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Miscellaneous - 217 BRENTWOOD CIRCLE 4/30/2018 (2)
217 BRENTWOOD CIRCLE 210!0640-0045-0000.0 r Date,a.....1.1-...................... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU s V. ......... ..................... This certi i th t .................................................\n......... has permission to perform ....................................... wiring in the building of . . .. . ............... �21 1 4*'***'**""*........C-i&................................. .......... ................ V—k North Andover,Mass. . ........... I.................. at ............. .................. Fee...�?4............Lic.No. .................... ELECTRICAL INSPECTOR Check# 12554 ��// Print Form Commonwealth o�/r/aaaachuaett� OfficialUse Only a 2c� Permit No. apartment o f ire Serviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code mgr,) 577 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D ate: M 50 ,206 City or Town of: N(X+"h 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) Owner or Tenant La 72 (A Cr) �^� ) � ' I Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility 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 Pro osed Electrical Work: Completion of the follow in able ma be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig ng rnd. rnd. Batte 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 TotInitiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Ale nta Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Beating Appliances KW Security Systems:* No.of Devices or E uivalent No.of WHaeaters KW ter No.of No.of Data Wiring: + Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $200.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE H BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: DIPIETRO HEATING&COOLING LIC.NO.:A18265 Licensee: ERIK PIERMATTEI Signature LIC.N0.:40803E (7f applicable,enter "exempt"in the license number line.) Bus.Tel.No.-978-3724111 Address: 5 SOUTH SUMMER ST BRADFORD MA 01835 Alt.Tel.No.:978-994-0725 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ �� The Commonwealth of Massachusetts Department of IndustrialAccidents l Office of Investigations 600 Washington Street r' Boston,MA 02111 �= f! www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): I✓1 !✓�� Address:,, SUn-)rye &�Cc+ City/State/Zip: 0 Phone#: T HZ " Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with�b 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.) required.] 5. ❑ We are a corporation and its 10.[A Electrical repairs or additions I.❑ I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself.(No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.91 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (, �,� ln&ff (Q_ �j Policy#or Self-ins.Lic.#: ,5 2 f�� `�j Expiration Date: -25"Zol LP Job Site Address: (1'(L City/State/Zip-JL And(, Me) 0 I�q5 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 lavestigations of the DIA for insurance coverage verification. Ido hereby certify un re pains an pen erjur k"the information provided above is true and correct: Signature Date: O l ' O' 0 Phone 4: "i Q 2 "l III 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 b.Other Contact Person: Phone#: i i �I CONTROL# :' i . , .9 J9 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. } } �7. 9Z81 Q W111d HQ 3.38--5Z 3 �N iltl3H Qa131 d i 0 V. j41 rk1303313 ti315tlW Q3N3Lii �'� ON1 0`i103 `V1 S'3nsS1 ::. gj • , . 1`$44 1H t� S'#W'30,�I1 N1IVOWWO R'..lT • r it ��� Date....�1..........J of NowrH,� TOWN OF NORTH ANDOVER ,► � n PERMIT FOR WIRING CHUS�� This certifies that ......L:. has permission to perform .. '' .....................................................:...... wiring in the building of............... �../.......,,/ ,.. :. at .............................1 � 7�^ ,North Andover,Mass. ........................................................................... Fee..: ��.:. .....:...Lic.No:�.7. 8............... ELECTRICAL INSPECTOR Check# 2�u tr Commonwealth of Massachusetts Official Use Only Permit No. 121 n -1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.imj (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 WINK OR TYPE ALL INFORMATION) Date: /) 6)1S! City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned p es not. of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant C, ; { NN, Telephone No.q745 Owner's Address 1 Nl L< r Is this permit in conjunction withra building ermit. Yes ❑ No (Check Appropriate Box) Purpose of Building 51&l'\Uk Utility Authorization No. - Existing Service (V Amps QU /Z,L/()Volts Overhead❑ UndgrdNo.of Meters New Service Amps / Volts Overhead❑ Undgrd r No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �f� Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires swimmingPool Above ❑ In- ❑ o.o mergency ig ting 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 No.of Alerting Devices Tons No.of Waste Dis osers Heat Pum Number Tons KW No.of Self-Contained p 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.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent ecommunications No.Hydromassage Bathtubs No.of Motors Total HP TelNo.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value oflectrical Work: Jboc (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 L*P BOND ❑ OTHER ❑ (Specify:) I certify,under the ains and enalties ofperjury,that the information on this application is true and complete. FIRM NAME: . EleckkLLIC.NO.: Licensee: Ve Signature LTC.NO.: / (Ifapplicabl me "xe pt" ' t e licg Umber e.) Bus.Tel.No.- Address: M �� ►1 tel`- 16"Ali0�, km QJ�P` Alt.Tel. *Per M.G.L c. 147,s.'57-6 1,security work requires Department of Public Safety"S"License: Lie.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. I am the(check one)❑owner ❑owner's agent. Own Agent PERMIT FEE:$ efS Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed c on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an ti J electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the Q notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass R Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IM Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Rl Failed M Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPEC ON: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: OC A Inspectors Signature: Date: F DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,ALL 021142017 't www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information j Please Print Le ibl Name(Business/Organization/Individual): L - k Address: City/State/Zip: �G NJ12,, ►JN4 0,V6)q Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.[nI am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t � 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs 6.Q We area corporation and its of�cers_have exercised their right of exemption per MGL c. 14. Other V11e 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is 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 MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under,the pai an penalties of perjury that the information provided above is true and correct. Si ature: `` Date: Phone#• L0�3'3��n P `kl l Z_ 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#: e Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their ceitiftcate(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 foi•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 shouldenter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia GENERATOR APPL DATE: ►jl�l�s' LOCATION: OWNERSNAME: GENERATOR kw N® INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS"' CONTRACTOR: `G PHONE NUMBER: (�S-Ma'Aa IZ ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: t ZONING DISTRICT: ��- - �-✓�- }P�'`���� ` *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL, r + "North Andover MIMAP November 6, 2015 w 5 • til gKi�f �� •��� �i � - M gn ,X i`. f� I `z y' o n ; 7 4 _ C9 C MVPC Bo Interstates Horizontal Datum:MA Slateplane Coordinate Syalem,Datum NAD83, —I —SR Maters Data Sources:The data for this map was produced by Mernmack ROHM Valley Planning Commission(MVPC)using data provided by the Town of - Roads �f Nonh Andover.Additional data provided by the Executive Office of j.Easements e�+ +e�� Environmental Affairs/MassGIS.The information depicted on this map is :-7 Parcels .i:' L for planning purposes only.It may not be adequate for legal boundary --• A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY •_ $ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ��SSACHuSFt Vi 45ft 4 'a COMMONWEALTH OF MASSACHUSETTS BG,Q tiF ELECTRICIANS ISSUES" THE FOLLOWING LICENSE AS A :REG JOURNEYMAN ELECTRICIAN rZ STEVEN E PARAD I S rti 17 CLYDES> D: LE DR..-: DANVILLE ;:NW` 03$19-325p 7 37158 =E 07/31/,76 1D101 4 i 1 i Cunningham Lindsey U.S.,Inc. AA P.O.Box 703689 Cunni n ham Dallas,TX 75370-3689 bLindsey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM i ***********************AUTO**3-DIGIT 018 800 T3 P1 95000058990 Building Commissioner or Inspector of Buildings 120 MAIN STREET North Andover,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 1115189 25 Policy Number: 1115189 25 o Company Name: CAMBRIDGE MUTUAL FIRE INS 0) Cause of Loss: ICE DAM o Date of Loss: 2/23/2015 o Insured: Lazzaro Modigliani Property Location: 217 Brentwood Cir. Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143,Section 6,to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 36 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B. No insurer shall pay any claims (1) covering the loss, damage;or destructions to a building or other structure, amounting to the one thousand dollars or more, or(2)covering any loss,:damage or destruction of any amount,which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable,without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven,the said payment shall not be made while the said proceedings are pending; provided, however,that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section,or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Date..... .............. '40FITP, 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...U. ......... ......................................................... has permission for gas installation P.!v 40', r........ Iq.... ......... ...... ..... in the buildings of.......10e,... ... ..... 14A................................ at 46 r.? ...................... North Andover,Mass. Fee..,,. ............. .......................................... ..... ..... Lic. No. ...5-0.1177. GASINSPECTOR Check 'I U273 . -` MASSACHUSETTS USN—IFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �f C'f✓ D101// - _�W - MA DATE PERMIT#— t — Uip �--- A— JOBSITE ADDRESS ���lP fl7f/�./t�c�^ .__ OWNER'S NAMEG( ' GOWNER ADDRESS TEL� FAX TYPE OR OCCUPANCY PE COMMERCIAL EDUCATIONAL© RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:ED PLANS SUBMITTED: YES F NO0-1 APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE (�. ( ( �l _ DIRECT VENT HEATER DRYER1. - FIREPLACE FRYOLATOR _ FURNACE GENERATOR �i� _ 1. _ I GRILLE INFRARED HEATER LABORATORY COCKS :.- MAKEUPAIRUNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST _.!C_� —I.J N _ i . 1 J I T ____J UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [] I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CrBY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 O SIGNATURE OF OWNER OR AGENT 1 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 wi h all Pertinent provision o the Massachusetts State Plumbing Code and Chapter 142 of the General ws. oy PLUMBER-GASFITTER NAME ( Choi r LICENSE# _._ SIGNATURE MP El MGF Ej JP 0 JGF LPGI E CORPORATION DI9 PARTNERSHIPOft LLC[j# COMPANY NAME: A✓ 11ADDRESS1 CITY C-611 STATEZIP &�:KJTEL p FAX _ CELL_ __ _ EMAIL US i " _ < C-0.411 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTIObWOTES Yes No AO5 %S THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r ' F i s - s+ e The Commonwealth of Massachusetts i. F Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 - .T o'*M SJ•V www mass.gov/dia Workers,Compensation Insurance Affidavit:Builder$/Contractors/Electricians/Pluwbers. TO BE FILED WITH THE PERIVIITTING AUTHORITY. please Print a 'bl A • licant Information fell Name(Business/Orgauizationllndividual): Address: City/State/Zip: f d, � Phone#:CO3 Pl' p box: Type of project(required): Are you a plover.Check thea ro riat em to ees fun and/or parttune). 7. F1New'donstriiction 1. am a employer with_ P Y 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remo deliiig any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3•❑I am a homeowner doing all workmysel£[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12 0 Plumbing repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•_employees and have workers0 Rbof repairs ave 'comp.insurance.t These sub contractors hlq Other 6.❑We are a corporatign and its,officers have exercised their right of-exemption per MGL c. 152,§1(4),and We have no employees.[No workers'comp.insurance required.] applicant thatchecksbbx#lrriustalsofilloutthesectionbelowshowingtheirworkers'compensationpolicyinformation: *�Y Homeowners who suclL submii•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating have tcontractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have employees. If the sub contractors have employees,they must provide their workers'comp.policy number. Yam an employer that is providingworkers'compensation insurance for my employees. Below the policy and job site is information. Insurance Company Name: C25 Expiration Date'- policy ate:Policy if or Self-ins.Lic.#: j Ar /{ ,I p'i/G r _City/State/Zip: Tob Site Address: @7 ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 0-00 nal Failure to secure coverage as requiredell as ivil penaltirMOL c.es in the form of25A is a aSTOPrWORK ORDER and a fine f up to$250.00 a and/or one-year imprisonment,as p atement may be forwarded to the Office of Investigations of the DISI for insurance day against the violator.A copy of this st coverage verification. I•do hereby certify under thepains an enalties of perjury that the information provided above is true and,correct. Date: Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: r J" 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 d'efhied 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 receivet'di trustee of an individual,partnership,association or other legal entity,employing employees.•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificates)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 IudustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori policy,please call the Department at the number listed below. Self-insured companies shodld 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/]icense 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia rj_. COMMONW dLTH OF MX§UEPUSEM 1.24 • • - • • ring 193=1011;� le" 80A�D;i)F PLUMBERS":AND 6ASF-1TTEks ISSUES ;THE :FOLLOW NG L:1: AS A; L'iCENSED JOURNEYMAN GASFiTIER '' MARKT MENARDr 1 'x :v 1062 A CL'tNTON ST dr W RU IN CJH 03046 4105 0 " 0 6 249994 � ��inaei7atemui ia:��a �.iiCi D a t e..i 18 1140 "ORT TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING, CHU This certifies that /;r�QJL�/*�� ........... ... ..................................................................... .... has permission to perform...... ... .... ........................................... plumbingin the buildings of............................................................................................. at 160(- ................ .................I................. ..., orth Andover, Mass. FeeSC).gx)...Lic. Nosw. .. ... ........ ... ...... ................................................ PLU1NG INSPECTOR Check# Date.....f .. �.1�..r.5................... OF NOR7►r,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION $$AC14Ug� � This certifies that .....lrq.1.. . !.......... ' ...�..�...�......... .......... has permission for gas installation ... ................................. i I tin the buil ' gs of ........................................................................ ....................................... r N A hover,Mass. at...�J©....... .Gt( .......................................... . . Fed A..... Lic. No .......... .. ...... tt A INSPECTOR Check# CJ� x10214 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: /S 1,1x/1 MA. DATE: S� PERMIT# I VO JOBSITE ADDRESS30 S C&L{1 RL OWNER'S NAME: v GOWNER ADDRESS:,.30 sib k L-I\ (L—i T 1�4 rs 3?FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL®� PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOOR-+ Bsmt 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE P-1 I have a current liabilijj insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ If you have checked YES,please indicate the type of coverage bpqhecking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE 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 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, PLUMBERIGASFITTER NAME: Ro�erxr LICENSE#dt y� _ SIGNATURE COMPANY NAME: (Rookplumb 1 A-rt IAL, ADDRESS: 19 �-(4�, 5 � CITY: 1RC Oy'e&— STATE: M ZIP:: ��/5� FAX: TEL,' 09 _ 'P- L14 CELL: 6Ar&-P-- EMAIL: I'`L/)11 MASTER❑ JOURNEYMAN 211"LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# Lam# ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FtNAL IENSPECTIOWNOTES Yes No S �� THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES h M MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �1��1 � L1 E MA. 1DATE r ' 45 PERMIT# JOBSITE ADDRESS 0 L ' \C OWNER'S NAME j&Mt POWNER ADDRESS )r 5 `LL TE���i��/c5Z.7FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL -� PRINT NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO CLEARLY r FIXTURES Z FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142. Yes No❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's 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 withallPertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME 1 O���L� ](01', SIGNATURE eO-A— ��. LIC# d/9� MP❑ JP CORPORATION ❑# PARTNERSHIP ❑# -�' -tm❑# COMPANY NAME I`V jjt P tumi tisk ��r"r ADDRESS: CITY lY ,�t' 0'V�P/li STATE47ZIP©/Oq� EMAIL Loo !'lv m�j ilt �jlW4�L �C�/Y TEL�()6 t'51 Gv G{ CELL 7 QC It FAX ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOWKS Yes No r THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES { Date.A)*. ................. NpRTM TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING 88�a,U This certifies that .............................. ............................................................. has permission to perform .......... .......................... wiring in the building of..... \,Z.,11! ^l............... .......................................... at ,..., „ . ....... P .ys,tila! .....'(.g JA—,North Andover,Mass. Fee...VN ...........Lic.No.� ....1... ...................... ..............................j....... ELEcTRiCALINSPECTOR Check# V \+rJJ 12006 Commonwealth of Massachusetts Oftial Us,-Only Deparbnent of Fire Services i Perxnito. BOARD OF FIRE PREVENTION REGULA-nONS Occupancy and Fee Chocked [Rev.11/991 leave bIartic) APPLICATION FOR PERMIT TO PERFORM! ELECTRICAL WORK All work to be performed is arcordaace with the Massachusetts Elearical Code C1;527,C'vlI212.00 (PL&4SZ PPXNT N INK OR YYFE ALL INFORMATIOI9 Date: City or Town of: ��n d"�� To the�n Spector f W res: By this appuc adoa the 3 undersigned gives notice of his or her intention to perform the electrical work desc:ibed below. Location(Sheet&Number) c�"I n �• Lot Owner or Tenant Telephone N o. .,2092 OwuWs Address �. IS this permit i8 cosioncrdoa with a bu3ldlirag permit? Yes ❑ No [✓]� Building Permit# ' Parpose of Utility Authorization No, /6©9-�? Jg7 _— Savice o � Amps Volts Overhead❑ Undgrd No.of Meters f New Service 0 Amps Vols Overhead Undgrd No.of Meters _ ' Number of Feeders and Ampaci ty 17 1 Location and Nature of Proposed Elearrcal Work: I(C�`h f 0_' ►lam J SF��t a I6tr e. Cr;�trr C'lLi�l-tn ��1P�}�� N�',r ,i Co Ie1wn of the foliowia :able be waived by the Inspector of{Wire No.of Recessed Futures No.of Cel-Susp.(Paddle)Fans Na of Total Ttnnsiormers -VA N0.of Ligbtiug Oetiess Na of Hot Tela (;cneratars KVA of N0.of Ing Fbftres swhDming Pool Above ❑ In Q o.o f Emergency d. Banerv,Units ( (� No.of Receptacle oudeft No.of Oil Burners FIRE ALARMS No.of Z.oxn No.of Switches No.of Gras Burners f No.of Detection and v itis ' Devices No.of Rages No.of Air Coad. Tota No.of Alerting Devices TOES No.of Waste Disposers Hesf Pomp Number I Togas jKW No.of Self-Contained r� Totals- Detection/Aleriis Devices 7 Na of Dishw�ers Space/Area Healing Low KW LoQ Co ❑ Other No.of Dryers Heating Appliances KW Securrty Systems: NIo of Devices or E quimknt 1'46.ot Water KW No.of No.of I Data Wiring. _ Heaters sips Ballasts I No.of Devices orent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eanivalent OTHER Attach additional detail if desired,or as required by rhe Irupector of i71 INSURANCE COVERAGE: Unless waived by the o Amer,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 s t coverage is in force,and has exhib'ed proof of same to the permit issuing office. CBECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) G (Fxpirats Date) Fsdmawd Valu of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,unda:r the pains mrd penahies ofperjury,that the biiformation on this application is true and coMZete FERM NAME: f r 5 �� ti , LIC.NO.: Licensee: I.tJP.i a n D 1 n& Signature IC.NO.: (Ifapplicable,emer•• in the license number line. Bus.TeL Nio.:2 ��� Address: b 345 Por nit, rng �';%�t� AIt-Tel.No.: OWNER'S INSLTftANCL WAIVER: I am aware that the Licensee does not have the liabilky insurance coverage normally repaired by 1: By my signatarebelow,i hereby waive this requirement, I am the(check one)13 owner Q owner's agent. Owaer/Ageat �('PER�MIT"FEE_S ire Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I A rg j S He 4f i G CI G Address: ()I> S City/State/Zip: o Phone #: Are�y u an employer? Check the appropriate box: Type of project(required): 1.L" 1 am a employer with `�76 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. = 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.[�'I lectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / J Insurance Company Name: i h e r L4 Policy#or Self-ins. Lie.#: R3' 3 %Date: p ) Job Site Address: /rJ ( j✓n ()� C/Y- City/State/Zip:A bAiII`1Z{.1 Gt/1�4 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. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: 1l j3 Phone#: �° 3 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#: 1 Q COMMONWEALTH.OF MASSACHUSETTS apAk#p ELE6TR I C ANS ISSUES THE- FOLLOW ING LICEtJSE AS A REG[STEllD MASTER ELECTRICIANcc _. lZ DlN:15 ELECTRIC INC ; LUC I ANQ M fl li3l S Z �J PO IMAX 3955 aeODY mA o�961-3955 ' j 17307: A 07/3 /16 45416 COMMONWEALTH OF MAS g4dHUSETTv^ IR,E:CTR I Cl AMS is ISSUES THE FOLLOW. G LfCENSE ::; AS k ;SEG JOURNEYMAN ELECTR I C i kl LU [A'NO M DIMS y W' P-0B;OX 3955 " PEA>BODY F1A 0.1961 3955 E 38581 ;: 0 /3116 45415 i j 941 G Date....A... ...../..... a 1 .. NORT1� °f, 'So '" IV, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SA U This certifies that .....................%... ....1....................................................... has permission to perform .........Se«' R �� 5�/S J� ................................ . .. .. .............. wiring in the building of..........'.`�.L .Q.�r'. .�'` ............. .................. �17 �?'�.... .... .. North Andover,Mass. ^ at... ................... 64 t— ICP 05� Fee..`7.`.:�."":' LIc.No.ys../...... 7/- ���f,��. ......... .. L.. .. LECTRICALINSPECTOR Check # 3y�cl? rVVMlIM.V j W.M�Va.•VqbV6.i.� BOAR® OF FIRE PREVENTION REGULATIONS Rev. I/07� (le�vcblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK. All work to be performed in accordance with the Mu nehusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: & -/d City or To'%m of: 1- -A"0y Vii"_ To the Inspector of Wires: By this application the undersigned 6ic-s notice of his or her intention to perform the electrical work described below. Location(Street&Number) aIilx (:�: Owner'or Tenant - )VI 12 G/i ma Telephone IYo.� Owner's Address Is this permit in conjunction With a building permit? Yes � IYet (Check Appropriate Box) Purpose of Building I Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd C3 No.of Meters New servece Amps t Volts Overhead C] Undgrd No.of Meters Number of Feeders and Ampaclty Location and Nature of Proposed Electrical Work: c�n IE: et*a rile lcwin table m be aheed the.l o Fruw. addle Pans o,o f Total No.of Recessed Luminaires Na.of Cell.-Susp.(Fiddle) "Transformers ICVA No.of Luminaire Outlets No.of Hot Tubs Generators JKYA A ve n- o.-51 Emergentyl4liting No.of Luminaires Swimming Fool ® ei. a Lattery Units No.of Receptacle Outlets No.of oil Btnruers _ FM9 ALARMS No.of Zones No.of'Switches Aro.of Gras Burnersetactron an IrtiEfa" Den%tees _ No.of Ranges Ne.of Air Cond. Tons filo.of Alerting Devices No.of Waste 1?bfposers eat mp umber ons o.o. ontain Totals: Dete�ow/Alertin Devices No.of Dishwashers Space/Area Heating IOW Local 0 Connection No.of D ers Heating Appliances 1CW .* Security ems. t'Y Nen.of ' or fAuivalcat o.or Water o.a R.of` Data Wiring: Heaterss g• Ballasts No.of Devices or ivslent No.Hydromas N Bathtubs No.of Motors Total HP TelecoDe cations t No..of Duces.or t OTHER: .tttae h aa�tr aoa:of c matt (dexi► ar ars eqeri vd by the frau:of ffire Estimated Yallue of 111w ical Work - ( =prod by t s cipal pohcY•) Work to Startgenions to be iequested in accordance with MEC Rule 10.and upon.completim INSURANCE COVERAGE. Unless waived by tate owner,.no permit for the peke of electrical work may is=unless the licensee provides proof of babilitp its iia hull tg"complemd opeuatdoir".cove;raga or its substantial rquivakat the undersigned cues dW such coverage is in force,and leas exhibited proof of==to the peradt issuing offim CLIMMONF 1NSMtANCE W BOND O anm 0 (spm) I ca*)%tinder the pants and pe nalti a of pelwy,that the byornrr dad on ibis app&adon is ti ae and a amptrte. FIRM NAME: rt er i - g".. L•IC.NO.: 5Cn Licensee: i,,-,Y/t'df/°4 ?,¢Zl cd' Lr- Signature LIC.NO.: of epplfsabte;,enter"txemist'�in the lieeme rmanbesr f Bus.TeL No.• Address: //AS Alt.TeL No.- *Per M.G.L.c.147,s.57.61,security wcrk raquim Deft of-Public Safety"r License: Lic.No.+ OWNER"S INSURANC31 MAIM: I am await that the I.uctmsec dues(rear have the fiability insurance coverage normally require d by law. By my signature below,I hmby waive this rexltiiment. lam the(check one)![]owner ❑o+ 's s runt. Owner/AgentSignature Telephone No. PE&WT FEE. -- t 07-7 Department of Pblit-Safe#y One".�shburton Place, #Rm 1301 Boston, Ma 02108--1618 License: Certificate of Clearance Number:SS CC 002577 Expires:12/23/2011 Restricted To: 00 WILLIAM M TAYLOR TR IS CLINTON DR 'HOL,L IS, NH 03049 ` Tr.no: 1420.0 Keep top far;receipt and change of address notification. Cat u 35*1001.104200KICID4SEFORM1 GTS•� , q�.�t: c«aoa•.�a�ao DEPARTMENT Of PUBLIC SAFETY Certificate of Ciearance Number: SS CC 002577 Expires: 12/23/2011 Tr.no: 1420.0 A � td a { S•License: ADT SECURITY SERVICES WILLIAM M TAYLOR JR 18 CLINTON DR 1z D MOLLIS, NH 03049 commissioner } N �p a G . f } r,>N tzi o '0v �+ o C) in r"• .n t`-4 tt1 X rn m V% ; • xr x � m a, m t I ` m i 7a O i ¢ r Kzt _. m n 0s Date. . . . "•�RT:14,0 TOWN OF NORTH ANDOVER 0 p PERMIT FOR PLUMBING SSACNUS� This certifies that . -�` �. . -r . . . . . has permission to perform,,.,. . . . . . . . . . . .�. ,. . . . . plpnp�g in the buildings of . . . . . . . : . . .{�"4- y . .. . . . atr�ll.--=.'. . . . . . . . . .. 1 . , North Andover, Mass. FeerCV ? . .Lic. No. �'/h.��. f.��.„- 4!�'-! /I'//'}}a!{.... . . . . . . . . PLUMBING I�N�'ACTOR Check # ((JJ 7426 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH AND �F�,MASSACHUSETTS //jj ``� ` . Date 2 Building Location ► Q!� L-v o o Cts`Ukmers Name g- 7777 Amount Type of Occupancy S 4�/C- f7-1 M New Renovation Replacement Plans Submitted Yes No FIXTURES Ln z E-4 a aQrjW H H U H GGW W q WWGn A a W WHd' H rti rA rA W In S�BgV]C H��11"IlVT lS�FLOa4 M ROck 3M FLOCK 4M KfM 5M HIM 6M FLO(R 7M FIOQt SIH RDD (Print or type) nn Check one: Certificate Installing Company Name o M It S 0a_Frb✓ q-- lti�,�r Corp. Address I C CL,���c�Y n i /'� Partner.' S t o- f" I Business Telepho e — Z. -0 Firm/C0. Name of Licensed Plumber. —rk.o ht Q S 0 1— 2 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 El 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 perform er Permit Issued for this application will be in compliance with all pertinent provisions of the Massach U g Owthapter 142 of the General Laws. $y: Nip of Licenseaum er Type of Plumbing License Title /'Town "2-0o 6 a Ci tY icense NUMDCr Master ❑ Journeyman APPROVED(OFFICE USE ONLY 1� — 7 Date..... ..................69......... kORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SAC$4us This certifies that ................P��V .5 k4ee779--c. ............................................................ has permission to perform ............................................ .. .............. wiring in the building of...... . ... ..7...-3 T+ ........... .. .......... North Andover,Mass. at......... Fee.....�� Lic.No.8173P7............... ELECTRICAL Check # 7553 i Commonwealth of Massachusetts offi�w Use only - Department of Fire Services Permit No. 7-5 s 3 _ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.11/99] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wodc to be performed in accordance with the,Massachusetts Electrical Code(MEC),527 CMR 12.Od (PLEASE PRINTW INK OR WE ALL MFORMATMV) Date: -2a 1 0 7 City or Town of: Q/h A To the I—W-ec of Wires: By this application the undersigned gives notice of his orherintention to perform the electrical work desenbed below. Location(Street&Number) 2)/ ? ' /pi a j,61)rl- �j�, { Map= Lot: OwnerorTenant �� /�f}�jC�/j��I Telephone No. •�j)�� Owner's Address Is this permit in conjunction with a building permit? Yes 05 No ❑ Building Permit# Purpose of Building_ &e ,o Utility Authorization No. EAstmg Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampaeity Location and Nature of Proposed Electrical Work Completion ofMcfalloWng table may be waived by the Insperlor of Wji-L, No.of Recessed Fizttures Z No.of Ceti cusp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Turf restu Swimming Pool `bow ❑ In- ❑ No.of Era rgency Lighting grad. grud., Battery Units No.of Receptacle Outlets r? No.of Oil Burners FIRE ALARMS RMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No:of Ranges No.of Air Cond. Toners No.of Alerting Devices Na of Waste Disposers Heat PamP Number Tons KW o.of Self-Coutained Totals: 'on/Alertin Devices No.of Dishwashers Space/Area Heating KW Local ❑ MConnectiounicipaln ❑ Other No.of Dryers Heating Appliances KW Security Systems: No.of Devices or E uivAent No.of Water KW No.of No.of Data Wiring: Heaters .Signs Ballasts No of Devices or E nfvalent ,/4 IN&Hydromassage Bathtubs Na of Motors Total HP Telecommunications Wiring: No.of Devices or E uivAeut OTHER: Attach additional detail ifdesFr A or as required by thelnspedorof fr 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 opera#ion"coverage or its substantial equivalent. The undersigned certifies that so coverage is in force,and has exlm ,' d proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) (Exp on Date) Estimated Value of Electrical Work: �� bYm��P t policy-) Work to Stark Inspections to be requested in accordance with NEC Rule 10,and upon completion. I certify,under the aims and penakies ofFeJ m34 that the infmma&n on ods ap n and complete: FIRM N r Gc-cs t'l LIC.NO- 6`) Licensee: ty(!4 vo ,,p n,5 Signa LIC.NO.: (If applicable,enter exempt"in die license ber Tinel us.Tei.No: Address �(� ,�j 3g ��ec✓, /f?� /e2 t'e l� Alt.Tel.No-- OWNER'S INSURANCE WAIVER: I am aware t6t the Licensee does not have the liability insurance coverage normallyrequired bylaw By my signature below,i hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent Owner/Agent PERMIT FEE:S -T�- ' Signature Telephone No. V Date....... NORTH of TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING �S$ACHU This certifies that ...............vuv�.-S has permission to perform ............. ........... wiring in the building of...........M. /* at....... lo..... ! ........ .North Andover,Mass. Fee..- Lic.No.J-7.3674......... ELECTRICAL INSPECTOR Check # VVV 7530 Commonwealth of Massachusetts Official Use only U91 - Department of Fire Services Permit No. �3C9BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pedonned in accordancewith the Massachusetts Electrical Cade(MEC),527 CMR 12.00 (PLEASE PRWW INK OR TYPE ALL INFORMATIOM Date: ( 9� City or Town of: j�fid, � s To the Inspector f By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location(Street&Number) �R) reo'wLy),4 ('1 ro e, Map: Lot: Owner or Tenant ---A )jCIL ILA A l io n i Telephone No. 97216L- ;49,72 Owner's Address A/j,-w C - is this permit in conjunction with a building permit? Yes ❑, No ❑ Building Permit#_ ��! — Purpose of Building /L4L44/�� Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Und d gr ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: y� e c y of -,lya,- Com leabn offhefolkWng table mqV b'e waived the Inspector of Hire No.of Recessed Fixtures a No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers ___K-VA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures 1 Swimming Pool Above ❑ bi grad. ❑ Ba.of EmergU� ency Lighting gruts No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No:of Zones No.of Switches No.of Gas Burners No.of Detection and Wtiatinp,Devices No.of Ranges No,of Air Cond. Tans No.of Alerting Devices No.of Waste Disposers Heat Pamp Number Tons I KW W.of Self-Contained Totals: - I Detection/AlpEft Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Water No.of No.of No.of Devices or E uivalent Heaters KW Data Wiring: Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HPTelecommunicat►ons Wiring: No.of Devices or E uivalent OTHER Aaarh additional detail ifdesired,or as roph-ad by theInspedor of t;<r INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the lic ensec provides proof of liability insurance including completed operation"coverage or its substantial equivalent. The undersigned certifies that su coverage is in force,and has exhibi g ince, proof of same to the permit issuing office. CBECK ONE. INSURANCE Ur BOND ❑ OTHER ❑ (Speedy-) Estimated Value of Electrical Work: en b municipal {�P on Date} (�► �lu� Y � Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. Y certify,wider Ike airs and penalties ofpedury,that the inforatation on this application is true and complete- FIRM NAME: LIC.NO-° /2 b Licensee: 6oci"o t l nn Signatue LIC.NO.: (Ifapplicabk,'everpt"in he lceme munb,er .Tel.No: Address: 9 peanen41, h9k 6qW Alt.Tei.No.:' OWNER'S INSURANCE WAIVER I am aware thaTt the Licensee does not have the liability insurance coverage normallyregnired by law By my signature below.I hereby waive this requirement I am the(check one)❑owner ❑owner's agent. Signature Owner/Agent Telephone No. PERMIT FEE:$�S� 1 r r .. . ! • - r.. .lel .. . ! \ Location 21 q 13 r`,Q� u'°bof C%v No. 303 Date �oRTM TOWN OF NORTH ANDOVER F41 n • i , a Certificate of Occupancy $ s'ACMUs Building/Frame Permit Fee $ 3 y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Q46 6 5 5 ca�S Building Inspector { ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH y{�A ONE pOR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ® DATE ISSUED: X M SIGNATURE: .-I Building Commissioner/I or of Buildings Date z SECTION 1-SITE INFORMATION I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: X10OR 4 D tO VM ,M k p �/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: l�1 Zonin District Proposed Use Lot Area(so Frontage 8 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required- Provided 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Infounation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIUVAUTHORIZED AGENT M 2-1 Owner of Record Name rint) Address for Service: Signature Telephone '--- - - O 2.2 Owner of Record: l Name Print Address for Service: Signature Tel"h SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Licensed ConstrucL-n Supervisor: License Number ry Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r Z Expiration Date ^ Signature Telephone V SECTION 4-WORKERS COMPENSATION(M.G.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.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: ylydt SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL Ug'.ONLy Completed by permit applicant . 1. Building r Off® (a) Building Permit Fee f Multiplier 2 Electrical (b) Estimated Total Cost of 160o- Construction a0U-Construction 3 Plumbing Building Permit fee(e)x(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L 4 22 L4 /1-t 0 L f ( as Owner/Authorized Agent of subject property Hereby authorize to act on My beh in all matters relative works.authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date �- ;,,,e, s, . ��:• ��:���Vii.:..: NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Is 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �q V WT77 m BUILDING PERMIT NUMBER: © _ DATE ISSUED: X ic SIGNATURE.- AKAU -q Building Commissioner/In or of Buildings Date z SECTION 1-SITE INFORMATION 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -, 11 '-�Iqjoob ,= lO r.1 Do V a n D � Map Number Parcel Number W 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District P—roposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Simply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: ZOIIe Outside Flood Zone 0 Municipal ❑ On Site Disposal System D Public 0 Private ❑ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT M 2.1 Owner of Record L ZZ1 © t — 1 Dame(Pnnt) Address for Service Signature Telephone 2.2 Owner of Record: O Name Print Address for Service: Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Constru*.-Supervisor: O License Number mn Address ?� Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number -- r Address Expiration Date G) Signature Telephone ---- — - �_-- -- __ - ,�--=----tom- -- _ ---- SECTION 4-WORKERS COMPENSATION(M.G.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.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition C Accessory Bldg. ❑ Demolition C Other C Specify Brief Description of Proposed Work: A19 W": �i�(����t�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Dollar ( Completed by permit applicant . 1. Building , (a) Building Permit Fee� � Multi lier 2 Electrical (b) Estimated Total Cost of / 0 U Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical AC o / 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owiier/Authorized Agent of subject property Hereby authorize to act on My b - in all matters relative work authorized by this building penuit application. —Signature of Owqier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A Ient Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FU,LED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM J 1- lob p 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*********************** )O APPLICANT L A-,>? Q Q0 6 G L f r PHONE 9 7ef 6 P -7 X7..2— LOCATION: Assessor's Map Number PARCEL �S SUBDIVISION LOT(S) STREET o2 f 7 7V ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** REC99PENDATIONS OFT WN AGENTS: Fit CONSERVATION ADMINISTR OR DATE APPROVED AA DATE REJECTED qq COMMENTS_ktc oloQ Atao .,4,4 f; � lnd+c� 66CHyedeiaii4i—Soi�s arr3k ksd4c4e_ r ��r 644iar Ae s;z was sma.l r a.► 3/14d r2p��r'� f a fi Ii�q. TOWN PLANNER J 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 Revised 9\97 jm rY h 'V i v 46% n � LoA In 20 k N 7q- : p v .25 Rt l x 74 ,r h G� C fi' -PST 7coo x' fo � `" 1 0•o° h� � `Q) �3. • ? ;a8� '"! o'g k rZ. >r � oo c8 ii NORTH Town o _ EAndover %In No. 0a�E^�' h dover, Mass.,, �A COC HIC HE-C , / a ORATED PPa�tG� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ` • ► BUILDING INSPECTOR THIS CERTIFIES THAT.... a.. �.Z.A 9...../�',. .........� .��d.N...0........... ..... .......................................... Foundation has permission to erect.. ., � oZO......_. buildings on... ..�. ...... •I� /�'• ^'.�. ....�................................ Rough to be occupied as....«S.' o ....... 4f.af......./../.�j....^is r Chimney provided that the person accepting is permit shall in every respect conform to the ter s of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the I spection, Alteration and Construction of Buildings in the Town of North Andover. 6 V/AIS- ,00m PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough A e t e si b ow / PERMIT EXPIRES IN 6 MONTHS Final vaIL flip & t 13* too sj o •••/ UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR r t i?, 4Ik J • � � # e42. • Rough ........ .... .. ..... ...... ....................... ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Date.70�k- NT 2 3755 NORT„ TOWN OF NORTH ANDOVER O�t,�ao ,•1.►.O " PERMIT FOR PLUMBING �,SSACHUS�� This cl�-Iitifiesthat �f?�I.�'. . . .��°�. . . . .�� C. . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . O. 1. G.11P.I'A. . . . . . . . . . . . . . at.a./. 7. . 5&e�� (,u.o.v. .d. G.I tt . . . ., North Andover, Mass. Fee. . . �.t. — .Lic. No..?.7)3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 07/15/48 09:51 15.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer I 'MASSACHUSETTS UNIFORM APPLICATION FOR PERM , 0 DO PLUMBING (Print or Type) �CZOu c=/P , Mass. Date_ 6-fib 19 9 Permit# J Building Location o2!? ,per C�ot�o! (fj,COwner's Narr►e�/aL Type of Occupancy tiw New ❑ Renovation O 'Replacement 9 Plans Submitted: Yes❑ No O FIXTURES _z x N z x a t- rn j N o z ►- rn w y J N } u a m = w w V) a ti a s a z ~ N z p z N p� W r- W N f. V a N U. Z .. v F.. z O :J Q �( W. d: a W Z ° a N Z K G a O Ir. W z F WV) o ° � -' N ►- a x ° ° a a ' N U y F- O x n N r' x a 0 z z a W u x W SUB—BS MT. BASEMENT 1ST FLOOR 2ND FLOOR JR0 FLOOR 4TH-FLOOR 5TH FLOOR STH FLOOR 7TH FLOOR STH FLOOR installing.Company NameM Alt •��ynrbin t �s��„p¢j�4 .2/trC. Addressy Dom/ Check one:. Certificate A/ y C. . Corporation rrV c.y /e']N� 0.l�.1 d• 9 • �p Partnership Business Telephone_ 2 23---.2 93la --- O hwco. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes JM No O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability,insurance policy ❑ Other type of Indemnity ❑ Bond O 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 q�Qenl Owner ❑ Agent❑ I hereby certify that all of the details and information I have submitted(or entered)in above knowledge and that all plumbing work and installations pe under the application are true and accurate to the best of my pertinent provisions of the Massachusetts Stale Plumbin Code p 2 of issued for this application will be in compliance with all Chapter 142 of the General laws. [By S+gnature tensed Plumber/Town Type of License:Masler(� Journeyman(] NPROVE!)(OFFICE USE ONL Ucense Number 71� SM-aW FOR OFFICE USE ONLY IOKSSk;=, ?_� PROGR=SS :},SP=CTIOh'S NO. APPLJCA� ION FOR PBr MIT TO DO PLUMBING 'v HL,W..Z' a T'FE 0= BUILDING LOCATION OF BUILDING PLUG.. cF2 DAT= 7 9 ?LLI'M2 !', :}ISP= OR l