HomeMy WebLinkAboutMiscellaneous - 21 DAVIS STREET 4/30/2018I
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that..1.................................................................
has permission for gas installation .........4..�-'
....................................................
in the bildings of ........................................................... ......
atc................V........................................................ No A over, Mass.
Fee.. ..0.0.. Lic. No&�N' ......... ....... ..............................
���y GAS ,NSPECT R
Check #�z�
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TYPE OR
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CLEARLY
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY MA DATE
j PERMIT#
JOBSITE ADDRESS OWNER'S NAME
OWNER ADDRESS L TE FAX
OCCUPANCY TYPE COMMERCIAL [] EDUCATIONAL
NEW: RENOVATION: D REPLACEMENT: D
APPLIANCES "I FLOORS-
BSM
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
RESIDENTIALIA
PLANS SUBMITTED: YESFJ-� NO Fj
1 9 1 10 1 11 1 12 1 13 1 14
INSURANCE COVERAGE
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142
1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW -
YES 1[4 NO [_3
LIABILITY INSURANCE POLICY F-31 OTHER TYPE INDEMNITY [j BOND 0-J
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.
CHECKONEONLY: OWNERL-J-1 AGENTEI
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 knowled�
and that all plumbing work and installations performed under the permit issued for this application Will be in compliance with-ORertinentrision 5�e
Massachusetts State Plumbing Code. and Chapter 142 of the General Laws. ---I le
PLUMBER-GASFITTER NAME LICENSE
IMP M MGF EjI JP [I JGF R
j LPGI CORPORATION M# PARTNERSHIP 0#= LLC [3#
COMPANY NAMEI— :ADDRESS
CITY -1
ZIP
STATE =/5- TEL
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Po Box 55098
Boston, MA 02205-5098
61.7-951-0600 .
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: Insured:
PATRICE PAPPALARDO
Property Address:
21 DAVIS ST, NORTH ANDOVER, MA
Policy Number:
HMA 0002204
Claim Number:
BOS00056526
Date of Loss:
3/17/2015
Company:
Safety Insurance Company
Claim has been made involving loss, damage or destruction of the above -captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
Holly Coughlin Claim Examiner 3/19/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3026
Fax: (617) 531-6684,
Email: HollyCoughlin@Safetylnsurance.com
Safety Insurance
W
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 001845- NORTH ANDOVER, MA 001845 -
RE: Insured:
Property Address
Policy Number:
Claim Number:
Date of Loss:
Company:
PATRICE PAPPALARDO
21 DAVIS ST, NORTH ANDOVER, MA
HMA 0002204
BOS00046213
10/23/2014
Safety Insurance Company
Claim has been made involving loss, damage or destruction of the above -captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate, please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
Allan Leavitt Claim Examiner 11/18/2014
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com
Location C,) �� V / S S
No. .2z, 2 Date e - a 49 9
NOR,h TOWN OF NORTH ANDOVER
n Certificate of Occupancy $
Building/Frame Permit Fee $
Ane'Foundation Permit Fee $
s�cwusE
Other Permit Fee P oo L $ 3�
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
1b'115/99 13:47 35.00 PAID
Div. Public Works
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTION
APPLICANT �i4 P11 PP,4LA PJO PHONE
LOCATION: Assessors Map Number PARCEL
SUBDIVISION
STREET p/ .A ()( S S4
LOT (S) /
ST. NUMBER a/
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OFFICIAL USE ONLY' p /� i
1 1 )\l0d 0 100-e � flNCL �bo
RECOMMENDATIONS OF TOWN AGENTS: �'`� �`� �r �°R 1w, Pro, -.t Naos
CONSERVATION ADMIN15TRATOR DATE APPROVED b -2t C4
�}} (,{ DATE- REJECTED
COMMENTS �y % \l• cjt(t?hti.�-
TOWN PLANNER DATE APPROVED
DATE REJECTED -
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
MORTGAG, E INSPECTION PLV L
NORTHERN ASSOCIATES, INC.
630 TURNPIKE STRE%T N. ANDOVER MA TEC. (508) 975-711.7
l�A ETe6, f-- C) i PA I G E
MORTGAGOR_-F,L'� P P AL �t2�dDEED REF -..2? -2-1C)-.- - PG._..___._
ADDRESS OF PRINCIPLE BUIL DING PLAN REF...___1D_
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PA V1 _.�. _-- DATE OF INSPECTION. 00Y.
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...._ticaticn to:
FI IZST M �R�S. J A0 2T Co.
,47':E: This mortgage inspection vas prepared
;�ecifically for Mortgage purposes only and
.s -.ct to be relied upon as a lend or property
._se scrvey. Building location and offsets
"Own are specifically for zoning determinatior.
and not to be used to establish property
.:nes. The land shown heis based on
referencsd information noted and may be subject
f.r:Cor takings and easements. Northern
Assoc:ates, Inc. accepts no responsibility for
ja=ages resulting from said reliance by anyone
:�tne,- than the said mortgagee and its assigns in
=or.r.ecti0n with its proposed mortgage financing
c said mortgagor.
OF &4X
This mortgage inspection was prepared in accordance
with the Technical
�P`ZH
J"
40
Standards for Mortgage Loan
Inspections
JAMES J. ti�
as adopted by the Massachusetts Board of
Registration
Zr
of Professional Engineers and Land
Surveyors 750 cHR 605.
11
otj ABELY -I
N
NO. 28520
further state that In m
the structures shown y professional opinion that
`\�OJ
tie local zoning horizontal dimensionalosetbackith
requirements at the time of construction
9
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or are
exempt under provisions
O
of H.G.L. CH. 10-A Sec. ^
UWA
�1.Property/House is not to a Flood Hazard.
i.._;7.Property/House is in a Flood Hazard Area.
❑ ].Information
is insufficient to determine
f
Flood Hazard.
Flood Hazard determined fr� m�J a o t Foderal Flood
insurance Rate Map PanellsAd
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Date
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that,...! ... .....................................................
has permission to perform ........ .....................................................
wiring in the building of ..( ......... . ......................................
at....... ........ ...... ....... ..... . North Andover, Mass.
Fee?.......—. Lic. No:a.... ... ....... .............
ELECTRICAL INSPECTOR
06/23/99 14:02 35.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MM0�7H0FMAS54CHUS= Office use only
MAP DEPARTA&%T0FPUBLIC&4fM Permit No.
OFFIREPREVEN77ONREGULA770AN527CMR 12:00
Occupancy &Fees Checked
pAREEL '
PERMff` TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) oL ( D4o E S7—, kl, �- /,-joo UP;1 r/h,4 S C
Owner or Tenant %P r/ r )� A4 PP a b
Owner's Address Z1` -,Q --
Is this permit in conjunction with a building permit: Yes No L VJ (Check Appropriate Box)
Purpose of Building [Qes ( V4,(- Utility Authorization No.
Existing Service Amps / Volts Overhead Underground No. of Meters
New Service Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
4
Location and Nature of Proposed Electrical Work 1A Ji Ute-- ACL,,) k K11 VA t JOj POO
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
BelowGenerators
KVA
ground
1:1round
No. of Receptacle Outlets
No. of Oil Bumers
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
Connections
.; f Water Heaters KW
No. of No. of
A
Sims
Bailasis
No.`Hydro Massage Tubs
No. of Motors
Total HP
f
OTHER
Irrnrar�Co.+3'age Ptasuant�thetaltmana�s�C�talLaws
I have a azffait Liability karxcePoticy mdudng Cartpir Grits a ui valerg YES NO
Miopribm dvatidptocfafsarnetatheo�
YES F7 If}ouha,,ed e3cedYES,pleseindica�the cifct agebyd>a�zgthe
aebcx. —a
NSURANCEE �. BOND OTIC ,..� ) t o%/y%
ExpimbcnDaw
Estin ekd ValuedEkcbcal Woik S
Wcdc;aSlart hlspec mDaeRalt»d Raigh Final
le
FiRMNAME l 4SrY LrxmeNa
Liter I ��' :� �_ �T,�t �� s �, I;erb .�
Ips Tel N�L
A`t ` A t. TeL Na —] 0
OWNER'S IIvELJR ANCE WAIVER; I am awaret Ei dr L=se cishfnt the aisOntoi Cgr6nas re4m2d byMasm3aisez Czi= Laws
andtha[mysi ts�rnthisp acpfic�iatwaresthistt UY=
(Please check one) Owne; Q Agent �1
�"'""3 Telephone No. PERMIT FEE S
TH®FliRMCUMM Office Use only
<�
MAP DEPARTALEW OFPUBLICS4FE7T Permit
C. -N No.
OF ME PREVEMONREGUL4770M527CMR 12:00
i a1
Occupancy & Fees Checkedyv
PARCEL
PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRLNT IN IMC OR TYPE ALL INFORMATION) Date
Town of North .Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) ] V S sr , 'o ,/1 JO0 V&(
Owner or Tenant a4rL2 Pd !7/� 1141- torW b r
Owner's Address K V1//Y�
Is this permit in conjunction with a building permit: Yes r7 No (Check Appropriate Box)
Purpose of Building _...OLS ( 6n-+1 Utility Authorization No
Existing Service Amps / Volts Overhead Q Underground Q No. of Meters
New Service Amps / Volts Overhead = Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work t4- tVY1 ✓ , t N OU
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
No. of Lighting ng Fixtures
Swimming Pool Above
Below
Generators
KVA
groand
1:1round
No. of Reccptacle outlets
No. of Oil Bumers
No. of Emergency Lighting Battery Units
N0. 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
Pumas
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
Connections
No. of Water Resters KW
No. of No. of
Sicns
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER
11 111MA
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1111200500 .t RAm
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ET-dbrnDam
Esorr>a�cd Vah c(Bectrical Work S
13111181t Final
Lio=NTa r� i0. < ,<—
Liarisee�-_ L�eNb r .�—
Bisiness Ta Na p C7
` Alt Tei Na _ 6 3-9 ?DIP
OWNER'S NaJRANCEWAAIE ;Iamawmeth1drL:casedcmnot} lheiara=cow.t@!!cr-zsutsbnt6egiiva tasro4mledbyM G=rj Lam
ac�i fhatrny si�ern the pem�t ep�ctt wai,es this re�rx�rt.
(Please check one) Owner Agent a
Telephone No. PERMTT FEE S
70-478
ARTICLE 680 — SWIMMING POOLS, FOUNTAINS, AND SIMILAR INSTALLATIONS
680-6. Receptacles, Lighting Fixtures, Lighting Outlets,
Switching Devices, and Ceiling -Suspended (Paddle)
Fans.
(a) Receptacles.
(1) A receptacle(s) that provides power for a water -pump
motor(s) for, or other loads directly related to the circulation
and sanitation system, a permanently installed pool or foun-
tain, as permitted in Section 680-7, shall be permitted be-
tween 5 ft and 10 ft (1.52 in and 3.05 m) from the inside
walls of the pool or fountain, and, where so located, shall
be single and of the locking and grounding types and shall
be protected by a ground -fault circuit interrupter(s).
Other receptacles on the property shall be located at least
10 ft (3.05 m) from the inside walls of a pool or fountain.
(2) Where a permanently installed pool is installed at a
dwelling unit(s), at least one 125 -volt 15- or 20 -ampere
receptacle on a general-purpose branch circuit shall be lo-
cated a minimum of 10 ft (3.05 m) from and not more than
20 ft (6.08 m) from the inside wall of the pool. This recepta-
cle shall be located not more than 6 ft 6 in. (1.98 m) above
the floor, platform, or grade level serving the pool.
(3) All 125 -volt receptacles located within 20 ft (6.08 m)
of the inside walls of a pool or fountain shall be protected
by a ground -fault circuit interrupter.
FPN: In determining the above dimensions, the distance to
be measured is the shortest path the supply cord of an appli-
ance connected to the receptacle would follow without pierc-
(a) Fixtures are of a totally enclosed type,
(b) A ground -fault circuit interrupter is installed in the `'
branch circuit supplying the fixture(s) or ceiling -
suspended (paddle) fans, and
(c) The distance from the bottom of the fixture or ceiling -
suspended (paddle) fan to the maximum water level is'.,
not less than 7 ft 6 in. (2.29 m). 7
(4) Lighting fixtures and lighting outlets installed in the•
area extending between 5 ft (1.52 m) and 10 ft (3.05 m)
horizontally from the inside walls of a pool shall be protected .
by a ground -fault circuit interrupter unless installed 5 ft
(1.52 m) above the maximum water level and rigidly attached•
to the structure adjacent to or enclosing the pool. t
(5) Cord -connected lighting fixtures shall meet the same '
specifications as other cord- and plug -connected equipment
as set forth in Section 680-7 where installed within 16
ft (4.88 m) of any point on the water surface, measured;
radially.
(c) Switching Devices. Switching devices on the property,
shall be located at least 5 ft (1.52 m) horizontally from the:};
inside walls of a pool unless separated from the pool by,
solid fence, wall, or other permanent barrier. '
(d) Motorstie�li IT Wirin
plying pool pump motors rated 15 and 20 amperes, 1:
or 240 volt, single phase, whether by receptacle or
connection, shall be provided with ground -fault 4
interrupter protection for personnel.
ing a floor, wall, ceiling, doorway with hinged or sliding `t:. 680-7. Cord- and Plug -Connected Equipment. Fixed or
door, window opening, or other effective permanent barrier. Z stationary equipment rated 20 amperes or less, other thane.
�tP: an underwater lighting fixture for a permanently installed,'
(b) Lighting Fixtures, Lighting Outlets, and Ceiling -
pool, shall be permitted to be connected with a flexible cord' -
Suspended (Paddle) Fans. '` to facilitate the removal or disconnection for maintenanc6:'
�. or repair. For other than storable pools, the flexible cord.,
(1) In outdoor pool areas, lighting fixtures, lighting out- " shall not exceed 3 ft (914 mm) in length and shall have'a°
lets, and ceiling -suspended (paddle) fans shall not be iri ti 11
f . g• copper equipment grounding conductor not smaller than No.
stalled over the pool or over the area extending 5 ft (1.5,'; 12 with agrounding-type attachment plug.
m) horizontally from the inside walls of a pool unless n, 14 . .-
part of the lighting fixture or ceiling -suspended (paddle)f1( FPN: See Section 680-25(e) for connection with flexible'i` ;
is less than 12 ft (3.66 m) above the maximum water levels cords. a''r
(2) Existing lighting fixtures and lighting outlets located
less than 5 ft (1.52 m) measured horizontally from the inside
walls of a pool shall be at least 5 ft (1.52 m) above the
surface of the maximum water level, shall be rigidly attached
to the existing structure, and shall be protected by a ground -
fault circuit interrupter.
(3) In indoor pool areas, the limitations of Section 680-
6(b)(1) shall not apply if all of the following conditions are
complied with
1999 Edition
680-8. Overhead Conductor Clearances. The ft
parts of pools shall not be placed under existing
drop conductors or any other open overhead wir
shall such wiring be installed above the following:
(1) Pools and the area extending 10 ft (3.05 m)
from the inside of the walls of the pool,
Diving structure, or
Observation stands, towers, or platforms unless the in=
stallations provide the clearances in Table 680-8
/ N FjOw
MAP
MASSA HUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
PARCEL
(Type or prmn-
, CHUSETTS-- Date —�- %cl
p n PDLL �� o
Building Location a/ 0h o's Owners Name r • r� / Permit #
Amount
Type of Occupancy° .=��
New 13Renovation Replacement ❑ Plans Submitted Yes No
FIXTURES
(Print or type) Check one: Certificate
Installing Company Name /Sly/
Address
Partner:
Firm/Co. �'-
Business Telephone. q 7 f 9 S- 2-
Name
Name of Licensed Plumber: W,
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box
Liability insurance policy Other type of mderinnity. Bond. M "2
-
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 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 performed,undcOerruit Issued.for this applicatiari:will.be in.. .
compliance with all pertinent provisions of the Massa sett t 1 CndChapter 142 of the General.Laws.
By: Signature or Licensua riumoer
Type of Plumbing License _
Title e�
Ci /Town n1_ b.e�r ,_
ounecesey
APPR-?VEDiCE USE ONLY