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HomeMy WebLinkAboutMiscellaneous - 254 GREENE STREET 4/30/2018 (2)O P Date...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ! ' a 2'' — �� . 4'\ NI e" ........................................................................................ has permission for gas installation ...........6.165 ........ 4e. z,........... inthe buildings of .........1"..�........................................................................... at..Z..�`f?-►-?-- .................. NorthAndover, Mass. Fee.. ............. Lic. No. �� °........................................................... GASINSPECTOR Check # v�77 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY I North Andover oza ll MA DATE 5/3012014 PERMIT # JOBSITE ADDRESS 4-6-6teen-14411-St1OWNER'SNAME1 J4444441 -- GOWNER ADDRESS I Same ITEL JFAXF TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL E] RESIDENTIAL❑ PRINT CLEARLY NEW:E] RENOVATION: Q REPLACEMENT: ❑ PLANS SUBMITTED: YES® NO[j APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 17-1 DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 G_as Meter x INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES E] NO I IF YOU 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 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 applicat4beinliance with all P rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. AfPLUMBER-GASFITTER NAME Joseph Marino LICENSE# SIG ATURE MP ❑ MGF ® JP ❑ JGF ® LPGI❑ CORPORATION ❑# 3285C P ❑#O LLC EN COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE = ZIP 101501 TEL 508) 832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com Akfy W H O z z 0 H U w pk d z w C ❑ a z ° u) El � w � ~ w O O w F- a f z W 3 U' W w a a a ° W d o a a a � U x J F a a LU x w W H z° 1 z 0 H a CA 4 d 0 a j.. -Deems, Maura From: Derry, James <J Derry@ Rhwhite.com > Sent: Wednesday, June 04, 2014 2:21 PM To: Deems, Maura Subject: RE: Gas Permit for 26 Green Hill The next batch of permits will be going out soon. If you would like to make it 254 green St. That would be great. I do not have any additional green hill addresses to speak of now. I will be in to get you the extra money. Thank you consrAUCtion a StRVICe soLUMNS James Derry R.H. White Companies, Inc. Assistant Project Manager 41 Central Street Auburn, MA 01501 508-686-0584 Cell 508-832-7084 fax www.rhwhite.com AA/EOE From: Deems, Maura[ma iIto: mdeems0)townofnorthandover.com] Sent: Wednesday, June 04, 2014 10:50 AM To: Derry, James Subject: Gas Permit for 26 Green Hill James, In making sure all the permits received today had valid addresses, we already have issued a gas permit for 26 Green Hill Avenue (Permit # 9255) for Homeowner Burke. There are two addresses on Green Hill that do not have permits yet, perhaps the permit brought in today was for either 16, 48 or 70 Green Hill Avenue. Please advise, Thanks, Maura Maura Deems Building Department Assistant Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2035 North Andover, MA 01845 Phone 978.688.9545 Fax 978.688.9542 Email mdeems@townofnorthandover.com Web www.TownofNorthAndover.com t .OAT,, S e t� 3S`L c ^ a �x�SACMUSfti Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. N �#CC7 ,--,MON 0 1�- CERTIFICATE OF LIABILITY INSURANCE page 1 of Fno(MMIDDNYyylE /z9/aoi..5 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is mn ADDITIONAL INSURED, the polioy(i®s)must be endorsed. If SUDROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on th is certificate does not conferrights to the Certificate holder in lieu of such endorsement(s), willi4 of Massachusetts, Inc. PHONE c/o as CRxitvey B1vA. P. 0, Box 305191 .No Exn- 877-945 -7378 F -MAIL .No): 888-467_-2378 Nasklville, TN 37230-5191 DO�tES.s ce�:tiEicateaC�willie _GOri1 INSURERS AFFORDING COVERAGE NAICrr INSURED INSURERA:The ChAxtOr Oak fire rnsuranCg COmpany 25615-001 R. H. White Conctruction Company, Ino. INSURERS:TravQlgro Property Casualty Ceimpany oi' Am 25674-00.1 41 Cmntrd7. Street P. 0. Bcx 257 INSURERC_Nati4YaaI IInion Firg yneuranea Com an e£ 7,9445-001 p y Auburn, MA 01.501 INSURER D; Tromeleas Indamnity Company 25655-001 INSURER F,; COVERAGES CERTIFICATE NUMBER: 20187680 INSURF,R F; REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUCD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED INSR BY PAID CLAIMS. TYPEOPINSURANCE DD' SUB VIM PQLIGY NUMBER(mminn POLICYEFF POLICYEXP A GENERAL LIABILITY VTC2000 977RD948-13 LIMITS 9/7./2013 '9/1/2014 EACH00WRRENCE E 2,000,000 X COMMF,RCIALGENERALLIABII.IJY TORENTFs_(Eeoceuaac�l 300,OQp CLAIMS-MADEYOCCUR A $ 10 000 JL&ADV INJURY $ 2 UDO,000 GEN'LAGGR6GATFLIMITAPPLIESPER; GENERALAGGREGATE 3 4, 000, 000 POLICY PRO LOC PRODUCTS-COMP/OPACsG 5 X000,000 ]3 I AUTOMOBILE LIABILITY vT.7CAP 977ii955p -j 3 9/1/2013 9/1/2014 OMgI EDSINGLELIMIT X ANYAUTO arx ent g 2,000,000 ALI,OWNED SCHEDULED SODILYINJURY(Perpereon) $ AUT08 AUTO8 X HIREDAUTOS X NON -OWNED BODILY INJURY(Peraccident) AUTOS X CONDefl X Cc11 Ded eraccldent 8 C UMBRELLALIAB X OccuR 586766140 /1/207.3 9/1/2014 EACH OCCURRENcF $ 5� 000, 000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5'000'000 DED ]{ RETENTION$ 10, 000 D WORKERS COMPENSATION 72RUEi 8205A185-13 AND EMPLOYERS' LIABILITY YYYYYY��,��,NNNNNN S 9/1/2073 9/1/2074 X 0 TARYLI 0 ANY PROPRIETOWARTNFRIFXECUTIVEi N N(A VTC2XUB ®203,A71A-13 OFFICERIMEMBRREXCLUDEtn u( 9/7,/2013 9/1/2014 E.L.EACHACCIDENT 11 000 000 �t(MyendetorrvYlnNH) UN uF UPFRATIONS E.L.DI8EA9E-EAEMPI,pYF_E 5 1,000,000 Esl;K11- Below F,L,DISEAsE-PoLICYLIMIT 5! 1, 000.000 Evidence of Inlsurance Remarks Schadula, I(more epece SHOULD ANY pF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Coll:4197604 Tpl:1694012 Cert::20287680 ©1988-2010ACORD CORPORATION. All rights reserved, CORD 25 (20 10195) The ACORD name and logo are registered marks of ACORD Date..�t11.��.......... TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION This certifies that . MO�P'iG 0� .... ?.oA............... . has permission for gas installation ....r ...�.1� ��: S ....... . in the buildings of at r...`........ S ' ............ North Andover, Mass. �` t Fee./.()U•,q9. Lic. No.-'9�q! !�3 . ......i!�� GASINSPECTOR Check # MASSACHUSETTS UNIFX)RM APPUCATON FOR PEIMT TO DO GAS FITTING (Type or print) Date I NORTH ANDOVER, MASSACHUSETTS Building Locations New 1� Owner's Name Replacement ❑ Plans Submitted ❑ Permit # Amount $ (Print or type)l , _ 1 _ Name _ 1 ALI-(i� 1AA' k �� 't- hYDITi Address Name of Licensed Plumber or Gas Fitter Ch one: Certificate Installing Company Cff Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes Lo No ❑ If you have checked y s, please * dicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent In I hereby certify that all of the details and information I have submitted (or entered) in above appli , tion are true and accurate to the best of my knowledge and that all plumbing work and performed under it Issuti or this application will be in compliance with all pertinent provisions of the Massac Gas C,q#iagd iC�na ter 142 a General Laws. 'own (OFFICE USE ONLY) ature of Licensed Plumber Or Oas Fitter fiber 6. CAU-3 Fitter License Num er Journeyman v� � U w 2 c� C7 U WdE>. WG Gd7F ~ z PQ d d 0. O A Cd7 U 00.' ? p W C SUB -BASEMENT BA SEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)l , _ 1 _ Name _ 1 ALI-(i� 1AA' k �� 't- hYDITi Address Name of Licensed Plumber or Gas Fitter Ch one: Certificate Installing Company Cff Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes Lo No ❑ If you have checked y s, please * dicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent In I hereby certify that all of the details and information I have submitted (or entered) in above appli , tion are true and accurate to the best of my knowledge and that all plumbing work and performed under it Issuti or this application will be in compliance with all pertinent provisions of the Massac Gas C,q#iagd iC�na ter 142 a General Laws. 'own (OFFICE USE ONLY) ature of Licensed Plumber Or Oas Fitter fiber 6. CAU-3 Fitter License Num er Journeyman wJ .j Date.....%.5� � 1 . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ..... J! I ....... .............. plumbing in the buildings of ...... t! ..................... at . . ..J 5 4 . . . Q, ..... ......... North Andov)er,, Mass. ........... PLUMBING INSPECTOR Check MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date qW A k Building Location Owners Name Permit # Amount TYDe of OccuDancv;Q New Ca Renovation 0 Replacement 0 Plans Submitted Yes 11 No FIXTURES (Print or type) Check one: Certificate Installing Company Name ( t ❑ Corp. Address C;� -SUPartner. 1 Business Telephone Firm/Co. Name of Licensed Plumber: L\tom Insurance Coverage: Indicate the the of insurance Covera y checking the appropriate box: Liability insurance policy FrOther type of indemnity D Bond a Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 erformed under Pe it IssupdTor this application will be in compliance with all pertinent provisions of the Massach to PI in i Cod d hap r 2 of the General Laws. Y Signature o um er Title Type of Plumbing License City/Town LZenselQum e—'6 r Master Journeyman PPROVED (OFFICE USE ONLY ■■■���rrr 092 Date ... 1.3...::...� / TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ....... .........�............................ has permission to perform .... :�.' .....,����. .........� �..� :. .. ......... wiring in the building of ......1 / 4..G ........:........................... at ...........AZ:.e.SIn............... ........... , North Andover, Mass. I:ee S G1. Lic. Nog:?f.Z?..r /��/C ELECTRICAL INSPE&OR Check # �s 3_2-- i Common wealth ®r MassachusettsFOccupancy Official Use Only HIMDepartment of Fire services ��l/U i� UV BOARD OF FIRE PREVENTION REGULATIONS leave Checked Leave blank APPLICATION! FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEAS'EPAEVT NWKORTYPEALLINFO .10.119 Date: 57—/-3—// City or Town of Fom To the Inspector of fires. By this application the undersifie,Pgi ves no ' e of his or her intention to perform the electrical work described below. r Location (Street &Number) ieer`i ie Owner or Tenant _ to - Lo 9 /7 Telephone No. Owner's Address r p t 7 SC 4rela fr n i.Ol Is this permit in conjunction with a building permit? Yes P" No ❑ BLDG PERMIT # Purpose of Building Utility Authorization No._J Q 47fl/l_ Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service WF Amps/ Z Molts Overhead 5?"" Undgrd ❑ No. of Meters l Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:��. �-e 4 � , Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with AMC 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 cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I cediry, under Fhe aa,j and p nalt es ofperj , that a information on this application is trace and complete FIRM NAME: V}} LIC. NO.: e—If� Licensee: /` b!2 ature LIC. NO.: (Ifapplicable, enter " empt" n th licens, urtaerline.) 0 Bus. Tel. No.: j�f6 Address: _ - 4 z ,[ 3 Alt. Tel. No.: *Per M.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" Licen LIC. NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. * PERMIT FEE: ,$ jQ d Luminaires Completion of thefollowing table may be waived by the Inspector of Wires. No. of CeiI: Susp. (Paddle) Fans No. of Total. Transformers KVA re Outlets No. of Hot Tubs Generators KVA ELuminaires res [No. Swimming Pool Above ❑ In- rnd. rnd. ❑ o. o Emergency Lighting Batte Units le Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Gas Burners No. of Detection and InitiatingTotaDevices of Ranges No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW Totals: No. ofSelf-Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑Municipal ❑ Other Connection No. of Dryers No. of WaterNo. Heaters KW Heating Appliances KW of No. of Si s Ballasts SeCNo ourif Devices or Equivalent Data Wiri ng: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with AMC 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 cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I cediry, under Fhe aa,j and p nalt es ofperj , that a information on this application is trace and complete FIRM NAME: V}} LIC. NO.: e—If� Licensee: /` b!2 ature LIC. NO.: (Ifapplicable, enter " empt" n th licens, urtaerline.) 0 Bus. Tel. No.: j�f6 Address: _ - 4 z ,[ 3 Alt. Tel. No.: *Per M.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" Licen LIC. NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. * PERMIT FEE: ,$ jQ ELECTRICAL PERMIT NO. ELECTRICAL INSPECTOR - DOUG SMALL REPORT: LL I. ROUGH INSP CTION: Passed — [Lr Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) 2. FINAL INS TION: Passed — Failed — [ ] Re -inspection required ($50.00) - Inspecfors' comments: (Inspectors' Signature - no initials) 3. UNDER GROUND INSPECTION: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - Inspectors' comments: k--F'�&W a 01gUHLUre - no initials 4. INSPECTION — SERVICE: DATE CALLED NArTTONAL GRID: Passed —NAME' [ Failed — [ ] Inspectors' comments: Re -inspection required ($50.00) - (inspectors' Signature - no initials) 5- INSPECTION - OTHER: Passed — [ ] Failed — [ ] • Re -inspection required ($50.00) - Inspectors' comments: 'Signature - no Date A —/�? _- Date Date/ .3 -L // Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE 1F THE ARTA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. The Commonwealth of [i2'assachusetts Department o. f'Xndustrial.Accidents Office oflnvesfigations 600 Washington Street t Boston, MA 0211.1 R4 5r` vww.mass.gov1dia Workers' Compensation Insuxanve Affidavit: Builders/Contractors) Eleciricians/Plumbers Applicant information )Please Print Legibly NaMo(B.usiuess/Organization/lndividual): Address: City/State/Zip:. Phone #: .Are you an employer? Check the appropriate box: 1. ❑ 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. 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 ofproject (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 7Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T Homemyners 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 affached 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: rob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1.,500.00 and/or one-year imprisonment,. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby certify under thepains andpenaldes ofperjury that the informationprovidedabove is true and corr ect. Si ature• Date: Official use only. Do not write rn this area, to be completed by city or town official City or Town: PermitUcense Issuing Authority (circle one): 1. Board of$ealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: phone 4 a y _ IU Z° Q LL 0 R Q� nnn LJ G crn m m 85 PARKHURST ROAD m SSE:°,;b; CHELMSFORD, MA 01824 NO:. ANDOVER, MA �o y tO u O N J Q a N ( Q LL 0 R Q� nnn LJ G crn y BUILDER'S PLAN SERVICE RESR)ENGEFOR: DRAWN BY. ewa :wns edam A DIVISION OF LOWELL BLUEPRINT INC. JEFFCO, INC DACE: aeMu end na m aNmtWel a e. 85 PARKHURST ROAD GREENE ST. SSE:°,;b; CHELMSFORD, MA 01824 NO:. ANDOVER, MA f—v�. P— o.. , (978) 937-5023 1{888) 937-5111 REMIGNS: �+v awn aaa wn 8 4 11 1 Udd. Ph. k &.W, p II =.BUUILDER'S PLAN SERVICE RESMENCE FOR- 0 0 0 0 m cr) > m &W-MMON OF Loxwl Buw-PRw' INC. 0 I - V? 11 1 Udd. Ph. k &.W, =.BUUILDER'S PLAN SERVICE RESMENCE FOR- DRAWN BY. &W-MMON OF Loxwl Buw-PRw' INC. I - V? Tt— 86 PARKHURST ROAD JEFFCO, INC EDATE-1 owd b. CHELMSFORD, MA 01824 GREENE ST. SCA�Ei = Z d. T�— 1.. (978) 937-5023 1-(888) 937-5111 NO'l ANDOVER, MA REMIONS. BUILDER'S PLAN SERVICE RFM°"CF FOR: y A DIVISION OF LOWELL BLUEPRINT, INC. 85 PARKHURST ROAD JEFFCO, INC CHELMSFORD, MA 01924 GREENE ST. (978) 937-5023 1-(888)937-5111 NO:: ANDOVER, MA DRAWN By- AAM ,wds aa,a m Wu�n,d e. DAIE:. (I. 2A •04 '.gu""�g hm.lTae qun,n ebd.e i«ab,�www , i SCE fa mvpYnn bbd hW9ry mora: m,v �.ati. nu wa o , wu D N o T N rr v CR v m o a = BUILDER'S PIAN SERVICE 'FO1MAWN �: �2a•.�e. (� ' y A Dnnsiox OF LOtVEIl atuEPRwr trrC. JEFFCO, INC DATE 1(' 2�'Ori �� ..—}� 85 PARKHURST ROAD SCAM CHELMSFORD; MA 01824 GREENE ST. k, Thm p� m� (978) 937-5023 1{888)937-5111 NOI ANDOVER, MA�:.�8 "0 OR BUILDER'S PLAN SERVICE tDENCEFOR DAWN BY:,. am w. Pw S w m ..'hd feb.,, —d..." V J A DIVISION OF LOWELL BLUEPRINT, INC. 85 PAPIMUMW ROAD CIHISFORD,MAo1824 IEL (978) 937.5023 1{888) 937.5111 JEFFCO, INC GREENE ST. NO:: ANDOVER , MA DATE: �(• SCAM- �'EVM0W. ,�°�d'" " .. ,,.. ,, .. rio 0RESIDENCE „ ^ 1 oSCALE D � ^� I vU °D O "r1 D I ^ I Uuu N o ^) O o D r- 0RESIDENCE „ ^ 1 oSCALE v' BUILDERS PLAN SERVICE A DIVISION OF LOWELL BLUEPRINT, INC. 85 PARKHURSI' ROAD CHELMSFORD, MA 01824 (978) 937-5023 1{888) 937-5111 FOR JEFFCO, INC GREENE ST. NO:. ANDOVER, MAO DRAWN DATE (f• 1oJ acou.aa.ebr.a amad,awsax.e.adro� NEW. ENGLAND CLAIMS SERVICE, INC. ReplyTo ❑ Reply To ❑ Reply To ❑ P.O. BOX 345 100 CONIFER HILL DRIVE, SUITE 308 P.O. BOX 578 MANSFIELD, MA 02048 DANVERS, MA 01923 SHREWSBURY, MA 01545 TEL. (508) 337-8058 TEL,. (978) 777-9900 TEL. (508) 842-3995 FAX (508) 339-5835 FAX (978) 774-9296 FAX (508) 842-7510 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3D TO: Building Commissioner or Inspector of Buildings J addresses J RE: INSURED PROPERTY ADDRESS POLICY NO.: 4 LOSS OF: Board of Health or Board of Selectmen W .0 FILE OR CLAIM NO.: 00 26 so / Claim has been made involving loss, damage or destruction of the above -captioned property which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143 Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139 Section 3D is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. ITL On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. r�.,. SIGNATURE ANDD E MAR ,10 ?n0' location No. r' Date `1G v MaRTM TOWN OF NORTH ANDOVER 3?0'�?`•o •,hoc oa Certificate of Occupancy $ Building/Frame Permit Fee $ t<� Foundation Permit Fee $ �Ss�cHus Other Permit Fee _ - $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector 04/27/99 13:3332.00 PAID Div. Public Works ti x �VV < G 1 } X — - !1 X } W W x �VV < G 1 } O z ..� W w u o wo C/) a cn ° w z z wo � v U ro w o w 0. m rL w R u aco U u W °D ao' ro w a O u w P-0 � °° ca w z w A w w� ° cin Q o V) ui om d f� 1>1 1= CL N C) N :O O � CO) a " Cly cm C ,_, m cm c N CD L o O V O 3 o c w- o m c c v • o � : O CO) CcO V n� aC M ca C CDCD O � EQ : D c ' m ;L V a N E C :gym co ". Q u cm CD c N m m m i o �' (a cm m 3 i CO C C O W co cc .f'' N m E� 0 v N m m N CL. C t `: w.9 r - R � Z o � c a 0 Q y m C = mm o E " o CL COD •- m .. om.. �N c A W N at C W �E v �o a, C.3 z sa4-m d f� 1>1 1= CL N C) N :O O � CO) a " Cly cm C ,_, m cm c N CD L o O V O 3 o Location `'' No. Date 11-('12-- TOWN t-('2-- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ / Ai-., • r .1 - Other^Permit ee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ a Building Inspector 11/43/95 10:01 25.00 PAI^ --- --- -- -- - - 9327 Div. Public Works i o APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. G m PAGE 1 MAP 4-40. �/ LOT NO. 12 RECORD OF OWNERSHIP iDATE (BOOK 'PAGE ZQNE I SUB DIV. LOT NO. , CATION Zs� GREE�i/E !!�7 URPOSE� R'S NAME /DOOE #S 6 GT M'/ NO. OF STORIES S E _04C OWNER'S ADDRESS •(JY BASEMENT OR SLAB -- BASEMENT ARCHITECT'S NAME SIZE OF FLOOR TIMBERS _1ST 2ND 3RD BUILDER'S NAME C� SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR I //2 s � E.4Trw 11 OF OWNER OR AUTHORIZED AGENT FEE PERMIT GR NTED / 19 93 M-- 3 PROPERTY INFORMATION LAND COST ST. BLDG. COSTI?CIjr/1J EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY SUILDING INSPRIMPt OWNER TEL.# CONTR. TEL. # CONTR. LIC. # H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE B 1 2 13 CONCRETE BIL K. BRICK OR STONE HAIR D PIERS PIASTER DRY WALL _ UNFIN. 3 EASEMENT AREA FULL FIN. B M AREA 1/1 1/2 1/4 FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW D COMMCN 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 SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) AMBQEI MANSARD TOILET RM. (2 FIX.) FG SHED WATER CLOSET ASPHALT SHINGLES 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. 6 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 OIL B'M'T 2nd _ tar 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. M ZU w o a C. cr i w N p G 30 C L7 O d C rL.+ O I-- O C2 cn z p W C2 w w w p cn M ZU w o a C. cr o Z w N p G 30 C a 0 W z c� O d C rL.+ O I-- a 0 w C2 cn ii p W C2 w w w p cn cn 0 LLJ CL CO) O y co C O O C.) ev E: H O rn O V 71 H C O C.3 O C cc a CO2 ��� co 3� �o co Q fl. Q: Q C cc J � O CO Z co O. y C G ap G H N p G 30 C _ F-- O d C rL.+ O I-- N m W r y m t E � � 4D o CO2 _ Q m� O� .O ` H O � t CL m CO) O y co C O O C.) ev E: H O rn O V 71 H C O C.3 O C cc a CO2 ��� co 3� �o co Q fl. Q: Q C cc J � O CO Z co O. y C mm O o N N f— r— �V- U co co m a) N U NCOy L O =�WU r - N �-a c l}i � o T �0 WL ~ O u L: W iF- 23 0 @ y ���cn W W W M M r w 00 LO U N 0 @W O@a) Uof ma0 -0p U Q Q) J (O W U i 0 Q or Z a( hi y ci �O �Na—i: o aoF-> 0 -@pC da),NNC @ @ t6 cu i mwU)U)0 O J r r N LO C) O H N O O Y @ U a) vQ j -0 co< -0 M O @ L C O X if N @ O O N DIR HHF- d Q 0 0 J m m E E O U 0 o Z O O O O O N O o � Q Ln LO m ns o0 O 0 O C LL Z W W C14 CD U) Z W Lu 0 IX uj U N MQ ~O N Q =' Z D d Z UW Wa i LU oa j�Cx U L_w d)<O ELOO Q 3 W m-0 N Z CL 0 a N O O N N M m ns U Lo (O �N r .., o wo 00(( -0-0 C C JJ LO La O- LO y. , Z ~ U. Q d Ln CD O C ,.. r N Z,q 0 O . 0� z w Z �� c� @@ ' �s 2Z do ONi N 0 Lo LL Q O W O O p F �� Z oo t :_ :- p � r a_ (O 47 �-0 N M Z NN $ fl.Q O N Nq�g p LL Z (n �N Vim Q wmaW NN JQ J p MN W}oo?cc J O)0 J.. W UO 2 WN �mm ---- �r� cn Z W C) p 00$AO Moo LLI � k Z LLJ a> o P� 00 a %' Lf) 00 LLU C O W --N It p m O >. 2 r 0 0 _ N U Fa .. E HH p pm c0 F- IMrr a 0 p 0)— n� a o fl O r (o N N @ @ a) Q t0 a0+ Q<U m v @ Om>:>o WLL U In E zQ 7N(nU)p QmLLno W:2-(O0QQ� a) @ 2 co to tin wm O (O M r,Of 0)1- rr oo'N V. LL O 0 ~ Q G. m @ a) W p C: m .Q � 'S 0 E ° ZLL m @ '6 =:I.L O co C LLCLL } (� 'masc0 W 6a@i o -n C; Z)� w_rt7Uao -a �� m cc Ln M(n Z m rry c 0 N W 0) q N o f- f- i c M 'T a m r00 @ LL = LL Li. °�° W Q: m N NiL- .. U(t3LL E EL_L_L CoL @ @U) ON.O N 00@@mfY0 UU`@ 9Laom avmmm� vY E'EU m O a) 3@ X@ �' X cn w Z COLL=W mYW MM< LO m U N 0 W h mo r` Z R) 0 6 ci aT0Q = 2 m �� H U wCc F- m a) in 0 ix W .2 LLL :_ LL LL U d a >I U)i Date/4.? 1 5761 TOWN OF NORTH ANDOVER 0 : PERMIT FOR PLUMBING • .SSACMUS*-' Y This certifies that .... �. ?. !`.. . l`.... �?�. �. �................... has permission to perform .. fl. .rt ......................... plumbing in the buildings of ...L`.. ..................... at ...?.:..'... P� ` r. .......... North Andover, Mass. Fee. ? ..... Lic. No..;./. ! .:... ...... `.-. ?�..—........ . PLUMBING INSPECTOR Check # 5761 10 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date//,:;L1 3 �^ ! Building Location J f��� Owners Name ��' I Ll� Permit # I Amount i ,r Type of Occupancy �� S•f j� L�N�! /�— New Renovation Replacement I:]----- Plans Submitted Yes No FIXTURES (Print or type)f ) Check one: Certificate Installing Company Name / U i JILlic Corp. Address 4,C) �� L ��T �� Partner. Busmess Te ep one / Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box: Liability insurance policy �'� Other type of indemnity El Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner n Agent 11 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 slllations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massau' etts to lumbing Code and Chapter 142 of the General Laws. - lr By: W "I LICenSerlumoer yl5e of Plumbing License Title City/Town icense um er Master ❑ Journeyman APPROVED (OFFICE USE ONLY IJ j-:Wl x JR13 E V 4)A > 0 Im, OC) 4S rA Go F-4 1-4 0 ILI 5(y cql 77 14 "C' 4t C-4 00 r-4 r-4 014 rA Ctrl 00 Ili W4 VI th 24T cr, 8AID 145 �i 14T iI ii 96 M V 4)A > 0 Im, OC) 0 5(y cql 77 14 "C' 4t r-4 rA Ctrl 00 Ili VI th cr, 8AID �i : I V 4)A > 0 Im, 0 5(y cql 4t z 00 Ili M x Lr, €x rt kr. � 0 00 hq En 0110 71 0 b 13 14 71- 6D O -T O I-4 M W OR 13