HomeMy WebLinkAboutMiscellaneous - 245 BLUE RIDGE ROAD 4/30/2018N
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Date ;- ...........1..7 ................
TOWN OF NORTH ANDOVER
RMIT FOR WIRING
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This certifies that ....:.......:G�&...4
.............! ti 1�—v...(G-..................
has permission to perform ........!.................... ...✓ bUff
..........................................................................
wiring in the building of.............................................................................
at ... ...'" .�...... � ...-... �.. �' .-......�:� ...... , North Andover, Mass.
Fee....` ........ Lic. No �2-...............................................................................
ELECTRICAL INSPECTOR
Check #�"
? �:) U `�
Commonwealth of Massachusetts OffIcial Use Only
(�
Department of Fire Services Permit No.
Occupancy and Fee Checked
aM BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] peaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C), 5 7 CMR 12.00
(PLEASE PRINT IN.INK OR TYPE ALL INFORMATION) Date:
City or Town oh NORTH ANDOVER To the Ins ect r of Wires:
By this application the undersigned gives notice of his or her intention to pgform the electrical work described below.
Location (Street & Number)
Owner or Tenant ,A,,
Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes La-" No ❑ (Check Appropriate Box)
Purpose of Buildings � /.f/ ,, /,/, Utility Authorization No.
0.- Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
y Location and Nature of Proposed Electrical Work:f�
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans No. of Total
Transformers KVA
No. of Luminaire Outlets No. of Hot Tubs Generators KVA Q
No. of Luminaires Swimming Pool Above ❑ In- ❑o. of Emergency.Lighting �\
rnd. grnd. Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE AT,A.RMC Nn_ i f 7nnoe
No. of Switches No. of Gas Burners
No. of Ranges No. of Air Cond.PumI'
7
No. of Waste Disposers HeaTotals Number Tol W
I
No. of Dishwashers Space/Area Heating KW
No. of Dryers Heating Appliances Q k
No. of WaterKW No. of No.
Heaters Signs Bal:
No. Hydromassage Bathtubs No. of Motors Tot
OTHER:
Attach addit es.
Estimated Value of Electrical Work: (When requi
Work to Start:q& Inspections to be requested in accor
' INSURANCE COUIR AGE: Unless waived by the owner, no permit ss
the licensee provides proof of liability insurance including "completed
undersigned certifies that such coves e is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
Icertify, tinder thep ns and penalties ofperjury, that he information on this application is true and complete.
FIRMNAME: LIC. NO.: )2,94—
Licensee: Z Signature ���/� LIC. NO.:
(If applicable, enter "exemp " in the he nse number Dine.) Bus. Tel. No.:
Address: � �,-,v�U i �,/✓riJ .%lam► !�� �% u Alt. Tel. No.: % `) 721,5_9
*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 PERMIT FEE: $
Signature Telephone No.
�*(
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. I �Q
Occupancy and Fee Checked
, BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] aeaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C), 5 7 CMR 12.00
(PLEASE PRINT IN.INK OR TYPE.ALL INFORMATION) Date: 3
City or Town of: NORTH ANDOVER To the Ins ect r of Wires:
By this application the undersigned gives notice of his or her intention to pAform the electrical work described below.
Location (Street & Number)
Owner or Tenant A
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit?. Yes 2-" No ❑ (Check Appropriate Box)
Purpose of Building/i,>tTG,�, �j�"t 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: 'X�,/�G��
Completion of the following table maybe waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Dis posers
p
Heat Pump
Totals:
Number
Tons .........................
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of 97res.
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 C GE: 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 covera e ism force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:)
I certify, under the p ns and penalties of perjury, Thathe information on this/application is true anti complete.
FIRMNAME:/`%/I/l_ i, �_ ,��/ nom r �% : �f,�r,_ �.�-�,_ LIC. NO.: %Z �2>�
Licensee: / lo= '— �I S�dZ lSignature—� ���1LIC. NO.: 2.5 /?2 /-F
(If applicable, enter "exemp " in the licignse number line.) Bus. Tel. No.:
Address: a Z-4 Alt. Tel. No.: !2'2 7 2d -J iiEi
*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 �EIzMIT FEE: $
Signature Telephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the p
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed s
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an !, `
electrical permit shall be issued to the person, fine or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑
❑ Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass 0
Failed M
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass F?1
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
TION:
FINAL INSPECTION:
Pass IN
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com
Name
Addre
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
yJ:YO www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
City/State/Zip:
Are you an employer? Check the appropriate box:
v Phone #: 157'/_ P" 2 �Fy ?If
1. FA ain a employer with 2 : employees (full and/or part-time). *
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. ❑ I am a homeowner doing all work myself. [No workers' comp..insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.$
6.❑ We are 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 required.]
Type of project (required):
7. ❑ New construction
8. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
11. ❑ Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13. ❑ Roof repairs
14. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not. those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site
information.
Insurance Company Name:-����/�/%f
Policy # or Self -ins. Lic. #: nJ ��9 2I Expiration Date: 1,2-2--T
Job Site Address: y ``—L /C(T�i7'c City/State/Zip: % A&I12 0/4
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coveraize verification.
I do hereby certify tut
the pains d p alties of perjury that the information provided above is teeand correct.
/l ria+P• _� 7711Z
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
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) 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 cityor 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
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1 1 i::i'J
Its certifies that....................,...........................................
hadpermission to perform ... ��- - �............................�
..........................................
plumbing in the buildin s Of..... c...vr.....................................................
�at ...�-`S. +.�,,�... ... �Q..e,.........
Fee5;?!�4.... Lic. No..��� ........
Date.tl...J. i, ..�A->........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
Check #
.........., North Andover, Mass.
PLUMBING INSPECTOR
VA—
1
TYPE OR
PRINT
CLEARLY
MASSACHUSETTS MW4DRM APPLICATION FOR A -PERMIT TO PERfORRM PLUN31NG WORK
CITY North Andover MA DATE 16 -Nov -2015 PERMIT #
JOBSITE ADDRESS 245 Blue Ridge Rd OWNER'S NAME Boucher
OWNER ADDRESS 245 Blue Ridge Rd TEL 617-512-1084 FAX
OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL
NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES ❑ NO
FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1
CROSS CONNECTIONDEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY 2
ROOF DRAIN
SHOWER STALL 1
SERVICE / MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION
WATER.HEATER.ALL TYPES
WATER PIPING
OTHER
Sillcock
INSURANCE COVERAGE:
1 -have a currentEgLitit insurance policy or its substantial equivalent which meets the requirements of MUCh.142. YES ® -NO ❑
IF YOJ CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ® OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac rate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in com Iia ce I P rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Robert J. Frazier LICENSE # 13425 �j IGNA E
MP ® JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ #
COMPANY NAME Bomar Plumbing & Heating ADDRESS PO Box 694
CITY Derry STATE NH ZIP 03038 TEL 603-325-8958
FAX CELL EMAIL Bob@BomarFH.com
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation- fnsura-ace Affidavit:- build /Contractors/Electricians/Ptirm-bers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Bomar Plumbing & Heatin
Address: PO Box 694
City/State/Zin: Derry, NH 03038
Phone #: 603-325-8958
Are you an employer? Check the appropriate box:
i. [:11 am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑X I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself .[No workers' comp_.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.$
5. ❑ We are 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 required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.X❑ Plumbing repairs or additions
12. ❑ Roof -repair -s-
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. Ifthe-subcontractors have- employees; they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: Liberty Mutual Fire Insurance Company
Policy #.or S.elf-ins.-Lic. #:
WC2-31 S366059-022
Expiration Date:.
22 -Apr -16
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 advisedthat a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under theins gnd penalties of perjury that the information provided above is true and correct.
16 -Nov -2015
Phone .#-: 603-325-8958
Official use only. Do not write in this area, to be completed by city or town offciaL
City or Town: Permit/License #
Issuing Authority (circle one):
1, Beard --of Health 2. Building Department 3.0ty/Tow-w-Clerk 4. Electrical.Impector 5. Pla-ml3ing-Inspectar-
6.Other
Contact Person: Phone #:
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... J G '....` ..,- . z
has permission to perform ..... w .........................
plumbing in the buildings of ... I?u t -X. `: t . ................... .
at : -T .............. , North Andover, Mass.
Fee.-?� .:... Lic. No../ .`/ }. ........0 `.... .
PLUMBING INSPECXOR
Check # --
FIXTl1RFS
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City(rown: 0/' 0 MA. Date: iP/,:I Permit#
elkAee
Building Location: e-! Owners Nam&N% U Cal tc
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ ResidentialDC
/%
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New: ❑ Alteration: ❑ Renovation: ❑ Replacement: X Plans Submitted: Yes ❑ N
FIXTl1RFS
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 of coverage by checking the appropriate box below.
A liability insurance policy 'k Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 ❑
Sianature of Owner or Owner's Assent
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 wth an
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title ❑ Plumber =Number:
nsed Plumber
C' /Town aster
'h' Journeyman Lic i 3 a yam_
APPROVED OFFICE USE ONLY
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Check One Only Certificate #
Installing Company Name:
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Name of Licensed Plumber:
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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 of coverage by checking the appropriate box below.
A liability insurance policy 'k Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 ❑
Sianature of Owner or Owner's Assent
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 wth an
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title ❑ Plumber =Number:
nsed Plumber
C' /Town aster
'h' Journeyman Lic i 3 a yam_
APPROVED OFFICE USE ONLY
Date. f�G
"oRT:1ho TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
sSACMOs� pp
This certifies that . ( .. ��... ��r . /'... " ..
has permission to perform ....
plumbing in the buildings of ....� ��'.`.. �. G ..................
at .),.t( 1'. 4-.
.�f.. ,North Andover, Mass.
Fee. Lic. No. �%� . i. ... ..... -^ ice;......... .
PLUMBING INSPECTOR
Check # 7 QC7 t/
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Akb Vol ,Mass. Date a 20 /6 Permit #
Building Location 14�- &u- &�u Owner's Name 8012CAEP
Owner Tel# 9-2? &?J a S Type of Occupancy
New ❑ Renovation ❑ Replacement 0' - PlanSubmitted: Yes ❑ No ❑
FIXTURES
Installing Company Name CAI-L-44-6—
Address
AI-Li44-6—Address 13�L 110 A.) S�
Iy API)OVL12 l`1/i- Ql�
Business Telephone # % 6 �-3 3
Name of Licensed Plumber aL E U A
Check one: Certificate
[corporation
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes IM— No ❑
If you have checked ,des, please indicate the type coverage by checking the appropriate box.
A liability insurance policy E3--- Other type of indemnity ❑ Bond ❑
OWNS& S INSURANCE WAIVER_ I. am aware that the licensee does not have the insurancecoverage required by Chapter 142 of the Mass_
General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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 the issued for this application will be in compliance with all pertinent provisions of
City/Town
APPROVED (OFFICE USE ONLY)
Chapter 142 of the Law .
Siguatur 7� Plumber
Type orLioense. Master 'e-- Journeyman ❑
License Number'
•
•
' '
■■■■■■.■■■■■..■■■■.■■■■■■rel
Installing Company Name CAI-L-44-6—
Address
AI-Li44-6—Address 13�L 110 A.) S�
Iy API)OVL12 l`1/i- Ql�
Business Telephone # % 6 �-3 3
Name of Licensed Plumber aL E U A
Check one: Certificate
[corporation
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes IM— No ❑
If you have checked ,des, please indicate the type coverage by checking the appropriate box.
A liability insurance policy E3--- Other type of indemnity ❑ Bond ❑
OWNS& S INSURANCE WAIVER_ I. am aware that the licensee does not have the insurancecoverage required by Chapter 142 of the Mass_
General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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 the issued for this application will be in compliance with all pertinent provisions of
City/Town
APPROVED (OFFICE USE ONLY)
Chapter 142 of the Law .
Siguatur 7� Plumber
Type orLioense. Master 'e-- Journeyman ❑
License Number'
73
Date .. �...�........ .
NOR7M
o? TOWN OF NORTH ANDOVER
1 9
41
PERMIT FOR GAS INST441LLATION
,SSACNUSEt
This certifies that t ....................
has permission for gas installation (?:.'.
in the buildings of ..G ...........................
at .,,). tf.1l . ...... , North Andover, Mass.
Fee. %.? ��V. Lic. No. I.> ?. !.1 .. r1 ... � 1/
G f GAS INSPECTOR
Check # �i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFTTTINO
N, UL A , Mass. Date q 20 I® Permit #
Building Location Owner's Name /93-0—c-71—&JZ,
BLUE RI.n E- RD. Type of Occupancy VQE$/A
New ❑ Renovation ❑ Replacement Et- Plans Submitted: Yes ❑ No ❑
G
Installing Company Name AC. -hg?'
Address fi /en L w
4 S`
Business Telephone ,Z 3
Name of Licensed Plumber or Gasfrtter - L,
Check one: Certificate
E] -Corporation
o Partnership
❑ Firm/Co.
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 of coverage by checking the appropriate box.
A liability insurance policy Et— 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 MGL, and that my signature on this permit application waives this requirement.
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 above 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 provisions of the ss ch etts State
Gas Code and Chapter 14.2 of the General Lawr,
By Type of. License -
Title E3 ---Plumber EJ—Master Sign Licens lumber/Gasfitter
City/Town ❑ Gasfitter ❑ Journeyman License Number
APPROVED OFFICE USE ONLY)
j
..•
■■■■■■■■■■■■■■■OEM
■■■■■■■■■■■■■■■■■■
Installing Company Name AC. -hg?'
Address fi /en L w
4 S`
Business Telephone ,Z 3
Name of Licensed Plumber or Gasfrtter - L,
Check one: Certificate
E] -Corporation
o Partnership
❑ Firm/Co.
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 of coverage by checking the appropriate box.
A liability insurance policy Et— 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 MGL, and that my signature on this permit application waives this requirement.
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 above 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 provisions of the ss ch etts State
Gas Code and Chapter 14.2 of the General Lawr,
By Type of. License -
Title E3 ---Plumber EJ—Master Sign Licens lumber/Gasfitter
City/Town ❑ Gasfitter ❑ Journeyman License Number
APPROVED OFFICE USE ONLY)
a
0
Date .........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... P
................................................................................
has permission to perform ..............
wiring in the building of ..... 4 . .........................................
at ..... 9Y .................. . North Andover, Mass.
.< . .........
Lic. No...... �.....
Check #
6 5
Ob
X
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
Lev. 1/07] (leave t,t�„v�
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 W INK OR TYPE ALL INFORMATION) Date: O fm 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)K TS
Owner or Tenant M i t .
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and.Ampacity
Telephone No.97f%�$'3�(
Yes ❑ No t' (Check Appropriate Bos)
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
Location and Nature of Proposed Electrical Work: 9-t7?t_ � � v "
No. of Meters
No. of Meters
,z...�.uuuttiurauc uerau y aestrea, 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 tinless
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:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete _
F11 M NAME: N i,GG j �"` o LIC. NO.:
Licensee: Signaturejn�!�LIC. NO.:
(If applicable, enter "exempt " in the license number line.
Address: (4110 �, % .ott h(� (� � �ysL �.• Bus. Tel. No.:
*Per M.G.L c. 47, s. 57-61, security work requires Department of Public Safety "S" License: Alt Lie. No.
OWNER'S INSURANCE WAIVER:am aware that the Licensee does not have the Iiability insurance coverage normally
required by law - Ay my signa e belo I hereby waive this requirement. I am the (check one) ❑ owner [:]owner's agent.
Owner/Agent
Signature Telephone No. 40 4jp. PERMIT FEE: $
N
I
7
Location���
No. Date *7-1 f
MaRTh
TOWN OF NORTH ANDOVER
f R
P
Certificate Occupancy
of $
s�CHust
Building/Frame /Frame Permit Fee $
9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 1160 .--
Check # 3Q I
,
A(
'� Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
101 set" ON* 10
BUILDING PERMIT NUMBER: _ •� DATE ISSUED: /� �IL&?T—
SIGNATURE:
Building Commissioner/IngWor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
Zq S iL t (fib
1,2 Assessors Map and Parcel Numbs:
210.OK6-v) 4 2. -owaa
Map Number &,5— Parcel Number
c
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
LA Area Fronts fl
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Reqttired Provide RzqWred Providedred
Provided
1.7 Water Supply AGI -C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zona Outside Flood Zone ❑
1.8 Sewetap Disposal system:
mutdapal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
'' i B t f i Ct: yes NO
2.1 Owner of Record &P, ph 4e.<f /14�A H #X 2yS' &*e jD4e AP-Aaork ALA
Name (Psi Address for Service:
Signature Telephone
T 2.2 Owner of Record:
Name Print Address.for Service:-
i
Sistnature Tel hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
.f 4n,rw t flSt a,oe — Cv s JtIA 6#j
r Company Name
AAA4 ) S?o
Not Applicable ❑
1'32- "737
Registration Number
-3121167
' Address
W 7
Expiration No
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... 0
SECTION 5 Description of Proposed Work check v bk
New Construction 0 Existing Building ❑ Repair(s) ❑ PAlterations(s) 0 Addition 0
Accessory Bldg. ❑ Demolition 19 Other Ig, specify 9,014 G e D e G K
Brief Description of Proposed Work:
()-cm0t,*r"011 rtna remootl off- f_X STI'vl beA
R-t?igce w,Th ryew Dr. c.
J
Qo
I SRC'TTON 6 - RSTtMATF.I) VnNCTRiirTTnN rneTe f
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFiaa USt ONLY
;
1.
Building
(a) .Building Permit Fee
Multiplier
2
Electrical
(b) Estimated Total Cost of
Construction
3
Plumbing
Building Permit fee (a) x (b)
160-
4 Mechanical HVAC
5 Fire Protection
6
Total 1+2+3+4+5
Check Number
.� a aav� A v DL' a,vDiriur, i L' it W r=rJ I
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,1 - .+ Q // ° + s , s , , i "Y as . - r + ' • ' ` . � �i ;. .
as Owner/Authorized Agent of subject property
Hereby au rize CAW&V S aJ _ to act on
My be)Il mpte relativ wok uthorized by this building permit appl cation.
Signature ot*Uwner Date
SECTION 7b OWNER/AUTHORI7.RD Ar.F.NT nRrr.ARATTnN
I, Curr s Drggoh EgRr1+ L4UM VE'
,as Owner/Au 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
C U r ii S O rC150 to
Print UN� -
SJ, Tl 2s1 oS
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2 ND3 KU
SPAN
DMNSIONS OF SILLS
DUviENSIONS OF POSTS
DIMENSIONS OF GIRDERS q
HEIGHT OF FOUNDATION THICKNESS r
SIZE OF FOO'L'ING
MATERIAL OF CHIMNEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED T'kO NATURAL GAS LINE
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f
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT.
400 OSGOOD STREET
NORTH ANDOVER MA 01845
978-688-9545
978-688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print
DATE &- l � • 6s -
JOB LOCATION
2515 gLub j2j:
Number
lJotir/v
Street Address
Map/Lot
HOMEOWNER �� `h . �ot� c yin �17�- 6P3'6 S' LG �,o 17- L/3 Y- y7yt/,
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
IS 1� LkQ4
/yo.,9VarAA . Vii- 41 � Yr
City/Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings of
two units or less and to allow such homeowners to engage an individual for hire who does not possess a
license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1.)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is or is
intended to be, one or two family dwelling, attached or detached structures attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and
other Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building
Department minimum inspection procedures and requirements and that he/she will comply with said
procedures and requirements. /? z
HOMEWOWNER'S SIGNA'
APROVAL OF BUILDING OFFICIAL
I fie Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
Boston, MA 02111
www mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): y�o . dt 840eA
Address: ?-Ys gLwe &a e
City/State/Zip: A),0- &D✓F✓t Mv4: dlBYS Phone #: 97 P
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employee's (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
C. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
COMP. insurance required.]
Type of project (required):
6. ❑ New construction
7. e, Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. El Electrical repairs or additions
I I Q Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
"" I—' �,,cVnJ wn rr, inusL also nil out pre 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.
tcontractors 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:
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-yearmprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify unde 4 pai nd pen4ies of perjury that the information provided above is true and correct
I/
-V= 4R'i-
Oficial use only. Do not write in this area, to be completed by city or town official
City or Town:
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6. Other
Permit/License #
3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employersservice of another ander any contrace workers' compsation for their t Of hire .
Pursuant to this statute, an employee is defined as ...every person in the
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
individual, partnership,
association or other legal entity, employing employees. However the
receiver or trustee of all
owner of a dwelling house having not more than three
apartments
anconstructioneorwho residsthrepau�work on such dwelling house
dwelling house of another who employs persons to d
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 munber(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or imited Liability Partnerships
LLif an) with
oo employees do haveother than the
members or partners, are not required to carry workers'compensation of
employees, a policy is required. Be advised that this
e. Also be sufidavit rge to sign and day be submitted te the affidthe avit. The affidavit should
Accidents for dustrial
confirmation of insurance coverag
be returned to the city or town that the applicationforthe rmorthe law or if you r license is being
ques required to obtain aanot the orkDepartment of
Industrial Accidents. Should you have any questionsregarding
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
to
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo
tm
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 app
licant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The 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 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
Number 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.
The debris will be disposed of in:
/J"WW Sob- 6%0-Tik
Si,,Awk" mrar o,
(Location of Facility)
O. mA .01?
o�
gnature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
EARTH LANDSCAPE
Arborculture / Horticulture
Ecological Organic Gardening
6 Abbott Street
Salem, MA 01970-1102
(978) 744-1475
T0: Roger & Maura Boucher
245 Blue Ridge RD
North Andover MA 01845
PHONE DATE
978-683-6526 1 06/12/05
JOB NAME / LOCATION
New Deck,Footings,Pea stone & Weed
fabric,Dumping,Play Set Area
Installed,Equipment, Transplanting,Sod,
New Plantings, Stepping Stones,& Mulch.
New Deck,Footings,Pea stone & Weed fabric,Dumpinf,Play Set Area Installed,Equipment,
Transplanting,Sod, New Plantings, Stepping Stones,& Mulch.
1. New Deck Replacement
2. Demolition & New Footings
3. Dump Fee's
4. Under Deck Pea stone & Weed Fabric & other areas in rear.
5. Play Set Base Installation
6. Equipment, Bobcat, Sod cutter, Tiller, & Trucking
7. Transplanting in front & new sod installed
8. New Plantings in front
9. Rear Right stepping stone path & Planting, $575.00 & $1000.00=
10. Design & Planning $300.00 - $600.00
11. Tax on materials $350.00
THIS ESTIMATE IS FOR COMPLETING THE JOB AS DESCRIBED
ABOVE. IT IS BASED ON OUR EVALUATION AND DOES NOT IN-
CLUDE MATERIAL PRICE INCREASES OR ADDITIONAL LABOR AND
MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORESEEN
PROBLEMS OR ADVERSE WEATHER CONDITIONS ARISE AFTER
THE WORK HAS STARTED.
For the sum of 16,175.00
$ 8000.00
1000.00
300.00
1000.00
1200.00
600.00
1000.00
1500.00
1575.00
NOTE: This estimate may be with-® 06/24/05
drawn by us if not accepted by
ESTIMATED BY C.�-v Y
- Board of Building Regulations and Standards
One Ashburton Pluce - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 132737
Type: DBA
Expiration: 3/29/2007
EARTH LANDSCAPE & CONSTRUCTION
CURTIS DRAGON
6 ABBOTT ST
SALEM, MA 01970
DPS -CAI is 5OM-04/04-G101216
✓/� %�asrrmooau�al�1. n`� �1.��;�rtu�;r�
Board of Building Regulations and Standards
n HOME IMPROVEMENT CONTRACTOR
b' Registration: 132737
Expiration: 3/29/2007
Type: DBA
EARTH LANDSCAPE & CONSTRU
E501S DRAGON
6 ABBOTT ST S ��
SALEM, MA 01970 Administrator
Your 3—rear ironing cycle crd.c on th- dale beloy.:
at which time. you may be audited to rLrifV all COKIId;a
hou.s (credits) earned durine the Irior 3 •ear;
Ci:
COMMONWEALTH OF 11AASSA0-, t
PESTICIDE
ICIDE
CURTIS J DRAGON
6 ABBOTT STREET
SALEM MA 01970
OacumentT,pa
Cir. r.•' :cart
Applicator License
12/10/2004
Ucense Numbe:
Ezriruor t^.,*.s
30640
12/31/2005
Categoryl&;bWegory
000
---- INSTRUCTIONS —
Update Address and return card. Marl: reason for change.
Address Renewal Employment Lost Car
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
1. Sign License. 2. Carefully peel out the license from the left
edge. 3. Flip license over. 4. Place license carefully over
remaining lamination. 5. Push through to remove laminated card.
123
J
Not valid without signature
V7 -�-SCIJRCES
S!_T_-KC
S
EI�
i. ._ - .. _ _ _. •
, .�.- 1•:..• •:f(..i Iil7i:ill.: Ji the
rjl
:u c:i , nt to chatlgc in
—.n.e:
...:mur:
i,nrniz�tion below
i
1. Sign License. 2. Carefully peel out the license from the left
edge. 3. Flip license over. 4. Place license carefully over
remaining lamination. 5. Push through to remove laminated card.
123
FORM U - LOT RELEASE FORM
CHIC PI AC
J-�>.eCfc
[ aA� 4,1 4%
INSTRUCTIONS: This form is used to verify that all necessary approvals% ermirforom�,
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTIO
APPLICANT R o 6ER, t3 v ch e Y' I���rcl ,EO PHONE q7$- 683_U.16
LOCATION: Assessor's Map Num 16 2005 PEEL_.___--_
SUBDIVISION LOT 101
=Mffity Development �s�
STREET_ Q 1 Vit R; 4,9 t. Rd . and Services ST, NUMBER 14
OFFICIAL USE ONL
do
'P/��_..���.:: LSI'
. LZ
. 1
v � �
TOWN PLANNER DATE APPROVED
DATE REJECTED
--------------
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR_
DATE
Rwlpd 9W jm —.
A)OIZCQ�aCj C --W Inspe-ccloti �Larz,
Cot 65
.Pcvpert-V: N. Ax✓er
ref Mood fan¢.: �.5 o o 98 ac)7c flood zone; x
�m6g certify tW mortgage insp don was.prrpar"-fbr
A
%Jom Geo lt %- sotm Ba ilk. a� 7fuft-
9heUutig slwwm herein does x4t' W im a spmc a, TEMA ftood,
hazard area witfv am eRMW daze Of G -2 -R3 and- Ie Location, aF
the dweliing dues mtf o- nn rro flu loud pn.ing fy-laws it,
atthe tune oFconstruction wift respectto horhontacl dimertsionar
setback- re%uuvn .e nts or is exw4n r f vtm Vtolactwn, artforeenurte
c(o o* under mass. Gen.erat -L,awS QU(pt 40 1-Sect10YL 7.
PLEASE NOTE: The
determination of the
used for recording
purposes. This plan
or lot configuration
is shown hereon.
PAUL
T.
GROVER
No 31311
Scale: I"
Date: ►-7i � J __ ---
File No.___O (-_Oj_3L__
structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise
building location and encroachments, if any exist, either way across property lines. This plan must not be
purposes or for use in preparing deed descriptions and must not be used for variance or building plan
must not be used to locate property lines. Verification of building locations, property line dimensions, fences
can only be accomplished by an accurate instrument survey which may reflect different information than what
Please note that this is "NOTA BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY
COLONIAL LAND SURVEYING COMPANY, INC.
269 Hanover Street - Hanover, Mass. 02339 - Phone: 781-826-7186 - Fax: 781-826-4823
4 0 9 5
.0k
S C US
Date ......o
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ .. . ...............
(A
f.. .... / .....................................
has penpission to perform .... t1..I.d .................................................
q Ch -e /2-
wirin& the building of .... . .....................
..........
�Y-I/ C/
at ........ /� ...... 41.f. A4 ..... -... h And
... .... .. ........... .
Fee .3.3. ....... 4 ........ Lic. No.W71a.. .. . .............. .....................
�LECTRICALINSPECTOR
Check #
THECOMMONWEALTHOFMASSACHUSEM Office se only
DEPARTM&VTOFPUBIJCSAFEIY
BOARDOFFIREPREVEVHONREGLYAHONS527CMR12-M P
ermit No.
ccupancy & Fees Checked
APPUCATIONFOR PERMIT TO PERFORM ELECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ��
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date l a2
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described
below.
7
Location (Street & Number) � w P Owner or Tenant (/� v c A el?
Owner's Address
Is this permit in conjunction with a building permit: Yes C-3 No ® (Check Appropriate Box)
Purpose of Building �.w(y �� �i9.41 Utility Authorization No.
ExistingService Amp ��Volts
Overhead Underground No. of Meters
New Service I Amps / Volts Overhead Undergiound � No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ft/'/< va . C ,Y/iT;/VG
No. of Lighting Outlets No. of Hot Tubs No. of Transformers
Total
No. of Li htin fixtures KVA
g g , Swimming Pool Above Below Generators KVA
t round round
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
No. of Ranges No. of Air Cond. Total FIRE ALARMS
No. of zones
Tons
No. of Disposals No. of Heat Total Total No. of Detection and
Pumps Tons KW Initiating Devices
No. of Dishwashers Space Area Heating KW No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Local Municipal Other
No. of Water Heater-, KWConnections
No. of No. of
t
Signs Bailasis
No. Hydro Massage Tubs No. of Motors Total HP
OTHER
filstlralloeCovaage Ruaaat>Ctoth m4meanaysofMa%adxmmGefaalLaws
[haveaomaltLiabktyh>Stmmpblicynr xkgComPletl,OpFabonsCom%poril atsultia oquwalalt YES NO
iwkingtheaadvalidproofofsametotheOffimYFS 17 ET Yyuhawdled®dYES,plea9eit>aicatethetWOfmvetageby
I�lgthe box
NSURANCE� BOND ORS (pmSpe*)
Vo(ktoSlatt hgec6nD&Regt>esW
gned underlie Ptd of pegtuy.
IRMNAME
Sigtiahne
Rough EslJmaWValueof8echiWWo1k $
Final
LiMWNTO. / ^�
_ Lio wNo
dclmcc ` Q6 D �i�� /f //�; / /�`^�-���/✓� '�y�0 BuAILTel No.
Wl'WSINSURANCEWANER;IamawatedattheLioatsedoesnothavedieit>,%rx)woDvaabo,eorAswbst ntdequival itastepWbyNb%xhuselsGaletalLaws
dthatniysignahneonthispemittapplicMthislequamn.
'lease check one) Owner Agent
Telephone No. PERMIT FEE $
.
Signature o caner or gen
Date.Y.��...J�..........
No 2JG2
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that t _ .�1 '`� ....rte`. .....................................................
has permission to perform'. ...
....... .............................................
wiring in the building of............................................................
L,s I ,
J` � .......... ,North Andover, Mass.
ee.j ELECTRICAL INSPECTOR
08/19/98 16:10 40.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
r,15 &07)M E11U7W it
1JgtaaC--e aj P-" Sa fccy .
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit Na C9&-Ocp^
Occupancy & Fee Chected _
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts EleGrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date - Y'
To the Inspe or of fres:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number z 4 s- bwiz '-� 106r
Owner or Tenant 11\4 Iz- E E Ij �-
Owners Address
Is thisit in conjunction with a building / Z 73 d
perm ) ng permit Yes No ❑ (Check Appropriate Bax)
Purpose of Building Re S ( r✓QA/(- �- Utility Authorization No.
Exis ' a Servt�+c�2-O � Amps 2 t0 Volts Overhead ❑ Undgmq-)S� No. of Meters
New Service Amps Volts Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed E!ect ical Work BA S 6 PIC&/ -F r/ %— L/ P
OTHER:
INSURANCE COVERAGE. Pursuant to the requremeri ts of Massachusetts General Laws
I have a current Uability, Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BONO = OTHER = (Please Sperafy)
(Expiration Date)
Estimated Value of rk$
Work to Start g Inspection Date Resquested Rough 8 Z 9� Final
Signed undera aM f perjury: 3
FIRM NAME t.1 4C ':7LIC. NO.
Licensee d t C ALL –7-- ?j+�- PAIL Signature I UC. NO.
�j n r e _ us. Tel No.
Address_ 1 O Q K a s 4 A4 1k /—S / AJ !� _ Alt Tel. No. SQ tA —
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE S__ -----
(Signature of Owner or Agent)
Total
No. of Ught8ng Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Ughtinq Fixtures
Swimming Pool gmd ❑
grid ❑
Generators KVA
No. of Emergency Lignbng
No. of Receptacles Outlets
No. of Oil Bumers
Battery Units
No. of Switch Outlets 4-11
No of Gas Bumers
FIRE ALARMS No. of Zone
No. of Detection and
Total .
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diooaal
No. Pumos
Tons
KW
No. of Sounding Devices
No.l of Self Contained
No. of Dishwashers
Soace/Area Hearing
KW
DetectiorvSounding Devices
❑ Municipal ❑ Other
No. of t'tvers
Heatin Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of W4ter Heaters KW
Signs
Badases
Winn
No. Hvoro ossa a Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requremeri ts of Massachusetts General Laws
I have a current Uability, Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BONO = OTHER = (Please Sperafy)
(Expiration Date)
Estimated Value of rk$
Work to Start g Inspection Date Resquested Rough 8 Z 9� Final
Signed undera aM f perjury: 3
FIRM NAME t.1 4C ':7LIC. NO.
Licensee d t C ALL –7-- ?j+�- PAIL Signature I UC. NO.
�j n r e _ us. Tel No.
Address_ 1 O Q K a s 4 A4 1k /—S / AJ !� _ Alt Tel. No. SQ tA —
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE S__ -----
(Signature of Owner or Agent)
Location
N6. Date
MaRT�
TOWN OF NORTH ANDOVER
�?O�,t `•o ,•,SOL
Certificate of Occupancy $41
Building/Frame Permit Fee $
+ ; .
s °, • .
�'�b'•••° •''��'
SJACHUSt
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ -5
16U il;ing I spector
7 3
J
Div. Public Works
Lpcation ,
Nb. Date •
NaRT� TOWN OF NORTH ANDOVER
3?0: .ao ,a,h•COL
a Certificate of Occupancy $
Ipp
Building/Frame Permit Fee $
+ "o
��b''•a°''<�' Foundation Permit Fee $
SJAGMus
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ '
Building Inspector
e
Div. Public Works
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This certifies that
Date/. ..��...`..�.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
................
has permission to perform .... . ` ` ..r........................
plumbing in the buildings of ... 4 .`..`.....`................... .
at ..�. �.-... I l ......... ':`............. . North Andover, Mass.
Fee.Lic. No........' .. ....................
PLUMBING INSPECTOR
Check #
5U;5
NORTH ANDOVER, Maas, Ods
Building Permit S a a )
Location . ,
Ownet's ��
Name • s✓
New p Renovation p Replaceent Plans Submitted: Yea p No. ❑
�iXTUAES •••
Check one: CartWicate
Installing Company Name ANDOVER PLBG. & HTG. CO. INC. �/C 2122
Address 20 AEGEAN DRIVE UNITI 10 ❑Partnership
METHUEN, MA. 01844 pFirm/Co.
Business Telephone 978=685-8383
Name d Ucensed Plumber runggl: LAROSF
INSURANCE COVERAGE: ChecK 06
I have a current Ilablifty Insurance policy or Its substantial equhralenL Yea W, No CI
It you have checked y". please Indicate the type coverage by checking the appropriate box
A liability Insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the ilceniee does riot have the Insurance coverage required by
Chapter 142 d the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner p Agent p
Signature o et a Omer a en
I?ueroby caMfy that all, of the dotage and Infortnatlon I have mAxrMod for enteredl In above application are true and sewrate to the best of my
knowledge and that aA plumbing work and Installations performed under thepenNt Issued foe this application will be In compliance with M
pertinent provisions of true Massachusetts State Pkrmbing Code and Chapter IIZ of the Cloner ,
-
Title tigna
uri or ucensod Mumbet
CRY/Town
Af'f' YMD (OFFICE USE ONLY)
Ucense Number 9983
Type of Plumbing License: Mailer
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tTH FLOOR
4TH FLOOR
-
Check one: CartWicate
Installing Company Name ANDOVER PLBG. & HTG. CO. INC. �/C 2122
Address 20 AEGEAN DRIVE UNITI 10 ❑Partnership
METHUEN, MA. 01844 pFirm/Co.
Business Telephone 978=685-8383
Name d Ucensed Plumber runggl: LAROSF
INSURANCE COVERAGE: ChecK 06
I have a current Ilablifty Insurance policy or Its substantial equhralenL Yea W, No CI
It you have checked y". please Indicate the type coverage by checking the appropriate box
A liability Insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the ilceniee does riot have the Insurance coverage required by
Chapter 142 d the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner p Agent p
Signature o et a Omer a en
I?ueroby caMfy that all, of the dotage and Infortnatlon I have mAxrMod for enteredl In above application are true and sewrate to the best of my
knowledge and that aA plumbing work and Installations performed under thepenNt Issued foe this application will be In compliance with M
pertinent provisions of true Massachusetts State Pkrmbing Code and Chapter IIZ of the Cloner ,
-
Title tigna
uri or ucensod Mumbet
CRY/Town
Af'f' YMD (OFFICE USE ONLY)
Ucense Number 9983
Type of Plumbing License: Mailer
Journeyman 0
Date. / l...il ..:. •......... .
TOWN OF NORTH ANDOVER
D
• PERMIT FOR GAS INSTALLATION
This certifies that f
has permission for gas installation .............................
in the buildings of .... ?... t . �..� ..- ....................... .
at ............ North Andover, Mass.
Fee......:.. Lic. No..:. ......
Check # / )
.... ..:::......
GASINSPECTOR
MASSACHUSETTS UII FORM APPLICATON FOR PERMIT TO DO GAS FITTING
or print)
I.vnfH ANDOVER, MASSACHUSETTS
Date
Building Locations 245 'R"e-16da Rb Permit # 3 V� 3
Amount S
New ❑ Renovation ❑
Owner's Name
Replacement y
x`04,e- %o er
—%J ❑Plans Submitted
(Print or type) Check one: Certificate Installing Company
Name Andover P1W. & Htg. Co.. Inc. 0 Corp.
Address 20 Agean Dr.-, Unit -10 ❑ Parmer.
Business Telephone
Name of Licensed Plumber or Gas Fitter George Lagosp
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Q No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver. 1 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.
Signature of Owner or Owner's
Check one:
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 Massachusetts State Gas Co�and ChaRterj�2 "e General Laws.
By:
Title
CityiTown
.�VPROV ED wi i-icF. USE ONLY)
lgnature of'.
Plumber .
❑ G Fitter
(✓lasfer
❑ Journeyman
ed Plumber Or Gas Fitter
9983
License 1 umoer
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(Print or type) Check one: Certificate Installing Company
Name Andover P1W. & Htg. Co.. Inc. 0 Corp.
Address 20 Agean Dr.-, Unit -10 ❑ Parmer.
Business Telephone
Name of Licensed Plumber or Gas Fitter George Lagosp
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Q No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver. 1 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.
Signature of Owner or Owner's
Check one:
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 Massachusetts State Gas Co�and ChaRterj�2 "e General Laws.
By:
Title
CityiTown
.�VPROV ED wi i-icF. USE ONLY)
lgnature of'.
Plumber .
❑ G Fitter
(✓lasfer
❑ Journeyman
ed Plumber Or Gas Fitter
9983
License 1 umoer
