HomeMy WebLinkAboutMiscellaneous - 29 GREEN HILL AVENUE 4/30/2018 (2)x
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
.. ..... .. ...
This certi fies that ............................................... / ....... 0.� . . ........
has permisgion for gas installationl.&A-,� ... Y�sJf�m ... A ...... a ...
in th ....... G", �6)c� a—
ebuildings of .. ....................................................................................................
at .......... 2,1) ........ ...... North Andover, Mass.
...... .... ...............
Fee,(00.:.!!?.,. Lic. No..13;k ..... H�k .......................................................
GASINSPECTOR
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MASSACHUSETTS'LINIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY I Nofth Andover MA DATE L4/15/2014 PERMIT#
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JOBSITE ADDRESS 129 Green Hill Av2 OWNER'S NAME
GOWNER ADDRESS ITE ____JFAX=
TYPE OR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL [j RESIDENTIALE]
PRINT
CLEARILY NEWU RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YESE] NOE]
I
APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER J
CONVERSION BURNER
COOK STOVE L --j 1--i
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE =1= LJ=1
INFRARED HEATER 11
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER L:J j 1 1 1
ROOM / SPACE HEATER
ROOF TOP UNIT
JEST
'UNIT HEATER
i,UNVENTED ROOM HEATER
MATER HEATER
OTHERI
Replace 1-Gnmeter x
and Piping as Needed
INSURANCE COVERAGE
I have a current liability -insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY F] . BONDE]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will 4bee in m with all Pertinent provision of the
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Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 9IGN[A-TURE
IMP El MGF [] JP JGF [:] LPGI CORPORATION PART SHIP El#= LLC [J#
COMPANY NAME: truction Co ADDRESS I St
CITY STATE�ZIPJ 01501 _JTEL
FAXI 508-926-4347 ] CELLI 508-832-4614 IEMAILI JMarin2_@RHWhite.com
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ALE!c�)�PPV CERTIFICATE OF LIABILITY INSURANCEP... I Of 1 0812912OY13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCEn, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SU13ROGATION IS WAIVED, subJect to
the terms and conditions of the policy, certain Policies may requirg an endorsement. A statement on this certificate does notconFerrights to the
Certificata holder in lieu of such endorsoment(s),
willim 09 masamehusetts, Inc.
C/o 26 CO-Atury Blvd.
P. 0. BOX �05191
Nanhville, TH 37230-9191
R- X- White COnstr;Action. Company, Znc.
41 Central Street
P. 0. Box 257
AubUrnj MA 01501
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I 1.;VVLKAG1z NA[Crt
INSURERA! The Cbartar Oak Fire Insur-00 COMpany 25615-001
INSURER9: TravalnrS Property Casualty Cot�jpany of Am 25674-06-1
INSURER C: Nftti*)3Al Union Fire) 13:Lsuranca Company of -�9445-001
INSURERD, TravelexB Inda=jty Company 25658 -Dai
INSURGRF;
WVr.1%1k%7r-D - QLKTIFICAT� NUMBER: 20287680 — REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RUOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUFD OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPEOPINWRANC: DD SUB POLICY EPP POLICY EXP
POLICYNUMBER 1mminnrrfyyi LIMITS
A LGENERAL LIABILITY
IMERCIAL GENERAL LIABILITY
CLAIMS-MADET OCCUR
AGGREGATE LIM[TAPPL(HS PER;
)3 1 AUTOMOBILE LIABILITY
ANY AUTO
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F--ISCHP.DULEE
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UTOS
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Comp Dad
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VTC2000 977X9948-ln 19/l/2013 1'9/1/203.4 JEACH
977K95SA-13 19/l/2013 19/1/2014
C :=LLA LIAS OCCUR BE8766140 /1/203.3 19/3./2014
d umBnr
P-xcrss LIA3 F-1 CLAIMS -MADE
I DED I X IRETENTIONS l0,000
D WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N VTRKUB 820SAI05-13 �9/1/2013 -9/l/2014
D ANY PROPRIETORIPARTNRAIEXECUTIVE NIA VTC2XUB 8203A71A-D 9/3,/2013 9/1/2014
OFFI ERIMEMSER EXCLUDED? 7N
below
Remarks
Evidonce of Inmurance
morespeco
I MED EXP (Any one person) Is L01 —() 00
I PERSONAL &ADV INJURY Is 9. - nnn - rinn
PRODUCTS
BODILY INJURY(Per person) I$
130DILYIMJURY(Peraccident) I$
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMP40YEI
F -L. D18P-ASr- POLICY LIMIT
21000, 00a
110001,00
1,000,000
1,000,000
SHOULD ANY OF THE ABOVE DESCRI13ED F30LICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THERC-OF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVI.51OMS,
AUTHORIZED RePRESI�NTATIVE
COXII4197604 TPI:1694012 Cert:20267COO @ 1988-2010 ACORD CORPORATION, Alfrights
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
I Im uumnun"rdiun ur irmLxvtLnvLmA.&L2
DEPARMWOMBIKAPRY Permit No.
BOAROOFFLREPREVEN7101VRBGULA7WM32702120
Occupancy & Fees Checked
I NEMENNENEMW�
APPUCAHONFORPEFAff TOPEUORMELECMCAL WORK
ALL WORKTO BE PMFORMED IN ACCORDANCE WrMTHEMASSACHUSSTSUECMICALCODE, 527cmR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFDRMATION) Datg,5 2 7-61�5 mm
Town of North Andover To thi Ins p�ector of Wires:
lie undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
owner or Tenant
Owner's Address
is this permit in conjunction with a building permit
ih, se of Buildine
Yes[:] No t�j� (Check Appropriate Box)
Utility Authorization N0.2- 1-7PY 7
Existing Service -- . 14;�� Amps)2,C2jZ4VVoltS- Overhea . d rl—Undergrodn'd No. of Meters
New Sej- .,200 Amps.1201216�10v'2Volts Overhead raUnderground M No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 2019&zi� ;�=171 7 J/
No. of lighting Orudetl
No. of Hot Tubs
No. of Transformers
TOW
KVA
No. of lighting Fixtures
Swimming Pool' Abov
0
Below
Generators
KVA
grou:
ground
No. of Receptacle Outists
No. of Oil Bumms
No. of Emergency lighting Battery Units
No. of Switch Outlets
No. of (In Barriers
FIRE ALARMS
No. of 7A)m
No. of Ranges
No. of Air Cond. TOW
Tons
No. of Detection and
No. of Disposals
No. of Heat TOW Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Am& Heating KW
No. of Self Centained
Detection/SoundinS Devices
Local Municipal
r7
Other
No. of Dryers
Heating Devices KW
connections
No. of Water Heaters KW
No. of No. of
sign
Ballads
No. Wy-&6-Massage Tubs
No. of Motors
Total HP
OTHER,
YES NO
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No. Date
TOWN OF NORTH -AN
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Certificate- of Occupancy
'A
41
Building/Frame Permit Fee
Foundation Permit Fee
ACH
Other Perm"',it-Fee
Sewer Connection Fee.
Water Connection Fee
TOTAL
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
41lease print)
DATE 7 5
JOB LOCATION
Number Street Address
"HOMEOWNER"
—Rovy,i,p A
Name home Phone
bection ot town
t1, /'?, C) 0
Wor
one
6
PRESENT MAILING ADDRESS.
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
engagean 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:
Person(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 Lo such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit'
to the Building Official, on a form'acceptable to the Bulding Official,
I'liat he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other appliCable codes, by-laws, rules and
,,�(�gulations.
!e_ undersigned "homeownerif certifies that he/she understands the Town of
-Lh Andover Building Departmert minimum inspection procedures and
and that he/she will compl w said procedures,and
;:equirements. 1/2 �� ix
'0MEOWNER'S SIGNATURE —:�W — /), -
PROVAL OF BUILDING OFFItIAL
jte:� Three family dwellings 35,000 cubic feet, or larger, will be
L:equired to comply with State Building Code Section 127.0, Construction
Control.
Town of North Andover kORT11
OFFICE OF 10
COMMUNITY DEVELOPMENT AND SERVICES 00
13
146 Main Street
WII11AM 1. SCOTT North Andover, Massachusetts 0 1845
Dimctor CHUS
0
In accordance with the provisions ofMGL 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 N/IGL c I 11, S 150A.
The dcbris will be disposed of 111'.
(Location A Facility)
YtgnaMre of Permit Applicant
b6
1 Date
NOTE: Demolition permit from the Town of North Andover must be obtained for tills
project through the Office of the Building Inspector.
BOARD OF APPEALS 69&9541 BUILDING 699-9545 CONSERVATION 689-9530 HEALTH 689-9540 PLANNING 688-9535
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Date..
861
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
( . ...............
This certifies that .............. rk.alzileA ....... 1', ........
has permission to perform .........
.. . . ...... ............................
winng in the buildingof �K( ..................................................
at ..... A.Q.41 ....................... NQrth And ve
'Va^AA-
0
Fee 415 ........... Lic. No. ..... ................. 4v .................................
ELECTRICAL INSPECTOR
04/10/97 10:42 15. oo PAID
WHITE: Appiicant CANARY: Buildirig Dept. PINK: Treasurer
oil
ammunwralo of masmr4auf tfir
19cpartment of Pubtir t1afetti
. . . . . BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office use Only
Permit No.
Occupancy & Fee CheckeC
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Eiectrical Ccde, 527 CIVIR 12:00
(PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date — - �;, .
City or Town of- . - - 1 To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
.;F ,�
Location (Street & NurrAer) z
Owner or Tenant
Owner's Address
le -
Is this permit in conjunction with a. build ing permil: Ye s No El (Check Appropriate Box)
Purpose of Building
Existing Service Amps —Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work - wc�k
Utility Authorization No.
-1
Overhead Undgrncl L'
Overhead Undgrnd Ll
No. of Meters
No. of Meters
No. of Lighting Outlets
Total
No. of Hot Tubs No. of Transformers KVA
No. of Lighting Fixtures
Swimming Pool Above In
grnd. 11 g,rid. El Generators KVA
No. of Receptacle Outlets
No. of Oil Burners 4�
No. of Emergency Lighting
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. ol Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Sell Contained
DetectioniSounding Devices
Local Municipal Other
11 Connection
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
No.of Heat —iotai Total
Pumps Tons KW
No. of Oishwashars
$pace/Area Heating KW
No. of Drysirs
Heating Devices KW
No. of Water Heaters KW
No, of No. of
Signs Ballasts
Low Voltage
iring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER: APR - 9 1997
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Compie ' led Operations Coverago or its substantial equivale I nt. YES E I
have submitted valid Proof of same to the Office. YES--7ff' NO --- If you have chocked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE -ZLR�NO C� OTHER C3 (Please Specify)
Estimated Value of Electrical Work $
Work to Start Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
(Expiration Date)
FIRM NAME _'r14(n0eNe_C_C_ 15Z __ At LIC. NO. /* i,� t- q cl
Ucensee . -717-k,9- wv,% 7- JJ g - na ure --3, �,
_LIC_ NO.
Bus. tel. No -
Address P1A!&.uv0-e_ PAue4,111U Alt. TI. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Ma"achusetts General Laws. and that my signal -ire on this permit application waives this requirement. Owner Agent
(Please check one)
(Signature of Owner or Agentl Telephone No. PERMIT FEE S
x-6565