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HomeMy WebLinkAboutMiscellaneous - 22 MIFFLIN DRIVE 4/30/2018rDate.... 1 .......................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION T' � �-1 tl�l1L. ti 0 his certifies that �..!... ,� �-1. WLS �.`-............ has permission for gas installation l..:.!... V W?�t:.-.......!..U.1.. in the buildings roff.... .... ��Y ... ...:......1..!..+-............................................ '� ��`� `��� �- , North Andover, Mass. at........................................................................................... Fee � �....... Lic: No. �� "...... ............................................................ + _ GAS INSPECTOR I ( Check # 9205 10 1 \reL G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 3/24/2014 PERMIT #J JOBSITE ADDRESS 22 Mifflin Drive OWNER'S NAME I Michele Provost -Tine OWNER ADDRESS Same TE 508-744-6757 FAX OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL NEW:E1 RENOVATION: Ej REPLACEMENT: APPLIANCES 7 FLOORS- BSM BOILER IF -- 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER RESIDENTIAL PLANS SUBMITTED: YES® NDE] rmt,0 m INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES E] NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 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 applicat4beliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph MarinoLICENSE# ATUREMP El MGF ® JP ® JGF ® LPG] ® CORPORATION E]# 3285C P ®# LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL 508 832 3295 FAX 508-926 4347 CELL 508-832-4614 1EMAILFJMarino@RHWhite.com w H oI z 00 z 0 a z d z w -N � � O ❑ a z 0 N ❑C7 � W � W Om a W m 3 a � w z Q w rj a O w �+ w d W N W fs+ d z0COO a Q C. ►� J F, a a a � w x w H LL O z z 0 H U W a C�7 x 0 x U. 5 A B C D D 04/03/2014 CCORD® 14:04 5088326751 RH WHITE CONSTRUCT CERTIFICATE OF LIABILITY INSURANCE page 1 of I PAGE 02/02 �I DATE (MMMDNYYy[ 08/29/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ios)murt be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Willia o£ Massachuaette, Inc. C/o 26 cottury Blvd. P. 0. Box 305191 Nanhville, TN 37230-5191 R. B. White Construction Company, Inc. 41 Central street P. 0. Box 257 Auburn, MA 01501. M �2.w= INSURERA:The Chartor Oak Piro InsuranCO Company 25615-001 INSURERS-Travolors Property Casualty Coggany or Am 25674-003 INSURERC:Natipndl Union Piro Insurance Company of 79445-001 INSURERD;Travelers Indomnzty Company 25659-D01 INSURER F.; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER E CERTIFICATE= MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSU RANCE DD' SUB POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE 2 2,000,000 VTC20C0 977X9948-13 X COMMFRCIALGENERAL LIABII.ITY nail il_ 300,000 MED EXP (Anyone arson S CLAIMS -MADE OCCUR PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE _$ GEN'LAGGREGATF LIMIT APPLIES PER; POLICY 5_1!1P4rLOG 000 000 S AUTOMOBILE LIABILITY 2, 000, 000 BODILYIINJURY(Perpemon) $ VTJCAP 977K955A-13 X ANY AUTO ,-PERTY 4E , £;,,,,dent $ ALI. OWNED SCHEDULED EACHOCCURRENCF. L-3-, 000, 000 AUTOS AUTOS 0 00, 0 0 0 S X HIREDAUTOS X NON -OWNED E.L. EACH ACCIDENT 110-00,000 AUTOS 1,000,000 El, DISEASE. POLICY LIMIT S 1,000,000 X Cc Deo X Co11 pea UMBRELLALIASR OCCUR BE8766140 X EXCESS LIA6 CLAIMS -MADE DED 1 $ IRETENTIONS 10,000 WORKERS COMPENSATION ' RRUB 82051185-13 AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNFRIFXECUTIVE N/A VTC2XUB 8203A71A-13 < OFFICERVEMBEREXCLUDED? LJJ Mandefoar�ln NN) U Kn+I�UNudOF'F'RATIONSbelow is rVidonce of Infalurance )/1/2013 1-9/1/2014 (/1/2013 19/7./2014 3/1/2013 19/1/2014 )/1/2013 19/1/2014 9/1/2014 )/1/2013 r more epees N NUMBER: D NAMED ABOVE FOR THE: POLICY PERIOD OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE 2 2,000,000 W(Eeoeeu* nail il_ 300,000 MED EXP (Anyone arson S 101000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE _$ 4-001000 PRODUCTS - COMP/OP AGG $ 000 000 S EDSINGLFLIMIT NO�ca� N $ 2, 000, 000 BODILYIINJURY(Perpemon) $ BODILY IN.IURY(Peraccident) $ ,-PERTY 4E , £;,,,,dent $ s EACHOCCURRENCF. L-3-, 000, 000 AGGREGATE L-5_, 0 00, 0 0 0 S X TOr{Y u E.L. EACH ACCIDENT 110-00,000 E.L.DI8EASE-EAEMPI,pYEE S 1,000,000 El, DISEASE. POLICY LIMIT S 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCQ.I.E:D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATNE Coll:4197604 Tp1:1694012 Ce7:t:20267680 ®1988-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered ,narks of ACORD uhe (fmmnwnwenlih of Awfiadpnlm Immtnrnt of Public %fttg BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 O"Ice Use On! Permit No. t Occupancy A Fee Checked 3/90 (Dave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN. INK OR TYPE ALL INFORMATION) Date 7& or Town of _NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street &Number)�'\ i�' ` 1 t +u V'�V i; Owner or Tenant D N N PA {4, ks Owner's Address _Z` � ' 1 Dr V "S Is this permit in conjunction with a building permit: Yes --K No ❑ (Check Appropriate Box) Purpose of Building$N rcA ep- R� 100 k�ibD0 Utility Authorization No. Existing Servige SOU Amps Volts Overhead ' Undgrnd ❑ No. of Meters New Service Amps _1 Volts Overhead _ Undgrna E' No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ���� �'e- t >J No. of Lighting OutletsI No. of Hot 7 cs I No. of Transformers Total KVA No. of Lighting Fixtures Lo i Swimming Pcoi �bo e= In- r I Generators KVA No. of ReceoNo. of Emergency Lighting, Outlets No. of Oil corners I Battery Units No. of Switch Outlets I ,NO. of Gas ?urners FIRE ALARMS NIF o. of Zones No. of Ranges t ( No. cf Air C_,nc. ota' No. of Detection and :cns Initiating Devices No. of Oisoosais 1 I No.of Heat Toca, Tota, Pur..cs 1 :ons KW No. of Sounding Osvtces I No. of Self Contained No. of Dishwashers SoacerArea Aeatira KVI petecttonlSounainq Devices No. of 0 ere ry Heating I g Devices KW — Muntcioal Local , � ,Other Connection No. of No. )t Low Voltage : No. of Water Heaters KW I Signs ?arras:s Wiring No. Hyaro Massage iUO3 OTHER: �� r✓r p'iu t V INSURANCE COVERAGE: Pursuant to the reoutrements of `.tassacncsers general Laws I have a current Ltaoility Insurance Policy including Ccmc�etec Ocerattons Coverage or its substantial equivalent. YES NO — 1 have suomttted valid proof of same to the Otfics. YESNO = If you have checked YES. please indicate the type of coverage Cy Checking the appropriate cox. Q INSURANCE i<-BONO = OTHER = (Please Scec;hO .9 Q� p Estimated Valu of E'ectn(Exotranon patelcal. w rk s � Work to Start — Insoecnon Date Recoes:ec: Rough ^ ` 6 7 Final s �t Signed under the Penalties ofury: ` FIRM NAME R%r_6_ ETgy r\\ G 1 �31'h1 LIC. NO. Licensee L_ V-, r r �•f i",' 46_ Sicrat re �� uc_ Nn_ ?T 3 YYI n Address � 0, 1�OX �2tv %�1f4Y►'t�'''t>� r��15 iJ t aa�14 Sus. Tel_ No. db63— f? " 3D'S %. Alt. .el '`IO, OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee coes not nave the insurance coverage or Its suastanttal eRutvelent as re- qutreo by Massacnusetts General Laws. and that my signature on :nts rermtt aopucatton waives this reoutrement. Owner Agent (Please checx oriel' Tsteonone No. PERMIT FEE S (Signature of Owner or Agenn -4'To *' Date. FA I r1.7.... 1164 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SACHU This certifies that ............... ............ has permission to perform ...... .... wiring in the building of ... \14-e . . . ................................................................. at ..... . .... N ass. ....................... ,North Andover, M Fee..v ........... Lic. ........................................ I ................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N2 2214 Date ..... ell TOWN OF NORTH ANDOVER PERMIT FOR WIRING -. This certifies that ............ .........t- P * C �R 1 Q has permission to perform .......... ......... ...... wiring in the building of ......... D,C' :I.A..t ...................................... at ....... P.�:."l ...... ........O. .......... Andover Fee .... ................ Lic. No.2*/"/"�"*X!............ roo, ... A.r ............... ICALINSPECrOR C �\t I 1G�ELECTR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THE 00W0AW E4LTHOFAASS4Q7USET1 S DEPARTMENT OFPUBLICS4MY BOARD OFFIREPREVFV170NRE9MMO N527CMR12-00 Office Use only �No. d L & Fees Checked APPUCATION FOR PERMT TO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 —/ /_ , ® CD (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date I '�J Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street S Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building perm`: Purpose of Building 5/ / e Existing Service2= Amps U/ ),cfaVolts New Service I Amps / Volts Number of Feeders and Ampacity Yes [No a (Check Appropriate Box) Utility Authorization No. Overhead "Underground M No. of Meters Overhead Underground [::] No. of Meters Location and Nature of Proposed Electrical Work 7i147 87777- a r No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets W( (( 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 Pumps 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 d Connections �No. of Water Heaters KW No. of No. of Signs Bailasis .,,No. Hydro Massage Tubs No. of Motors Total HP OTHER hmnceCmcmge: Ptttstatttothemgt�dMasmdwcMt, mmalLam Iha%eacmertLiabhyhmrmmPbbcymdrttgCaT#A$.- m CoveagetritssikstrtaleVivaiwt YES 0 NO Ihawsubmimadva6dpmofofsame1otheOT= YES [aNO IfjcuhavedmdwdYESpkmmdrr*thetypecfmwaWbydwdagthe INSURANCE BOND offim a (PlseSpo* ©04,00 2000 WakmSlltt 'I hpe imD*R4xs1ed SigttedundeaRrakiesofpetjtay FIRM NAME � iJ. 61 Li== fJ0/7ro S,�,91b Siglare EstimatedValuecfEkctWWak S / Rao y' UU Feral W1 Li=wNa AN 6( G _ Lioa>,seNo ,� / } BtactessTd.Na fotJ;-�-f'�-yYy� ��%(�{� �}'lm{ /l% 0" d � 9 AttTelNa OWNER'SINS JRANMWANEKlatnawat dutheL=m ur thei awma mWorilsse*n%dftas m*mmdbyNtwmdmM Canal LTm aodthatmysi�ttsernthspan>�appGcabonwai�thistt�artat. 1 (Please check one) Owner Q Agent a V v tJ Telephone No. PERMIT FEE $ Date. -.� � - G G N° 4335 .'ti TOWN OF NORTH ANDOVER , �. 0 PERMIT FOR PLUMBING s 'This certifies that ..T) S....... /V ............ . has permission to perform .............. plumbing in the buildings of ............. �/ !... ... .f ? . .. , Orth Andover, Mass. at............. .. Fee..%.Lic. No. q. ...... �. �,�ti�y, ...... . % LUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSti CHUSETTS _ C� ` �� ' Date Building Location /�%ZG 1� `�-9'�; Owners Name 04P Permit # J✓ Amount Type of Occupancy 01,z"1-t111A1C- New ❑ Renovation E3//' Replacement ❑ Plans Submitted Yes ❑ No ❑ FIXTURES (Print or type) Chec ne: r� Ce tate Installing Company Nam /� �C� Corp. Address (7'01 ❑ Partner. '" Business Telephone Firm/Co.❑ Name ofLicensed Plumber. Jj Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy ❑/ Other type of indemnity ❑ Bond Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations per#med under Permit Issued for this application will be in compliance with all pertinent provisions of thes husettsoatl bin �g Chapter 142 of the f.Gg�neral Laws. t'/ ��-, ,Type of License / Title i;/a City/Town License i umDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY o f 0 r A o • 0 c '+ r > o Z e 0 F 0 N z > w o � Z 0� w A > O z c A m 3 n z r 0 w n 0 0 N N m 0 w w g z w A 0 z n s I 0 w w 0 c z v 0 z t. i C c O L] > N to O i N r i 1 3 c A z N e I • w i W r r r N is i• Z 0 > 00 a o f 1 r cj A) ) � za • WA N 4 � .cj n ti t�I j LI ; I,' r z � n A 71 �+ n n I" h nnl N rl O 0 0 Z. a v z n n r w 1 S _ 0 < z A Z e n = M � 1 s M A N N c n " pp Z A o f 0 r A o • 0 c '+ r > o Z e 0 F 0 N z > w o � Z 0� w A > O z c A m 3 n z r 0 w n 0 0 N N m 0 w w g z w A 0 z n s I 0 w w 0 c z v 0 z i > O L] N to O i N r 0 z O 3 c A z z w w i W r r r N is N Z 0 > 00 a o f 1 r cj j N 4 � .cj n M N 0 z � n A 71 �+ n n I" h nnl N rl O 0 0 Z. a v z n n r w N _ 0 < z A Z e n = M � 1 s M A N N c n " pp Z A x Z 0 f 0 --X=i Z _ N. o f 0 r A o • 0 c '+ r > o Z e 0 F 0 N z > w o � Z 0� w A > O z c A m 3 n z r 0 w n 0 0 N N m 0 w w g z w A 0 z n s I 0 w w 0 c z v 0 z _D fn z _N 0 z M 0 w N r i 4 i z O 3 c A z z IY W r `^A • is N Z 0 > • a o f 1 r O j x 4 v i n 0 z A -1 A 71 �+ z I" h nnl N rl O O v z n n O e Z0 0 < z A ; " e n = M x s M 0 N N A n " pp Z A x Z A .e 0 --X=i gr0 M N c MM o `(1 Z A 0 VVV N 0 7I Z m A l N � o V Z ) _D fn z _N 0 z M 0 w N r i 4 O 3 IY W r `^A — Z 0 4 0 c° a o f 1 r O j x 4 v i n 0 z A -1 A 71 �+ +� I" h nnl N rl O O v > Z i e Z0 z A ; " e > = M N� o A N N A n " pp Z A Z A .e 0 --X=i gr0 M N c o `(1 Z A 0 N 0 _D fn z _N 0 z M 0 w N r i Y ttd N O 3 `^A — Z 0 4 0 Z 70 !�R O � e N� o N M A o w " pp Z Z A .e 0 --X=i gr0 M o ;0 Z A � N Z m A N � o Y ttd N N ^ Zn AZ ✓ d v D ° o -4CC * (G LA M o o .` (D° °-o 3 n _ ° Ot 0 2 Q: 7'� 1p O o i'o x = S o rn Z 101. 0 CL =n tr -1)3 �2d O �. crro c Z �-• n� <� N Tom' O ° c� foN o' a3 O > O� O CL 6•-• m ro S— O_ S O cr n f° A= R1 °► c _ ° cr ° A� e r r N n !° N N D _• ° oZ D ^n c a '" _ < n�mo mroa H c c lip P., z _ _ = pf ' N ro a ro a ° In -• Fr 1 n N G ro ^ 0 o `° 0 _? ojj .°• (A D°- ip ° f c = — n < a ro c ro N f o ro o = z i 0 = < ro c i Q A O N 1 O n a •� C N= a c ' v o 0 ro O = n = N' fD ° N f 3 O - Q. a o ° o N a ? ro O ° O m N I = t< a o ° ° n N o L _ = a a N s •ro 5 Lr 0 C. 1 -4CC * _ S o Z p KCP f c Z M OC'• p > O me N A� e r r T ° _ H c c lip P., z _ iIX.. ' 3 _? ojj ip ° N z i = a � O ° D o n +� 1° n N o L s •ro 5 c o• on. a °. 7 AN � p a N 0 h a • o �y p ° O.3 CO O o V A 0• �n � S I r _ ° A � a ~' N a + a Sent by: MEDTRONIC INTERVENTIONAL VASC. 508 777 0390; 09/03/97 3:16PM;,JetraX #443;Page 2/2 The Commonwealth of.tlasseehusew Deparanent of Indwazal Accidents 4r 600 Wasbiir; ton Street Bosron..NjL= 0:111 Workers' Cooaoeasadoc Iaaunnce AMdavir I CALAIS J� L- I ikl� _ On aLe L --Tin 2 I am a .homeowner rer:or:ning all workvse. I am a so(e'orocre:cr and have no one •arcr,,.<--Q »cac-, C l am an e;npiover,rovlcing worKc-$ Cam. e;:sacon ;or =v a ^::oars �orx;ng on MLS -00. III an a soia rropre:ar, general coaerac:or• �r aocirat.�e- �s inij aaa ;rave c :ona"u ors 4'istec;eiow woo as the'ollowitlg works -s' ccompensanon;oiic:s: l enennn„v same. 1_l0 -c) l ,f1R I C—f r, ,b3 ='i)0.-•{� cc�,�2��` r�� lo�� . city! 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A Z ?'fl y -4 yo' T CL �* a' m CD o a c ti o� gr ca a = N O t0 0 O O tp y7 • m d = O fCjVm Jm m H m o m Z BE y rocwna °° o►Ib Z • cn ? y p CD m 2: o On :► o m. Cn CD CD 0 � 9 m� n _ .. . �C lu O = ro: c Ma m cn R (n ° to ° ^ ° tai :1 ° b 5 o o CL 0• d y Md O 7d z • 003 0 Location VVA No. Date i. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ,%Cmus Foundation Permit Fee $ Other Permit Fee Ccf3 � L/; - 6)0 TOTAL -Specz # 13 6 7 4 14 Building Insp(Vctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING MIR N, N Section for Official Use Onb 2120IN-41.11111 Imam 0 .5 . . . . . . s WELDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Bui(Ang Conunissioner�or oj%uildings Date 1.2 Assessors Map and Pa -eel Nuinbei. 1.1 Property Address: ,M LzNr PERMIT P i Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage (11) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Rq*red —Provided Required PrOVI&A 1.7 Water Supply M G C.40. § 54) 1.5. Flood Zone Information: 1.9 Sewerage Disposal System: —Public 0 Private 0 ZoneOutside Flood Zone 0 municipal On Site Disposal System 0 33 2.1 Owner of Record ZA 9 M 4 T1 AJ Z -A) Name (Print) Address for Service: 00, 6 Signature Telepffone - 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 ,6r)rj W �,)Ideydxj- G n 3 P_ Address License Number nsed Co ti Supervisor: � 6' Expiration Date 0 Y? 71 Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name'. Registration Number Address Expiration Date Signature Telephone 0 TM z 0 z M rtz I, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date Vt Item Estimated Cost (Dollars) to be Com leted b t applicant P y P� PPS 1. Building (a) Building Permit Fee .. Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number q ,. ),��� <vL i::Gk 4.�>.r'::. .%TJr % ,e?hi ;, k.GFt �l,R 7?.: � � if 7.... J3?i''q., �9. �5 y :'�,9 ? ';titut tlsX'.. -ryj'lV �,#i t 1 F#,rrr.1t3 n ;;,. ✓G .4. :, �t .. 1 `�YF iv 'ti'r 'h,SEr �7i! ' `li ) . � f - f t. S` Y � � u,. �' 4f rF' � Y.. f tt4� t (.1 "",A � �1 k)lf ` ��!{-�.�4� `y ull��. t2.. f'R `*iil t��l al l= i'< L h ✓ M1JTn.l((, ?SF tN �Ch �C�J' �.'1C � :j $7 fi �' � Y :1� / ,+! ,c. � r: :��1� YJ. •�` � HT1 �-}2.. Xr,? 3 S)!YF! �' �. Y�ii�;V yk :� —.� { '�\'Nd�, { 3:' 3 2wi'.uF r}A 1- i i i'. 24 '� t �. ,. 4 / i'✓;` � : NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS 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 ," 5 S4 yz�- i.zk6 � "`� i 'z;'�,1� Ti 3„¢�'7a�sa ,7•�. Z,L'6�".+`� ��`.:Y, .its 4� �, u� .75`F. 'L'. `t: ��l _ -. f f i 41',�3k« 1 `� X.,�t;',E �t�;,•<` l 5412, �' f 5f kx l r� f �'k�i�'W 4�3t '. ,X`i^F J J'4'' Sp''� SYi !.S ^�',� _ ,*1t 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 Yea .......❑ No ....... ❑ sECI`I4N 5R©F1SSI©1L IfEiS�N al�t"T11fiiNt'V1C5Q �tli)CT)t bT3"1FiR1G� SCl�,l' T+�f CtDNSTRUCT QN ct 1d .0 CSR 1 C%i A ifl�t' 11 f;a E T IEA lflr t) EN > l) S'A ,.. 5.1 Registered Architect: Name: Address Signature Telephone 3.2 Re�ts�e'd;)t'mY�ss�iuna� � .rt�sa�elr��s'� � fi Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address `� '- - Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name ` Address Signature Telephone yy `If Company Name: Not Applicable ❑ Responsible in Charge of Construction Sl��"lO�,�;��+t�►l�i+�!�' PI�4I> �'�, l;c� all ,i�pl�eable New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ 1A 1 B ❑ ❑ B Business ❑ Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ 1A 1 B ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ 1-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2. ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ ; S-1 ❑ S-2 ❑ U Utility ❑ M Mixed Use ❑ S Special Use ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING WELDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: bxisting Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: yjy BUILDING AREA %-� EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft 111 -11 -Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on Date. -3 C�061/0 ,40RT#j to TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........................................ has permission to perform plumbing in the byildings of(., .................... at . I—)--,-." oy " I .....I....... ........ North Andover, Mass. Fee-�. . Lic. No.. / 2 SPECTOR Check # PLUMB I as C � a v g U •+-' cn a 0 or w° X00 GX0 U cC w a W 7 a�' cd w a W W o�G chi cd iz O 00 d M w W A wo y GJ c/) cn .. O r.;c'J � V. o ` �� c .r N C O V C� 460 c wo m c s o • c M V m c _, w, Q CD ca $ o. EE m GLc 'o cm m c O..- E • N to �mm o ; 3 • cm N .� 4 m � •= C N y O C O � N m �.mo cm � CLC.) m Nm� z r ocn Ir C O a act m c�NO c�•SZcc o o c_ H m y m C •C a o os3 N CO2cc •ca O.Z p C Z E v��N o ci gVD o. m O �_ _ A .0 ` N .= O .O. aim ? 0 O lu v r4 CA .y CLO L co .Z. C O co C) m CA 0 V CA C 0 V tC C _O �.CA LLI U) Ir LU ccW w ^ '' vJ 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING forint or Type) . (� Massa: at 23 Permit Building Ilii" Owner's Name- /(! Type of Occupancy • New ❑ Renovatlon O Replacement Submitted: Yes ❑ No IN FIXTURES Company Name —1/ r4AI C Check one:. 7' ale Business Telephone 4 7 ' g-_1 - 29S6 Name of Licensed Plumber _ -17,4701,7111 tl�, O Corporation O Partnership M -KW --Co. Certificate INSURANCE COVERAGE: 1 have aYes cuRent I}•aWlty Insurance 10� No policy or its substantial equivalent which meets the requirements of MGL Ch. 142: If you have checked y.W. please indicate the type coverage by checking the appropriate boot. A Iiablity insurance policy 0 Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that `my signature on this pemhit application waives this requirement. Check one: ---• --- -• _ _ Owner O Agent 0 I hereby cedity that all of the details and Information i have submitted knowledge and that all plumbing work and installations pedormedjp pertinent provisions of the Massachusetts State ftnbinaDxle add C Signature of Uaw* entered) in above application are tnle and accurate to the best of my Um MalOt issued for this application will be in compliance with all 40142,bf the General Laws. Title Type of License: Master Jouriheyman D City/Iovm . ' L License Numther f 3 S( d z z � Y � , f to (A N Y O 0 Z < b W W p ]L Z 0t J a.. ar '~ N 7 C Vhs = Q O al p W y Y1 :gyp r Q< < f N W Z C p d < Go p < IC G O d 14 W= 1r' 1 W 1- J= < X a {. W s is Y W ►- < V h• !� C Y a . 6 el.. N �. Q Z p O y _Z z �' < O O S >• Y < J t m z w a c t. t 3 s < 1-, J a J a. t o oC a aC a to < 3 O a <' m F- o Still—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR S.TH FLOOR eTH FLOOR 7TH FLOOR Hj,., STH FLOOR E -J -- Company Name —1/ r4AI C Check one:. 7' ale Business Telephone 4 7 ' g-_1 - 29S6 Name of Licensed Plumber _ -17,4701,7111 tl�, O Corporation O Partnership M -KW --Co. Certificate INSURANCE COVERAGE: 1 have aYes cuRent I}•aWlty Insurance 10� No policy or its substantial equivalent which meets the requirements of MGL Ch. 142: If you have checked y.W. please indicate the type coverage by checking the appropriate boot. A Iiablity insurance policy 0 Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that `my signature on this pemhit application waives this requirement. Check one: ---• --- -• _ _ Owner O Agent 0 I hereby cedity that all of the details and Information i have submitted knowledge and that all plumbing work and installations pedormedjp pertinent provisions of the Massachusetts State ftnbinaDxle add C Signature of Uaw* entered) in above application are tnle and accurate to the best of my Um MalOt issued for this application will be in compliance with all 40142,bf the General Laws. Title Type of License: Master Jouriheyman D City/Iovm . ' L License Numther f 3 S( d Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..1 .... `.......................... . has permission to pe plumbing in the bui at `. Fe' a .`� .. '... Lic. N Andover, Mass. 0 Check # 4-1 i � � M MISACHUSIMSUMFORM APPLICATIM. FORPEnq- TO DO GA.RPrrrWG NOMasa Katie &V -BuslingLocadM2 zw -Type4lf Occupancy A New 'Renovation r Repbcoupot PIM y NO Mmmitte& es G s-, UM, Ll- sfwq " ^A C'L ap.1 4f ,I Che*Om- Catfi= Comwwwam ;4rm 144eq e, 00 /-9, 9 7t—SS V Co Fitter '-)I oss Nam aMpensed plumber Or Aqs DR A NC a C o�G E5 liabWay AAmemtbezequizmmenftcfAM Ch 142. Ihavea :991mio Yes lhm. t"ecoweEw by checking ft bm Aliab'qAy policY Otber type ofbodemnity 0 OWNERS d'dnmmmwcovamVzequiwd bye ]� Mvflhciffi.Imm and tha- mys meugthi on waives this mquhmemt Ow= Agemt S*Md= of owner rowncesAgent Ihmbymtlf yaltzWoMedetaUs andkfinmWanlhavesubnitt (or entered) in Am application we tme and acemate to the beaofmy.kwv dams"idaUph=Vmgwmk--ll-3M- Mod gr-pCmdu=cdfwWsq*&u&v-wabein vd*aU*fiamjpwmm &eMas=chuseftStBft43jf3o fis�= of nadMapter 142 oftL- amad bm& r 0FMGK