HomeMy WebLinkAboutMiscellaneous - 260 CARLTON LANE 4/30/20180
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Pw.
This certifies that ........ S.,4
..............
......................
has permission to perform ...................
wiring in the building of.. y&'4z7 ...............................................
at ......... 4 ..... 4 ... 0 ......... ... 4..7- f;J /� IV
vt . .................................. ,�orth Andover, Mass.
Fee.,. ................... Lic. No,4
..14
..................
...........
ELECTRICAL INSPECTOR
Check# 77-3 9 7.
q j, 0
Commonwealth of Massachusetts Off, , I Use Only
Permit No.
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
I [Rev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 521-7 VMR 12.00
(PLEASE PRINTININK OR TYPE ALL INF.01M TION) Date: 0 ��,6
City or Town of- V, 44W To the Inspe-c'to'r qf Wires:
By this application the undersigned gives notice of his her intention to perform the electrical work described below.
Location (Street & Number) �2- W/,Q 64,,�,Z
Owner or Tenant 1-4rry j/ay,�J, Telephone No.
.t� �r
Owner's Address I
Is this permit in conjunction with a building permit?
Purpose of Building +_,, e!s
Existing ServicecP-&Z-17 Amps 44� 3-Vi9Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
41- , �7-- A4
Yes EJ No Ej--�-(Check Appropriate Box)
Utility Authorization No.
OverheadE] Undgrd [��J��o�of Me�ters
Overhead [:] Undgrd [:] No. of Meters
R
Completion of thp follniving inbla mly ha i—iiyod Ai) yho I—X—i— �f pu;—
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. 5 0 1
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above El In-
IV55—.5TE-m—er-gency Lighting
grnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
!Vo -.—o7 Detection and
Initiating Devices
No. of Ranges
No. of Air Co,nd. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Number
Tons
KWI
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
mumcip�l El Other
Local 11
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equival2nt
No. of Water
KW
No. of No. OF
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
--JTelecommunications
No. of Motors Total HP
Wiring:
No. of Devices or Equivalent
OTHER:
I I
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Eyctrical Work: (When required by municipal policy.)
Work to Start: I/ c5� 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 covera e is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURAI BOND [] OTHER E] (Specify:)
I certify, under the pains in dpei alties =per ry', 71ht the information on this application is true and complete.
57
FIRM NAM LIC. NO.: 0
Licensee: Signature LIC. NO.:,e��,;e
(Ifapplicable, entelr" x 7pt �pthe license rwn7ber line)
,- y
Address: Bus Tel. No.:-
�-5 A e�—lla �7 Alt' Tel. No.:
*Security System Contractor License required for this work; if,�(pplicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage non-nally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) E] owner El owner's agent.
Owner/Agent
Signature Telephone No. FPERMIT FEE. $
Date.....................
,AORTH TO",' OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
--7
This certifies that ...........................................
has permission for gas installation ............................
in the buildings of ................................... I ...........
at .................................... North Andover, Mass.
Fee......... Lic. No ........... ..........................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
N.
M 'ACtiUSETTS UNIFORM APPLICAT[Ot4 FOR PERMIT TO DO GASIFITTIno
ASS
(Print or Type)
NORTH ANDOVER Mass. Date
building LocationZo/'O Permit #
Owners Name /V
New Z!� Renovation Replacement Plans Submitted El
(Print or Type) Check one: Certificate
Installing Company Name Rey Corp.
5,/
Address 00 A�
Partrier.
Firm/Co.
Business Telephone: 6P
Name of Licensed Plumber or Gas Fitter—
Insurance Coverag Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy MX Other type of iridemnity 0 Bond
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 coverages.
—1 Agent
Signature of owner/agent of property Owner I F1
6) 6�1
I haeby ccrffy that all of the detAils and Infotmation I hye submitted (or entered) in above application 2FC true and accurate to the bcit o(my
knowledge and Mat all plumbing work and lnitAtlaflons retfornicd under l"efrnit itsued lo; this application will be tn compliance vith all pcttlncnt
provisions of tho Massachusetts Mile Gas Code snd chaplet 142 of tho Central Laws.
z /'�- X
TYPE LICENSE:
F -f -u--i�r b e r
Gasfitter Signature of Licensed
Master Plumber or asfitter
Journeyman ____? zc�
License Humber
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SUR-13SIMT.
MERT
IRASE1ST
FLOOR
2RD FL.00R
31113 FLOOR
4TR FLOOR
STH FLOOR
6THFLOOR
7TK FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name Rey Corp.
5,/
Address 00 A�
Partrier.
Firm/Co.
Business Telephone: 6P
Name of Licensed Plumber or Gas Fitter—
Insurance Coverag Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy MX Other type of iridemnity 0 Bond
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 coverages.
—1 Agent
Signature of owner/agent of property Owner I F1
6) 6�1
I haeby ccrffy that all of the detAils and Infotmation I hye submitted (or entered) in above application 2FC true and accurate to the bcit o(my
knowledge and Mat all plumbing work and lnitAtlaflons retfornicd under l"efrnit itsued lo; this application will be tn compliance vith all pcttlncnt
provisions of tho Massachusetts Mile Gas Code snd chaplet 142 of tho Central Laws.
z /'�- X
TYPE LICENSE:
F -f -u--i�r b e r
Gasfitter Signature of Licensed
Master Plumber or asfitter
Journeyman ____? zc�
License Humber
4, 5 j* '7
No . i
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
....................................
has permission to perform ............
plumbing in the b f ..........
at ....... North Andover, Mass.
Fee ........... Lic. No.,>
.. .... .......
Check # PLILIMBING'�l N SPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION
(Print or T
/k 4L9211- - Mass. Date.A
IN
Building
New El Renovation C1
FOR PERMIT TO DO PLUMBING
t
Type of Occupanc"t-51 -D E �j 'ri
I
Replacement fl?",
FIXTURES
7 pla Yes 0 No C1
Installing Company Name-�2011JEel Check one: Certificate
Address 0 Corporation
/r If Ti,4 o e: -A) Al t4 VL1 0 Partnership
Business Telephone 2 -r1cl-7
i� t 9-01'rm/Co-
Name of Ucensed Plumber 7- �5,4 mm,4 reqeo
INSO�ANCE COVERAGE:
I have a cu're ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No El .4
If you have checked Yes. please indicate the type coverage by checking the appropriate box.
A liability insurance policy Q'-� Other type of indemnity 0 Bond 0
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:
r'%-., A I owner 0 Agent C1
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
knowiedge and that all plumbing work and installations m#ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum Aig Mode and apter of the eral Laws,
L
Plum r
Title V
2�"own Type of License: Master Joumeymab
L M FO—FFICE—US-E-O�NL� I License Number 133
Em
ENEENNEENNE
Installing Company Name-�2011JEel Check one: Certificate
Address 0 Corporation
/r If Ti,4 o e: -A) Al t4 VL1 0 Partnership
Business Telephone 2 -r1cl-7
i� t 9-01'rm/Co-
Name of Ucensed Plumber 7- �5,4 mm,4 reqeo
INSO�ANCE COVERAGE:
I have a cu're ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No El .4
If you have checked Yes. please indicate the type coverage by checking the appropriate box.
A liability insurance policy Q'-� Other type of indemnity 0 Bond 0
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:
r'%-., A I owner 0 Agent C1
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
knowiedge and that all plumbing work and installations m#ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum Aig Mode and apter of the eral Laws,
L
Plum r
Title V
2�"own Type of License: Master Joumeymab
L M FO—FFICE—US-E-O�NL� I License Number 133
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Location 7 k
No. Date
TOWN OF NORTH ANDOVER
41
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
Building Inspector
j %/,�7/99 11:30
M. 00 PAID
Div. Public Works
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Location �O
—CQ�,
No. Date A /CP
TN TOWN OF NORTH ANDOVER
Certificate of Occupancy $
4L Building/Frame Permit Fee $ f
ion Permit Fee
CHU Rf�TEI $
Other $
Sewer Connection Fee $
-ftffr� onnection Fee $
Building Inspector
Div. Public Works
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FORM U -'LOT 'RELEASE FORM
1 11
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICA-NT fiLLS OUT THIS SECTION******************
C0rDtVr-C30C& r- 3-. Leut"'a%A-�
APPLICANT RICLrJ S4glc�[Ald PHONE lQ9_619.713c(t-S'
LOCATION: Assessoes Map Number loll PARCEL [r)(,,
SUBDIVISION LOT (S)
STREET Cal\ ��O LAJJ ST. NUMBER
USE ONLY************************* _.k.,
RECO"ENDATIONS OF TOWN AGENTS:
CONSEWATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
OR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
Md
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUJLDING -INSPECTOR —DATE
Revised 9\97 jm
- vu MR. kl.
-C QRD
M.-mmx
CASSIDY ASSOCIATES
234 HUMPHREY ST
...... . . ....
9
ED A A M
I C CA I I U ON
ONLY C ON ERS N R a
H WW MS C FICA
r M 1 0
ES N OR
ALOM �-S COW E AF R
r0M6!%60E0 By LOW.
COMPANIES AFFORDING COVERAGE
SWAMPSCOTT MA 01907-
(617) 593-9853
COMPANY
A WyLAND CASUALTY
INSUREO
JASON LEVREAULT
COMPANY
a
J LEVREAULT CARPENTY PAINTIN
53 HIGHLAND RD
COMPANY
c
ROXFORD MX 01921-
(978) �352-8235
COMPAW
HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I mc %,y OD
MON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICrHr THIS
FORDED By THE POUCIES DESCFUBED HEREIN 13 SUIBJECT TO ALL THE TERMS.
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POUCYHUMBEN
FOUCY E"ECTNB
DATE (MUMPIM
POLICY EMNATION
IDATE (MM/00A"
LIMIT$
X
COMMEAMAL GENERAL LIABILITY
CLAIMS MADE F7 OCCUR
04/29/98
04/29/99
-QWERALAWAMATE 8600000
PRODUCTS - COMPIOP AC -4 $600000
AL & AIYV INJURY $600000
& CONTRACTORS PROT
EACH 00CURRENCE $300000
IM DAMAGE (AAy wm fire) S50000
rOWNERS
MM O(P (AAy Opq pqLWJ,. S5000
t
AUTOMOBILE
LIABIUTY
ANYAUTO
COMBINED SINGLE UMrr
ALL OWNED AUTOS
SCHEDULED AuTos
I
BOOLY INJURY
(Per parson)
HIFEO AUTOS
NON-01MED AUTOS
SOOILY INJURY
(Per accideno
P"CRTY DAMAGE
LI
GAMAGE
LIABILITY
ANYAUTO
AUTO ONLY - EA AMDeNT S
OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE S
EXOM
LIABIUTY
UMBRELLAFORM
OTHER THAN UMBRRIA FORM
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION AN*
CMPWVDW LIABILITY
THE PP40PRETOFV INCL
PARTNEPAUECUTIVE
-OFFICERS ARE7 EXCL
OTMER
.......... ...
ER
EL EACH ACCIDENT
ELDISWE-��Ywrr
EL =EASE - EA EMPLOYEG
01MCRI"M OF OPERATIOX31LOCATIONSNIENICLMMPECK IMM
RE: 260 CARLETON LN NORTH ANDOVER MA
.. or
SHOULD ANY OF TME ABOVr; "SCRIBED POLICIES K CANCELLED 46FORE 'ME
TOWN OF NORTH ANDOVER
BUILDING INSPECTOR
�CITY HALL
NORTH ANDOVER MA 01845
8~7M DATE THEREOF. THE ISSUING COMPANY VALL ENDFAVOR To MAIL
.10 DAYS W*rMEN KOnCE To THE CERWICATE NOIDER NMED TO THE MT.
BUT FAILURE TO MAIL SUCH X0nCE SMALL IMpOSE No OgUGATION OR UAII,Uyf
Of ANY KIND UPON THE COMPANY. IU AGENT$ OR REPRESENTATIVE&
Z*d ILOL ZLE 2L6 IIIAV31/ Vd3'V7VddVZ NOaA Hvso:c S66L-SO-9
The Commonwealth of Massach'userts
Department of Industrial Accidents
Mics 911BY85119.711affs
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
am
name: ��1,9 / CAf L,4^3
location� _26 Cz--W1._7-QQ LA)10
I"YADI )v6e-
r7 1 am a homeowner per,orming ail work myself.
1 am a sole proprietor and have no one working in any capaciry
I
V1 a -m an employe ovidLing workers' compensation for my employees working on this job.
company naime:
addrm: 53 1-1164-11_4^J)D
;& - (, / /F -
ADCC C., Z_6_v17-1 - lwel A4^j
7 1 am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers comperisaclonpolices:
comparly name:
addr=-
city:
—Date _,3
Print ame V'IsQ'i
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addre".:
city-, phonc4-
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Failure to secure coverage 33 required under Section 25A ofNIG L 152 can lead to the imposition of criminalpenalnes of a fine up to S1,500.00 and/or
one years' imprisonment 23 well as civil penalties in the form ofa STOP WORK ORDER and a fine Of S100.00 A day against me. I understind that a
copy of this statement may be forwarded to the Office of investigations of the DIA for cover3gc YCrlfk3rion.
I do hereby cert�o�er the pains a��aities ofperjury that ���n_provided above is true and correcy
Signarurc
—Date _,3
Print ame V'IsQ'i
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Phone #
,p
official use only do not write in this area to be completed by ciry or town official
city or town: permit/licerise 4 E7 Building Department
[7Ucensing Board
C] check if immediate response is required EiSciectmen'3 Office
C:,Hc2lth Department
Contact person: phone 1: r-10ther
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MORTGAGE PLAN
ENGINEERING SINCE 1920
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HOME jMPROVEMENT CONTRACTOR
126476
Registration
Type, - INDIVIDUAl
ExPiTatiOn 06/08/00
JASON A. LEVREAULT
53 HIGHLAND RIO
��ORD MA 01921
AnNnRAWTOR
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Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
NQA:C2u:SV
This certifies that .... . .... . ....................................................................
has permission to performe;.w-./'Y,-g . ........
Iding of ... /V M
wiring iathe b� ....... ...
',North Andover Mass.
�. 2
4Fee ... Lic'. No.��7 ........
...........
Check it ii�(�iR ICAL INSPECrOR
5 TI /-
J� T- _t'
330
Commonwealth of Massachusetts
Department of Fire ervices
BOARD OF FIRE PREVENTI N
REGULATIONS
APPLICATION FOR PE
All work to be performed in �ccordani
(PLEASE PRINT IN INK OR TYPE A I
City or Town of: Wlnz
By this application the undersigned Eves r
Location (Street & Numb ) C�2 1A D
OwnerorTenant M/M Z-J4k
Owner's Address
Official U
Permit No. � rIN;1—
�MlhT TO PERFORM ELECTRICAL WORK
t t
wi the Massachusetts Electrical Code (MEC), 527 CMR 12.00
TION) Date: "M �X
4 To the Inspe dor of Wires:
1�this or her inte 'ion to perform the electrical work described below.
Is this permit in conjun . ? Yes
,WQn with a buildin pertm
Purpose of Building_'
Telephone No.
No Z (Check Appropriate Box)
Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity '-2
Location and Nature of Proposed Electrical Work:
Completion of the following table may be waived by the Inspector alres.
I
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures:
Above,, E];. In.-,
Swimming Pool,
No. of Em htm
g! , erWgy 19i
4tte 11 1
grod
E1 nit&'. -,
Na."of kec�pta&ebuileis
No .of0il: u`rneJr0
�
FIRF
I & 6,1- 14" - i 6 n e�s
No. of Switches
No. of Gas Burners
N6. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
J.N.umb.er.
... .... ... .. ..
... .. ..
I Tons ..........
......................
JxW
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local Ej Municip�l El Other
Connection
No. of Dryers
Heating Appliances KW
I Security Systems:
No. of Devices or Equivalent cai
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equival9t
INo. Hydromassage Bathtubs
I No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE Z B�OND OTHER El (Specify:)
151 (Expiration Date)
Estimated Value. o7lel, ical Work: yj 000 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under hie pdns and penalties of perjury, that th e information on th is application is tru e and complete.
FIRM NAME: DAVCO SECURITY SYSTEMS I LIC. NO.: 1215C
Licensee: FREDERICK W DAVIS Signature LIC.NO.: 452D
(If applicable, enter "exempt " in the license number line.) Bus. Tel. No.: 781-233-4960
Address: 6 WEBB PLACE, SAUGUS, MA 0 1906 Alt. Tel. No.: 800-227-1726
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By iny signature below, I hereby waive this requirement. I arn the (check one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. FERMIT FEE: $