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Home My WebLink AboutMiscellaneous - 23 GARDEN STREET 4/30/2018 / 23 GARDEN STREET 210/042.0-0009-0000.0 L yiDate.. `. . . ... ... .. f Of „O aT s 1ti r F� °p TOWN OF NORTH AN OVER PERMIT FOR GAS IN ALLATION SSACMUSE s � This certifies that . . . . . :�.� . .f� . . . . . . . .,f. . .... . . . . . . . . . . . . . has permission for gas installation . . .Pr.4, . . � . A�'.s in the buildings ofd� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at : .?.�.� . .(r. .14 r. . . . .r t , North Andover, Mass. Fee. .)R. . . . Lic. No. AS INSPECTOR Check# 17 p ) t 6011 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) // SOU N A 0DOC , Mass. Date_ /a3/d 7 Permit # -6-QBuilding Location �,5 --AS GA Qd)(�N ST Owner's Name i,i 1,i iet�O X( " lV21H A IJ.001I 5-k- , NA Type of OccupanL� j New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ U N W N � lu N N V Z s df U) rC N a O N = Fz � J0 N W F- V m ~ s0) �.S z O W ~ Q CC z a O r W s+t4 W m W to- N ° 0 R N H tl v W = H Z Q a o. c > W tu W 0) Ix zOyW N IZ 0zW0Q W > CC W z. Q D: Qrt ' O tl z u. a 3 a tl J U � Y p a0 V SUB—BSMT, BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR j STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET SCJ Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone q 7!B-6 8.7=110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery 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 have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 18( Other type of Indemnity❑ Bond ❑ I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner[] Agent[I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accur to to the best of my , knowledge and that all plumbing work and installations performed under the permit IssUA f r this application will r mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene By T e of License: Plumber Signature of Licensed Plumber—or Gas anw- Title Gasfitter Master License Number 3745 Cit /Town Journeyman f O IC SE O BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING e' NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE GAS INSPECTOR Date. .// . f of<NORT:'�o TOWN OF NORTH-ANDOVER PERMIT R PLUMBING ,SSACMUS� L This certifies that . . l-..o.. . . . . . . . . . .. . . ... . . . . . . . . . el. . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . Ac A. u.,- :T. !. .. . . . . . . . . . . . . . . . plumbing in the buildings of . . . . r °`� at .) 3RH !41--. . . . . . . . . . , North Andover, Mass. Fee. 3 �. . . . .Lic. No.71 Y.`.N . . `. . . . . . . . . . . . PLUMBING INSPECTOR Check ff 8154 (r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ll-- Date Building Location 3'e'�5-GpcdA, Owners Name �j''1 YI M b rq �kj Permit## v � � Type of Occupancy Amount 3 New Renovation ReplacementC3----- Plans Submitted Yes ❑ No ❑ FIXTURES x w x w Z w rA Cn 0 rf arA 0 w � SIMM x a BASMW 1R KJOCIR M>HrOM 1 t pan HfM 4MHi" M HjoC 6M It" 7M HOCP. SII3)F><�0(>It (Print or type) t ' ` Check one: Certificate Installing Company Name 1tij �v 1dw H I n ` ❑ Corp. qqAddress .�< �tS d V`�* ❑ Pier. Scih Vvl 03 s�7 usmess leleptione 601 7 O - 1 7 1 Firm/Co. jName of Licensed Plumber: 1+64 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 i0irance ignature 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac u etts State PI in o and Chapter 142 of the General Laws. By: SignaLUre or Licensruum er Type of Plu bing License Title /%1(f U y City/Town own icense 74umner Master ❑ Journeyman APPROVED(OFFICE USE ONLY The Common wealth of Massachusetts k' l Department of Industrinl Accidents Office o Investi ations ..f .f g ti l . 600 T rashington Street Boston, MA 02111 www_massgov/din . Workers' Compensation lwkrance Affidavit: Builders/Coutractors/Electricians�pI A licant Information. ambers Please Print Le�i6 Name(Business/Dwiration/[ndividual): Address: y l L4 C ( " City/State/Zip:_��dteJ� r-- o l7 - Are you an employer?Check.the appropriate box: I•❑ 1 am a employer with 4. ❑ 1 am a general contractor and I Type of Project(required):' 2.Eemployees{full and/or paetnn .* have b>Ered the sttb-contractors 6. Q Naw coristrvchon ] I am.a.sole proprietor.or partner- listed on the attached sheet i 7. ❑Remodeling ship and have no employees These subcontractors have working for me in any capacity, workers' comp.insurance. 8• Q Demolmon [No workers'comp. insurance 5. [].We are a corporation and its 9• ❑Building addition required.) officers have exercised their 1 Q•Q Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11. m self, ❑ Plumbing repairs or additions Y [No•warkers comp. C. I52, §I(4),and we have no insurance ra uired. 't 12.❑ Roof repairs -required.] employees. [No workers' comp. Msurance required_] 13.0.0ther "Any applicant that checks bob 0 l mvat also fi[l out the section below showing their workers'compensation policy information, t fiomeownera who submit this affidavit indicating they are doing a0 work and then hie outside con twat actors that check this box must attached an additional shearshowing.¢he mm of the suh.co tractors mvqtsubmit a new affidavit indium*such. d ser p,po?ice•meson.ar anE�tployer that is I nMbetm and their",kers' protadtrrg:workers compensatraninsurance or information, f m1'employees; Below is the policy and job site . Insurance Com �. --. pang Name: ' �� o �i S v KC C_ Policy#or Self-ins.Lic.#:_ Jr i l� C l $ 2 Q p� Eicpiraiion Date:_ Job Site Address: city/staterz;p: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration da* i:ailum to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal pena}ties 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 Of up to$250.00 a day against the violator. Be advised that a co of this statement ma be forwarded to the a fine ,i Investigations of the DIA for insurance coverage verification.copy y Office of I ' Ido hereby c under the patRt a enalti a P 1 Perj►erJ' that the infnrntation provided above is true and ror rd Si tune" `! Date: Z —� Phone k — 7y 77q FBoard only. Do not write in this area,to be completed or town o by cit}' .ffaaCn: PermwLicenseority(circle one): ealth 2.Building Department 3.City/Tovvn Clerk 4. Elec er tr-icat Inspector S.Plumbing Inspector 6.Otit Contact Person: "' Phone#- Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Icy=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 emplayer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or mom of the�foregoing engaged in a joint enterprise,and includirig the legal representatives of a dec cased employer,or the receiver or trustee of an individual,partnership,association or other legal errtity,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 fiednsing agency shall withhold the issuance or renewal of 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 tie 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 beea 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),addresses)acid phone number(s)along with their certificate(s)of R 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 of devit. The affidavit should be returned to the city or town ti>at 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,pleasecall the Department at the nurmberlisted below. Self r-i m ed cnies should ent-+hen self insurance-license number on the'appropriate tine. 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/licrose number which w-ill be used as a reference number. in addition,an applicant that must submit multiple perrnit/lir arse 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 affrdaOt is on file for fugue 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of investiQWons would tike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Indust W Accidents Office of Investigations 600 Washington Street Bosfon, MA 02111 TeL#617-727-4900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov(dia r,. Date.7....a.?.. .... NoRTOhl, TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,ssACMUs� This certifies that .*!`........... +- -:# :� ..c,'. l .... ..............�'............... has permission to perform '64. `� :� .. .................................... wiring in the building of . ..,, h1!1.... .................................... �•L` s ........,North Andover,Mass. i .........r�.. Fee; �.......... Lic.No.............. ...... . .......... .............. . ........... E�ecrn�cn�. rEcro Check 8899 f Lommonweann of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a -�► q 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) 2 3— a!�L (ra r01P f Q� Owner or Tenant T d V M a r 9 a h Telephone No. Owner's Address Sa l/Vl P Is this permit in conjunction with a building permit? Yes 9-- No ❑ (Check Appropriate Box) Purpose of Building_ Z Hca tm �� 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: 2 h d t:lQ a t„ ct n d Q�1_ K_Tl^ e VVL(r Completion o the ollowin table ma be waived by the/ns ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets � No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches t fi No.of Gas Burners o.o Initiating Devices Detection and No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heatum umber Tons o.oSelf-Contained Totals .......... .. . __. . .. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unic'pa ❑ Other Connection I No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent N&o Heaters KW o.o o.o Data Wiring: Signs Ballasts No.of Devices or EcAivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications i mg: No.of Devices or Eggivalent l OTHER: t3Q ,attach additional detail if desired, or asrequired by the/nspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: `7 - 7 c7 o a. 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 BOND ❑ OTHER ❑ (Specify:) certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: J- f_,o c, L=7o h t. LIC. NO.:`--ct 17 y Licensee: j-0 Sp 0 l s ev c s SignatureLIC. NO.: (lfapplicable,enter 'exem�pPt"in the 1, ense number line.) Bus.Tel!. No.: . 7 S' 7' 7 Address: (CSU Xt, K1 SW- /ul,� V?Q1OUpr /k Al p Ik j<(�_ Alt.Tel. No.: - *Per M.G.L c. 147,s. 57-61, security work requires Department of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ v � 7� �� r 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): J / 2 CHCS Address:_ 1(0 o p 1 Pa.S,J +,f "do ('e, City/State/Zip: l„ d C) c,n t Int "/ 1.6 Phone#: q Z k- 6 ,)7 Are you an 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.�am a sole proprietor or partner- listed on the attached sheet. t ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 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' 13.❑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 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: i Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can 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 herebycertify under the pains an enalties of perjury that the information provided above is true and correct Si nature: Date: 7—,2d d Phone#: 12&--- F 1 2U3 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.Plumbi g Inspector 6.Other Contact Person: Phone#: R I Location -2-3 No. "� Date Al Vol— TOWN OF NORTH ANDOVER 3?Oi�?�•D '�,h00 F e 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �Iv Check # 3/,:l 7 "18 3 3 9 Building Inspector TOWN OF NORTH OVER BUILDING DEPARTMENT CONSTRUCT REP RENOVATE,--OR OR DEMOLISH A ONE OR TWO FAMILY DWELLING APPLICATION TO a , S � 3 Walift BUILDING PERMIT NUMBER: DATE ISSUED: M SIGNATURE: Building Commissioner/I for of Buildings Date z SECTION 1-SITE INFORMATION Q 1.1 Property Address: 1.2 Assessors Map and Parcel Number. dyzo Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin Dislrid Proposed Use LA Area Fronta ft 1.6 BUILDING SETBACKS Pt Front Yard Side Yard Rear Yard redr534) ovide R red Provided red Provided 1.s. Flood Zone hdommaim: 1.8 Seweraap Disposal System: 1.7 Wats Supply M.G.L.C.40. Zone Outside Flood Zone 0 Municipal ❑ on Site Disposal System ❑ Public 0 Private 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 11' District: Ye PJ0 M j 2.1 Owner of Record ;; Name(Print) Address for Service Signature Telephone 2.2 G*ner of Record: t 4 Nave Print Address for Service: "' M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number ,,n Address Expiration Date z Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number r Address j Expiration Date ature Telephone SECTION 4-WORKERS COMPENSATION(N.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 rmit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check ad a Ne New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL,USE Ofty. Com leted b permit applicant 1. Building 61 OD (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Mechanical(HVAC) Construction 4 Mecha 3 Building Permit fee(a)x (b) 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' as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. —Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I' ,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 Si tune of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEJBERS 1' 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION A THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE " {' � f '�/e,-i°orvno�cu�ea�la'o��/ ae�+.,�,Cra`' . . s • - .:; -- F ', tBoard of Bold and Slarsard , r License or registration valid for individul use only. } HOME IMRROVEMENT CONTRAQ'Tt? before the expiration date. If found return to: Registration:. 122153• � W" Board of Building Regulations and Stansiards ExPiratiow 7/M2004 One Ashburton Place Rm 1301 TYPe� DSA Boston,Ma.01108 JOHN BERTHOLD CONsTRbt 10 {� Sohn-Berthold i� 15 Popular Rd' Salem NH 03079 dministrator Not valid-without signature I 1 i s ■ter ■ ■�■■■n _ �N� ►11� om iii i �=:�■■■■■ EnE■■■■ ■ .■■■■■ N ■■■. 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MMIMMI �i No ■ Nin■■ � �NErjNn .■ � �� ■��m ■■Nn .■ A■ ■.1�/ EE n■N■■ ■ �EE■ ■■� . r1Gi� ii . 0 snom= 0 1 Err, NEE�Ei� i i��N is:�■ ■ Nn ■:■�:� ■SEE ■■MEZVE ..■■ ■ ■nN. �n.N. ■■/■ ■ ■.EEI■�. !■■■EEVi■■ EtN ..■ ■■■■■. ■■ ■E1n■■NME SOME IS EW.■.EES... nC.■/ . law /■ ■EI■w .. . .,'�. MOMMIN ISO MWIMIMMEME ■ �■ ■■: ■moi■ 'VIII��, 'rE � fSEE 2 WED G9 5$ AP I IIMT-, 4NDE�' �n?paar aavica av aq 6a aur�irs lU'it ax 1X'[�Kxaap aqi! . is g�i S`uGZ/6/S Palmsa A�/t7� ;o aoav=oddv tcu�a.7b vtgdo uOW40lttt*4 T 1 Y: >OOZ/S/ P7 8 :�, O,zs?axv uc s!8awv.xp stgy:aioH k it I j ♦� �--,Jar ( II , , i 7 I�t 1 I; it 1i I I � II f I JUN-22-2006 'WED 09: 57 AV 1k':;rNE"OC'&i1 36034212979 002 ;asxa as aq of iacam iarx sx iI-x: eq; SOOZ/6JS ; o3vttY ' B iq �Q"^ ° a vouvaevdd� aav$q � a3y 3 1� 413o ao?i�l�t4►v1Utt soot/s/r:paG,HisvQ `��1� , anFunz mu ax Sar�nmx�a acg,L:o;api f f�ff I ! { f �Y 1 . w LL .v- 1 II �� i I E'. J.' �;.. I I I � J Page No. of Pages PROPOSAL Qia Suit MA Lic.#122153 13ERTHOLD CONSTRUCTION FL Lie.#PT38 ea • Int./Ext.Painting -Siding(603) 339-1465 •Carpentry Soffit Windows• do •Doors •Renovations Fully Insured•Over 15 years Experience•Free Estimate PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME r CITY,STATE AND ZII�CODE JOB LOCATION i I We hereby submit specifications and estimates for: �, � •� l f r� �r �� v �� r �1 �� 1 �Gi �l ' � I j c i • I I i ' I i WE PROPOSE hereby to fumish material and labor—complete in accordance with above specifications,for the sum of: j 1-1,P Pdollars Payment to be made as follows: L r�Li e C a•�-� lFf- 7 All material is guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or Signature: deviation from above specifications involving extra costs will be executed only / upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accideni.yr delays beyond 'Note:This proposal may be �= our control. withdrawn by us if not accepted within r} days. i ACCEPTANCE OF PROPOSAL.—The above prices,specifications i and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Date of Acceptance: Signature: t i II i NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: .2 3 � .S,47 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) /A5�Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date I He Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 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): Address: /.S 'e City/State/Zip:_f-1,2j Phone #: Are you an employer?Check the appropriate box: 1.El am a employer with 4. El am a general contractor and I Type of project(required): 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2 am a sole proprietor or partner- listed on the attached sheet. I ?• ,WRemodeling 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 10.❑ 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 El other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they an:doing all work and then hire outside contractors must submit a new affidavit indicating such tContractws that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I an employer that is providing information. workers'compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address:—,2 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year Imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy,of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and r the pains and penalties of perjury that the information providedabove is true and correct Signature: Phone#: Oficial use only. Do not write in this area,to be completed by city or town official, City or Town: Permlt/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other i Contact Person: Phone#: 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 ah 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 certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being 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 should 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/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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia NORTH To' " o�f . _ 4 over No. 77? _ i� LA E over, Mass., ` woolqF `® s� D /f, COCHICHE W ICK AORATE O S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT &.h..V......... ®. .... .. .......................................................................... Foundation has permission to erect..pwiW.611140 buildings on .l .../.... / 11 4y/�p........ .......... Rough t0 be occupied 8S........ . ... 1. ......... ..N ' �........ l. O.rrz ti '.... ....�IL�1iI Chimney provided that the person accepting this permit shall in every respect conform to the terms Id the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 40-IA PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STY Rough .... ... ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. ` Date..: :60 .. 0;,M� T°•'4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING « � - i o I SSACMUS� This certifies that . . . . . . . ?. . . . . . .. . . . . . . . . . . . . . . . . . . . J 1 has permission to perform,.-/". . . . . . . . . .'�.`:�. . . .��. -� --yj plumbing int eftildings of .. . . . . . . . . a at �... . . . . . . . . . . . . . . . . . . . . . . . . .1. . . . . , North Andover, Mass. Lic. No.7�<� . . . . . . . . . . . . . PLUI4131 VG INSPECTOR Check N � 65u5 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date /� +9 Permit # = Building Location 23 601 1 Owner's Name AJ Type of Occupancy New Renovation R placement ❑ Plans Submitted: Yes ❑ No 10//J FIXTURES Z _Z 0 H Q tq to to Id U Z Z W W O H W y H •WS. y t... V W V)H U. Z + F� (� m W < CA Z&1615 Z Q d Q �. La 0 U. 0 J �. 7 99 16 Cke EW U a = 0 = SO. Z t=it t- Y d O y Z Z W p. O V = 3 3myccg3 = Z941Wa319mq SUB-BSMT. BASEMENT 1st FLOOR F ti i R l 2nd FLOOR 3rd FLOOR 4th FLOOR Sth FLOOR i 6th FLOOR 7th FLOOR 8th FLOOR 4 7 t Installing Company Name Crane ' s Plumbing & Heating Check one: Certificate Address 70 Douglas Street ❑ Corporation Haverhill , MA 01830 ❑ Partnership Business Telephone (9 7 8) 373-4001 ❑ Name of Licensed Plumber Peter J . Crane • 'k INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance polity CX Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. R Check one: Owner❑ agent Signature of Owner or Owner's Agent hereby certify that all of the details and information 1 have submitted for entered)in the above application are true and accurate to the best of my knowledge and that atl piumhim.g vork and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter i 'of;hv General Laws. By Signature of Licensed Plumber Title Type of License:Masters L; journ an i. City/Town License Number APPROVED(OFFICE USE ONLY) FINAL INSPECTION SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS 1 FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED Date 19 U.G. Insp. Rough Insp. P Final Insp. Plumbing Inspector Date................. .. ..... NORTI, ° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACNUS� 1 This certifies that ... . p .,c ..................................................... has permission to perform ,-c r..................................................... wiring in the building of +� t" 7.-?"` :%'��---'................ at...i�....: -........................(�J... 1.�..........................,North Andover,Mass. Fee... '' .......... Lic.No. a� ..... .......!!.ry..� 3,A ...... ECTRICAL INSPECTOR LE Check # i - t✓'omnnonweafth o f 1f1assacltusell.-! �] Permit No. 2',partmenl o1Jire Ser ce3 ` Occupancy and Fee Checked - 1 BOARD OF FiRE PREVENTION GULATiONS Rev- 11/991 (Ica+e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD I; Burk to be perlor+ncJ i:;xcaJa++cc:� h tin t�iassaclmsctts Electrical C::uc(XILC i, C.i�]R i-)00 (PLEASE PRINT IiV INK OR TYPE ALL 1tV1'01Z; L 1710N) Date: Q� City o.r "l oivn of: Q• 'Af To the Inspector of Prlres: By this application the undersigned gives otice of is or her intention to perform the electrical work described below_ Locution(Street& Number) Owner or Tenant O Telephone No. Owner's Address Is this permit in conjui ioti witli a buildinb permit' 1'es No ❑ (Check Appropriate Box) Purpose of BuildhigP��f (��c rr/A-L_ Utility Authorization No. Existing Service Ampsf Volts Overhead[jUiidgrd 0 No.of tjkleters New Service Anips Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Anipacity Location and Nature of Proposed Electrical Work: 7"r, Completion of the loltvuyitt table maybe waned b►rhe Ins.cctor o1lVu es Na.of To(21 No.of Recessed Fixtures No.of Ccit_S_usp.(Paddle)Falls Transformers KVA No.of Ligliting Outlets No of Ilut Tubs Generators KVA Above In_ o.o . rnergencti ig.itin9 No,of Lighting FixturesSivimniing Pool rnd. ❑ rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners 19RE ALAR11I9 i\'o.of Zones No.of Detectiomaiid No.of Sivitcties No.of Gas Burners Initiating -lees Tota} No.of Alerting Devices No.of Ranges No.of Air Coiid. Tons Hey Y-ump FXuntber Tons KvV No.of Self-Contaitied o.of Waste.Disposers *I? jg I7etect'roiilAl rtrir Devices S acdArea Iieatin KIV Local ❑ IYlunicipal � Other Disliivaslrcrs l p g Connection No.of _ / Security'Systrnls: No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of N"•of Data Wiring: No.of Water Key Ballasts No.of Devices or Equivalent Heaters Sins Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total IIP No.of Devi es or E uivalent r OTHER: Attach additional detail if desired, oras required b+-?he Inspector of Wires. I^+SLiR-.1,10E COVIsIL1GE: Unless'valved by if-.-:esvner, no perrnit for the perfornnance ofelectrical %.orl: r:taJ ss.;c unless ti,e licensee provides proof of liability insurance including"completed operation"coverage or tts substantial equi�,alent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHL-CKONE: 1tiSURANCE (Expiration Date) Estimated Valiti al I id43171tal ievired by riltitti'Cipal policy.) Work to Start, hisprctions to be rcauested in accordance«7th MEC Rule 10,and upon completion. I�ertij, rnnler the wins and pettallies of pelptr�,that the information on thus application is ii we and complete. L Fi.FLNI NAME:: CL L_e-n ice- t✓1-� LIC.NO.: f�Z Signature LIC.NO,: t soe: t„1c'T r q: rl . Icft 1�,, '1 e erflcr e:eiti t"in die license imatber line-) N flQ-, P: ��A-�lts�ti�•�r��1 ETt;'pel.iso. OWNER'S 1, waive I am aware that the Licenseedots not have the lt�b:ltt}' insurance coy a��c't"or?"a �s 1 hereb waise this requirement. 1 am t1 {chr;:k em_1 0% ocr (J below, — , rcquirc_I b- la�.�. 13;� mV s,-naturc - - - - P/ R. II7 - - -- .. n, PLEASE FILL OUT BACK SIDE • ADDRESS ELECTRICIAN PERMIT NO. _:i Date.....��....... " . NORT1� "°0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING sSCHUS This certifies that ............. ... ....................................... 5r ... 10-S.. has permission to perform .......... �Q°�h-D�/ ST 7'F' .................. ...... ...................................... wiring in the building of nn,,,, � �`'!eU / at... North Andover,Mass. Fee.... "- '" Lic.No..do l9 �...... Ai. ,.. ELECTRICAL INSPEMR 1 Check # 13 81 7429 (fommonwaa&of Hamad ally Official Use Only 20 arlmanl of,}ira Serviced Permit No. Z� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank} APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: y a 3 d Cityor Town of: tin�'�T) A�} L U oh� 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(St &Number) 2-3-2-S GA /�E l� I Z Ffi t1I L` Owner o E�t - �� 12�z/J T 3 GLIA I<DQ aS Telephone Ntb��149,�J �16 0 Owner's Address LP 1J K Nnt 1)� Is this permit in conjunction with a building permit? Yes ❑ No ❑ (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 Proposed Electrical Work: �,�S L/W/Z- epe:/L Completion o the ollowin table ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA i No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool b e El In- El o mergency ig ng rn rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No,of Switches No,of Gas Burners o.or Detection andTotal - Initiating Devices No.of Ranges No.of Air Cond. Tons No,of Alerting Devices No.of Waste Disposers eat ump um er Tons_ _ _ _ o.oSelf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ElOther Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water o.of o.of Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications irmg No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. j CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pairs and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: L1censee:j20t3ERT T, MA1-g2/F Signature LIC.NO.: G fo-E (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:9 M-40-11Z15- Address: S-S MotI2 Sno-,/ ST. L.�wl?t✓.fiCE- l 4?/¢, Alt.Tel.No.: k 43/0 *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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ i i