mode and/khapter 14� of the General Laws. Title City/Town lrIrrlIUVM) (OFFICEUSEONLY) I Signature of 'censed Plumber Or Gas Fitter [--g-flumberQ Gas Fitter lcense u ber 12_Master rl Journeyman w x � w w o c c Z z V w x �, z r H z ., x x a w c� w H a x y� Q W > Q z¢ C ~ W Z O Z U U x 5 O x w 3 0 U o a > a SUB -BA SEM ENT .aa a p BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLO O R 5TH. FLO O R 6TH. FLOOR 7TH. FLOOR 18TH. FLOOR (Print or type) Name VC Address __� © s t, j Business 1 elephone Name of Licensed Plumber or Gas Fitter i _i� A /I Check one: Certificate Installing Company ❑ Corp. ElPartner. �irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or. it's substantial equivalent. YesNo If you have checked� Vis, please indicate the type coverage by checking the appropriate box. Liability insurance policy®� Other type of indemnity 13 Bond 13 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 Owner11 Agent i herIJ 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 i Ilatio performed and Permit Issued for this application will be in compliance with all pertinent provisions of the Mas %�s� as mode and/khapter 14� of the General Laws. Title City/Town lrIrrlIUVM) (OFFICEUSEONLY) I Signature of 'censed Plumber Or Gas Fitter [--g-flumberQ Gas Fitter lcense u ber 12_Master rl Journeyman _.A The Commonwealth of Massachusetts Department of Industrial Accidents` Office of Investigations 600 Kashington Street Boston, AM 02111 www -mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnlirnnt Tnfnrm."__ Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Type .of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contracors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 Investigations of the DIA for insurance coverage verification. of I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town off,-ciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town 6. Other Contact Person: Clerk 4. Electrical Inspector S. Plumbing Inspector Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ElI am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a have hired the sub -contractors sole proprietor or partner- listed on the attached sheet I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required_] cop. ins " "-nv applicant that checks box #1 must also RE uut the sectioa b Type .of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contracors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 Investigations of the DIA for insurance coverage verification. of I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town off,-ciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town 6. Other Contact Person: Clerk 4. Electrical Inspector S. Plumbing Inspector Phone #: Information as d 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 apartzlents and who resides therein, or the occupant of the dwelling house of another who employs persons to .do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented_to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being regaes*•ed, 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 m 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 0.2111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 v m w.mass..o ov/dia .N CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 306( 10/18/2006) Date: May 4. 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 20 Lincoln Street MAY BE OCCUPIED AS American Training - Live Home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: _ American Training 20 Lincoln Street NmlhAn&wer MA 01845 Building Inspector AL E0/Z0 39Vd m m m LJLJ /n 4L a A r U C30 rel 4c CF r 1w. La's 'ID 'fk 4b L: qw do ID dmw C ra. qL to NO d*A% Ci LL 1= do* IU6Z* Euj E ve jz:ff .2 COO AV89 r AHiOWIi 0 tir rS Or P4 p ■ 43 z C 1= 6L60ZSEOL6 40 CM IN cc cc CL c MOW w CL W fm da.m C w of w LU C4 117:10 L00Z/60/90 0 r U rel 43 z C 1= 6L60ZSEOL6 40 CM IN cc cc CL c MOW w CL W fm da.m C w of w LU C4 117:10 L00Z/60/90 05/03/2007 01:41 9793524979 TIMOTHY J GRAY PAGE 03/03 i meq, r_css..ur. ,.0 as t•at,.�^ un•!�c\lnuervt �n� .as..:.....+.�....�, "" "-► _" >"'+o �+- w. iwvr�cyy. Kryl� rCKM! f (IAJCY UiU..Or no Ir1snQC 1!!M% ..�. ...-.._...� �.. ,........, - - - - ....... --- -- i�, F s b1 S Sonhm� Full 2x4 Keyte C anuous strip Inrainn* fnr infeinnr mkimna FUti; r" i OaS rCR�4AI14Mj Ar?aior molts or straps itiidlowww and outlet connection. �•;+rr` =�ctc - over gtrlsiplates riecween floor joist Penetrations for plumbing, heat, elec, etc. windbraae Cone and Center bearing partitions, Size ridge to mtMde Rall beaCinQ at raftry MAR Hip and Valley rafters , watch gearing at wails. Ridge & Hip - Provide proper connections. \a av\.: 1: ,w; ,a1;pa p WUV,Lm Pupw WtinP.[muri5 ano use numcane nips- ne to plate, Stair;fingem - watch cuts and heal support. Joist hamar; - flaw nailpd wi h:,nnab- v.:kac Sill plateS 2-2X6 (1P7) w/sill Seal, - Gift - solid brick or shW plate tiring at foundations ttir swdce at sores in munosuon pocws. Lateral bracing at ends. r.WfifiM 0n alt 1!t ,m T` -.--- Solid bearing support for IH ms etc, - --�-- Check headroom dearanoes - stairways, under beams AMC A00M. (min. 11X30 w13' headroom abs*), Crawl space aow$$. (min, 1W41). Basi, e..,---, t.._., In —�-a -�..I -- ----j - - ' --- •- ..at w--% i- \.w+v,.vi kaav\ iii 4wii.;. f=ireopde Slit wood frame of "0' clearance fireplaces & stoves Window Sdledule or Every Habitable Room Must Have: Natural fight equal to 8% of favor area. S4 of required glazing shalt be operable. S►edi ooms required min. 20)(24 egress wirt " Or aaor. Vent attic spaces - "propW vent", soffit and required ridge vents. Firec]ode under stairs if usa-t fesr ttr FIREPLACES: Si"rete permit required, inspections at Footing - Smoke Chamber. Finish Smooth psrging, dean joints, 8" solid ® combust. DECKS: Lag to house, provide flashing. Rails min. 36 'high, Baluster max sMm 5" on center. Over 8' above grade, use 6)6 posts wnateral Wacing. Lag all posts and rails. �ecc fvasiiia•`fa cJ,c��iysi, °L0iti, Pau At 6wir vase. FINISH: Handrails returned to wallfnewall rmst- Guardrails required alongside open oeilar stairs. Exterior grading complete. %emfiicaw Of occUpancY required prior to occxtpYing structure. Temporary Stairs ragwred for inspection. Re -inspection fee - $30.00 (Be Ready), of 2MMM ulraEKfprior to pec Location r -'?a _ No. ' Date Q TOWN OF NORTH ANDOVER i Certificate of Occupancy $ ..... •Eta' Building/Frame Permit Fee $ wC 14US Foundation Permit Fee $ Other Permit Fee $, TOTAL $ Check # L43 of 201 L4�-- f Building Inspe�t& CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 306(10/18/2006) Date: _.May 4, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 20 Lincoln Street MAY BE OCCUPIED AS American Training_- Live Home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: American Training 20 Lincoln Street North Andover MA 01845 Building Inspector ,w MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MASSACHUSETTS �� Building Location A6 fj�/ n��Jj O New Renovation rl of ame Replacement FWTT TR FC Date '7 ermit # �d 1 Amounty �- Plans Submitted Yes No ❑ (Print or type) Check o Certificate Installing Company Name 1220 orp. Address D Partner. Business Telephonefri0 Finn/Co. Name of Licensed Plumber: 4i;/z zo Insurance Coverage: Indicate the type -of -insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D 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 cr� 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 installatiops performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta a umbing Code Chapter 142 of the General Laws. By: iv signature o icujlmzu rlumnp.r Type of Plumbing License 'own l icense um er Master Journeyman ❑ Z�VED (OFFICE USE ONLY o . �,SSACH SEt Date.�.Ii. ` �....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that :7.1. ............... has permission for gas installation .Y 13 ...................... in the buildings of . , % T r l? (C ih?.! z f .( ............ at ...2 '0 C-4 ....... , North Andover, Mass. Fee.�R, .... Lic. No..& 1. �. �.. -• . GAS INSPECTOR Check # )�1 6394 MAS.SACHUSEM UNBDRM APFUCATON FOR PERM TO DO GAS FnTING (Type or print) Date 7" ���• NORTH ANDOVER, MASSACHUSETTS Building Locations U � I've, l G.1? � � Permit # Amount $ 2.#. i /�-/V�{i2�(�/V ���✓i!�«'i�J Owner's Name New Renovation Replacement UTZ Plans Submitted ❑ (Print or type) Name Address usmess Melephone Name of Licensed Plumber or Gas Fitter ik/E l/ Chec Corp Certif/a7���alling Company ❑ Partner. ❑ Firm/Co INSURANCE COVERAGE Check one: I have a current liability Insurance poli it's substantial equivalent. Yes D No❑ h h k d le e ' icate the t coverage by checking the appropnat x. If you ave c ex a y_es, p ype ❑ 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 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 1 have suomitte(I (or enterea) in aoove appncaaon are true anu accurate wine 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 S}ate,Gas ode and Chapter 142 of the General Laws. IAPPROVED (OFFICE USE ONLY) of Licensed Plumber Or Gas Fitter %Q 22 r [cense Number - 01001MA �S, '3RD. FLOOR (Print or type) Name Address usmess Melephone Name of Licensed Plumber or Gas Fitter ik/E l/ Chec Corp Certif/a7���alling Company ❑ Partner. ❑ Firm/Co INSURANCE COVERAGE Check one: I have a current liability Insurance poli it's substantial equivalent. Yes D No❑ h h k d le e ' icate the t coverage by checking the appropnat x. If you ave c ex a y_es, p ype ❑ 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 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 1 have suomitte(I (or enterea) in aoove appncaaon are true anu accurate wine 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 S}ate,Gas ode and Chapter 142 of the General Laws. IAPPROVED (OFFICE USE ONLY) of Licensed Plumber Or Gas Fitter %Q 22 r [cense Number