HomeMy WebLinkAboutMiscellaneous - 26 MILTON STREET 4/30/2018 (2)O
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10229
Date .
/O.'OU.......1..3
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ......... r..1....... -........ UG��a''' �X.
has permission to perform...........:.........--�.............................
j plumbing in the buildings of...... .vh.1N........ N 14� ...
at ... g.(......... .t..... .......... ........................................... North Andover, Mass.
_..Fee . ... L ic. No. .....
.. ,,7.e�.,�I ...r...!r�......PLUMBING INSPECTOR ...................
Check # J
EO
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
k) ..... s
- =
CITY MA DATE I �- --
_. -..-. .. � _ ..._. _.... i!-.zg PERMIT# li
--l� -'
JOBSITE ADDRESSp?� OWNER'S NAME
OWNER ADDRESS! , TE FAX
- - --------- -- — - - - - --- --- -- - _...CJ_ . _ .
TYPE OR
OCCUPANCY TYPE COMMERCIAL.' EDUCATIONAL RESIDENTIAA
PRINT
CLEARLY
NEW: ._' RENOVATION:; REPLACEMENT:'] PLANS SUBMITTED: YES NC; '
FIXTURES 7 FLOOR BSM 1 2 3 4 5 67 8 9 10 11 12 13 14
BATHTUB _ _...
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM ; --
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM - -- -
DEDICATED WATER RECYCLE SYSTEM - -
�:
DISHWASHER
DRINKING FOUNTAIN
f
FOOD DISPOSER I .... ;.__. _ .. _
FLOOR / AREA DRAIN --
INTERCEPTOR (INTERIOR) --
KITCHEN SINK _......
LAVATORY
ROOF DRAINIF
SHOWER STALL
SERVICE / MOP SINK --t;
TOILET _.. - --
URINAL
WASHING MACHINE CONNECTION
,....._..:...__ ...... ----
WATER HEATER ALL TYPES ..--- - ------
WATER PIPING -._.. ....-.—,--._....- --- ----- _._..-._...- .._.... --- --
OTHER
I;
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 CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND i
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ' AGENT j
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
that work and installations
and all plumbing performed under the permit issued for this application will be in com liance with all Perti t ro sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws,
PLUMBER'S NAME i MICHAEL HOUSE IIG TU
LICENSE # ' 7173 S RE
MP: JP CORPORATION _ !# 3377 C PARTNERSHIP•`I# i LLC; _!#;
COMPANY NAME , MERRIMACK VALLEY CORPORATION ; 'ADDRESS: 15 AEGEAN DRIVE, UNIT #3
CITY' METHUEN ; STATE !_._—_-_--- "- --
MA 01844 TEL 978-689-0224
FAX 978.689-2206 CELL i 978-815-4523 EMAIL LLITTLE@MVALLEYCORP.COM ,
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..G......�-.1�" .............
........... .
..............................
..........
has permission for gas 'nstallation ..... G1 ..... -
bein the buildings of ........... d �.h............nth---........................
P. at.. */.... �. �.................................................. . North Andover, Mass.
Feed... 0 .......... Lic. No. ,
GASINSPECTOR
Check #
8937
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY �j'� �'�yij�('jZGQ�� MA DATE :,l��t3�jiJ/ PERMIT # J
JOBSITE ADDRESS ,,? /, / f /l OWNER'S NAME
GOWNER
ADDRESS TEL 8'9 Q�®9 FAX
TYPE OR
PRINT
OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL RESIDENTIAL
CLEARLY
NEW:; RENOVATION: REPLACEMENT PLANS SUBMITTED: YES' N0,
APPLIANCES Z 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
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS - -
MAKEUP AIR UNIT
OVEN —
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
r
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES !'VNO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE/RAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY W OTHER TYPE INDEMNITY i BOND j
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.
C
HECK 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 application will be in compliance with all Pertine t p vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME, MICHAEL H HOUSE LICENSE # 7173 S A U E
MP -/ MGF JP. JGF LPGI ; CORPORATION V# 3377 C PARTNERSHIP # LLC #
COMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS 15 AEGEAN DRIVE, UNIT#3
CITY METHUEN STATE MA ZIP. 01844 TEL 978-689-0224
FAX 978-689-2206 CELL' 978-884-3427 EMAIL.` llittle@mvalleycorp.com or srutter@mvalleycorp.com
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass 02111
www mass gov/dia
Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers
Applicant formation Please Print
Legibly
Name (Business/Organization/individual) :
Address:__
City/State/Zip:_/7%�i>�,,-) zd4 �/� �� Phone#: 4f' _.
:Are you an employer? Check the appropriate 1
l . I am an employer with 4.0
employees (full and/or part time).*
2.3 I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required] 5.0
3. i_] I am a homeowner doing all work
myself [No workers' comp.
insurance required] t
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. $
We are a corporation and its
officers have exercised their
right of exemption perm MGL
c. 152, § 1(4), and we have no
employees. [no workers'
comp. insurance required.]
Type of project (required):
6. 0 New construction
7. 0 Remodeling
8. L Demolition
9. U Building addition
10. 0 Electrical repairs or additions
11. 0 Plumbing repairs or additions
12. 11 Roof repairs
13. 11 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information
tHomeowners who submit this affidavit indicating they are doing an work and then hire outside contractors most submit a new affidavit indicating such
;Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees If
the sub -contractors have em to ees, th must rovide their workers' comp. number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the
information ,/ poY and job site
Insurance Company Name:�116 % %��.✓� 7_,;s " OA z 4 lin �� Ia _ . i►
Policy # or Self -ins. Licc. /Expiration
Job Site Address: �U/ /J�" % 1J ,�'� City/State/ZiPA. /I 14i'o
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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification_ _
I do herby
Print
Official use only
City or Town:
and pen 'es o� jury that the information rovided above is true and correct
Phone
Do not write in this area to be completed by city or town official
Issuing Authority (circle one):
1.Board of Heath 2. Building Department 3. City/Town Clerk
6. Other
Permitllicense #•
4. Electrical Inspector 5. Plumbing Inspector
Contact person: Phone #•
8794
Date. t" .�.�' l d
O
TOWN OF NORTH ANDOVER
p
•:
PERMIT FOR PLUMBING
- ,SSACHUS�
This certifies that ...
laot;ek.! fou/,
has permission to perform .... .
in �55'f
plumbing the buildings
of ..../. ! ........
at ... ),IQ.I!t't 4r OKP...
n
'$............... . North Andover, Mass.
Fee. 9: i" . Lic. No...�...
� ���{............................ .
4 '700
PLUMBING INSPECTOR
Check #
P
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: Jr) (I ,
MA. Date: Permit# ff�
Building Location: � I Owners Name:
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residentiala
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No
FIXTURES
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YeskNo ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A 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 ❑
Si nature of Owner or Owner's Agent
hereby certify that all of the details and Information 1 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 Ormit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapte9f
J0 of the General
By
Type of License:
lumber
E USE ONLY)
QJourneyman License Number:
�P'llumb
910
DEDICATED
SYSTEMS
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SUB BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3"D FLOOR
4T" FLOOR
5T" FLOOR
"ST FLOOR
r" FLOOR
8T" FLOOR
Check One Only
Certificate #
Installing Comp ny Name:
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orporation
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Address:
City/Town:
State:
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BusinessTel:
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Fax:
Firm/Company
Name of Licensed Plumber: •.
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9
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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 YeskNo ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A 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 ❑
Si nature of Owner or Owner's Agent
hereby certify that all of the details and Information 1 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 Ormit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapte9f
J0 of the General
By
Type of License:
lumber
E USE ONLY)
QJourneyman License Number:
�P'llumb
910
• NORTH ANDOVER, Mass. Osie.ip
811gding Parma t `
Location .D,
owns f i M
Name 1 Vv -,1 � o KK -q<
New ❑ Renovation Replacement ❑
FIXTURES "
:_.. .. ._....,r.. - 1Y•-0 a MT.
{ eAet11a1MT
/&T FLOOR
•` $NO FLOOR
$1111 FLOOR
ITN FLOOR
$TM FLOOR
eTMFLOOR
tTN FLOOR
ITN FLOOR
Plans Submlited: Yes ❑ (o
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C44
o Y a«= o` $ M s o
O O ] ar er • • • i 1 - s • 0 ..
Check one: CadvicataCW
iInstalling Company Names Z�`� ��� ❑;.'
. Address ❑ Perinership
0 Firm/Co. ..
Business Tele h e
p
Name
of Licensedu
PI mbar
' INSURANCE COVERAGE:
Cne1 have a current (labilty insurance policy or Its substantial equlvalanlL YescO a No
It you have checked --
ygl, please Indicate the type coverage by checking the appropriate box
_ A Ilabllty insurance poitcy �--❑ _ Other
,.... _. -. .. _ . ..__ ... -_ typed kidemnRy [3 Bond Q
OWNER'S INSURANCE WAIVER: I-V 7:'
am aware that the 11cenies does not have the Insurance coverage required by
Chapter 142 of the Masa, General Laws, and that my alonature on this permit sppticaUon-walares_thla.
Check one.
s urO o Oc « ars Owner p Age E3...,-
hereby certlty that all of the details and Informetton I hays wbmltted for entered) In above _ _.__:. _: :��'�z ... ►:. __
inowledpa and that all pknnbinp work and Inrlaltattons � wa��d-amwale-W11►b,est,ot;pgy
perllnen prodsbne of •Massachusetts Stela Pham under pe issued for We application wA be.In oomplanq sA
bkro Code and Chapter to a a» r
TRIO
CRY/Town
M'1'rOWD (OFFICE USE ONLY)
LAWV
4 y,
erre -
Ucenas Number
Type of PWmbina t cense. Master ❑
JournsymarL
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opv
. - N 0 pRQ
r°aoM_AN00 3SS'
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AS S^L�. tr'at k°C� G SNS
f;es e'�°C • ' • ' '��N
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SjZ�,..MMSACNUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print of type) v
1 - Ia,� -�✓`- , Mass. date_ I Z - /1-. 19 Pernik
Building Location Owner's Name ti l l ; �b�� u c�h �wI,
Type of Occupancy
New Renovatlon 0 Replacement (j Plans Submitted: Yes❑ No t j
Installing Corhpany Nand -12d- /ice S ky 116*41, ✓lc� ` Check one:
Address_ �Z lr',o S i- ( Corporation
, f 4-12- O ! f,3 --Z ❑ Partnership
Business Telephone . fOF 3 7S-/=/7YJ ❑ Firm/Co.
Name of Licensed Plumber or oas Filter Sfe ,e% r,o,; lD, 4'a. /..� _� A
cetl[MW6
r,
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirement* of MOL Ch. 142:
Yes fY No ❑
It YOU have checked yet, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy LAY 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 waive* this requirement.
Check one:
Signature o Owner or Owner's Adent
OwnerO Agent
I hereby certify that all of the details and information,l have submitted tot entered) In above application are true and accurate to the bast e( my
knowledge and that aQ plunrbiny work and installations performed under the permit Issued f this ap cation will be plia th an
pertineht provisions of the Massachusetts State Gas Code and Chapter 142 of the General ws.
Y of License: -
TRIO 1PI
umber gna u o n m or s Filter
Gasfitter
Pt_ y�To,� Master License Number / 0 +3 5L9
APMYW o c Journeyman
MMiisiiiiiiiiiiiiiiii:ii���i
mom
ME
Installing Corhpany Nand -12d- /ice S ky 116*41, ✓lc� ` Check one:
Address_ �Z lr',o S i- ( Corporation
, f 4-12- O ! f,3 --Z ❑ Partnership
Business Telephone . fOF 3 7S-/=/7YJ ❑ Firm/Co.
Name of Licensed Plumber or oas Filter Sfe ,e% r,o,; lD, 4'a. /..� _� A
cetl[MW6
r,
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirement* of MOL Ch. 142:
Yes fY No ❑
It YOU have checked yet, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy LAY 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 waive* this requirement.
Check one:
Signature o Owner or Owner's Adent
OwnerO Agent
I hereby certify that all of the details and information,l have submitted tot entered) In above application are true and accurate to the bast e( my
knowledge and that aQ plunrbiny work and installations performed under the permit Issued f this ap cation will be plia th an
pertineht provisions of the Massachusetts State Gas Code and Chapter 142 of the General ws.
Y of License: -
TRIO 1PI
umber gna u o n m or s Filter
Gasfitter
Pt_ y�To,� Master License Number / 0 +3 5L9
APMYW o c Journeyman
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Date/... �! ...............
1
MORTM , TOWN OF NORTH ANDOVER
OE, 'eti0
cr ' to �0 PERMIT FOR GAS INSTALLATION
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.t o_ '.••• .a` .a LTJ.
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This certifies that :.....'............... r ................... .
has permission for gas installation . —IX ..... ! .................
in the buildings of ..I.... ...:...................
at ... `....... �......... North Andover, Mass:
Fee..,. ' ..... Lic. No. f.....:., `•�` .._.... .. ` .^ .. .
GAS INSPECTOR
Y
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
�» ra
•+r'� office use Ontv ;3
�- t uht Lfummunwaifth of gusarhim iffy Permit No.
a 1h artmtut of Vublic E-dOccupancy A Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 C JR 12:00 3190 peave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(M)Q or Town of NORTH ANnOVFR To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street 3 Number) Z l, NAI t-TOiJ S
Owner or Tenant M io Q -k-6 C> µ
Owner's Address Zip M t l_1-00 ST . ' ) ?a�J t1Z
Is this permit in conjunction with a building permit: Yes. Z No C' (Check Appropriate Box)
Purpose of Suildina Utility Authorization No.
Existing Service Amos —I Vcits Overhead _ Unagrna No. of Meters
New Service Amps _J Voits Overneac - Uncgrna No. of Meters
Numoer of Feeders aria Ampacity
Location aria Nature at Prccosea Elec:ncal 1.11crx l20'A0Del.- 3 kTr e01011 -t
No. at L:gn ing Outlets i Total
No. c! Hct ':cs !I No. ct Transformers KVA
No. at Lignting Fixtures I Swimming ?cot A9me a� � 5 rhe. _ I Generators KVA
—
j I No. at Emergency Lighting r
No. at Recectacie Outlets No. ct Oil 5urners I Barely units /I
No. of Switcn Outlets No. = Gas=urners I FIRE ALARMS No. of Zones
No. of Ranges
No. of Oiscosais
No. at Cisnwasners -
No. of Oryers
No. c! Air C; r.c. Totaltons
i NO cf Heat Total Total
Pumps Tons KW
SoaceiArea Heating �'1
Heating Devices KW
No. ct NO. of
No. of '.Vater Heaters KW I Signs Satlasts
tu., N.,.,... kA... a 7,1. 1 Na. of Maicrs Total HP
OTHER:
No. at Detection ana
Initiating Devices
No. of Souneing Oevices 1
a
No. of Sad Cantainea
Oetac::onrSounatnq Devices A,
Lcca1 -' Munlcmat Other
Connecnon _
Low Voltage
Wiring "M
INSURANCE CCVERAGE: Pursuant t0 the reeuirements at %Iassacr.1sers ;eneral Laws
I have a current Liaotiity Insurance Policy inctucing Comc:eteQ Oeerauens Coverage or as suostantial eeuivalent. YES = NO = I
nave suomlttea vatic proof of same to the Office. YES = NO = It ycu nave cnecxea YES. ::lease (noicate the type of coverage cy
cnecxing ;he aoproartate oox.
INSURANCE = BONO = OTHER = tP!ease Scec:ty)
` � t c> � (Excitation Oate1
Estimatea Value of E!ec:ncat Work 5
¢ Worx :o Start Insoec:ton Cate Racues:ac: Rougn Final
Sjgnea unoer the Penalties of perjury:
FIRM NAME
LIC. NO.
Licensee Signature LIC. NO.
Bus. 7e1. No.
AQQfe35
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware :hat the L:censee apes not nave the insurance coverage or Its suostantlal eauivalent as re-
awrea oy Massachusetts General Laws, ana that my signature on :rts cermit aopiication waives this reawrement. Owner w Agent
�
(P!ease cnecx one)
Telecnone No. PERMIT FEE S
(Signature of Owner or Agenti X -i.265
�_:, _. .. .._. _.;�„ _�..`-r� i,,. .+..�,.. t..-..._>:. a•r.--,.„, ..... .«. ., .� „�.. r•..�v. `sty ..9,' .,...
. 1
//y r
Date...
a-° 1090
HORTM
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
11
This certifies that ..... ................................ �:.....................................
has permission perform-''* �.:... -'�
................ �.... .
wiring in the building of . ��..........................................................................
%��
at .......................... ............................................. , North Andover, Mass.
icf J
................... Lic. No. -*- �
ELECTRICAL—INSPECTOR
/9D
4
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
L
%- Location Pt;
No.. t Date
N°RTMTOWN OF NORTH ANDOVER
0? Certificate of Occupancy $
Building/Frame Permit Fee $
ACMUs
Eth Foundation Permit Fee $, ° �_`
s�G
Other Permit Fee $
Sewer Connection Fee $
{
Water Connection Fee $
4.
TOTAL $
��Buil Inspector
y� 005/01/97 13:51
Div. Public Works.
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE 7-5-q-1
JOB LOCATION Zb MIL-Ty0
Number Street Address Sectioh of town
"HOMEOWNER" JMttlfc--i L LtW MI) t3TbCH
Name �Home Phbne
�9-Z3zt
Work
-'-f 7 1..
gone
PRESENT MAILING ADDRESS 7- to t-1 S,
City Town State Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six 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 109.1.1)
DEFINITION OF HOMEOWNER:
I'erson(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, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
structures. A person who constructs more that, one home in a two-year
jDeriod shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a forrn•acceptable to the Bulding Official,
.iat he/she shall be responsible for all such work performed under the
..,i.3ding permit. (Section 109.1.1)
ie undersigned "homeowner" assumes responsibility for compliance with the
hate Building Code and other applicable codes, by-laws, rules and
regulations.
°:e undersigned "homeowner" certifies that he/she understands the Town of
rth Andover Building Departme: 7n:7imum inspection procedures and
quirements and that he/she will comply with said procedures and
<juirements.
i10MEOWNER' S SIGNATURE___ -J, d-,
APPROVAL OF BUILDING OFFriAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
:.quired to comply with State Building Code Section 127.0, Construction
.,Li trol.
a
e
1
9W7
sink closet
shower
window
door
to
outsi d
7'6
toilet
door to kitchen hall to kitchen
The above 9'8" by 7'6" space is currently a single room used as a mudroom or
back door coat/boot room.
Our intention is to put up a wall and make the space into two rooms, one a bathroom,
the other would be a smaller version of the mudroom. There is currently a toilet on
the first floor and this will be moved to the new bath identified above.
Except for the required plumbing changes, I expect to do the work myself. The following
is my estimate of the total cost to implement the changes:
bathroom fixtures 600.00
licensed plumber 600.00
miscellaneous building materials 500.00
total 1,700.00
Barring unforeseen problems, it is my intent to keep the total cost under $2000.
b
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO- GASFITTING
'(Print or Type)
NO, -GLMoy o , Mass. Date 4." 3 19 47 'Permit #
~OA fS 11/11 hil`o/1 1` —
Building Location Z Owner's Name
44t `A/o t4 nd over 1�4CY Type of Occupancy
-r
New ❑ Renovation 0 Replacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name WHITE ROG T6MBING Z HTG=
+� Address P.O. BOX 728
r
MA. 018405
Check one:.
(Corporation
❑ Partnership
Business Telephone S Ug c? 75 42-99 O Firm/Co.
Name of Licensed Plumber or Gas Fitter P—vbo, I"+ i2ltat Ch efi�v-
Certificate
Ap 09 e_
INSURANCE . COVERAGE:
I have a curve t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy) Other type of indemnity O 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 walves this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner O Agent O
I
1 hereby certify that all of the details and information I have submitted for entered) in the above applicationares true and accurate to the bed d my knowledge and That all plumbing work
.and igdsllatiax pedormed under the permit issued for this application will be in compliance with all pertinent provisions d tlfa
me Mafcuslrts $taGCodd
�`t teas e an
Chaprer 142 o(#* General Law,.
ry
..
6vT d License: -
4y�✓umtrer
Title ALJ Gaahmer
" tete. ignore of Licensed Plumber &orGm Fitter
Citv/rown /0 Journeyman License Number O
4PvttOVFO fOFFiCE USE 0
NLyI
•
•
•
•
•
or R -M
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■■
■■■■■■■■■■■■■■■■■■■■■■
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■■■■■■■■■■■■■■■■■■■■■■■■o
Efflim
Installing Company Name WHITE ROG T6MBING Z HTG=
+� Address P.O. BOX 728
r
MA. 018405
Check one:.
(Corporation
❑ Partnership
Business Telephone S Ug c? 75 42-99 O Firm/Co.
Name of Licensed Plumber or Gas Fitter P—vbo, I"+ i2ltat Ch efi�v-
Certificate
Ap 09 e_
INSURANCE . COVERAGE:
I have a curve t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy) Other type of indemnity O 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 walves this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner O Agent O
I
1 hereby certify that all of the details and information I have submitted for entered) in the above applicationares true and accurate to the bed d my knowledge and That all plumbing work
.and igdsllatiax pedormed under the permit issued for this application will be in compliance with all pertinent provisions d tlfa
me Mafcuslrts $taGCodd
�`t teas e an
Chaprer 142 o(#* General Law,.
ry
..
6vT d License: -
4y�✓umtrer
Title ALJ Gaahmer
" tete. ignore of Licensed Plumber &orGm Fitter
Citv/rown /0 Journeyman License Number O
4PvttOVFO fOFFiCE USE 0
NLyI
lw
`T Dat
2� 5 Date.
W
t° Nar+TM TOWN OF NORTH ANDOVER
p PERMIT FOR GAS INSTALLATION
SSACH
.. -
This certifies that.. % t z .! ... d ` u S ti 01 ^'
h9k permission for gas installation...f .... .. .
in the buildings of .. /�j�Za:« .a .r../?/................... .
-:
at . t; C. kr:.. ?�: ". :.......... ,North Andover, Mass.
Fee. ,.2. 5 s .... Lic.
2A!
INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD:-File H