Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 23 CIDERPRESS WAY 4/30/2018
S �- - - �_ Date.. NpRTH14, TOWN OF NORTH ANDOVER pE4„ao ,6, 0 �• • `p PERMIT FOR MECHANICAL INSTALLATION �,SSACHUSEt This certifies that . . .4. ... . . .�� t4 ��. . . . . . . . . . . . . . . . . . has permission for mechanical installation . *VNC'-a'4"wr. .'`4 . .: �=:-V in the buildings of .�4?r'-'.Irl 1h. ,01� : . gl'^ .?:. ./I-,) �— at .��, �. �.� !�- ' .!.!--�!?y. North Andover, Mass. Fee.�,'3/;� Lic. No.. .° . . . . . . . . . . . . . . . . . . . . . .��J . GASINSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date: Permit# q�_J Z CAD Estimated Job Cost: $ � �X.OD Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # 196 Applicant License Business Information: Property Owner/Job Location Information: Name: J&J Heating & Air Conditioning Name:Tara.,Lei&.Development LLC Street: 17 Arlington St. Street: 23 Ciderpress Way City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 Telephone: 978-454-8197 Telephone: 978-687-2635 Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /M-1-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential:T=-2-family - v' Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ✓' over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: ✓ Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: �� 0WV/ i �✓I( �• � " /"wI I ' IV I i V ..A,� �i-� /uG./�'�QfA�wY 7INSURANCE COVERAGE: nt liab11 Insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes® No❑hecked Yes'indicate the type of coverage by checking the appropriate box below: Bond A liability insurance policy Other type of indemnity F1 ❑ OWNER'S INSURANCE WAIVER:I am aware that the Ilcensee does not have the insurance coverage required by Chapter 112]the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,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 ent provision of theil shoot metal work and Massachusetts Building Codeations and Chapter 112 of the General under the permit issued for this application will be in compliance with all pert Duct Inspection required prior to insulation installation:YES NO Prowess inspections Date Comments Final Inspection Date Com Type of License: By [TeMaster Title ❑Master-Restricted cityrrown ❑Joumeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number. Fee$ ❑ Check at www.mass.gov/dal Inspector Signature of Permit Approval Ik11V� 1WEALTH.OF MASSAGFtU,SETXS `? •. '. METAL WORKER57701, IFS 13TDRN LZ i `i.INT N S .r , 'FREE aE f1CliT "�M�4 ACORD,, CERTIFICATE OF LIABILITY INSURANCE 06�06�2' '' 011 PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 4S7 Tops fi el d, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED ]&] Heating & Air Conditioning, Inc. INSURERA: Great American 17 Arlington Street INSURER B: Dracut, MA 01826 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE jMMfDDIYYYY1 DATE(MMIDDNMI LIMITS GENERAL LIABILITY PAC6418906-04 06/01/2011 06/01/2012 EACH OCCURRENCE $ 1,000,00 COMMERCIAL GENERAL LIABILITY PREMISETO S Ea occu ence $ 300,00( CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,00( A X PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC JECT AUTOMOBILE LIABILITY CAP64189S7-02 06/01/2011 06/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY X NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC6418907-04 06/02/2011 06/02/2012 X TORY LIMITS AND EMPLOYERS'LIABILITY Y/N ER ANY A OFFICER/MEMBER EXCLUDED ECUTIVE[::] E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below. E.L.DISEASE-POLICY LIMIT $ 11000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE Peter Sennott/LA ACORD 26(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD v-r IOUV/ 'V4 laua/L4/0 1u/ ts UKIGINAL COPY 0503031 GREAT AMERICAN ALLIANCE INS CO Administrative Offices 301 E 4th Street WC 00 00 01A ( Ed . 01 /97) Cincinnati OH 45202.4201 RICAN. 513 369 5000 ph INSURANCE CROUP Policy No . hN I C I I 1 6 1 4 1 1 1 8 1 9 1 0 1 7 1 1 0 1 4 Prior Policy No . MCI 1 16 14 11 18 19 10 171 1 I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insurance is afforded by the Company named below, a Capital Stock Corporation : GREAT AMERICAN ALLIANCE INSURANCE COMPANY NCCI Company No . 14028 I<3N.E...........G1<IE1=IE�3.AL:::::�.:N.IFfl. ......:::::::::::::::.;:.:.;:::::;:.:::::::::::::::::.:.:::::::::::::.:::::: RMA'F. . N :;;:.:;.;:.;:.;:.;;>::.;:.;:.:.:.:.::;.;:.;:.:.;;::.:::.:.;:.:.;:.;:.;:.>:.;:.;:.;:.;:.;:::.;:.;:.;:.:.:; The Insured : J&J HEATING & AIR CONDITIONING Legal Entity : INC . Corporation Mailing Address : 17 ARLINGTON STREET FEIN No . : 042488433 DRACUT, MA 01826 Dther Identification Number : See Extension of Information Page . Dther workplaces not shown above : See Extension of Information Page . :. :::::::::::: :::.:... The policy period is from 06 /02 /2011 to 06/02 /2012 12 : 01 A.M. Standard Time at the Insured ' s mailing address . ........... A. Workers Compensation Insurance : Part One of the policy applies to the Workers Compensation Law of the states listed here : MA, NH 3 . Employers Liability Insurance : Part Two of the policy applies to work in each state listed in Item 3 .A. The Limits of our Liability under Part Two are : Bodily Injury by Accident $ 1, 000 , 000 each accident Bodily Injury by Disease $ 1 ,000 , 000 policy limit Bodily Injury by Disease $ 1 , 000 , 000 each employee Other States Insurance : Part Three of the policy applies to the states , if any , listed here : All states except ND, OH , WA, WY states designated in Item 3 .A . ). This policy includes these endorsements and schedules : See FORMS AND ENDORSEMENTS Schedule , WC 99 06 22A (01 /97) . ::::.::::: ::.::: :::::::::::::.::::::::::::.::::............::::::.::::::::::....... :::::::::::::::.:.::...:::::::::::.:::::.::::::::::. -he premium for this policy will be determined by our Manuals of Rules , : lassifications , Rates and Rating Plans . All information required below is ubject to verification and change by audit . See Extension of Information Page ..t..... .: .: .:;.>::;:.>:.;:.;;i`5;::::::::::::::::::i::i:>;•>:;.::.:::.::::.::.::.>::::::;::;:::::::i:::::;:::::::::.:i;•;:;•:;.;:;.:;.:>;:;.>;.:;.:;. :: :::::::::i::i::>ii: ;:.;>;;:.::.;:.;:.:.;:.::::::;;::;::::i5:;ii;;::::.::::i:: PREM .UKA.... UMIi/#�AI .....::::::::::.:............:::::::::::::.............::.::::::...............::.::::::::::::::.:. 'OTAL ESTIMATED ANNUAL COST : $ 46 , 014 Minimum Premium: $ 750 leposit Premium: $ 46 , 014 Date of Issue : 06 /22 /2011 'iE...::::.......:.:..:::::::::::::::::.:::::::::........:::.:::::::.::::::::::::::::.:::::::...... .:.::::::::::::::::::::.:::::.:::.:::::... 'ame of Producer : EDWARD F . SENNOTT INSURANCE A Servicing Office : PO BOX 457 SPECIALIZED MARKETS TOPSFIELD 01983 657 o u n t e r s i g n e d by : --� ----- Copyright 1987 National Council on Compensation Insurance 's7zc4s9ott100 01A ( Ed . 01 /97 ) PRO ( Page 1 of 4 ) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION c;-3 Cider 12r e S S WG y Print PROPERTY OWNER Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �'X.. a � Sepic dV�7elli ``" op%a � � �WerShD�s ct�� � � O Water/Sewer ..X DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: Tara Leigh Development LLC Phone: 978-687-2635 Address: 115 Carterfield Road, North Andover, MA 01845 CONTRACTOR Name: J&J Heating & Air Conditioning Phone: 978-454-8197 Address: 17 Arlington St. Dracut, MA 01826 Supervisor's Construction License: 7894 Exp. Date: 01/31/2012 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3 (1_ FEE: $ Check-No.: Receipt. No.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si6:ature0Agent/Owner�{ COMMONWEALTH OF MASSACHUSETTS y , AS A MASTER-UNRESTRICTED` ISSUES THE ABOVE LICENSE TO: i t ERIC R KLINE I J & J HEATING & AC 17 ARLINGTON ST I- DRACUT MA 0182 - 3 1568 05/28/12 8 148 J i 11Iassachttsctts- Ocital trllc It of Public Public �';tfeo Board of Building Regulationanil Stautdal lig Construction Supervisor Licejlse I Li¢.ense� C8 7894 , Restricted to: 00 EDWARD T AYOTTE f ?40'MARSH HILL RD DRACUT, MA 01826 Expiration: 1/31/2012 (onmds.i n:Cr T 2: 12767 I j Ij 1 ' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date C nMMRNT� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter Jocation, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ' ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi 76 . 7 Date. -F e. 'A. ...... .. NOftTM Of�.,,.o ,,1ti0 # ° OL TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION • o� s "S CH This certifies that .14.4j.hE Ze,!�.. . . . . . . . . . . . .//. . . . . . . . . . has permission for gas installation` . !'h4�C.f .lr.441eWv.. . . . in the building's of . .Ill ee 1!h��IPU, . . .�GC . . . . . . . . . . . . . . . . at . . .z . ela�rl?,?!; . . . . . . . . . . . . . .. North Andover, Mass. FeetLic. No./.57�S?. . 104i Ov. GAS INSPECTOR Check#A Q MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING • Cit /Town '/ Y �jh�� Oa/�L , MA. Date: Permit# Building Location: C2 3 (f, d l P^2_ S Owners Name:_ ��� AL Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES co vi W z N Ile Co Q = m = O W W 0 co O = W W Wowwo z Z p W W O I— W N W IM 0 F- W O Q F �n > W ZQ a I— W W Wco x W ~ W Q W W W Z 9 N = W W CO O W F- p j- LL Z W w z y J I- P: O Z J U' LLFes.. = W H W W V D 1= C7 U' Z = Qm > O QZ O W Z Z W U- a H .I O a a' a' f- > > > O SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR _ 4 FLOOR I r)TH FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# r( /"/` ` ElCorporation Address: & City/Town: P! ,� Stater ❑Partnership Business Tel: — Fax: M"4Z -, " ❑Firm/Company Name of Licensed Plumber/Gas Fitter: 17 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 2"No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner El Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ❑ Plumber Title ❑Gas Fitter Signature of Licensed Plumber/Gas Fitter ❑Master City/Town ❑Journeyman License Number: Z J`/ J c- APPROVED OFFICE USE ONLY ❑LP Installer t v Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . !./.� e. . �.4�4�r . . . . . . . . . . . . . . . . . . . + has permission to perform . . //ew. ?u ''��`?4fueI. . . . . . . . . . plumbing in the buildings of .heel"',,ve�&. . . . . . . at . . �� �?K -SS. . . . . . . . . . . . . . .. North Andover, Mass. . Fee'..-A.0. . . . . .�Ltc. No.. /.S. ./.S 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # /./- a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING . City/Town: MA. Date: /Gt Permit# Building Location:_ Owners Name: �R e Type of Occupancy Commercial❑ Educational❑ Industrial ❑ Institutional❑ Residential New:[Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES n60 DEDICATED 2 SYSTEMS W o y UC O o a z a ,� z ," ? Q z z d d a 0 a X Q N LU Q Q y O ~ v O p a 2 vsi FW- w dt O LU Q m m i] o uJ i O O 0 d it d d Q z O i d >- g 3 N En 0 3 3 0 < W Q -SUB BSMT. L) 3 BASEMENT ° 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 0 FLOOR 7TH FLOOR 8TH FLOOR Ii1S1:81;iiicf'.�'iiY_`£.ri�r " ��� ��� (;hnnti�iri��.ii1' �:,.i�;��ti,:it:i:• (v3mc. /7 Address: 1, ❑Corporation City/Town:_ALState: ❑Partnership Business Tel: Fax: Name of Licensed Plumber: El Firm/Company z INSURANCE COVERAGE: 1 have a current Iia. bifity insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yes Q<o❑ If you have checked Yes,please indicate the-type of coverage by checking the appropriate box below. A liability insurance policy. Other t > ype of indemnity ❑ Bond ❑ • OWNER'S INSURANCE WAIVER:1 am aware that the licensee does 1101 haee 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 Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate Knowledge and that all plumbing work and installations performed under the permit issued for this application will he in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. a to the best o,my 3y Type of License: 'itle Sign❑ umber 9 Lure of Licensed Plumber �ityRown I'laster PPROVED(OFFICE USE ONLY) ❑Journeyman LiCense Number: u � C' 1 15) Date. .g/cal TOWNJOF NORTH ANDOVER PERMIT FOR P (JMBMG' i • SA HUS ti This certifies that . . . ./V. kl. .'.� 1. . . . . .l,f !J. . . . . . . . . has permission to perform . . . �iQr.- . . . . . . . . . . . . . . plumbing in the buildings of . . . .,!!l.c:��!,��. /(,V.5': . . 41�-. . . . . at .�. . � . . . . . .��.� . )Y?S 5 1 North Andover, Mass. Fee'-3 Lic. No.. .� , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # ���� / � 7 pl- 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: � � MA. Date:_26p,& Permit# Building Location: Owners Name: L Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:[.Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED SYSTEMS 2 H z � x v V) LU Z ,n =) Ln �'"'.! U N W D O 0: z z 0 m y � in F- w Q Y p a O N 0 W w Q ofn ❑ z = a cr F d s o x _ ❑ ❑ w z r _3 a 3 = Q 4 y y O 0 H j > O p a. Y z 0 H F W a'f O L w 3 0 ¢ 'SUB BSMT. q BASEMENT 1sT FLOOR 2ND FLOOR ' 3RD FLOOR 4T"FLOOR 5'FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR 1;1St'-ks'i „��;i�E.,i} f%am.2' Address: El Corporation City/Town: State: Business Tel:- — Partnership f Fax: Name of Licensed Plumber: El Firm/Company INSURANCE COVERAGE: 1 have a current Iia_ bility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy.� Other type of indemnity ❑ Bond ❑OWNER'S INSURANCE WAIVER:I am aware that the licensee doesnot have the insurance coverage required by Ch Massachusetts General Laws,and thatmysignature on this permitapplication waives this requirement. Check One Only �i nature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby ge an that all or the details and information(have submitted(or entered)regarding this application are true and acc fo Knowledge and that all a Messing husk and ate llations performed under the permit issued for this appiication will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t•a.�to the best o,n,y i Type of License: Je ElSi n Plumber 9 ture of licensed Plumber y/Town ❑Master 'PROVED(OFFICE USE ONLY) ❑Journeyman License Number: r 7 i / Date. . . V61. . .... .. Of.NORT1. 1 1ti TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SACHUSE� 1 ).1tv. . . .���.�-,. . . . . .f?.f. .�-1. . This certifies that . 4 . . . . . has permission for gas installation . ,/.M . . X .1l�. . . . . in the buildings of . . . . .... . ref' j�;,✓SE /(L at . . .�. . . . .ez 4 4'!�.�./'�. S. . . . . . .. North Andover, Mass. �4 GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: MA. Date: Permit# Building Location: Owners Name: 2- in ko Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: [I]/ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES Z W Y I.- U) Q x W O M to N m x (7 0 LU J 0 O M W W Z H z O w W W O h- D U) w W w m 00 Q a F o 0 w X > z w Q W x W a w W W z �a cn = w � w z w > U W Z N W H W W z W >- R N Q Q m w O z 0 U ~ > z Q H U o o t=i 0 _ _ O a. H > > > 3: O SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6TH FLOOR 7 1 HFLOOR f' 8TH FLOOR InstallingCompany Name: P y �,Ll �� (� Check One Only Certificate# El Corporation Address: �ty/Town: State: C ❑Partnership Business Tel: �7 6 r �o�� — /s(} �o Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: � I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 0-14,0❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i Type of License: �� By [J Plumber Title � Fitter Signature of Licensed Plumber/Gas Fitter L Master City/Town ❑Journeyman License Number: -157 APPROVED OFFICE USE ONLY ❑LP Installer G 7 Date. Y.61.d. . "•�'�°':�h TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . 411 . . ./5- -ff�'�. . . . . f , f. . . . . . . . . . . has permission to perform . . . . . . . . . . . . . plumbing in the buildings of at. . CP. . . . . . . t� ?y�.�� x.5.5. . . . . . .... ., North Andover,, Mass. Fee.4�0 . . .Lic. No. �./`.5. .� . . . . .�t t, <-�. . PLUMBING INSPECTOR Check # � K 1 Ak— MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: J Qr/( MA. Date: ` Permit# Building Location: 3 l"( � r�S Owners Name: �_ Type of Occupancy: Commercial(] Educational ❑ Industrial❑ Institutional❑ Residential[� New:L✓J Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED 2z SYSTEMS W N U U W Ln WWLn Az 1�- _W FQ-• Q ti Z p Q W U Q Z C En C x y WO 4 N H W ~ W QZ a O o= Q cn H O O~ H O > O O - Z _z 0 F- 1W- W Q m o o LL z R2 g 5 0 X En s ° � o Q -SUB BSMT, Q � � � 3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4'FLOOR 5TH FLOOR 6TH FLOOR 7'FLOOR 8TH FLOOR C� I z. r t:a _ I�'t � ) ICO P u C•, nk Ona Address:4m—+b � &City/Town: ❑Corporation ��` Pe— Stater Business Tel: -17S Y' Fax: ❑Partnership V�o / ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: V 1 have a current lia_ bility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YJ'N"to If you have checked Yes,please indica a the-type of coverage by checkingthe appropriate box below. A 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 Cha teMassachusetts General Laws,and that my signature on this permit application waives this requirement. p Check One Only ��nature of Owner or Owner's Ag nt Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate f Knowledge and that all p[umbing!��rork and install perrormed under the permit issued for this application will be in compliance with all Pertinent provision of the Massa(ir usetts State Plumbing Code and Chapter 142 of the General Laws. a "'a`e to the bast o.my i f Type of License: -_ :fe +xC�V umber Signature of Licensed Plumber y/Town Master PROVED(OFFICE USE ONLY ❑Journeyman License Number: Date........... f NCRTM� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACNUS�� C ��/1 C This certifies that ..........................�F�i...�..................................................... T�1 (4.�{�.I... ............ has permission to perform ................................. wiring in the building of........... at... ............ . � rth Andover,Mass. Fee.. /_/ / � 5.. ''"Lic.No.I. C`�.'�. (�.............././ ...... ...................(... . CLECTRICALINSPECTOISJ Check It ` �-s`�"' / t Commonwealth of Massachusetts Official Use Only j Department of Fire Services Permit No. �-7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 1 b 1 L( City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Z-3 eo PL44!,:;;7 55 tv Owner or Tenant 6&- \,VG w1.44cV- Telephone No. 7' `�r 7 Owner's Address l (�}.tisk /�E-s� ti\J A�� ,4,�.�Ov��� .��i �L 5y Is this permit in conjunction with a building permit? Yes [9- No ❑ (Check Appropriate Box) Purpose of Building &1�tb6A,-4-2 A-C— 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 Proposed Electrical Work: Completion o the following table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets po No. of Hot Tubs Generators KVA No.of LuminairesSwimmin Pool Above ❑ In ❑ No—.of Emergency Lighting g rnd. rnd. Battery Units No.of Receptacle Outlets O 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 Disposers Heat Pump Numbe Tons........_ KW No.of Self-Contained L Totals: Detection/AlertingDevices No.of Dishwashers k 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 l Signs Ballasts No.of Devices or Equivalent t No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent t� [OTHER, Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: [, 0ain t`� (When required by municipal policy.) Work to Start: 9 ka k ,\ 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 infor ,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: E LZ— -4-v1.c LIC. NO.: 0 Licensee: j`�,�{�.c.4Fc� ,A4a0".J a-i„t ignature LIC.NO.: iV"— (If applicable, entff "exempt"in the license number line.) Bus.Tel.No.: - 2 Address: ,� ('t�S 60-4 Pt-s�VZ th�. 1 ,�>7` A°� - { Alt.Tel.No.: 7 r--0-6-6 *Per M.G.L c. 147,s. 57-61,sec rity 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 Owner/Agent PERMIT FEE. $ Signature Telephone No. 1 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 aY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):� V,AA A./ (_C,£C_y�uL_ Address: _&6Q v_e- City/State/Zip: 4-AA,$1--D ,U i(At Phone #: 3 3 k Z-Zoe Are yoy�n employer?Check the appropriate box: Type of project(required): 1. I am a employer with� 4. ❑ I 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. $ E] 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.❑ Electrical 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#] 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. Insurance Company Name:_ A,,y ID U� !� Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Z:� City/State/Zip: W ( Q( b"P + Attach a copy of the workers' compensation policy decla ation page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert'y under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: fo l Phone#: �'4 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#: