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HomeMy WebLinkAboutMiscellaneous - 25 BRENTWOOD CIRCLE 4/30/2018 (3)91 N O f,, O co W X G) m Q z g0 N O O go C7 O;oO O l -.0 Date... 10552 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This,certifies has permission to perform .... . ......... ......... . ................................................. plumbing in the buildings of........:at .. .............. 2-c5 4 Ctzz-o-k . .................................................................................................... North Andover, Mass. Fee -90 ............. Lic. No. 1325 .... .. N ....................... PLUMBING INSPECTOR Check # P TYPE OR PRINT" CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A CITY LhO,r—WN ,....+1 \1..___..__._.._. MA. DATE JOBSITE ADDRESS aS-..,_.�rr1.. .. ��_f:�p__.__..._._: OWNS OWNER ADDRESS: OCCUPANCY TYPE: COMMERCIAL Q EDUCA NEW: ❑ RENOVATION: ❑ REPLACEMENT: lei Fi)UMES l FLOORS, I Bsmt 1 1 12 13 1 4 1 5 16 11 DEDICATED SPECIAL WASTE SYS I DEDICATED GASIOIL1SAND SYS DEDICATED GREASE SYSTEM 1 DEDICATED GRAY WATER SYS I UL"uivA 1 C'iJ V IA T ER RCUOC J T O 1 I I I I 1 I C� l! —A-\ 0- \qu FOOD WASTE GRINDER UNIT FLOOR/A REA DRAIN I INTERCEPTOR INTERIOR M KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE ! MOP SINK TOILET URINAL I WASHING MACHINE CONNECTION I II WATER HEATER ALL TYPES �, G� is -->a" ��-�-- INSURANCE COVERAGE�j�q,Pt,� I have a current liabili insurance policy or its substantial equivalent which meets the requit If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the liceitsee 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. OF OWNER AGENT CHECK ONE ONLY: OWNER ❑ AGENT LI thereby ce rtify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to a best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applica n will be in complia cl all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws44); �. PLUMBER NAME: . _. _..._�- $' LICENSE # 1-7 -- SI _ ' ATURE - COMPANY NAME: RESS: CITY: _ _ ._ _.._. STATE ZIP: _- -- CELL: �EMAIL: MASTER JOURNEYMAN [] CORPORATION E2 /#22KPARTNERSHIP ❑ #�. . ..... .. ......1 LLC ❑ # -SJ2��q bj ry�ckL H Uw a r , w a z LU + CO3 M .w 3 j a o w a v J a a � a ti W I I 0 F � U a o « O O f '* MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK TY'R OR i'IiT111T CLFARLY CITY ....A)Q'(-W ....... v\ .._._..____.._. , MA. DATE I-....... ..a_��`i ...�... PERMIT# JOBSITE ADDRESS aS�- _ CiJ.'C.. r_ ._.__ OWNER'SNAME �0 __..1✓1`l__._._ ., _..... _ OWNER ADDRESS: ........ . . TEL:[FAX OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL j NEW: ❑ RENOVATION: ❑ REPLACEMENT: 21 PLANS SUBMITTED:,YES ❑ NO ❑ FDaMES 1 FLOORS— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GASIOILISAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS GEniCHTCU VtiM —I CR REUSE S'l ^0 DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR /A REA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY - ROOF DRAIN SHOWER STALL _ SERVICE / MOP SINK TOILET - - - URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 'WATER PIPING INSURANCE COVERAGE 1 have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES ❑N NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT thereby ce rtify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to a best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applica n will be in complia ct all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER NAME: _ ... S LICENSE # SIGNATURE E CX COMPANY NAME: .. - -- RESS:� . _ ...... ... CITY4, -_ - - STATE: ZIP: _ CELL: �._._ EMAIL,, MASTER JOURNEYMAN ElCORPORATION Lam# Mrs� PARTNERSHIP ❑ # LLC ❑ # -SI2� 1 q Ce_. c-10 b j ryAcA- .w V O U e� a ` z❑ o F z N a 3 N a o g a a � � a J a CL H { , x O F t D O � r Date....! TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 10 t ss �c r This certifies that !..:.. �...` C.1�C 1 ..........................................t.................�............................. has�permission for gas installation. .. � NA-�- s ...................................................... in the buildings of ..........�. a^''?.......................:............................................. at ...... Z...<�........v?.......�:.��.e:O, North Andover, Mass. Fee .1.p...� .. Lic. No.� t �.... ............................................................... GASINSPECTOR Check # IYRMI MWRANCECOVERAGE -vigORMthbItbmw=POL70rbwASWrAWNphWMWft I-lgwmp*wnoftofMGLCILia YES"'o -9 hove docked XM 09m bWbo . da"of "" ;7 ftapprCpjwb=lhAmmj- J I LUMMOMAWCEPOLCY OTHER TYPE IMDaVffff E3 BOND 0 MEWS WSURANCEWANER: I= - W Iff FT iF7r,:FT7 AM �j r4F Mir Otte! 0 C G1 ,x n z b A °z z 0 H tai i i m y m y 'r 1 n � i � b � m � N m D � m O z r ❑ Of �C F% y b izzmr H O z z 0 H The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 UP www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Al iDUcant Information Please Print Legibly Name (F Complete Comfort Systems, Inc Address DBA Climate Zone 230 Essex Street �., Haverhill, MA 01832 Y Phone #: - )+ Are you an employer? Check the appropriate box: 1. RFI am a employer with Q 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ 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' coma. insurance reauired.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. [Other N V ,Ar— *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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. . Insurance Company Name: Policy # or Self -ins. Lic. #: l ��C `J,�jt�j.�({���(�}j� Expiration Date: I 1 I S Job Site Address: @S ('(? A WCO& C�O(>_ City/State/Zip: G~✓P� l G�(iS` S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct I n _- '1 _ A 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 Town of North Andover Your permit has been sent back to you for the following reasons: 1) Check amount incorrect 2) No copy of current license 3) Insurance Binder not on file or expired - 4) No Workers' Compensation Insurance Affadavit 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. 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed 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, firm 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 lnspector_of_Wires abandoned-and.invalidiflie—.._. 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. El 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 puipose by establishing an automatic four-year extension to certain permits and licenses concerning 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. 8 — Permit/Date Closed: y-�%%�k*Dote: Reapply for new permso 0 Permit Extension Act — Permit/Date Closed: 9576 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ Pte" .................................... ............................. has permission to perform ...... .............. wiring in the building of .......... EL G ................................. / ................................ - ......... ...... 0'�� ................ . North Andover, Mass. at ..... ....... .......... .... .. ...... Fee ..... Lic. No. fq?I.,4 .............. Check # -"-N liV//////U/IWCd/L1/ UI /7dD.�d�.IILIJCLlD ---- -Q--- - Department of Fire Services Permit No. !,�' %� � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank 't APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8-10-10 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) ,(I ePLjj , Owner or Tenant (,'j(je (, (� �'� $ %/L,j�e a� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 01/o Utility Authorization No. Existing Service 2PC-)&mps /?-0/46 Volts Overhead ❑ Undgrd [�r No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location nd Nature of Proposed Electrical Work: 1�� jq j1� w j %T $ aAj AVe GV 1fo(,ire,,a Ls _ Rewt2 �Xt sTi t �CCtx� re Gv/2ps �� z � U All E X/ 571n.r C% RL't,,'t% S '+ Completion of the followin table may be waived by the Inspector of Wires.MAjrei`, No. of Recessed Luminaires No. of Ceil: (Paddle) Fans of Total TransSusp. Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. Elrnd. ❑ o. o 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 g No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: 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 No. of No. of Data Wiring: Heaters Signs Ballasts 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 Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /O / 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover)a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the ams and penalties ofperjury, that the_htformation on this applicatio e . true and complete. FIRM NAME: F/?-Imc FF/?-lm(e �' Licensee: A2 (If applicable, enter " Ae t" ''n the I'cense Address: G �vQ�,� *Per M.G.L c. 147, s. 57-61, security w OWNER'S INSURANCE WAIVER: required by law. By my signature belo, Owner/Agent Signature 6"7 - LIC. NO.: f ,3 / Signature . LIC. NO.: Fl,> 4(0 us. Tel. No.. -277 6 Y2 76 8 6 Alt. Tel. No.:9X `! i i/ 3 �j quires epartment of Public Safety "S" License: Lic. No. I aware that the Licensee does not have the liability insurance coverage normally I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Telephone No. I PERMIT FEE. $ _J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information _ Please Print Letzibl' Name (Business/Organization/Individual): Address: City/State/Zip: Are you an employer? Check the appropriate box: 1. R I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ 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.] q2_7( Vb Type of project (required): 6. ❑ New construction 7. [modeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. El Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 1 . 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-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 a st the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of theDIA insurance coveragecation. I do hereby certi fkgoer the pains information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town oftciaL City or Town: Permit/License # _/C) -, 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 #• Date .. ...... WORTH 32 �` TOWN OF NORTH AND,61VER p PERMIT FOR GAS INSTALLATION 9SSAc HUSES This certifies that ....�, ....... ...................... . has permission for, gas installation ......�°� 04 y -4 .......... in the buildings of ......................... . �iZe�.(�. 0ocl C (h at .� .% ....�........................ ., North Andover, Mass. Fee. D s Lic. ...... GAS INSPECTOR Check # / 7327 MASSACHUSETTS LMORM APPLICATON FORPERAW TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date $ - 3-10' Building Locations .oP rl Permit # 1" . Amount $ '� v 1 Owner's Name fS CV7`lta�/ New1:1Renovation n Replacement Plans Submitted (Print or type) Name_ Address _ W . d kW S, �0 C"/ �Pn3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company .❑ Corp. ElPartner. u , INSURANCE COVERAGE Check e: I have a current liability Insurance policy or it's substantial equivalent. Yes No' If you have checked yes, please indicate the type coverage by checking the appropriate b x. Liability insurance policy r --T 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 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 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 I sued for this application will be in compliance with all pertinent provisions of the Massachusetts Sieg Gas Code aocd? Chapt _the General Laws. Title City/Town APPROVED (OFFICE USE ONLY) Slinature of Licensed Plumber Or Gas Fitter © Plumber `s-3 2 E] Gas Fitter Cy License um er ® Master Journeyman �SUB-BASEM ENT (Print or type) Name_ Address _ W . d kW S, �0 C"/ �Pn3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company .❑ Corp. ElPartner. u , INSURANCE COVERAGE Check e: I have a current liability Insurance policy or it's substantial equivalent. Yes No' If you have checked yes, please indicate the type coverage by checking the appropriate b x. Liability insurance policy r --T 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 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 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 I sued for this application will be in compliance with all pertinent provisions of the Massachusetts Sieg Gas Code aocd? Chapt _the General Laws. Title City/Town APPROVED (OFFICE USE ONLY) Slinature of Licensed Plumber Or Gas Fitter © Plumber `s-3 2 E] Gas Fitter Cy License um er ® Master Journeyman The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiv Name (Business/Organization/Individual); ¢ S u Wibj Address: City/State/Zip: dvlK . Phone #: P:? f - rzJ = -� 7/0 Are you an employer? Check the appropriate box; 1. ❑ 'I am a employerwith 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors 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.® Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other " Y applicaat that cher s box.#1 must also ill out the section below sho:~ •^ . Taw .,_., 1 i. b or �' comms anon policy information. T F€omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contactors 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 emp information. loyees Below, is the policy and job site Insurance Company Name: Policy # or Self -ins. Lie. 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 criminalenalties of a p fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: _ Date.: Phone #: 97 f' 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 CIerk 6. Other Contact Person: 4. Electrical Inspector S. PIumbing Inspector 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 coxnpliance with the insurance coverage required." Additionally, MGI, 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 chapterhave 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 city or town that the application for the perimaitor I,cens e is being reouestea, not the Department of Industrial Accimlents. 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 "Sob Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance f6r 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 o-fMassachusetts Department of Industrial Accidents Office of Invrestibns. atio 600 Washington Street Boston, MA 0.2111 Tel. # 617-727-4900 ext 406 or 1-8 77MASSAFE Revised 5 -26 -OS Fax # 6.17-727-7749 wvcm1.mass._gov/dia Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1SSACNUSEt J. ..... . This certifies that ... .....,. ............ has permission to perform ................. plumbing in the buildings of ...-....... at .2�.).- s -n C v..,North Andover, Mass.. . ... �` Fee.Lic. No../ �...... ....... ,PLUMBING INSPECTOR Check # L 8392 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIlNG (Type or print) NORTH ANDOVER, MASSACHUSETIS Building Location � r 4 Q?,,4.v0 Cy G Date _ ' 3 "/,0 - Permit # ' kj ?i -L Amount— T — - Type of Occupancy New Renovation Replacement Plans Submitted Yes No r+r.vmir�7'l T C (Print or type) f ( % Check one: Certificate Installing Company Name "ItS vsv4' nJStPy zst9y✓ a C'. , Address Y/ 119 El Partner. _ a,/r 7 4ro Business Telephone J 9 7 f- 9./S'— Name of.Licensed Plumber: -Xfownc&7 � Insurance Coverage: Indicate the type of ' surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee ofthis application does not have any one ofthe above three insurance Signature Owner F1 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 mylmowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusState Plumbing the General Laws. Ty&' of Plumbing License /.r3;6, License Number Master journeyman ;D (OFFICE USE ONLY s I iiii�i iiiiNo NOON mom OEM mom (Print or type) f ( % Check one: Certificate Installing Company Name "ItS vsv4' nJStPy zst9y✓ a C'. , Address Y/ 119 El Partner. _ a,/r 7 4ro Business Telephone J 9 7 f- 9./S'— Name of.Licensed Plumber: -Xfownc&7 � Insurance Coverage: Indicate the type of ' surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee ofthis application does not have any one ofthe above three insurance Signature Owner F1 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 mylmowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusState Plumbing the General Laws. Ty&' of Plumbing License /.r3;6, License Number Master journeyman ;D (OFFICE USE ONLY The Commonwerzdth Of A, Department ofI"radustr-ialAccidents Office Of.tAvestigations 600 Washington Street Boston, I.L4 021II xw"nv_Mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/COntractors/Electrician 5/Plumbers �Iicant Informafion .. NaMe (Business/Oro nizatio&ffidividual) / S'7`iJ(?a�iyv - Address: _• '-(// • Je�aevSow A City/State/Zip:�r���,. , ,r ?6 . Phone #: i7,` - 8'��--•� ?�� . •Are you an employer? Check the appropriate box: 1.0 I am a employer with. 4. ❑ I am a general contractor employees (frill and/or part-time).* 2. [ I am a sole proprietor or and I have hired the sub -contractors Misted [ partner- on the attached sheet I ship and have no employees *in These sub-coh{mctors have working for me any capacity. workers' comp, insurance. [No workers' comp. insurance �. ❑ We are a corporation and its 3. ❑required.] am a homeowner doing work officers have exercised their .I all myself. [No workers' comp. right of exemption per MGL c. 152, §_1 (4), and we have insuraam required.] t no employees. [No workers' comp. instxrauc� required ] fha. chc`.a`l_. box.41 m.^qt �lSCt finl L•i„f L2�..e.••L .Op.• . Flomeowner5 •--••...P.S '• ...^ V•CIl..L' S' cOIIl^a^�a;n Type of project (required): 6. ❑ Ne -vv construction 7. ❑ Remodeling 8• ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions .11. [] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other wno suomtt Trus affidavit indicating they re a ' g e3' =_ �cmg all „ o:3ti and then hire outsi& cont*zc±ors Kiri t submit +Contmcwr- that ch, k t� box must attzbd sn additional sheet showing the a new amdavit indicating such. sante of the sub-contcaeto s and their workers' comp. policy information. .I ant an employer that isproviding workers' compensadon irzszrrance for my eraplbyees Bel©}a is thepoficy and job site inforrnaizon. 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 humber.and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the mimposition of criminal penalties of a Enc 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 Enc of up to' $250:00 a day against the violator. Be advised that a copy of this statement may b Investigations of the DIA for insurance coverage verification e forwarded to the Office of I do hereby cern under the pains and peizalties of perjury thrzr the information provided above is true and correct: Siffiattu-e: `� - Phone #: 7 -F 7/ [6.Other use only. Do not write in this area, to he completed bjJ citJn or town official a Town: Permit/Llcense # Authority (circle one): of Health .�, BtuIaiub Iiepartment 3. City/ I ownClerk 4. EIectricaI Inspector 5. Plumbing inspector 1`�ersort: Phone'#: Information ani d Instructions Massachusetts General Laws chapt-r 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statate, an employee is defined as "...every pczson in the service of another under any contact 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 Brie legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association Ox- other legal entity, employing employees. However the owner of a dwelling house having not more than three apartmL ents and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainteaaance, 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 loyal licensing'agency shall withhold -the issuance or renewal of a license or permit to operate a' business or to r--onsfruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coAnpliance 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•perfoffiance of public work ua-til. acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." I Applicants 'Please fill -out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) iVi no employees other than the members or partners,. are not required to carry workers' comp =sation insurance. ce. 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 confirmaiion of insurance coverage. .Also be rnare'to sign and date the affidavit. The affidavit should be ret'uued to the City or town That the cu`: licau L u,r the perryart•or lire -nee is b-* reque38ed, not - h, iepartWent of Industrial Accidents. Should yon have any questions reb rdLg the lav, m• i you are re hired 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 fll out in the event the Office of lnvestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be -used as a reference number. In addition; an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under `.`Job Site Address" the applicant should write "all locations in (city or town)." •A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each . year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office oflnvesiigations would like to than 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 ancHaznumber— The Comimonwealh of Massaehusa ts. Department of £ndlas ri.ail Accidents -Oce of Iuwesfiaateo.�as 600 Washimgtc n street, Boston, MA 02111 Tal. #- 617-7274900 ext 406 ar 1-9 i 7-MAS.SAFE Revised 5-26-05 Fait # 6.17-727-7749 Q � Location 5 No. 0 5 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Flame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ' FS7 tv - —'"`Building Inspector 02/13/96 12:16 78.00 PAID 1{; 9555 Div. Public Works PERMIT NO. (I vs— It APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. vole PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZONE SUB DIV. LOT NO. 422�J C�` LOCATION r�`r ��� `/ /yam [ PURPOSE OF BUILDING '[ OWNER'S NAME `2 / f� k_V1 CG ✓ 1 11r.•�rt G[ZG � NO. OF STORIES SIZEY OWNER'S ADDRESS /ll 715 �F 'AJ BASEMENT O S ARCHITECT'S NAME �, SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUiL.61NG % DIMENSIONS OF SILLS DISTANCE FROM STREET % POSTS DISTANCE FROM LOT LINES — SIDES 'f REAR ®tom I 7 -Eli " GIRDERS AREA OF LOTFRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ✓i_ C/,/ .. �/,1e SIZE OF FOOTING X IS BUILDING ADDITI els MATER:AL OF CHIMNEY IS BUILDING ALTERATI �1' n IS BUILDING ON SOLID OR FILLED LAND � WILL BUILDING CONFORM TrO REQUIREMENTS OF CODE C../ � /l ` IS BUILDING CONNECTED TO TOWN WATER p� BOARD OF APPEALS ACTION. IF ANY � IS BUILDING CONNECTED TO TOWN SEWER 6-7 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS pip—to �I-A4 -t(— /IDL[ SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHEDG AGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS BE FILED AMD &fPROYED BY BUILDING INSPECTOR RIZED AGE FEE PERMIT GRANTED 2- 19_ 3 PROPERTY IIOORMATION LAND COST EST. BLDG. CQBT/eh EST. BLDG. COST PER SQ. FT. EST. BLDG. COBT PER ROOM r SEPTIC PERMIT NO. 4 APPROVED BY NUILDINO INSPKCTOR OWNER TEL. # CONTR. TEL. # CONTR. LIC. # Of H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE d 1 2 13 CONCRETE 8L K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 114 1/2 FIN. ATTIC AREA NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING B 1 2 �_ 3 _ CONCRETE EARTH HARD"J'D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I I POOR ADEQUATE I I NONE 10 PLUMBING 5 ROOF GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES R LAVATORY % WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL, SHOWER _ ROLL ROOFING ' MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd _ 1.r 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM 4' LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. "'1 4-1 IRON O & STEEL Co. 50 Tanner Street Lovved. Ma. 01852 Jo',) name: KALLOWAY 2BRENTWOOD CIRCLE NO. ANDOVER Residential ;louse 18' Ig beam x 28W with bedrooms over, no storage. The beam is supported at both ends. The beam is uniformly IoadedoveF its entire length. ' The maximr_!m unbraced lateral length shall be 24". The n-Jm'rnu,,,n bearina on each end of the beam shall be 3 1/2" x. flange width. All information contained within has been supplied by the contmctor/owner. All dimensions shall he confirl•ned by the contractor. Instadlation is by others. No sit.F-, visit has been rnadc to determine the suitability of sunt, a b=a,,:rm installation. ��Qsinn gar str.Fyi beam nnit�: Bern design lencth(actuai length may vary) L, i �';'t .6�� Clear span/no c:olu-nns Beam is supporting thr, 1st + 2nd floor + 2nd floor ceiling load. Ir-;ngth. WLp, 24. it 1..padinq r"%! -ea;: 71cor �(,ading 1i2 joist length on either side of stee! beam. LA i7 14,11 nc, rc)-.f loads contribute to the beam iC)ad. Two story house.w/np.a%,- storage;. Dead area :'•c)r ,i jpisti 416/ft2 D1. - 15-lh- /ft2 , 31 51h/1 2 risulrs ic,n ----- 2.b! t2 Total dead load 151;0,'1'12 Live Lead (bedrooms): i i VV-)!: 'enoth: 15...11) 8 j • 417.1; fi it ` 1.11. :- 40•_ib A2 BW :_:4 -;.ib it W., --160 . ih 'i 1.31W -f WL -2 W =- .975.103 1h i(. • J:M 41, Beam characteristics: A-36 Steel A-36 ModUlUS of elasticity: Fiber Stress A-36 Steel Compute the deflection, inertia and stress: Maximum allowable defie(Alon: Maximum moment of inertia: Maximum Moment: Stress and Lendinq moment: maximum stress in steel: Point of maximum deflection: Amax = 0.6 - in Maximum moment developed: Maximum stress developed in steel: Maximum moment of inertia developed: Steel beam required to support the above loads: W 12 x 3' x 6 1/2" S=45.6 in3 1=285 in4 page 2 18 x 28 house bedroom+living no storage 107 Ib in` fs:=22000• lh .2 to Amax := L•- l -- 360 WL•5-L3 )max steel:=-- - 384•F.s•Amax W•L2 Morax :_ ----- 8 Nirnax Smax steel:-.--- . fs at center of beam Morax = 9.598.105 •lb -in Smax steel = 43.63 •in3 Imax steel = 268.096 •in4 Reaction at either end of the steel beam:(co!umn loading) W.1, 4 coholin_loading ----- coliumn loading = 1.777.10 -lb 2 - Allo,.vable column loz•ds: 4" std )ally 20,000 lbs @8' long - 3" sch 40 pipe 34,000 lbs n8' long f...,f '�4,_,1/' ' A t. _ t..... ...6 INUIR b4. � .4 :4 L �—ee _ 50 Tanner Street �_o vp 1. Ma. 0,1852 (:: 08)458--8.4 76 Jol, name: KALLOWAY `'`'` '' 2BRENTWOOD CIRCLE r NO. ANDOVER (�e al house 18' Ig beam x ;'.8'w with bedrooms over, no I storage,. The beam is supported at both ends. The beam' is uniformly Ioaded'oVet its entire length. ' The maximum unbraced lateral length shall be 24". The n- ilim .rrn be2rina on each end of the beam shall be ;i 1l?" x. flange width. All inforrnirition contained within has been supplied b;� the contr�aotor%owner. All dinlensi,)n,3 sh; li he confrm.e;d by t," contractor. Instn.liation is by others. visit has been made to determine the suitability of srrrh a b<'arn installation. s')ssrran for s1,fei beam clnitr. Be;,m design l@ilrtil(4actuai lencitli r,�ay nary) : I. s ;t 6" Clear span/no c::olu nns Beam is supporting the, 1st+'2nd floor 2nd floor ceiling load. WLPI l..oadiri , ,:,; r; 1; Tloc,r'c .c:,ing V2 joist length onside of stee! beam. LA in 14-P r!c rc)r,.f loads contribute to the beam iC)ad. T�Vu story house vi/noaitir; storage;. 1 �f,: c' 1-+cr:rattr^;bedr�ornt1iLrinG area `ha;!ri°.g ,;!r.ift2 liL c.e:iling 5lhift7 . insula'ic,n 2!b!1 Q T-:)tc l dead load 15111/112 Live I_r•ad (bedrooms): 4.11%e Load OM -9 a. ca) VV -.,Il !enaffi: 2 fi ` BW it W) , =160 . Ib ll 1'ck.)! {oz.;ir,l : W -. :}T.'•' =r I.,i_`:; •4 -1, -,J -,)•1.,A -, BVI+t WL -2 li 0 9 u Beam characteristics: A-36 Steel ' A-36 Modulus of elasticity: Fiber Stress A-36 Steel Compute the deflection, inertia and stress: Maximum allowable defiec;tion: Maxim um moment of inertia: Maximum Moment: Stress and bending moment: maximum stress in steel: Point of maximum deflection: Amax = 0.6 -in Maximum moment developed: Maximum stress developed in steel: Maximum moment of inertia developed: Steel beam required to support the above loads: ' V 12 x '3r x 6 1/2" S=45.6 in3 1=285 in4 page 2 18 x 28 house bedroom+living no storage Es : 2.9.107• Ib 2 in fs :=22000-I—b .2 in Amax := L•-1--- 360 Imax_steel : = - WL5••L3 384•Es•Amax W-1, 2 8 Morax t.S at center of beam Morax = 9.598 -10 5 •lb -in Smax steel _ 43.63 •in3 Imax steel = 268.096 •in4 Reaction at either end of the steel beam:((-a!umn loading) W.1..4 column loading = 1.777.10 alb 2 Allowable column loads: 4" std lair 20,000 lbs u8' long., 3" sch 40 pipe 34,000 lbs n8' long 0 O,(,I_ r�,YZ (��• a rU,O apoib Aoloq I�O.J, bqj(o� lo/A)so410 wol}og - s - ----- -- ---- -- ---- I N N � I 1 1 I 6 y �.'� � I 1 •,. 1 ,A O i t ; — 3 2P- O u 4 O00 " Q V IN 1 _1 1- --------- -------------- - - - - - - Ci i i J i I 44 cr �- - ------------------ i .�+ 1 ' U QII ' I ! 4 1 I 0 1 v a '1.,' 0 1 v;� a 1 ' a) CIS , . 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" -' .1) c E t1= _0 r- .9 00 � o V LO A yQN ®.Ll O c E .. o N •� O° O NS iQ \O C r ny+ .� ' J + o o E� to �+tpy� Y 0 y `o o f S. I5 o J 3g N� ° b til - i -- m ca 1� 06 ai O > 0 4N 4f O "O N N I r N9, $ O E Q � ■ � � X 'o aC14 E !e tet- G � � M O ~' •L O •� as � � � u a) 40 cio 9 o 000 g -p yyy�FFFjiii '--• �p` i3-. .& 32 -'E yV O C O N y yh� 'OC +D 04 O Cl FS O d d 0 y c -.c E° ,so o 8^ o a c ya CDo $� E.So Qo _ N O O yy x ra � O� O� L q) CJ o o U O L2 A BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: W—A9111 Date Received Date Issued: / Q IMPORTANT: Applicant must complete all items on this page Mr. VKtt-UKMED: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �'' . FEE: $ ;ate 2d Check No.:c�S'' Receipt No.: 0?3,sj NOTE: Persons contracting with unregistered contractors do not have access to theti—a-a-16 M co C 4�• Tok N CD n �Me J��o x \' ��aa •�2 Q� O c° -I =r o c -CDD a a -« T 0� n CD = 'n m 3 O TICD m O cCDD 3 -v 0 .: m c 1 T 1 CD CD 7 n CD '< CD 69 69 69 4A Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Re.viewed on �1/0110 Si nature ; I �V-03 �6-L COIviMEN T S ids' wyC U� I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature i?ate Driveway Permit DPW Town Engineer: Signature:. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc -Building permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work. ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or..Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses l ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products . NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit -'New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And. C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application, Doc: Building Permit Revised 2008 ,% 0 Ix W W Cd x H CCl - O w cn u v U) W W ,� jA G�',� 'o p w O w ami G C U m X0G W p w G w � O� U a U WW p w U) G iL, oG O p a' C w z W P G rO O cn - i.; Q 0 O cn :co O c is E W o � � O � w y : co h•a o m :W E a Cn kB o x E C/) c o® 1 y 0 ° -4D E �O �y CL= L m 3 N mtg \ m o 'J c.t� L m v,mC:D oc Y o CM Cf N •� W dC t c O m � N O LO O Z O a.. Cf U C3 d 0 C _ ® m� 3 N F- L o m •O. H coCOD_ f.. •N •dt C=m C Z p •+ o .y O V •m p CD= C CJ* fl. O�Ofl _ 03 m ` yam O F- r . o_= m S N 0 ,� 2 O O O CD L O O v z °D Q. O y � C I Com_ Na in 'o O� a O.O m m O am CL 3.0 GD O G O L O Q �Q ca o eC env Q. O ca z C CD V h c C C _c �. CO2 i LLI 0 CO) 19 W LU 19 W A. BUSHNELL CONSTRUCTION 89 Meadowbrook Rd N. Chelmsford, MA 01824 Fed ID # 04 385762 PROPOSAL SUBMITTED TO Bob and Jennifer Anthony 25 Brentwood Cicle North Andover,MA (978) 256-4388 Registration # 108952 7/30/10 WORK PERFORMED AT same I propose to furnish labor and materials to remodel Kitchen and master bathroom Scope of work 1.Permit A. Apply for and supply building permit 2.Demolition Kitchen A. Do all necessary demolition to remove existing cabinets salvaging and leaving in garage B. Remove pantry as discussed to allow for built in refrigerator C. Salvage walls and ceilings 3.Demolition master Bath A. Remove vanity, tub, shower unit and remove wall towards closet B. Salvage walls and ceiling 4. Framing A. Contractor to do miscellaneous framing for new refrigerator opening B. Contractor to frame new closet as discussed off existing master bedroom C. Contractor to frame new wall into existing closet D. Contractor to frame new tub platform 5.Electrical A. Do all necessary electrical work to meet code for new kitchen And bathroom including pendants and undercounterlights owner supplies fixtures 6. Plumbing A. Do all plumbing for new kitchen sink and moving gasline B. Do plumbing for 2 sinks and new tub and stand up shower in master C. Owner supplys fixtures 7. Cabinets, vanities, trimwork A. Owner supplies cabinetry B. Contractor to install cabinets C. Contractor to supply and install 2 new closet doors to match existing D. Contractor to install new baseboard to match existing 8. Wall finishes A. Contractor to blueboard and plaster all new walls smooth finish 9 -Miscellaneous A. Contractor to install new hardware for cabinets owner to supply B. Contractor responsible for all trash removal C. Contractor to install hoodfan ductwork to exterior Total Estimate $23,000.00 '�- IN70vt' t Payment Plan 10% deposit $2300.00 20% first day of job $4600.00 30% completion of framing $6900.00 20% completion of rough electrical $4600.00 Balance upon completion $4600.00 Work will commence week of August 1 completed week of August 14 2010 2010 and will be All contractors shall be registered with the State of Massachusetts any inquiries shall be forwarded to Office of Consumer Affairs Ten Park Plaza, Suite 02116 Boston, MA 02116 (617)973-8700 All warranties on the owners rights under the provisions of MGL c. 142A Owner has the right of 3 day rescission on this contract Any alteration or deviations from above specifications involving additional costs will be executed only upon written work orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado and all other necessary insurance upon above work. Workmen compensation and public liability insurance on above work to be carried by Bushnell Construction. Do not sign this contract if there are blank spaces M KITCHCEN�N TER One Framinoam Center • One FdgelfRoad. 5nite #7 • Framingfiam. MA 01701 r -V (508) 875-4004 • www.magniWcenthI1cfiens_rom • 1nFo@rnagn1ffcentkitcfiens.com Fax Covey Sheet Faso Pao= Pham Debet D Iris: 2,.T- W/`�4 -o rc/ M ❑ ugpm ❑ For R*Wewv ❑ Please Canmcnt ❑ Please Reply ❑ Please Recycle The information contained In this facsimile is privileged and confidential. It is Intended only for the use of the Individual(s) or entity named above_ If you are not the Intended recipient of this facsimile, or the employee or agent responsible for delivering It to the intended recipient, you are hereby notified that the dissemination, distribution or copying of this facsimile Is strictly prohibited. If you have received this facsimile ir, error, please notify the sender immediately by telephone and destroy this document. Thank you for your cooperation. e Comments:06�A_A417 Mir mad• B C� H /ln! 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Expiration: 3/31/2012 Co nunissioner Tr#: 18684 HOME IMPROVEMENT CONTRACTOR Registration: 108952 Expiration: 8/27/2010 Tr/r 274351 Type: ,Individuai BUSHNELL CONSTRUCTION Michael Bushnell 89 MEADO'VVBROQK RD.>?og.Q-Rw�� Chelmsford, MA 01863 Admiuistr:tor