HomeMy WebLinkAboutMiscellaneous - 263 CANDLESTICK ROAD 4/30/20180
6 f -
M
cn
CP I
o
0 M
C)
L
rA\
Vj
Date.
TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
CH
This certifies that
�vz * �-
or gas install
has permission f ai i
- I-- J. ". //y
in the bviildfifgs o
North Anddver, Mais.
at.,M - - 1. . ., -./ "'t
Fee4l& /V Lic. No..
GASINSPECTOR
,�-'heck # ,
�5 C 5 9,v
<L
MASSACHUSETTS UNIFORM APPLICATION
(Print of Type)
0- 1 A it -4 y c P,,, - Mass.
Building Location c2 &
New 0 Renovation 0
PERMIT TO DO GASFITTING
—2QL— Permit
'Yowner's Name- JV a- n / et-,
Type of Occupancy A�ef / C4� _A(A-,
Dl-� Plans Submitted: Yeso N o
Installing Company Name --The_Plumbin g Co., Inc.
Address P 0 Box 1607
Wakefield,'MA. 01880
"Iness Telephone 781-246-0019
Name of Licensed Plumber or Gas Fitter Clifford H- Cilpq
Check one:
13 corporation
0 Partnership
0. F1rm/Co.
Certificate
. 12 lq<:.
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantW equivalent which meets the requirements' of MGL Ch. 142.
yes 12 No 0
It you have checked OA plane Indicate the type coverage by checking the appropriate box
A liability insurance policy OX . 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:
ownerO Agent 0
Signature of Owner or Owner's Agent
I hereby ce" that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws
T of License: CE��=!&
Plumber 9—gnature of Ucen!pe
I ,Aurffber or Ga
T11161 Gasfitter 6701
1
Master License Number
Wown 5Journeyman
W
NOMENERINEMENNE'M
MEN
N
ON
Installing Company Name --The_Plumbin g Co., Inc.
Address P 0 Box 1607
Wakefield,'MA. 01880
"Iness Telephone 781-246-0019
Name of Licensed Plumber or Gas Fitter Clifford H- Cilpq
Check one:
13 corporation
0 Partnership
0. F1rm/Co.
Certificate
. 12 lq<:.
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantW equivalent which meets the requirements' of MGL Ch. 142.
yes 12 No 0
It you have checked OA plane Indicate the type coverage by checking the appropriate box
A liability insurance policy OX . 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:
ownerO Agent 0
Signature of Owner or Owner's Agent
I hereby ce" that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws
T of License: CE��=!&
Plumber 9—gnature of Ucen!pe
I ,Aurffber or Ga
T11161 Gasfitter 6701
1
Master License Number
Wown 5Journeyman
W
j
z
-4
m
0
ce
i
40
a
m
j
z
-4
m
0
CA
Location e;2
No. Date
0 RT
RT#j
TOWN OF NORTH ANDOVER
0
0
AL
Certificate of Occupancy $
41 -WO I
Building/Frame Permit Fee $
*0
Foundation Permit Fee $
CHUS
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
-3
TOTAL
N2 12qOM13:55
B ilding Inspector
25. 00 PAID u
Div. �PubficWorks
2
9
Location
No. Date
,AORTPI TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
%
Building/Frame Permit Fee $
MUS Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
Div. Public Works
0
z
LU
z
&n
<
V)
D
, z
LLI
LLJ
u ZL
LIJ
z
tol
0
96
LU
uj
L.4
ca
'flow
1
96
uj
uj
in
(A
z
u
z
Ll
z
w
0
z
w
0
z
rl
0
Ito
-rj
uj
LL)
CZ5
--
0:
Cd
Of
z
z
2
Z
I
I
I
0
z
LU
z
&n
<
V)
D
, z
LLI
LLJ
u ZL
LIJ
z
tol
0
LLI
ui a 9
R 404
U. <
W z Uj
< ui
a p� L.
41
LU
uj
LLI
ui a 9
R 404
U. <
W z Uj
< ui
a p� L.
41
LU
LLI
ui a 9
R 404
U. <
W z Uj
< ui
a p� L.
41
r
Free Estimates
James Debreceni
23 1/2 Oakland Avenue
Methuen, MA 01844
(508) 470-8415
_�AOPOSA, �SUB-IrTED TO
IVR# MP< Al) - 1,
&no
LEAK TITE
ROOFING
__TPHONE
ANS
JOB NAME
We hereby submit estimates for:
10
Mee,) br' &-I
,le r, I. &(` I P �&(j5e -`h I q " . I
IPT _Tre it jazl"rSA &V( -S �e /,-'
1000t.er
ir 4t -e
11�JC)6
Page of
Professional Workmanship.,
Without Professional Pricinq
WO P"POSO . hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
Payme to be made as follows: dollars
Fully Insured
All material is guaranteed to be as specMW All work to be completed in a
workmanlike manner according to standard practices. Any alteration or Authorized
deviation from above specifications involving extra costs will be executed Signature
only upon written orders, and will become an extra charge Oyer and above the
estimate. All agreements contingent upon strikes, accidents or delays beyond
our control. Owner to carry fire, tornado and other necessary insurance. NOTE: This proposal May be
Our workers are fully covered by Workmen's Compensation insurance. withdrawn by us if not accepted within days.
Aaw$uce of PM" -The above prices,
specifiCalions and conditions —are satisfactory and are hereby
accepted. You are authorized to do the work as specified. Payment Signatur4e
will be made as outlined above.
Date Of Acceptance:
Signature
IT
;74
0
u
x
u Cc:
g
co
C:
x
0 !9
ui
Ow
C/)
C/)
04
0 C/)
Z
C/)
0
u
C/)
C/)
4-1
4
z
E
0 p EO
CO En V)
E
t5
w
z CL
C) CO)
CD cm
ca
0
.ca 0
E cc
CD 0 CD
L- I.— =
CL
Ca
co
0" cc
C3
ca z
co
CL
C.3 ca
cc
ca
CD C
OC -1
CL
co
w.2
G3
CL
cm
E
0
co
M
ca
:=CI3
w cc
E
a 0
cm
CLU
0
Via
0
cm
CA
CLC=
.2 -t
cc
i amo
0 CL
cp
CD
39
0
0
COD
CD
0
v)
mm
CL= �.—c
z
cc
ui
E
L.
ca
Co
40
—
ID
CJ.00 L=
0 =
CL
CD -
Go
M
.0 :;
ob A 2
.0
F.
Ow
C/)
C/)
04
0 C/)
Z
C/)
0
u
C/)
C/)
4-1
4
z
E
0 p EO
CO En V)
E
t5
w
z CL
C) CO)
CD cm
ca
0
.ca 0
E cc
CD 0 CD
L- I.— =
CL
Ca
co
0" cc
C3
ca z
co
CL
C.3 ca
cc
ca
VW WHIN 80
36V ONVJMVO Z11 CV
IND38930 'r S3kvr
i r
86/9?/go UOTIPlrdx�
V80 �- OdAl
58CUT U01jej
- IST698
8OljV81NOJ INAROMI 3'W'OH.
i
Location (=�26-3 04,voll,4,t C�
No. S6 S — Date
40RToq TOWN OF NORTH ANDOVER
AL
Certificate of Occupancy $
N3
ACHUS Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#- I- "Y
15285
Aw (6.-- —
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERMIT NUMBER:
SIGNATURE: Ah,
SECTION 1- SITE INFORMATION
1. 1 Property Address:
1.3 Zoning Information:
ZoningDistrict Proposed Use
1.6 WELDING SETBACKS (ft)
DATE ISSUED:
Date
1.2 Assessms Map and
10G
Map Number
1.4 Property Dimensions:
/ - 62 o 6 C'�,,
nber:
21
Parcel Number
Lot Area (sf) Frontage (11)
Front Yard . Side Yard
Rear Yard
Required Provide Reglired Provided
R equired Provided
1
1.7 WaW Supply M.G.1-C.40. 54) 1.5. Flood Zone Information:
Public 0 Private 0 Zone — Outside Flood Zone 0
1.9 Sawerap Disposal System:
Munk4w 0 On Ske Disposal System 0
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT
2.1 Owner of Record
ve--q.,,jA5
C C�
Name (Print) Address for Service:
Signature
2.2 Owner of Record:
Name Print
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licenned Construction Supervisor Not Applicable 0
,jq 1---\-e 3 '—� e
Licensed Construction Supervisor:
Eicense Number
Addre
-3'
n Expiration Date
Signatub Telephone
3.2 Registered Home Improvement Contractor
—� e S+,A
Company Name
Address
A,
Not Applicable 0
) -;L (-) -,)- C, �
Registration Number
( I /1,J)DI -
Expiratioh Date
SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted uith this application.
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... @-- No ....... 0
SECTION 5 Description of Proposed Work (check all applicable)
Failure to provide this affidavit %krill result
New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) Er Addition 0
1 1 . -_ I
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
YA:S f -
Roo
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by t applicant
1. Building OL TD (a) Building Permit Fee
. Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5) Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WBEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUHDING PERM[IT
L as Owner/Aut hoxized Agent of subject property
Hereby audorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
S.RCTTON 7h 0WNFR/ATTTHnR17._F.D A('-F.NT DF.CLARATMN
as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
-e- V4
e
ell
Si a of Owner/Agent Date
NO. OF STORIES SIZE
BASENENT OR SLAB
-SIZE OF FLOOR TE"BERS iST 3KD
-SPAN
DUviENSIONS OF SILLS
DEMENSIONS OF POSTS
D11\4ENSIONS OF Gll�DERS
HEIGHT OF FOUNDATlON TH[CKNESS
SIZE OF FOOTING X
MATERLAL OF CHDvINEY
IS BUILDING ON SOLID OR FMLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE'FORM
7 —YR —20
als/permits from
INSTRUCTIONS: This form is used to verify that all necessary approv
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
***********************APPLICANT FILLS OUT THIS SECTION************** ----]
APPLICANT--Jo�-, Oc--PO4SCO
PHONE P:�-
LOCATION: Assessor's Map Number PARCEL—
SUBDIVISION LOT (S)
STREET—��,��,,Oe �41 ST. NUMBER q(,O':!>
USE
I RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATEAPPROV1513
DATE REJECTED
COMMENTS
TOWN PLANNER
Comm
FOOD INSPECTOR -HEALTH
c,"I — 3 A
S
L,/,*.
INSPECTOR -HEALTH
COMMENTS
S [*�,
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 im
1 -
,.4 I -W -6a
. Olt mr� ul-r,*-t
ATE_
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number - is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
Q 0 ,zi- .9- �-J
(Location of Facility)
Signature of Permit Applicant
0
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
The Commonwealth of Massachusetts
Please Print
Name: -p— :5
Location: (2�
cily -e- Phone 9-77 Co T )i. -
am a homeowner performing all work myself
E��ram a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
citv: Phone
Insurance Co. PolicV
Compgny name:
Address
Qi1y: Phone #:
Insurance. Co. PolicV #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the Imposition of criminal penalfies.0of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
I do herby certify under the pains and penalties of pedury that the infixination provAded above is true and correct.
Signatur,� Date. o
Print name A Phone # -,4- 0
Official use only do not write in this area to be completed by city or town official*
E]Check if Immediate response is requked
Contact
FORM WORKMAN'S COMPENSA TION
Building Dept
E]
Building Dept
E]
Licensing Board
E]
Selectman's Offic e*
n
Health Department
0
Other
co
0) G)
38'11
38'11
Jan*09 02 08:51p John Vernasco 978-683-4241 P.1
BUILDING SKETCH
BorrowerlClient Michael/Linda Ustick
Address 263 Candlestick Road
oty N. Andover County rEssex State MA Zip Code 01 5
Lander/Cliern Norwast Mortgage
20
Deck
6
Den/Office
38
1/2
Batb
Kitchen/
Dining Area
r
Family Room
w/fireplace 25
33 Living Room
v/Firepalce
Dining
Room
Foyer
2
16
14 2
Laundry
Master
Batb
Bath
Bedroom
Master
Bedroom
Bedroom
Bedroom
TWs f� was reprodumd by UNted Syst�s Softwam Cmpany (800) 969-8727
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
January 9, 2002
Mr. John Vernasco
263 Candlestick Road
North Andover, MA 0 1845
Re: Application to finish basement for playroom
Dear Mr. Vernasco:
Telephone (978) 688-9540
Fax (978) 688-9542
Your application to finish the basement for a playroom at 263 Candlestick Road has been reviewed by the Health
Department. The application was denied on January 9, 2002 for the following reasons:
1. X Missing information
2. Passing Title 5 inspection of septic system may be required
3. Location of structure not acceptable
To address the problern(s):
If #1 is chec ked, please supply:
a. the' existing d.w.ell�..
Certified 'p" lot plan showing house, septic system and proposed project in scale
If #2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine'the size of the system and
whether it is operating properly: OR
b. Tie-in to municipal sewer
If #3 is checked:
a. Relocate the project
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
S��Op-"
BrZn J. LaGrasse, I-It-alth Inspector
Cc: Building Department
File
James Testa, 120B Hill Street, Topsfield, MA 01983
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
Cl)
m
m
m
m
m
m
Cf)
m
C/)
0
m
CO)
co
az CA
CD 0 '0
CL
W
cm CO)
>C=
CD
0
CD Q
CL
CD
Er
CD 0 CD
mm a.
CD ra
CD
CL C= CO)
to CD
S -
COO)
CD
co
.CD
r)
I
n
0
z
cn
cn
H
C/)
0
�40
z
ca
ITI
Go cr
=0 So
&a
=
it
::r-
=Faas
0
m
;z
0
z
0
=r -O
%a,
CA --4
L-4. �i
:7"
rL
w
=r CL .* CL
0
0
CL
7�
Cl
=r 0
CAOO
CD
r4
IE =r!!R
0
= CD C.
-0
u
to
C2
0 co,
-.I. a -CD
ir
GO
CL
co
0
CD
CD
co
0 CD
CD
CA
r,3 CL
cr
�73
rGOL
CD
co*
pj * 0
CA
CA
CA Q
0
2
ai i
CO:
:elf
=Cv
t
cc
0
CD
Lk w a
P CD i
CA
CD
CL'o
C-)
C/)
0
�40
z
to
ITI
::r-
M
;z
0
m
n
:7"
rL
w
C)
C/)
0
CL
7�
Cl
z
0
ell -
.1
104
0
41�
3 5 0
Date . ....... ... .. .. ..... P-
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�4-
This certifies that .......... / J ...... ......................
has permission to perform ..... /I. �I ....... ....................
wirin in the building of ............... 10.,? -.5
19
at AW....,AorthAnd ve "'ase
Fee.;.5 .... dL). Lic—o-A ..... .................
Check # E��[ A INSPEcrOR
Official Use 0. nly
I—,
Permit No.
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS527 CMR 12:00
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)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Num
Owner or Tenant v-, V e Cl
Owner's Address Aid % e
Date
To the Inspector of Wires:
Is this permit in conjunction with a building permit Yes Z--- No 0 (Check Appropriate Box)
Purpose of Building Ax J -Loo Utility Authorization No.
Existing Service—AmPs voits Overhead 0 Undgmd 0 No. of Meters
New Service Amps____---Yoits Overhead 0 Undgmd 0 No. of Meter.
Nun4ber of Feeders and Arnpacity
Location and Nature of Proposed Electrical Work— ZU Jr AJJ'�-1012 75;E
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy incJuding Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Starl:42 6) 12, Inspection Date Resquested_______________----Rough —Final
Signed under the Penalties of pejury:
FIRM NAME LIC. NOA
*6 (f, -
N051 ri 9 E -Al
Bus. Tel No. Y M- - t1-0 0 --Lf L-10 L-'
Address 00 S f\ t- C- kfl'�O W' -VII _ Att Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not fiave the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this req�lrement. owner Agent (Please Check one)
Telephone No. PERMITfEE $C-7�f6)0 -
(Signature of Owner or Agent)
Total
No. of Lighting Outlets /0
No. of Hot fuse
No. of Transformers - KVA
Above 0 In 0
No. of Lighting Fixtures
Swimming Pool
gmd 0 gmd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. 9f Diposal
No.
Pumps Tons
KW
No. of Sounding Devices
No.1 of Self Contained
No. of Dishwashers
Space/Area Hea ng
KW
Detection/Sounding Devices
0 Municipal 0 Other
No. if Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy incJuding Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Starl:42 6) 12, Inspection Date Resquested_______________----Rough —Final
Signed under the Penalties of pejury:
FIRM NAME LIC. NOA
*6 (f, -
N051 ri 9 E -Al
Bus. Tel No. Y M- - t1-0 0 --Lf L-10 L-'
Address 00 S f\ t- C- kfl'�O W' -VII _ Att Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not fiave the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this req�lrement. owner Agent (Please Check one)
Telephone No. PERMITfEE $C-7�f6)0 -
(Signature of Owner or Agent)
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBIN
00-
11000'
This certifies that ..... F. �5� .. ..................
0
has permission to perform ..... p ..... I.k....
4.;:r? - -f�'
plumbing in the buildings of . 114 �i .......................
at, ........... North Andover, Mass.
Fee. Lic. No..!5�.'J/ / .. ........ .... ----------
,PLUMBING INSPECTOR
Check # 9 'L-
7367
I
Ir
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
........... ...... . ..... . . . ... .....
City/Toww North Andover ,,,Permit# 7 �14
MA. Date: 04/24/2007
Building Location:, 263 'Candlestick Road - Nania Owners Name: 263 Candlestick Road - Nania
.. .. .. . . .
Type of Occupancy: Commercial Educationalll;_ Institutional Residential
Industrial
P Alteration: No
New: j Renovation:--- Replacement:' I Plans Submitted: Yes',,
L96
FlYT1 IRFR
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes" �jNo`,
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.
Ch.eck One Only
Owner Agent
Sionature of Owner or Owner's Aaent
I hereby certify that all of the details and information I have submitted (or entered) reqardinci this aDDlication are true and accurate to the best of mv
Knowledge and that all plumbing work and installations performed under the permit issued for this application will b * compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142_e"fi7e 1!7
,,,Uneral LawA-.--_
By'� Type of License:
Title, *1 1 Plumber Signature of License/dP
Master
City/Town Journeyman License Number: 9:3�li
A0n0f%X1Cr% j_ —, , _ " _1
i
z
W
z
0
3�
W
w
00.
z
U) U)
a: z
<
1__�e
z
Z
0wow
<
M
Z D
3.-WW=WW—
0 ca
9
U)
U)
(L
IX
Lu
1--w—
0
9
U)
U)
MOKI-
— X
j D<U)
u_ I-
UJ Qgl.-ZWO0lXK
a:
<w0j.-
wu)wqz
It
IL FL
W_ Ix
<�eZR'.00ir-3:TZ
wul.-MIL
Ow
_�-Omg000zzw�-�-=
u_3,.MRj<1WWW
_j
0
t=
0
W -j
RD
<
Ro.
3'. 0
SUB BSMT.
BASEMENT
15' FLOOR
2 Nu FLOOR
n
3 R"F-LOOR
4 1H FLOOR
51H FLOOR
6'm FLOOR
FLOOR
FLOOR
. .... . ....
.......
Check One Only Certificate #
Installing Company Name:1 Eric C. Foster Plumbing
& Heating LLC
Address:�
145 Stedman Street
City/Town' Chelmsford
�State:'� MA
ik Corporation
Partnership
Business Tel:
59ii�'256-5976_ j
Fax:
Firm/Compairy 04-354-2016
Name of Licensed
Plumber:F��ic CFos
r'
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes" �jNo`,
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.
Ch.eck One Only
Owner Agent
Sionature of Owner or Owner's Aaent
I hereby certify that all of the details and information I have submitted (or entered) reqardinci this aDDlication are true and accurate to the best of mv
Knowledge and that all plumbing work and installations performed under the permit issued for this application will b * compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142_e"fi7e 1!7
,,,Uneral LawA-.--_
By'� Type of License:
Title, *1 1 Plumber Signature of License/dP
Master
City/Town Journeyman License Number: 9:3�li
A0n0f%X1Cr% j_ —, , _ " _1
F.
im
El
co
U.J
CA
cr
I
Of 40RTH
0
Date., --5—../-.,,)..7 .........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........
............................................ I ........................................
has permission to perform
. ...............
.... n ...............
wiringin the building of ....................................................................................
1; V /, 3 6 � � z � - 2,r;--, A -, -, v
at ................................................... ...... . North Andover, Mass.
J' ..........
-ZS — " ..............
Fee I ................. Lic. No7;�:(�a' ..............
ELEcrRICAL'INSPE R
Check# �7
7356
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (M 527 MR 12.00
(PLEASE PRINTIN INK OR TYPE ALL INFOR11ATION) Date: - it 1 o-2
City or Town of. NORTH ANDOVER To the Inspeitor qf Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Q(a3 Land�es,-y�cL Rd,
Owner or Tenant �s A N& Telephone No.V?-VS-khal
Owner's Address
Is this permit in conjunction with a building permit? Yes R" No [:] (Check Appropriate Box)
Purpose of Building' rl�e 5, Ide rr� k 0A Utility Authorization No.
Existing Service� D-00 Amps 3-0 1 '1 �-(OVolts OverheadE] Undgrd H- No. of Meters
New Service --------- A-ffips I Volts Overhead Undgrd F1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: nc) J�L.)r Ze ri lo VQ+dW
Completion qf the following table n7av be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above n In-
grnd. grnd.
7�—o. of Emergency Lignting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
[No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
.. I
I
I Tons
I
I KW
.. ....
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
LocalEl Mun'C'PP' El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
--TT
No. of Motors Total HP
elecommunications 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: SM (When required by municipal policy.)
L11 0
WorktoStart: 7�,,:)OLO_7 inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVER A�GF: 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 c-ov!epge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE kr BOND [I OTHER F1 (Specify:)
Icertify, under thepains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: C--,-2auaoA- Len -s -i c cna-,panq LL( - - LIC. NO.: 304-7S AL
Licensee: Caa_U&&SYginature LIC. NO.: SODS(p
(�f applicable, enter "exe�t " in the license nu iber lin Bus.Tel.No.:-72k--?11-11 b
Address: &U16",�)Nn'MA Q Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, securily work requires Department of Public Safety "S" Li -cense: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
requiredbylaw. By my signature below, I hereby waive this requirement. I arn the (check one)E] owner Elowner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
Ok
64" AV
The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le2ibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: k A
11
Phone #:. �] i� � _� 9 � — S I S-0
Are y an employer? Check the appropriate box:
1. [71 aim a emplo er with 4. EJ I am a general contractor and I
employee full' ind/or part-tirne).* have hired the sub -contractors
R� +
D I arn 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.
[No workers' comp. insurance
required.]
3. D I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
workers' comp. insurance.
5. 1:1 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. F� New construction
7. AVemodeling
8. E] Demolition
9. E] Building addition
I 0.�lectrical repairs or additions
I I.E] Plumbing repairs or additions
12.E] Roof repairs
131� Other
*Any applicant that chocks box #I must also fill out the section below showing their workers' compensation policy information.
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 niy employees. Below is the policy andjob site
ipformation.
I
Insurance Company Narne:
Policy 9 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 against the violator. Be advised that a copy of this staternent may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify1un#1erAe painspndpWalties ofperju
_gifti-the information provided above is true and correct.
Sivnature: Date: S-1 / lo?
C en�
Phone #: 9 1. _� - D b \A — D- S_
Official use only. Do not write in this area, to be completed ky city or town offliciaL
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 #: