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9579
Date ...... 9.—. /. P
..... .. .. .. . . ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thi s certifies that ........................ ............... ;�� .......
.... ... .... ... ............. ...
has permission to perform ........ ...... ............................
<51 0-i y
wiring in the building of .......................
.............................
at ............... ..... ....... ............... North Andover, Mass.
Fee ... 6
. ? No. ....... . 16
. . ..... ...
ELEcTRiCAL'iNSP'E&**OR...
Check #
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the
Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. (31 c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited ap to the time ofongoing construction activity, and may be -deemed -by the Inspector-of-W-ires abandoned.and-invalid-iflie—
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, art extension of time for completion of worli�shall be Qermitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or -the installing entity stated on tl;e permit application. . -
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence' during the qualifying period beginning on August 15 2008 and extending -through August 15, 2012.
8 — Permit/D.ate Closed: Note: Reap"ply for new pernlAll�
0 Permit Extension Act — PermitADate Closed:
tl\ (flmmonwea& ol Va-Mackujeffi Official Use Only
MM9 Permit No. � S—)
14 Mf 16 Apatmd ol3ie Sewiej Occupancy and Fee Checked
)w BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PRINT IN INK OR TYP -, -16
,�ALLJX170RMATIQN) Date:
—7 _;,2 IF
City or Town of: JA el To the Inspector of Wires:
By this application the undersigned gives notice_of his or her intention to perform the electrical work described below.
Location (Street & Number) 9- la- Vocle— t?—OA W
Owner or Tenant
Owner's Address
No.
Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Box)
Purpose of Building_ 12 �� i &=�e- Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd [:] No. of Meters
New Service Amps Volts Overhead UndgrdE] No. of Meters
Number of Feeders and Ampacity
and Nature of Proposed Electrical Work: 1,0 J rp .4 Ipto 1.-�2, OZ72)
Completion of the following ble may be waived bv the IdsDector 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 E] In- E]
grnd. grnd.
o. of Emergency Lighting
Batte!y Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
s
No. of Switches
s �Burners
No. of Detectioi 3nd
Initiating Devices
No. of Ranges
Total 47 - &et
P —Coo f Air Cond) / Tons ;4 + L)
No- of Alerting Devices
No. of Waste Disposers
He—fflliiimp
Totals:
I.Numb�r]
I ............. * -
Tons IKW
[ .................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local [:1 Municipal El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total IIP
Telecommunications Wiring:
I No. of Devices or Equivalent
OTHER:
-- Attach additional detail i(desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 25 0 — (When required by municipal policy.)
WorktoStart: tomp JtA�F—Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVIEWGE: 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! coyfrage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEAZ BOND[] OTTIEREI (Specify:) 2-14 r t c �4u ro
I cerWfy, under the pains ani*en-arfthes ofperjury, that the infornurdon th * pfication is true and c Im lete.
P
FIRM NAME: P7 Z- !�7a LIC. NO.:
Licensee: Signature LIC. NO.:r3el�l 7
(If applicable, enter "exempt " in the license number line.) Bus. Tel. No. 9 ' �W7
: �'gL
Address: 7-61 o.: 7,Y 3
I 7:i a )Ckl .5?�Z M2 ;& Alt. Tel. N
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: 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) El owner El owner' t
Owner/Agent
Signature Telephone No. FP—ERMIT FEE. $
-4
Date. /' ..... .9 ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ... ..... ..............................
has permission to perform ......................................
z9 . . . ............
wiring in the building of .......
r- ) - (� ............. a . . .................. e ..................
at.. -r/ ... R..
.......... ...................... North Andover,, Mass.
Fmk ... . ........ Lic. No /2?/*`*�.8�q .............. .......
I ELEcrRicAL INsPEqdR
Check #
8825
2012 Massachusetts Electrical Cod, Amendments 527 CHR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. p. 143, § 3L, the
cb�,,.,. Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursu an
inn or corporation stated on the permit application. Such entity shall be responsible for the
electrical permit shall be issued to the person, f ant to M. G1 c. 166, § 32,
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of ongoing construction activity, and may be.deemed by. the inspector -of -Wires abandoned-and-invalidiflie—
or she has determined that the authorized work has not commenAd or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity.stated on the permit application.
El The Permit Extension Act was created by Section 173 of ChaUt r240 of the Acts of2010 and extended by Sections 74 and 75 of Chapter238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
putpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence'� during the qualifying period beginning on August 15, 2008 and extending'through August 15, 2012.
qg-Rule 8 — Permit/Date Closed: 1. /
***Note: Reapply for new permit4N�'
0 Permit Extension Act — Permit/Date Closed:
r
)1"
\ 4
(famnwnweahk o/ ma&iac�wg& Official Use Only
20 Permit No,
Occupancy and Fee Checked
�OARI) OF FIRE PREVENTION REGULATIONS Rev. 1'/07] (leave blank)
APPLICATION FOR PERMIT TO -PERFORM ELECTRICAL WDRK
All work to be performed in accordance with the Massachusetts Electrical Codc.(JyMC), 527 CNM 12,.00
(?LEASEPPYA71K INK OR =E ALL XPORMA T10AI) Date: 0/11A"
City or Town of: W�Ili Andflw":�c To the Inspector of Wires:
BY this application the undersi.gned gives notice of his or her intention to peiforni the electrical work- described below,
Location (Street&, Numbe"� 2 4R 1K R J
Daviij ��Tv,,Ytletw
Owner or Tenant Telephone No.
Owner's Address 2 8 ko ck R_d, N o n I i d u M A -0-1174- 3 -7 2 0 6
Is this permit in conjunctiorl, r,,nkti ij building Permit? Yes F7 No F7 (Check Appropriate Box)
Purpose of Building Rosi. en ia
Udlt*, Aulhorization No.
Existing Sery e Amps Volts Overhead Undgrd [7 No. of Meters
New Service Amps 'ndgrd 7 o. of Meters
Volts Overhead U N
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Wo—rk:
t. 0'i 1�j
ComViCtion of theibliawinr table may he waived bv the inimptetar nyrwi_
N o 0 f P e c
No. of Recessed Luminaires
Luminair
of CeL-Susp. (Paddle) Fiiuts
No. of Toral
Transformers KVA
nen
N 0 f L u uned
No. of Luminaire Outlets
a,re Outlets
lNe. OfRot Tubs
Generators KVA
a. of Luminaires
N 0. aj 5
--]No.
Above in-
Swimming Pool Md. arrid.
c. of Emergency hung
jBiattery Units
N _e e e in a
No. of Recelitacle Outlets
c ptacl 0 ti U
orp .
of Oil Burners
FM ALARMS No. of Zones
N o it h A
o. of Switches
NO. of'Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
lNo. of Air Cond.
Tons
No. of Alerting Devices
No. of -Waste Disposers
1; r p 'lumber 'I'On
J-ti:!T?
T"
'0
No. of SL
N W-ILontained
eL
Detec:
Der on/ 'e
'fi De
-fion/Alerfing Devices
No. -of Dishwashers
32 �e/A
Space/Area Heating KW
'Spac : W
Lo [] f4un
Local
esi Coll
Connection 7 0&er
No. of Dryers
No. o ate r
Heaters KW
Heatking Appliances
ptz KW
KW
NIL Of 0.
No. of'
Bafins7d
jData
I
ec tyS Xte
ecurity Systems:*
a en es or
No. of IbMces or Eanivalent
Wiring:
No. of Devices or Eouivaient
No, Hydromassage Bathtubs
No. of otors Total.RP
f otoris Totj
11
eiecommunica
TOW's'
its or
4,(,. of Device or E uWal7ent
OTHER:
-----------------------------
A aacn aaal"or= aerall tr 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 NEC Rule 10, and upon completion.
IN'S'URANCf_C�OVERAGE. Unless waived by the owner, no permit for the performance of electrical work may issue unless
flit licensee provides proof of liabifity insurance including "Completed operation" coverage. or its substantial equivalent.. The
Lin d ers igned certifies that such coverage is in force, and has exhibited proof of same,to.the'permit issuing office.
CHECK ONE: INSURANCE F7 BOND F7 OTHER F7 (Specif�:)
I cert6Fy, under thepahis an�p jup�
S` A
n 0
n 61is apph=don is &me and complem ? 0 E.
P1 RM NAMM: NO.-
Licansee: A A J, X LIC.
Signatu Z,1 LIC. NO.:
(11'applicabla, enter "exempt in the license number line.)
A d d ress: Bus. TeL No.:
Alt. Tel. No.:
'1'er 147, s. 57-6 1, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSLTPANCE WAIVER: I am aware that the Licensee does not have the liability insurancc coverage normally
reqUiredbylaw. Bymy signature below, Ihcreby waive this requirement Iamthe(check one) El owner Downer'saizent
0-11 er/Agent
Telephone No.— PERMIT FEE. S,_
�C,
AWAM-b
July 14, 2009
Inspector of Wires
1600 Osgood Street
North Andover, MA 0 184 5
Re: MGL Chapter 143 Section 3L notification
Dear Inspector of Wires,
Please be informed that the permitted installation wiring for David Gwynette at 28 Rock Rd, T
Andover, (978) 688-9168 is complete and ready for inspection.
Respectfully,
Richard F. Cayer, MA Lic. #A10128
KeySpan Home Energy Services
62 Second Ave
Burlington, MA 0 1803
(781) 359-2710
Date../617-�5�74;!7-
TOWN OF NORN AN60VER
PERMIT FOR GAS�Ni/TALLATION
This certifies that . ... C??� /4� .............
has permission for gas installation
in the buildings of 41,11
....................
North Andover, Mass.
at C;R.e? ... / ...................... (
Fee,7.7.,Z�, . — Lic. No.lq'��IP ... .........
G;i ZPM-'204R
Check # 1"e)
6171
<C\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING - —
(Print or Type)
AJQA)VLK . Wss. Date 20.0-7- Permit*—V//7/
N11AA . 6� �A A I I ed e
Owners Name
Building Location , 'olL
0 . PW Ive —Type of Occupa�y__&�,l
New 0 Renovation 0 Replacerrient 0 Plans Submitted: Yeso No 0
Business Telephone 9-ig- q�q -q)±I-
%-ame of Licensed Plumber or Gas Fitter
Chock one:
(K Corporation
0 Partnership
0 . Firm/Co.
Ce
_LrT,1
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL CK 142.
Yes �a No El
If you have checked ym please Indicate the type coverage by checking the appropriate box
A liability Insurance policy 1A 00w type of Indemnity 13 Bond 0
'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
1 2 of the M General Laws, and that my signature on this permit application waives this requirement.
one:
Check Agent 0
)ren—t
I hereby cer* that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my
kn go ano.that all plumbing work and installations performed under the permit issued for this appli will be in compliance with all
pernVt provisions of the Massachusetts State Gas Code and Chapter 142 of the C*rilrjd Laws.
BY T Of License:
Plumber re of Licensed ber or Gas Fitter
Title Gasfitter
Master License Number
1
lJourneyman
0 1
N
I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(print or T
Mass Date 19 �b— Permit #
Rf-j Owner's Name <,Oyr4
Building LocationjjY c K K d "
U18 - Vj � Type of Occupancyj
New 0 Renovation El Replacement * Plans Submitted: Yes El No k,
FIXTURES
Installing Company Name METROpoLfTAN
Address & HEATING CO., INC.
Norwcoa Commerce Ctr., SIdg. 34
Endicott Street
Business T
Name of Licensed Plumber
1779
Check one:
Alcorporation
[3 Partnership
11 Firm/Co.
Certificate
1766
INSURANCE COVERAGE:
I have a curr"n liability insurance policy or its substantial equivalent which meets the requirements of M'GL Ch. 142.
Yes )K-. No F-1
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 11 Bond F-1
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 Acent Owner El Agent 0
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all,plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisiohi offthelMagia-cWusetts State Plumbing Code and Chapter 1.42 of the Geneml- Laws.
By
Signat4urof Licensed Plumber
Title-
City/Town Type of License: Mastei Journeyman E]
APPROVE15 (OFFICE USE—ONLY) License Number -M[660-
ONES
mommossommmmmmsm
NONE
SEEK
SEEN]
MEMEMEMEMEMEMMEM
MONSON
MESSIMESIMMEM
0
Eons
MEMESIMEN
MEN
Installing Company Name METROpoLfTAN
Address & HEATING CO., INC.
Norwcoa Commerce Ctr., SIdg. 34
Endicott Street
Business T
Name of Licensed Plumber
1779
Check one:
Alcorporation
[3 Partnership
11 Firm/Co.
Certificate
1766
INSURANCE COVERAGE:
I have a curr"n liability insurance policy or its substantial equivalent which meets the requirements of M'GL Ch. 142.
Yes )K-. No F-1
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 11 Bond F-1
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 Acent Owner El Agent 0
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all,plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisiohi offthelMagia-cWusetts State Plumbing Code and Chapter 1.42 of the Geneml- Laws.
By
Signat4urof Licensed Plumber
Title-
City/Town Type of License: Mastei Journeyman E]
APPROVE15 (OFFICE USE—ONLY) License Number -M[660-
VI!
In
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Date.... ................
:8
Ui
TOWN OF NORTH ANDOVER —
PERMIT FOR WIRING
SACHUS
This certifies that
..............
has permission to perform
wiring in the building of ............. ............................
at .. r,�7.E ....... ...................................... North Andover, Mass.
FeeO. .............. Lic. N05��&�F'q ....
-C- A --L- -I- N --S- P --E- C.- r-0-- R- .................
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
TO
1.- 2873
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that A -r- ?-,A ell)c' /". 'r/, -,w
has permission to perform ... 4.<.- /'k .................
plumbing in the buildings of.. qh/-'�- ......... I .........
at. . 9. or. K:: i -?4 ....... orth Andover, Mass.
Feel ? ...... Lic.
PL*U*MB*ING IAPECTOR
WHITE: Applicant CANARY: Suitcling Dept. PINK: Treasurer GOLD: File
"- o�4
TM COARION WE 4 L TH OFAIA YS 4 (R USE T 7 S Office Use only
ly Permit No.
BOARDOFFB?EPREYEMONREGY)LA7YOAS527CM12-00
Occupancy & F= Cliccked C—C
AFPLI(�'ATIONFORPEI?NflTTOFFEFORM==CAL WORK
ALL wORK TO BE PERFORIvMD IN ACCORDANCE WITH TEE MASSACHUSSTS ELECTRICAL CODE, 527 cNdR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. FM=17 PARCEL
Location (Street &
Owner or Tenant
Owner's Address -� 4 4.
Is this permit in conjunction with a building permit: Yes [M No (Check Appropriate Box)
Purpose of Building P L-, 2,� V- E- jjn� 4 L--, ' Utility Authorization No.
Existing Service Amps Volts Overhead Underground No. of Meters
New Service Amps 'Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 7 -?z V. SCdfik b) 9 -7Z JILIJ-411 11A), L
N(
5�
No.,,�f Lighting Outlets
No. ofHot Tubs
No. of Transformers
Total S'10)
KVA
No. ofLighting Fixtancs
Swimming Pool Above
Below
Generators
KVA
ground
ground
No. ofRcccptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burn
FIRE ALARMS
No. of Zones
No. ofRanges
No. of Air Cond. Total
Tons
No. ofDetection and
No. ofDisposals
j.No. of Hcat Total Total
I Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. ofDi3hwasham
Spaca,�rea Heating KW
No. of Self Contained
C4
Dctection/Sounding Devices
Local Municipal
F7
Other
Nor.'ofDryers
Heating Devices KW
Cormcctions
N%of Water Heaters KW
No. of No. of
SiRns
Bailasis
No. Hydro Massage Tubs
No.'ofMotors
Total HP
a, k- a G.,K, [R, wt
ove v. om.-
moll IQG MI
Big
am=
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OWN�SNST�J -�WAIVEPIamavzediAlirL=)sedoesr-ctizn1
ar)ddiatmysgrt=cndmpmr.daFpb'mb'aivm'r�ad�sreqmumt
(Please check one) Owner Ao-ent
Si�naaffe ot Uwner or A,(,Tent
MINIMPI-Wo"Cl-ro
.,,A� /) //� g,-)
777- 37,7176 77
/-T,(/ -- I AIL Ttl Nb
d-rinsLraixeco�.mmorits a±star�eq�asieqmedbylvbmdmgctGaymILaAs
I'd- 6W
Telephone No. PERMIT FEE S /,b , --
7 r—
Location '�-Poad
No. Date - 7/Q a X�7
TOWN OF NORTH ANDOVE@
0 Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
3381
Div. Public Works
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Town of North Andover 40RTH
OFFICE OF , , 1. , �
0
COMMUNITY DEVELOPMENT AND SERVICES
27 Charies Street
North Andover, Massachusetts 0 13,11 5
WILLIAM 1. SCOTIT
Director
(978) 688-9531
In accordance with the provisions of MGL c 40 S 54, a condition of Building
Fax (97S) 683-9542
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 MGL c 11, S
150 A.
The debris will be disposed of in:
I*Al�-ce lv�'
(Location of Facilit/)
Signature of Permit pplicant
-7 g --e -
�1,a 7�
//62te
NOTE: ' Demolition permit from the Town of North Andover must be obtained for
this project throuch the Office of the Building Inspector
13ONRD OF -UPEALS 682-9541 K71LDINNG 68S-9545 CONSERV,�TION 683-9530 623-9540 PLA-\ NINC. 68S-9535
In Order To Be Protected Under The Guarantee Fund
Hire A Registered Home Improvement Contract6r
Hi
-Tech Is A
Registered Home Improvement Contractor
1�� -,�-,.HOME IMPROVEMENT CONTRACTOR
. e Tation, 118836
is
CORPORATION
x iTa ion 04/25/01
HI TECH WINDOW & SIDING INSTA
"' LIAM P. CHASE II
ADMUSTRAMR
—136 WASHINGTON ST
—�—LHAYFaT-U -MA-01830�--
Hi-Tech Also Holds A Valid
Construction Supervisor License
4
OEPARTNENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires: Birthdate:
CS 016201 11116/1999 11/16/1947
Restricted To: of
WILLIAN P CHASE
15 KIN6SBURY AV
HAVERHILL, 4A 01835
44
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P4MK Oft OUVWVM AFFQF� BY THE POUCU MLOW,
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"S-588-fU9 5RNk $70-973-3917
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INSURANCE COVERAGE:
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es No 0
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COMMONWEALTH OF MASSACHUSETTS
BOARD IN PLUMBERS AND GASFITTERS
PL REGISTERED AS V -PLUMBING CORP
ISSUES THIS LICENSE TO
TYPE THOMAS R'GAGNON
—C
PO BOX 8860.
SALEM Ilk -01971-8860
67�686 1524 05/01/96 674686
IMPORTANT NOTICE
PERMITS FOR PLUMB1140 AND OAS FITTINQ
INSTALLATIONS ON STATE OWNED OR USPI
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
COMMONWEALTH OF MASSACHUSETTS
I �_�;
BOARD
IW�
IN PLUMBERS—AND GASFITTERS
IMPORTANT NOTICE
P L
LICENSED ASA0,M'A_S;IER PLUMBER
Ptr?&IT3 FOR PLUMBING AND GAS FITTING
ISSUES-THIS,110ENSE TO
INSTALLATIONS ON STATE OWNED OR USEI
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FACI LITIES MUST BE FILED AT THE
TYPE
THOMAS R�P'AG�JbZ:-
OFFICE OF THE STATE BOARD.
L
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PO BOX a
SALEM 01971-8860
691783
101, 05/01/96 691783
COMMONWEALTH OF MASSACHUSETTS
M-11111-IL-109-1;0*1;[,]�--idg�- ,
BOARD
IN PLUMBERS. -AND GASFITTERS
IMPORTANT NOTICE
P L
LICENSED AS A,JOURN,EYMAN PLUMBER
PERMITS FOR PLUMBING AND GAS FITTIN,
ISSUES THIS LICENSE TO
INSTALLATIONS ON STATE OWNED OR USL
/ , .1
FACILITIES MUST BE FILED AT THE
TYPE
THOMAS R/GAGN'qN
OFFICE OF THE STATE BOARD.
F 886
'0 BOX
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691784
18597 05/01/96 691784
LICENSE NO. EXPIRATION DATE SEAIAL NO,
Restricted To: 00
13428
Ulu
DEPARTMENT OF PUBLIC SAFETY
SPRINKLER'CONTRACTOR LICENSE
Nuiber: Expires: Birthdate:
SC
002265 08/31/1997 08/31/1957
Restricted
To: 00
THO H A S GAGNON
4 ORUHLRN RD
IPSWICH, MA CUB
Date. 9�A
977
T
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
X
This certifies that 6�"qj IV. 0.�-y .... P.) H ..........
has permission for gas installation ... /.(?.j ......... .........
in the buildings of . L.A"�. iv .& C ............
at ................. I North Andover, Mass.
Fee. 151 No. ZOO C ...
915 .5f il
PAID
GASINSPECTOR
WHITE: Applicant CANARY: Building pept. PINK: Treasurer GOLD: File
Location
No. 013 Date ,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
v1-4 3,5�9
13021 Building Inspector
Div. Public Works
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Town of North Andover koRT11-
0
OFFICE OF
0
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
North Andover, Massachusetts 0 1845
WILLL4,M J. SCOTT SA U
Director
(978) 688-9531 Fax (978) 688-9542
In accordance with the provisions 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 MGL c 11, S
150 A.
The debris will be disposed of in:
(Location of Facility)
Signabire.of-Permit-App4cant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through- the -Office -of the-Buflding-Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNrNG 688-9535
Th e Commonwealth of Massach usetts
Department of Industrial Accidents
Mes at/flyest/9.71100S
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurnnee Affidavit
IMI
CIN Pho
[] I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
M
v*d*
I am an employer pro f, ployees working on this job.
d Lng worke s' compens )a�or my
city-, phone
Failure to secure cover2ge as req uircd under Section 25A of Nl G L 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or
OUC years' imprisonment as well as civil penalties in (he form of a STOP WORK OR -DER and a fine of 5100.00 a day against me- I understand that a
copy of this St2tement May be forwarded to the Office of' Investigations of the DIA for coverage verification.
I do hereby cerrifyAjjder th
,/ pains
Print narne
i -al the inforrnation provided above is true and cor7ect
Date
k:�l lo n � 1
official use only do not write in this area to be completed by city or town official
city or town: permit/license [7 Building DeparTment
C] Licensing Board
C] check if immediate response is required oSclectmen's Office
r7Hc2lth Department
contact person: phone f7Other-
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'Room 1301bne.-Ashbur't6n, PlaceHOMELIMPROVEMENT,CONTRAC,T OR,ROOF,ING DBA'P, TEWKSBURY,, 0 1876, CHARLES J.'WOOSTEA ROOFINGADMINISTRATOR
6772
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CONSTRUCTION _ SUPERVISOR LIC -"NS[
Numh*r; [xplrws:
'CS: 064268 05/11/2000
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010'. &SHDURTVN NACF, KM l:W)1
BOSTON, MA 02108-161.8
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---- ---'-'---------------- -
Koc|` I -lop fn/� reueipt�and chango
01 ad�rp,y noCi<icot�on.
Location
No. Date
TOWN OF NORTH ANDOVER
AL
Awa
Certificate of Occupancy $
Building/Frame Permit Fee s
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #,2;7,�x&
1 8L; 4 6 Building lnspe&r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER:
DATE ISSUED:
SIGNATURE:
Building Commii(sioner . /InEeector of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
06 jx�, 2 a --R 0 a
1.2 Amsessors Map and Parcel Number:
1 50
Map Numbe; Parcel Number
�Qr4h qn8c)Ver-
1.3 Zoning Information:
Zoning Dii-r �cl Se UrfeQ4 L)-��
1.4 Property Dimensions:
)3j)66
Lot Area (sf) Frontage (ft)
1.6 BURDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required Provide Required Provi&d Reqtlired Provided
1.7 Water Supply M.G.L.C.40 54) 1.5. Flood Zone Infomution: 1.9 Sewetne Disposal System:
Zone C, Outside Flood Zone Municipal OnSiteDisposal System D
Public V Private 0
SECTION 2 - PROPERTY OWNERS111P/AUTHORIZED AGENT IC U!Stnct: Yes _�,Jo
I Ownerof Record
�Ddojd e t?oad
Aqame (Print) U Address for Service :
(748) 91,6 9'
Signature Telephone
2.2 Owner of Record:
5C) mc �12 C) eb C
liar ad
Name Print Address for Service:
'Ahl �0
SiAdaiii-re - - Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable 0
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
-F-Akv" L -Y) tv i3s GA Pe -t Cor)-STYL, c,-f�' akv
Registration Number
-� I 0�e? (a
Address (o A 66o-ff 04. 64tYe,10) MA
C/ -7,87
Expiration Date
Signature Telephone
09
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SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (check appUcable)
New Construction 0 Existing Building 0 Repair(s)--7-Terations(s) 0 Addition 0
Accessory Bldg. 0 Demolition 0 Other X, Specify
Brief Description of Proposed Work:
C'XJ'dLV!q
I QW.CTION 6 - VNTIMATR'n V0NQT1211VT1rnP9 irnCIM I
Item
Estimated Cost (Dollar) to be
Completed b permit applicant
y
OMCIAL USE ONLY
1. Building
0oo
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechatfical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
a&%-JLJ[%J1'4 /3UWf4rJKAU1nVK1LA*11ULN 1U ISE UUMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature ofOwner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, -U cl U J, 0 UJ W f I C 11cf- (as Own&/Authorized Agent of subject
property Ili
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
WZIWQ�wm
Print Name
of
0
Date
NO. OF STORIES SIZE
-BASEMENT OR SLAB
-SIZE OF FLOOR T13VIBERS ST 3 RD
-SPAN
_DD,4ENSIONS OF SILLS
DINIENSIONS OF POSTS
-DIMENSIONS OF Gl[�DERS
-HEIGHT OF FOUNDATION THICKNESS
-SIZE OF FOOTING X
-MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUELDING CONNECTED TO NATURAL GAS LINE
�'_eqq Ou-e_ - -I--
VQ-p W- *,'—' D)pt- Jz-
FORM U - LOT RELEASE FORM 5a"
INSTRUCTIONS: This form is Used to verify that all necessary approv 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.
APPLICANT FILLS OUT THIS SECTION*****-*******
APPLICANT P eumnc4c,
LOCATION: Aisessoes Map Numwr�_�4 9L
V_
SUBDIVISION
STREET_!��
AGENTS:
PHONE�97S) 68 8 -9/69
PARCEL 50
LOT (S)
ST. NUMBER, Q8
USE ONL h**** * ****--
I
A 6'1_0�16;ISTRATOR DATE ��ROVE6___'7
DATE E ED
WT
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR TE
RavloW 9197 )m
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL 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:
CA. c, r- M TA2
0 -0A S klE - U—Ak
A
(Location of Facility)
Signature of Permit Applicant
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
Department of Industial Accidents
Ofte of 1nv"dgaftns
Boston, Mass. 02111 -
Workers'Cm7pensetbn Insurance Affldavt
Nwm P! rint
Nam:
Location:
city I am a homeowner performing all work mysW. PhWe S
F-1
F� I am a sole pq)detor and have no one working in any capacity
F-71 I awn an employer providing workers! compensation for rrry employees mrking on this job.
Compami name: e6kTo.. La rvp SCA P-4-1 Ir Co r) S -r)- (-/ c, rl,o- n
Cft 6/970— 1 /0 -)- Phone * 0/ 14 L4 -
.Co. M fqA1, tl POL-V # ;L C 0 9-
e Al F(? rl 1, 1 Y .-/f K4-L,,Iq 1,.,f -e, J q 11, �'S k/ L 1'(3 0 M
AM. / 0' S t")q " k,� �9 S 1--P- !� 0 9
Cft f-&PgF-'-r(-b K4 �- 0/� I? Phone#
I naurance Co. PokV 8
Falkwe to secure coverage as required under Secdon 25A or MGL 152 can lead to the knposigcn of aky*W pgns�of's flne up i - 0 $,,SW.W IN
andfor one yeers' lmprisoi..mffl-n.vM-M.CbA4wnM=Jnbshm dA STOP vyDW OF4MkMd.8 tkw d.(S1W.GW-zAW qpbd_WAL I
understand that a copy of this stataned may be fanvarded to the Offlce of lnvndgsdon@ of Me DLA fbr coverage vwfficsdon.
I do hereby cw* uncbr ft pebw and partaffin ofP&JUrY bW the Informatian provftd above Is bw aw 011n
signature Q—xxx�%-- Date 0
Print name -C -Ur -r 0RVt(2C-+,J PtWW # LJ
OfflcW use only do not wrfte In this am
to be completed by dty or town after
d1ty or Town P
C]Check I Immediate msponse k requked 0 BuilaWng De#
0 Licenft fildaid
Conted pason., ph" 0 C] Seledman's Ofte
C] Heafth Depertrnent
C] Other
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
Farm INFORMATION PAGE
AGENT NO 2591 OFFICE NO 2591
Family
JAMES W UGONE
FARM FAMILY INSURANCE
Casualty In Company
10 S MAIN ST STE 208
Genmont Now York
TOPSIFIELD MA 01983-1832
978-887-8304
NCCI COMPANY NO. 16721
POLICY No 2005W6638
ADJUST RENEWAL
EFFECTIVE 4/24/04
EMW, U99HRME INSURED AND MAILING ADDRM:
CURTIS DRAGON
FEDERAL 10. NO 015420163
DBA EARTH LANDSCAPE
6 ABBOTT ST
SALEM, MA 01970-1102
THE INSURED IS INDIVIDUAL
Workplaces covered by this policy:
ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO.
MA 01 6 ABBOTT ST
SALEM MA
The policy period is from 4/24/04 to 4/24/05 12-01 A.M. Standard Time at the insured's mailing
address.
A. Workers Compensation Insurance. Part One of the policy applies to the Workers Compensation Law of
the states listed here: MA
Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of our liability under Part Two are.
Bodily Injury By Accident Bodily InjurV By Disease Bodily Injury By Disease
$ 500,000 each accident $ 500,000 policy limit $ 500,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here. All states
except the states designated in item 3.A. of the information page and NV, ND, OH, WA, WV and WY
D. This policy includes these endorsements and schedules:
WC 00 00 GOA WC 00 00 01 WC 00 03 15 WC 00 04 14 WC 00 04 20 WC 20 03 01
WC 20 03-02 WC 20 03 03B WC 20 04 05 WC 20 06 01
INSUREDS COPY PROCESSED 08/04/04
Corfriol 1997 National Council
on Compensation lasomm
WC 00 00 01 B Serving Farm Bureaus Members' Insurance Needs
Issuing Office - PO Box 656 e ALBANY, NEW YORK 12201-0656
Farm
Family
Casualty Insurance Company
Glenmont, New York
WORKERS COMPENSATION
and
EMPLOYERS LIABILITY
Insurance Policy
ISSUED TO:
CURTIS DRAGON
200SW6638
Serviced By:
JAMES W UGONE
FARM FAMILY INSURANCE
10 S MAIN ST STE 208
TOPSFIELD MA 01983-1832
978-887-8304
Serving Farm BureauO Members' Insurance Needs
iffice - PO Box 656 * ALBANY, NEW YORK 12.
Board of Building Regul ti
One Ashburton Place - Room 1301
EARTH LANDSCAPE & CONSTRUCTION
CURTIS DRAGON
6 ABBOTT ST'
SALEM, MA 01970
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registratl6ii: 132737
��E , XPI iitio�n.- �12912005
Type: DBA
EARTH LANDSCAPE i CONSTRUCTION
CURTIS DRAGON�
Update Address and return card. Mark reason for change.
Address F� Renewal E]. Employment 0 Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
6 ABBOTT ST
SALEM, MA 01970
Administrator Not valid witifout signature
Your 3 -year training cycle ends on the date below,
at which time, you may be audited to verify all contact
hours (credits) earned during the prior 3 years
" mmaz
nj I
ffinanwim I ON 02/07/0005
COMMONWEALTH OF MASSACHUSETTS
PLSTICTIDE CERTIFICATION/LICENSE
CURTIS J DRAGON
6 ABBOTT STREET
SALEM MA 01970
Document Ve Date of Issue
Applicator License 10/10/2003
Ucense Number Expirmw Date
30640 12/31/2004
THE COMMONWEALTH OF MASSACHUSE17S
DEPARTMENT OF FOOD AND AGRICULTURr
251 CAUSEWAY STREET SUITE 600
BOSTON, MASSACHUSETTS 02114-2151
* * IMPORTANT
1. NomeorAdd=Chan : Notify the Pesticide Bureau at the
above address in w-ritin .
2. Lost Licens -. Report any loss of this certification/license
immediately in writing to the above address,
3, ARRjjojqLjmj2nce: Notify the Pesticide Bureau in writing
when insurance is altered, revoked or amended due to change in
employment status.
4. Ining RequirgWen Every three years you need:
• Dealer License PP. 3 contact hours
• Applicator License o 6 contact hours
• Private Certification - m, 12 contact hours
• Commercial Certification P 12 contact hours
oategory/subcategory j 5. ReSpipt/lAcense Recall: "Fill in" your license information below
000 and save for your r=rds!
License Number and Expiration Date
Date License Received
Payment Check Number
Page 46 Contact Hours To Date
3 Year Cycle Ends - TURN OVER -
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