HomeMy WebLinkAboutMiscellaneous - 30 CHARLOTTE WAY 4/30/2018AORT#q
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0 TOWN OF NO�RTH DOVER
X, PERMIT FOR GAS,,INSTALLATION
This certifies that . -�? F. (. � ......................
has permission for gas installation . . pf� 1, J.'� ...........
in the buildings of .... .....................
at North Andover, Mass.
Fee./(�q.— Lic. No./. -3. /3-2 .. .....
'ye- .........
GIAS INSPECTOR
Check#: K(((b
6993
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .... ....... 4 Pr J. C . ........................................................
has permission for gas installatio�n ..... ................................
in the bulldin�,s of ....
.. . ........
at ......... ... .. .............. ..... Andover, Mass.
Fee.. 3.(.0 .. . .... Lic. No. A?WAK.. ......... No . . ..... I ......................... I ........
. .. .... ....... ...... ......
GASINSPECTOR
Check #
9049
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MAS8ACHU6ETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
kX
TYPE OR
PRINT
CLEARLV
CITY MA DATE JPERMIT#
JOBSITEADDRESS OWNERS NAME
OWNERADDRESS TEq_j�o� JFAXF
PE COMMERCIALE] EDUCATIONALE
OCC'PA'Cy Ty RESIDENTIAL
N E W: MX RENOvATION:E1 REPLACEMENT: 0, PLANSSUBMITTED: YES[71, NO E �1
APPLIANCES -1 FLOORS— BSM 1 2 4 5 6 7 1 8 9 10 11 12 13 14
BOILER
BOOSTER -T
CONVERSION BURNER
COOKSTOVE . . . . . .
DIRECT VENT HEATER
[—IRLYER
imr-rLtAutz
FURNACE
GENERATOR 14
GRILLE. -
INFRARED HEATER
MAKEUP AIR I
OVEN
POOLHEATEf
ROOM/SPAC
ROOFTOPUN
TEST
UNIT 4ATER
UNVE14TED R(
WATER HEATI
1100
INSURANCE COVERAGE
I have a current liability nsurance policy or its substantial equivalent which meets the requirementsof MGL Ch. 142 YES (��,NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY L -F( OTHER TYP E I NDEMNITY 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.
R
Eliiiii
--c
CHECK ONE ONLY; OWNER 0 AGENT [] _1y
SIGNATURE OF OWNER OR AGENT
I hereby cerfify that all of the details and informaflon I have submitted or entered regarding this application a a d accurate to the besW my 4(h owl `e
'r
11
and that all plumbing work and installations performed under the permit issued, for this application M411 be�in com;022re with a �enX;rZovl '�n of
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME LICENSE #2R SIONAILAE
MP I 7r MGF CORPO ATIONE/4 PARTNERSHIP LLC A
JP 0 JGFF IE R
LPG
COMPANY NAMEI-&q.- ........ ....... ... ADDRESS
..... - - - - - -
CITY STATE'ZIP TEL -151
FAX
CELL EMAILI
C6
m
co
m
El (D
41
%
7 ME
g�"
WVU
ta a
EPWOURERS AND QASFrMRS
ED AS L. JOURMWAN P
i'g LIU M i E,:. -3 0 V j C 5-4 S E T Q
St��R---QH, ST
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IA
.4s.-
. . . . . . . . . . .
21
BEER-
PLUMMURS AND OASF
UCENSED AS A MASTM PLU B E
EL
GO ST
14A 0 2
771e COMINWnwealth ofMassachuseift 06'rit Form
71
rz DeParftnent ofIndustrid Accidentt
Offlce of Investigations
I Congress Street, Stdk 100
Boston, MA 02114-2017
uv� www.masLgov1dFa
Workers' Compensation Insurance Affidavit. Buflders/Contractors/Electricians/Plumbers
Avylicant Information Please Print Lepd
Name (Busineworpnizafion&dividtw).--,—�fle 120fLAM PWIE5 WC
Addressjbif G-P�bT— 5r
City/State/Zip:Fa6WV0 TT)ft0dN-Q,3b Phone#:
Are u an employer? Check the, appropriate box: Type of project (required):
I . g
I am a employer with 4. [] I am ageneral contractor and I
employees (full andior part-time).* have hired the sub -contractors 6. C] New construction
2.[] 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required-]
3.E1 I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
listed on The attached sheeL
These sub-contraacirs have
employees and have workers'
cDmp. insuranceJ
5. E] We arc a corporation and its
officers have exercised their
right of exemption per MGL.
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance reouired-I
7. E] Remodeling
8. Demolition
9. Building addition
10. YElectrical repairs or additions
I I -Ba4lumbing repairs or additions
12.E] Roof repairs
13.0 Other
*Any applicant that checks box #1 must also Ml out dic section below showing their wodmW compmation Policy infMiioL
I Homeowners who sibmit this affidavit indicating they we doing all wGit and then hire outside contractors must submit a new affidavit indicating such.
2Commcims that check this box must amcW an additional sheet showing the am ofthe and state whether or not those entities have
employem ffft alb�s have employees, they must provide am workere oompL policy number
I am an emplojw that ispmvit &i�g wworkern' COMPMaftn Msurancefor my Mp1wm Bdowisthepa&!vandiehsfte
informadom
Insurance Company Name:, G i i-- mo ar,- Ki ca, P- R tj
Policy # or Self -ins. Lic. #: P1 O;a ri-s r1 a, C) i JL 0 11 Expiration Date.- ?J
JobSiteAddress: city/smejzip--KLJ��Q �Cf- MA -4
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date� ct�
Failure to secure coverage as required under Section 25A of MOL 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 fbrm'surance coverage verification.
GENERATOR APPLICATION
DATE: I D-- -�-O - 13
LOCATION: 56 -wpsy- )\Jo
OWNERSNAME:
GENERATOR kw- 14
NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS*
CONTRACTOR:-hR12.12.06 (-OMPEWIL-6 INC,
PHONE NUMBER: 9D Y -543 -,5 1; ( �?
ELECTRICAL D
RESIDENTIAL COMMERCIAL TEMPORARY
LOCATION OF GENERATOR: 12161;�7- (9/jc' 6,47 7qdV,5,c-- -,,/Q
f;Eo'n -7 4� tlJ�4�
*ZONING DISTRICT:
*PLANNING APPROVAL (IF IN WATERSHED)
*CONSERVATION APPROVAv��!
6
L
Town of North Andover
Your permit has been se back to you for the following reasons:
71
1) Check amount incorrect 1,,/ -56,
2) No copy of current licens e
3) insurance Binder not on file or expired
4) No Workers' Compensation Insurance Affaclavit Form
Please call with any questions 978-688-9545.
Workers' Compensation Form and Schedule of Fees can be found on the Town of North Andover
Website under Building Department.
-0� eA
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Date .... 9-.. �P ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
HU
This certifies that .....
......................... .. . . ......
has permission to perform ...............................................
wifing in the building of
atx.4V .... Jo .... ..,North Andover, Mass.
Fee. 2 �--?.... Lic. No A�4.cP�7 ............. . . ........... ... .
L RICAL INSPE R
Check #
R9^;7
Ivi
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
official Use Only
Permit No. ?K7,
occupancy and Fee Checked /.3(0 27
[Rev. 9/051 (1.... blank) 10
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.0D
(PLEASE PRJWT LV flVK OR TYPE ALL LVFORIVIATION) Date: _T S1 - idaq
City or Town of, /J i A MEM'11ER To the nsperctorlof Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
'A?_LQJ!:rE WAY
Location (Street & Number) A4 C_ 147
Owner or Tenant Telephone No.
Owner'sAddress
Is this permit in conjunction with a building permit? Yes S200" No (Check Appropriate Box)
Purpose of BuiidingmOLEI 1NWE?,2,11JG I -Utility Authorization No. �Jyjq
Existing Service Amps Volts Overhead Undgrd [] No. of Meters
New Service 10CI Amps LZgLL2,6,40 Volts Overhead Undgrd S?r No. of Meters IL
Number of Feeders and Ampacity 4.00 A Y�l
Location and Nature of Proposed Electrical Work: W-111 A�ZW T_YJ PLEK DW (F- 12-W 6-
Com letion -f the f-11-wipiq ttihlp may he waived bv the Inspector of Wires.
No. of Recessed Luminaires
No. of,Ceil.-Susp. (Paddle) Fans
No. 01 Total
Transformers KVA
No. of Luminaire Outlets
0* of Lum*naire Outlet,
No. of Hot Tubs
N'
Generators K -V A
nair
No. of Luminaires
N! - of Lumu es
0
Ll
A
Swimming Pool 9
S'
No. ot tmergency Lighting
Battery Units
cl
No. of Receptade Outlets
S
No. of Oil Burners
FIRE A ARMS
JNo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranues
No. of Air Cond. a
Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
�.K.W
.... ......
...........
No. of Self -Contained
Detection/Alerting Devices ---
No. of Dishwashers
Space/Area Heating KW
Local y Municip�l E] Other
Connection
No. of Dryers
Heating Appliances
KW
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters
KW
No. of
Sians
No. of
Ballasts
Date Wirinu:
No. of D'evices or Equivalent
No. Hydromassage Bathtubs
No. of Motors
Total HP
Telecommunications Wiring:
No. of Devices or Equiva"Ient OIL
OTHER:
Attach additional detail if desired, or as required by the inayector g r-.
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.
INSURANci —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 El OTHER [] (Specify:)
I certify, under the pains andpenalfies ofperjury, that the information on this application is true and complete.
Interstate Electrical ServiVs Gorpor.at qlp.�— �LIC.Nj .:A-5217
FIRM NAME:
A. Alibrandi Signature
Licensee: Pasquale
(�fappiicabl� 67ter 11 exe I t " in the license number iine.) Bus.Tel.No.:978 667-5200
Address. Tre e Cove Rd., N. Billerica, MA 01862 Alt. Tel. No.:
*Security System Contractor License required for this work; if applicable, enter the license number here:
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) ED owner L_,,,pwner's agent.
Owner/Auent [ PERWT FE
Signature` Telephone No.
I
4.0
if
,LORTbl
4K
"A
SA
Date.�?
t. ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............ . ......................
has permission to perform ...............................................................................
wiring in the building of ..................................................
at ... . ............................ North Andover, Mass.
Fee.;S�"'�'... Lic. Noj�,1.239��- ........
'0$of
'J;.� ��e�41.0 . -.% . . . . . . . . . . . . .
�ffc�� 1,
Check # - �74 31;�9. rRicAL K/
7-- -
14TIllm-
11
I
LOMMonwealth Of Massachusetts ��O�fficial Use �Only
nu
Department of Fire Services permit No.
� �p �y
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORV ELECTRICAL
(PLF-4 All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 WORK
SE PALYT flV NK OR TYPE ALL XFORMA TJON) Date:
City or Town of. NORTH ANDOVEP, 2
By this application the undersi - To the lnsple'to—r Mf���
gneG ves notice of his or her i't-en-t3o—nto pe onnthieelec ical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address Telephone No.
Is this permit in co 'uncti" wi ? Yes No (Check Appropriate Bo
nj ODwi ao ding permit
VVA
Purpose of Building CMIA ----- Utility Authorization No.
Eiisting Service Amps Volts Overhead Undgrd
3- qu - No. of Meters
New Service -a L—b AMPS !,qb- / Volts Overhead
Number of Feeders and Ampacity Ar Undgrd No. of Meters
Location and Nature of Proposed Electrical W Ic-
No. Of Recessed Luminaires
No. of Luminaire Outlets
No. of Luminaires
[�o- of Receptacle Outlets
[No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
Heaters KW
No. HYdromassage Bathtubs
No. of CeiL-Susp. (Paddle) Fans
No. of Hot Tubs
Pool ADove in-
- Rrnd. frrnd-
a. of Oil Burners
of Gas Burners
0- Of Air Cond.
Space/Area Heating KW
Heating Appliances KW
No..of —No. of
Signs Ballasts.
No. of Motors Total E[P
Oble may be waived bV tt��2 �C�-, Of Wn,
NO- Of Total
Transfnrmpre V"17 A
Generators KVA
Batt . U - Y T g
pry nits
FIRE AL 0. of _7-DeS
.1u..ul "CLection anc[
Ini tia Devices
�o- of Alerting Devices
q0 ---Pr Sen -contained
)etection-/Merting Devices
,ocal F� 4-u—mcipal
Connection Other
No. of Device Egaivalent
lata Wiring:
No. of Devicar
�ACUU111111unicanonswiring:
No. of evices or Ecuivalant
Estimated Value of Electrical Work: Attach addifional aelazi Y desired, or as required by 1—he —Inspector -'of wies.
Work to Start 0aen required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10, and upon completioTL
'NSURANCCCO—VERAGE.- Unless waived by the owner, no Permit for the performance of electrical work may issue unless
the licensee.providcs proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cove;vage is in force, and has exhibited Proof of same to the permit issuing ofyice.
CHECK ONE: INSURANCE 2" BOND 0 OTHER 0 (Specify:)
I certify, �nder thppqins andpenalties ofperju?y, that the information on this applic
FIRM NAMI: adon is frue and complete
Licensee: LIC. NO.
-�4;, - �- - -. �-- , - - �� Sigmiture LIC. NO..
(Yapplicable, en irlexempn*1 - jn� the license number line)
Address: Bus. TeL Nol�
*Per M. G.L c. I ', s. 57 5 1, security work requires Departrnent of public S AIL Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hav S" License: Lic. No.
required by law- By my signature below, I hereby waive this requiT e the liability insurance coverage normally
Owner/Agent ement I am the (check one) [I owner 11 owner�s agent
Signature
Telephone No. PE"IT FEE.- S
�s��
� �,� � �
/� o� ������ ��
J
L
y
The Commonweauk of Afassachuse&
Department of Industrial Accidmts
QJf1ce of Invesdgations
600 91"ashington Street
Boston, M4 02111
www.mass.govIdia
Workers' COMPMELtion Imilirance Affidavit- Builders/Contmctors/Electncians/Plumbers
Iftlie!mUt TnfA.-,g--
Name
Address:
city/state/zip Phone
Are Ou an employer? Check.the appmpriate box:
ITI'M aemploycr with
4. [11 am IL geneml contractor and I
employem (L11 and/or part-time).*
2. 1 am a sole pruprietor or
have hired the sub-contnactors
listed
partner.
on the attached sheet
ship and have no employees
These stx&contractors liave
working for me in any capacity.
[No workers' comp. insurance
workers' comp. insurance.
5. We are a corporation and.its
required-]
3. F1 I am a homeowner doing
officers have cx=ised th . eir
all work
right of exemption per MOL
myself [No-wor6rs'cornp.
r- 152, § 1(4),*and we have no
insunince required.] t
.=Pioyees, [No workem'
comp. hisunance required-]
Type of Project (required):
6. Now construction
t. Remodel ing
S. Demol ition
9- Building addition
10.[] Electrical rcpairs aradditions
Plumbing repairs or additions
Roof re'pairs
13.[].Othtr
ti-lomeowni uuumeseff DCIOWSIIDW.ingftrworkeii'rompenswi- policy information.
IC n who submit this afffdavil indi.cefing they Rm doing all work d them hire outside cOnnetm must submit a new affidavit indicating such.
.n'.tors that chwk this box must AftaChed an additional shect showing. the name
of the sub-contmctms and thci!, V.Mri=, corrp. Policy inibmr.�Cn.
ant an employer that is prqri&ng:W01*erS' compensation imurancefor nzy employem
informadorL Below is the policy andjl7k Sfte
Instmet Company Name:
POlicY 4 or Self-im. Lie.
Expiration Date:
Job Site.A4ddress:
City/statz/zip:
Attach a copy 0 t -e workerV compenation policy declaration page (snowing the policy number and expirati
f h tk,!-,
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositi I on of enminal an date).
Malties 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 S250.00 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 here"co ify under the ains andpmaides OfPerjsuy that the inVor"WOR Provided above is une and correct
Official use only. DO nOt write in this area, to be conVleled by
City OT lawn official
City or Town: Permit/License 4
Issuing Authority (circle 0,,):
I. Roard of Health I Building Department 3. CitYrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
LContact Person:
C11!:1.tPe-rs1u-- Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all emp I oyers to provide workers' compensation for their employees.
Pursuant to this statute, an anployee is defined as "...evwy person in the servic e of another under any contract of hire,
express or implied, oral, or written."
An movyer is defined as "an individual, partnenhip, assc:)diation, corporation or other legal entity, or ary two ormore
of the'foregoing engaged in a joint enterprise, and including the logal reptsentativ . es of a dectased employer, or the
receiver or trustee -of an individual, partnership, associatioin or other legal entity, employing employees. 'However the
owneir of a dwelling house having not more than three apax-tinents and who resides therein, or 11m occupwit of the
dwelling house of another who employs persons to do maimtermce, 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."
MOL chapter 152, §25C(6) also states that "every state or- local licensing agency shall withhold the issuance or
renewal ofa license or permit to operate a basness or ito construcibulidings in the commonwealth for any
applicant who has not produced acceptable evidence.aJ7 compliance with the insurance coverage requ . ired.%
Addhional�, MGL chapter 152, PC(7) states "Neither the commonwealth nor any of its political subcHvisions shall
enter into any contract fbr the performance of public work until acceptable evidence of compli� with the msWMce
ance
requirements of this chapter have been presented tz3 the contracting authority."
Applicants
Picase fill out the workers' compimis;ation. affidavit completely, by checking the boxes that apply to your situation and, if
necessary, nipply sub-contractor(s) name(s), address(es) a.-nd phone number(s). along with their certificate(s) of
irmmmce. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or pnIners, are not required to carry workws' m-rnpensation insurance. Ifan 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 tmn that the application for the permit or I icense is being requested, not4th Departmentof
e
Industrial Accidents.. Should you have any questions regarding the law or if you am required to obtain a workers'
compensation policy, please call the Department at the number. lked below. Self-insured companies should enter ther
self-insuran6eliwnse numbef on ffie*appropriate line. _J
City or Town Offici2is
Please be sure that the affidavit is complete and printed legibly. The Department his provided a space at the bottom
of the affidavit for you to fill out in the event the Office of' lnves�iptions has to contact you regarding the applicant
Please be sure to fill in the permit/license number which %A -ill be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given yW, need only submit one affidavit indicating -current
policy infonnation (if necessary) and under "Job Site Address" the applicant should write "all locations in _(city or
town)." A copy ofthe affidavit that has been officiall stamped or marked by the city
I y or town may be provided to the
applicant as proo� that -a valid affidavit is on file for fluture 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 investi.Wions would like to fl=k YDU in advance for your cooperation and should you have any questions,
plmw do not hesitate to give as a call.
The Department's address, telephone and fax number
The Cominonwcalth of Massachusetts
Deparimcnt of Industrial A=idents
Office of tMvestiggations
600 Wadiin�n Strret
30ston, MA 02111
Tcl. # 617-727-4900 6xt 406 or 1-9.77-MASSAFE
Revised 5-26-05 Fax 4 617-727-774-4
vrwwMass.govidia,
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 10(7/2/09) Date: jpmM 22, 2010
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 24 & 30 Charlotte Way
MAY BE OCCUPIED AS Multifamily Dwellina IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Edgewood Retirement Community
575 Osgood St
North Andover MA 01845
Building Inspector
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APPLICATION FOR -CERTIFICATE OF-OCCUPANCYfiNSPECTION
Buildingg Permit# /0
ADDRESSILOCATION OF PROPERTY:
Map Parcel Lot Number
SUBDIVISION
DATE REQUESTED FILEDIREADY FOR INSPECTION
CLOSING DATE ON PROPERTY:
ALL WORK AND SIG.N-OFFS MUST BE COMPLETED WITHIN THIS TFIAE FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL 13F CHARr.Fn IF TW= _QTmi ie, -n ioc
DOES NOT MEET ALL APPLICABLE CODES.
Pell—, i1ft, lssu-=%A to:
Address
SIGNED
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY[INSPECTION REOUEST I
DPW
File: Application for OC form revised Jan 2007
ROUTING
CONSERVATION
PLANNING
FV1 'A///0,7/
DPW - WATER METER
SEWERIWATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY[INSPECTION REOUEST I
DPW
File: Application for OC form revised Jan 2007
fi
APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION
Buildinq Perrrfit #
ADDRESS/LOCATION OF PROPERTY:��6
Map Parcel LotNumber c,;t�
SUBDIVISION /2- .. . '
DATE REQUESTED FILEDIREADY FOR INSPECTION
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE. COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS Smooi wILL RF r'-WAPC-'i=n icrum eIrm lf%Vl inn
DOES NOT MEET ALL APPLICABLE CODES.
Pei-filift Issued to:
Address
SIGNED
RO
-71 I]t 1-0
CONSERVATION Fv
PLANNING
DPW - WATER METER b
SEWERIWATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER MET ER HAS BEEN INSTALLED PRIOR TO
SUBMI17AL OF THE OCCUPANCY/INSPECIION REQUEST
Signature
File: Application for OC fom revised Jan 2007
� 0' -
Registered En M.eering Sery ices
structural Construction Control Affidavit at GornpleLion of Structural Work
Project Number: DSA Project #0706.00
Project Title: Edgewood Retirement Community Cottages
Project Location: #30 Charlotte Way, North Andover, MA 01845
Scope of Project: Wood Framed Cottage with Concrete Basement and Foundations
In accotdancexith Section 116.0 of the Massachusetts State Building Code, 1, Geoffrey S. Conway,
MA #32753 being a registered professional engineer (structural), hereby ccrfi�,- that I have prepared
or directly supervised the, preparation of all design. plans, computations and specifications
concerning -
Entire Project Architectural XX Structural
—Mechanical Fire Protection Electrical
Other (Specify)
For,the above narned project and that, to the best of my knowledge, such plans,'computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, all
acceptable erigmieeling practices and, all applicable laws for the proposed project,
I further cerd6,- that I have performed the necessary professional services and have been present on
the construction site on -a regular basis to determine that the work 's rocee in accordance -with
i p ding * . ,
the documents approved for the bifflding permit and have beenresponsible for the following as
specified in Section 116,2.
1. Review for conforinance to the design concept, shop drawings, samples, and other
subtnitt2ls, -which are submitted by the contractor in accordance with requirements of the
construction documents.
2. Review and approval of the quality control procedures for all code -required materials.
3. Been present atintervals appropriate to the stage of construction to become generally
familiar with the progress and quality of the work and to determine, in genet.al, that the work
has been performed *in a manner consistent with die construction documents.
Geoffrey S. Conway, P.E.
Date
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that e? !� (. � ......................
has permission for gas installation . . k . . Pk�'� /. L*1 ..........
in the buildings of .... S,.K . � .....................
at ... North Andover Mass.
0
Fee./O.' Lic. N .. .... IN' S*P*ECTOR
Check #
f 6993
Date./&/. 4-r-2.1. V-77 ....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation*. ......
in the buildings of . "5-49 r- C4-'.4 A .� ......................
at .3 North Andover, Mass.
r -
Fee. Lic. No .. .... I ......
FGAS-INSPECTOR'
Check #,
Re�Jstered EngLneering Services
Structural Construction Control Affidavit at CoWletion of Structural Wo
Project Number: DSA Project #0706.00
Project 'fide:
Edgewood Retirement Community Cottages
Project Location:
#24 Charlotte Way, North A adover, XU� 01845
Scope of Project-
Wood Framed Cottage with Concrete Basement and. Foundations
In accordance with Section 116.0 of the.Massachasetts State Building Code, 1, Geoffrey S. Conway,
NiA #32753 being a registered professional engineer (structural), hereby certify that I have prepared
or directly supervised the preparation of -all design plansi corriputations and s , ifications
peci
concerning:
Entire Project Arcliitectur-al Structural
Mechanical Fire Protection Electrical
Otbe.r (Speci,�)
For the abov e named project and that, to the best of my knowledge, such plans, computations and
s I pecifications meetthe applicable provisions ofthe Massachusetts State Building Code, all
acceptable engineering practices and all applicable laws for the proposed project,
I further certify that I have performed the neccssan . , professional services and have been present on.
the construction site on a regular basis. to deterrninethat the Nvork i . s proceeding in accordance with
the documents approved for the building permit and have been responsible for the following as
specified in Section 11.6.2,
I. Review for conformance to the design concept, shop drawings, sarnples, and odier
submittals, xAdchare submitted by the contractor in accordance Nvith requirements of the
construction documents.
2. Review and approval of the quality control. procedures for all code -required materials.
3. Been present at intervals appropriate to the stageof construction to become generally
familiar with die progress and quality of the work and. to determine, in general, that tiie work
has been performed in a manner. consistcritwith the constructio.a. documents.
Geoffrey S. onway, RE Date
Date. 140 - '�A '�7 .....
nx TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .'/.
5-/�I— V
.................................
has permission for gas installation ��Y ..............
in the buildings of ��.o P.? .......................
at .3. X-. North Andover, Mass.
Fee. fi�. No. .. ..... ....... ........
GASINSPECTOR
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
CHUS
This certifies that
has permission to perform "C ............
plumbing in the buildings of C
. ..........................
at North Andover, Mass.
Fee. Li c. N o. ........ � ............
PLUMBING INSPECTOR
Check .# el 2 1-
8194
CIVIn Ince
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Cityfrown: MA. Date: 410 q Permit#
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Building Locatiom-?o e161 -14e wa- Owners Name: � &I n"
Type of Occupancy: Commercial E] Educational [I Industrial [I InsfitutionalEl Residential 93-,'
New: D--�A.Iteratlon: Renovation: Replacement: Plans Submitted: Yes[] No 0
CIVIn Ince
tmecit one only lueraTicate a
Installing.CompanyNameiM8LtksfieldP!�u-mbiil-g&,H,e.at,i,ilg-,Inc,.
.2561—C
[9 Corpoiation
Address: 36-Jackma:n.�SL- Cityfrown:-Georg6town -666.��
0 Partnership
Business Tel:- Fax:(916A52-5410 0 FirmlCompany
Name of Licensed PiumberTIM01hy J. Mansfi .. q . ld
INSURANCE COVERAGE:
I have a current flability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 50 No El
Iff you have checked Yes. please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy F] Other type of indemnity C] Bond [I
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 0 Agent
I hereby cartify 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 Side Plumbing Code and Chapter 142 qfthe General Laws.
By Type of Ucense:
Title Plumber Si6nature iflumbep5l"
Cityfrown Master
I
APPRnVF:n InFF1111: I M9 nNI 'kn -- -ffJoumeyman License Number 13437
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tmecit one only lueraTicate a
Installing.CompanyNameiM8LtksfieldP!�u-mbiil-g&,H,e.at,i,ilg-,Inc,.
.2561—C
[9 Corpoiation
Address: 36-Jackma:n.�SL- Cityfrown:-Georg6town -666.��
0 Partnership
Business Tel:- Fax:(916A52-5410 0 FirmlCompany
Name of Licensed PiumberTIM01hy J. Mansfi .. q . ld
INSURANCE COVERAGE:
I have a current flability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 50 No El
Iff you have checked Yes. please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy F] Other type of indemnity C] Bond [I
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 0 Agent
I hereby cartify 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 Side Plumbing Code and Chapter 142 qfthe General Laws.
By Type of Ucense:
Title Plumber Si6nature iflumbep5l"
Cityfrown Master
I
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TOWN OF NORTH ANDOVER
0
PERMIT FOR PILUMBING
.,"4cmus
"This certifies that ... ..........
has permission to perform ..... :-: .............
plumbing in the buildings of ...........
at N ... �A. North And over, Mass.
PLUIVI� -2
GIN 4� OR
Check#
8195
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 0 No [I
IIf you have chocked Yes. please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy F] Other type of indemnity [] Bond E]
OWNEWS INSURANCE WAIVER: I am aware that the licensee does not the insurance coverage required by Chapter 142 of the
Massachusetts General Unw, and that my signature on this permit application waives this requirement.
Check One Only
Owner El Agent El
I hereby cerft 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 pf Um General Laws.
BY
Type of Ucense:
rive CKIplumber alunavure �-O�Pansea riumoer
CftyfT(Ywn OzMasti ber. 13437
Apppnvpn inarma ME= AM vi t3journ, License Num
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Cityffown- k0A AdA��e�'r MA. Date:-<—f4WO t7 PeffnIt# L�/ C? Ij
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Building Location. ?q e a)a.(Z Owners Name:.2L]6 CaJ00 d
FIXTURES
Type of Occupancy: Commercial [] Educational [] Industrial E] Institutional E] Residential
New: Alteration: El Renovation: Replacement: Plans Submitted: Yes El No El
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 0 No [I
IIf you have chocked Yes. please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy F] Other type of indemnity [] Bond E]
OWNEWS INSURANCE WAIVER: I am aware that the licensee does not the insurance coverage required by Chapter 142 of the
Massachusetts General Unw, and that my signature on this permit application waives this requirement.
Check One Only
Owner El Agent El
I hereby cerft 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 pf Um General Laws.
BY
Type of Ucense:
rive CKIplumber alunavure �-O�Pansea riumoer
CftyfT(Ywn OzMasti ber. 13437
Apppnvpn inarma ME= AM vi t3journ, License Num
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Check One Only Certificate #
Installing Company Name- M, ansti,61d
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A liability insurance policy F] Other type of indemnity [] Bond E]
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Massachusetts General Unw, and that my signature on this permit application waives this requirement.
Check One Only
Owner El Agent El
I hereby cerft 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 pf Um General Laws.
BY
Type of Ucense:
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This certifies that .... h7. e�--x ............. I .............
has permission to perform ..... Aj .- .............
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at C, Y North Andover, Mass.
+ee. Lic. No..
.........
IPLUMBING INSPECTOR
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DateAD/
TOWN OF NORTH ANDOVER
PERMIT FOR
-PL-UMBING
SS CHUS
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plumbing in the buildings of ... /Y .................
at C, Y North Andover, Mass.
+ee. Lic. No..
.........
IPLUMBING INSPECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Cityfrown. t�n Jq" J6V Lo t-- MA. Date: PermitV
16167 9 7
Building Location Owners Name: E,4eu)m
Type of Occupancy: Commercial Educational C] Indusfaial E] Instiftdional[] ResidentialE�--
Now: Altemtion: E] Renovation: Replacement: Plans Submitted: Yes E] No E]
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TOWN OF NORTH ANDOVER
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TPLUMBING INSPECTOR
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