HomeMy WebLinkAboutMiscellaneous - 296 APPLETON STREET 4/30/2018N)
C) -4
Date ...... . )j -/z
7.
v�ORTN
9. TOWN'OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .................
has permission for gas installation ..........
in the buildings of .2 .................
at .... North Andover, Mass.
6.7
Fee. . Lic. No.. .�. I ' -� —1 . . .....
946AS INSP CQ
Check # 23 2
5354
--,;a IRAI
5
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Prini or Type)
rM 20 05 11crinit #
4-dover .. Date
Building Location Oq9l�
,RIQ-11M Owlicl*'sNill,IC----g��4�q,�e------
.1
0wnerTcI#
New 0 Rellovation 0
Type of- OCCIII).111cy X 'tq' ec
2�'
Replacement lllanStibmiued: Yes U No El
FIAURES
Installing Company Name___ Check one: Certificate
Address—... �Y � Corporation
/1�-e UJ Partnership
Business Telephone 0 Firni/Co.,
Narne of Licensed Plumber or Gas Filter
INSURANCE COVERAGE;
I have a curreqViabililly Insurance policy or its substantial equivalent which-meels the requirements of MGL Ch. 142.
Y,
ej,* No a
If you havd 5)ecked Xes, please indicate the type coverage by checking (he appropriate box.
A liability insurance pol ' 4 Other type of indemnity a Bond 0
_�AIVER: I am aware that the licensee goes _not have [tic insurance coverage required by Chapter 142 of the
Ir
OWNER'S INSURANCE
Mass. General Laws, and that my signature on this pen -nit application waives this requirement.
ovidiure oi L)wner or vwner-s Agent
Check one:
Owner i_*i Agent i i
- to the best of my
I hereby certify Iha( I the details and information I have submitted (or entered) in above application are true and accurate
knowledge and that all plumbing work a . nd installations performed under the permit issued for this application will be in compliance with all
�ertinenl provisions of the Massachusetts Slate Gas Code and Chapter 142 of (lie General Laws.
By__� Type of License:
T. i I I' n - -Plumber Signature of Licensed Plumber or Gas Fille'r___
-Gas filler
-Master License Number �7-7�
-4yffown 2,
Z5:30umeyman
NEESE
NONE
ONE
MEMENUMMEMEM
0
MEMM
ONE
MEMMEME
MENEM
NONE
0
MOMMEMEMEME
ENO
MEMO
MEMEMEME
No MENEM
ENO
NOMMON
MENEM
0
ENO
0
ENO
M
0
OMMM
MMEWEEMEMMEME
__NMW_
-0
Installing Company Name___ Check one: Certificate
Address—... �Y � Corporation
/1�-e UJ Partnership
Business Telephone 0 Firni/Co.,
Narne of Licensed Plumber or Gas Filter
INSURANCE COVERAGE;
I have a curreqViabililly Insurance policy or its substantial equivalent which-meels the requirements of MGL Ch. 142.
Y,
ej,* No a
If you havd 5)ecked Xes, please indicate the type coverage by checking (he appropriate box.
A liability insurance pol ' 4 Other type of indemnity a Bond 0
_�AIVER: I am aware that the licensee goes _not have [tic insurance coverage required by Chapter 142 of the
Ir
OWNER'S INSURANCE
Mass. General Laws, and that my signature on this pen -nit application waives this requirement.
ovidiure oi L)wner or vwner-s Agent
Check one:
Owner i_*i Agent i i
- to the best of my
I hereby certify Iha( I the details and information I have submitted (or entered) in above application are true and accurate
knowledge and that all plumbing work a . nd installations performed under the permit issued for this application will be in compliance with all
�ertinenl provisions of the Massachusetts Slate Gas Code and Chapter 142 of (lie General Laws.
By__� Type of License:
T. i I I' n - -Plumber Signature of Licensed Plumber or Gas Fille'r___
-Gas filler
-Master License Number �7-7�
-4yffown 2,
Z5:30umeyman
j4
t
1
Date. ...........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform ... PC f-% .....................
plumbing in the buildings of . . . . . . . . . . . . . . . . . .
a t "/ ..... ...... r, North Andover, Mass.
Fee Lic. No.. ......... � ........
4UMBING INSPECIOR
Check # //)-/, ..
5034
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NO . RTH ANDOVER, MASSACHUSETTS Date
Permit #
Building Location OwnersName X'02
Amount
of
New Renovation Er Replacement Plans Submitted Yes No
NJ laul
U.
op
(Print or type) Check one:
Installing Company Name L�k�c- Corp.
) Mic" �Ie 0" 0, C" - El
Address Partner.
'S--'.)w-xS , a
Busine§-s-l'elephbne -) I - S V,:, q - -7 6� 9 q 0
Name of Licensed Plumber -
Insurance Coverage: lndicat�. �he of insurance coverage by checking the appropriate box:
Liability insurance policy F-1 Other type of indemnity El Bond
Certificate
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
Signature Owner El Agent 11
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 perfon-ned under Permit Issued for this application will be in
compliance with all pertinent provisions of the Yfa-s- u ing Code and Chapter 142 of the General Laws.
�hchusetts I
By: SignifLure or Mcensea FlumDer
Type of Plumbing License
Title I a' 9 ula(
City/Town 1-Tuense IN unioer Master meyman
APPROVED (OFFICE USE ONLY lj--�Jou
Location C�:?, Ln A A) S4 -
No. Q�0. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
CHU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 41 �
15076 Building inspector
TOWN OF-WORTIM AN—DOVE
�BUILDPNGIDEPARTMENT
REPAM RENOVATE,_,OR_.DEMOLISHA ONE OR TWO FAMILY -W
BUILDING PERMIT NUMBER: DATE
SIGNATURE!
Building Commissioner/1 tor of Buildin2 Date
SECTION I- SITE INFORMATION
1. 1 Property Address: 1.2 Assessors Map
Z 0) �P ARL E To A) 6 T9L E, T (D
No. AnOOVQ_r
IV) Map Number
Parcel Number:
)71
Parcel Number
M
z
0
1.j Lljnmg 1.4 Property Dim sions:
P _�,Lot Area (sf) Frontage'(ft.)
Zoning District
1.6 BUHDING SETBACKS (ft)
Front. Yard... .__,Si&Y
Rear Yard
Req#ired Providc Aeqtjjj6j Tr_(Oyviid� ed RNuired
PrOvided''
1.7. Water Supply MGJ-C.4o. 54) E-5. Fl -zone S—erag6 M4.6salSysteur
Public , b �,Pri,.w 0 zone Outside Flood Zone 0 Municipal 0 On Site ]DIS06'.4
SECTIO . N 2 - �PROPERTY�-OWNERSECIP/ATJTHORIZE,D,.Ai��'.
M
2.1 Owner of Record
myy\() V%
.N 14 44 5
Name (Print) Address for Servi& I
Signature Telephone
2.2 Owner of -Record:
Name Print Address for Service:
z
Signature e
. T I It
. one
SECTION 3 - CONSTR UCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable
--A
);,Y\ L) +61 L) 0
-icensed Construdion Sup"sor:
Co n
A
License Number
Wdre -------------
791 qSS
Expul.41011
Date
�ign re., Telephone
OEM
row
a"i,
.2 Registered Home Improvement Contractor
Not Applicable 0
C
25-1,
M
ompany Name
Registration Number
el Y'
Y) IA
r10
z
ddre
7
's
natuVre Telephone
Expira
G)
U
ESECTION 4 - WORKERS COMPENSATION (NLG.L C I - 52
Workers Compensation Insurance affidavit must be completed and submitted with this a- 1� 4
, P0 ication. Failure to provide this affidavit will result
in the d enial�ofthe issuance ofthe building permit.
$igned affidavit Attached Yes ........
SECTION 5 - Desere6i"iyt"16h *rMp- dkd.
New Co'nstructi6h 0
Eidsting 8dilding 0'
-ons(
terati S) 0
Addition 0
Accessory Bldg.- 0
.-Demolition 0
Other 0 Speci fy
Brief Description of Proposed Work:
C�'
SECTION 6 - ESTIMATED CONSTRUCTION-C-OSTS J,
Item Estimated Cost (Dollar) to be I - ",
'A
Completed by permit licant
1. Building (AY 'Bu'dding Pd t F ee
2 Electrical� ),!,,Estim46d' TotaY.Cost-of
-construction
Building. Permit fee (a) x (b)
4'� Mechanical,!2E!�q
5 Fire -Protection.
6 To,�al,. Q+2+3+4+5) L 7hebk"K
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNHT
L as Owner/Authorized Agent of subject property
Herebyauthorize to act on
.My behalf, in all matters relative to work authorized by this building permit application.
�Siinature of Owner Date
- Donavan-Ducatt Ineurance Agy go 11GITS UPON TIS CUT F1 ATZ auku , T 13 " MILA11 UW" WWI an"u,
2119ID OR 111 - - - WE Ifyoul; BY in POLIcill BLOV,
fi 7 s" Street -- ------------------------------------------------------------------------
8, NA COMPANISS AFFORDING COVZRACE
fs".18.7 - 101 - 9 7 79
. ............................................ ................ ----------- * --------------- * ............
CONPANY LETTER INSWUw= COMPANY
.... ..... .. ----------- ---------------- -------------
LOVII LILLO Di A iPAIY LETTER 9 ZURtCH INSURANCE COMPANY
CONTU ........................ I --------------------------------------------
111c fill 8TIMET CONPANY LETTER C
8AM, MR .. ................................................................
1 KPJJY LITIRI D ------------------
PW LETTED Z
> COVERAGES
TaIS IS to CISTITY THAT POLICISS Of IISUUICI Ll 110 BILOV BAR 6191 ISSUED 10 121 INSUIRD 11110 AIOVI PON VII POLICY
PERIOD INDICATED. NOTWITHSTANDING ANY ISQUIRIM? TIN 01 CONDITION Of MY COIMCT 11 191 DOCUOT VITI 118FICT TO
VITC1 Mis C1111FICATE MAY 19 WORD 01 MIT PRI1,11i vu INSUIUCI 11101018 By 7 1 L I DISCIIIII Bills Is SUBJECT To
ALL WKS, 11CLUSIONS, AD CONDITIONS Of SUCH POLICtES- L111113 U011 Iff 1111 Ha an By fill cum.
..................................................................... - -------------------------------------------------------
co TYPE or asowd POLICY loan POLICY "I POLICY ZIP ALL UNITS it TIOVOUDI
LTR Dill Dill
--- --- - ------ ..........
GENERAL MOUG"I 100000
-W 00
A PQ tOMICIAL ON LIABILITY BCP3?09759 )8/29/01 P9/29/01 -p-ii-complops mg. Nii
j I CLAIMS NADI it) OCC.
OVIERIS i CONTRACTORS
PIOTICTIVI
.............
LIAR
ANY A010
ALL OVID AUT0$
SCMULD AUTOS
HIRED AUTO$
NOR-OVIRD AUTO$
SANAGI LIABILITY
................................
11, LIABILITY
T-1 Ull LU 011
OTHER ?BAN UMBRELLA FORK
---------------------------
VOHXXRS' COMP
AND
XMPl,OTMtS' LIA9
.. ...................
i .
VC50009SIS01 _�8/29/01 8/29/01
........................... ......... ...........
. . ... .. .............. ........ ........... . .....
-ii CRUT10i OF OPIRAIIOIB/LCCitlCIS/VSiICLES/SPECIiL ITINS
fit$. avc, IIJQRY 100000
i iii Rculklicl 1 00000
..................... ...........
FIN DANAGS
(ANY oil Fill) S0000
----- -----------
(BIT on PERSON) 2000
--------------------- -----------
C8L
-- ------------------ -----------
BODILY INJURY
(Pit PRISON)
DUY INJURY
(?IN ACCIDENT)
.. .................. ..........
PIOPIRTY
........................
RACI occ I IGGIEQTI
......................
RICK Acc
DISRISI-POLICY Lill?
DISIA81-110 RIPLOTH
---------------------------------
CIVIVICATI HOLDER CANCILLATION
SHOULD ANY Of 19 ABOVE DESCRIBED POLICIES It CAICILLID BEFORE THE El-
PIRAtION DATE ?BUOY THE ISSUING COMPANY VILL INDRIVOI TO NAIL 10
TOWN OF NORTH RRADING DAYS VII111I NOTICE i� THE Clff IFICITI 30091 KIND TO THE LEFT IV
FAILURE TO NAIL SKI NOTICE SIILL INPOSI 10 OBLIGATION 01 LIAsiftif or
NOMM RRADING, NA ANY ZIND UPON TIM CO1711Y, ITS AGIN?$ 01 VIRISISTITIVES,
.. ..............................
5:�� .............................
101111D REPRESENTATIVE
ikCX)RD 25-9 (31891 V / A - � A I A k
f
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
. . . . . . Number:.CS 067585
Birthdate- 12/06/1967
0
Expires' 12/06/2001 Tr. no: 11810
Restricted To.- 10
TIMOTHY B JOYCE
89 FERNDALE ST
MANCHESTER, NH 03103 Admiwls-trator
Uoor,J of Building Rtgulations 2nd, Standards
HOME #MPROVISMENT CONT PACTOR
Uwe Registritkin:
Ex p; ra ( 1 u n-:' 0-2"/2 12 0 0:�
iypt.-.
--RECIS:ON CONTRACTOR$
TIMOTHY JOYCE
3 CONN -ST
MA 0 1801 Ad.-nini.stratoi ........
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NQ- 2406 Date ...... .. 71�� (-)
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... 1:�.C.J . (,?. �. -.k ..... CQ ...... :Z.11. � ...........
has permission to perform ........ ............................................
wiring in the building of ...... //:q. �,.q ...................................................
at ....... .... 5/�:..��orth AndcLy-er-, NaV
Fee ...... .... Lic. No. .......... .....
Check # Z�-w 1,1-96CTRICAL INSPEcrOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
4
Official.Usc Only
Perrnit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS rRev. 11199] (leave blank) ---
----------------------
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to bc perflornicd in accordance with the Massachusctis Electrical Code 0-113c) .52'CNIR 12.00
(PLEASE PRJiVT LV INK OR TYI-'L--,,i L IiXOR�L'l 7YOjV)
City or Town ol &XYA
To the Insp to,- o' Wires:
By this application die undersigned gives 110tice of III orlichitqi1tiouto rform the electrical, work described below.
o to
Location (Street & Number) Z9( a .7& (�
Z="' , 'er
Owner or Tenant
Owner's Address
Is this perinit in co"junction with a building permit?
I'Ll"110se of Building
Existing Service
2:1 Anips N'Olts
New Service Anips Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Yes [I No
Telephone No.
(Clieck Appropriate Box)
Utility Authorizition No.
Overhead 0 Undurd
t. El No. orAleters
OverheadEl UndgrdEl No. of.Nleters."
Cumnletion ofthp fnih—q—
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Faus
uy "Ic ", oi rtres.
No. of �ROC-E�1-101'
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
17-0. -0TYm—ergency Li- iting
No. of I Lighting Fixtures
Above
Swimmina Pool ffl'rnd, 0
2rnd.
Battery Units
No.'of Receptacle Outlets
No. of Oil Burners
FIRE ALAR.L%'IS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devic es
No. of Ranges
No. of Air Cond. TotaF
Tons
No. of Alerting Devices
No. of Waste Disposers
He2tPuII]PJjjN
-qE
KW
.......... . - - ------ -
-N-0— -Contained
N -of Sell
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
b
Local Nlujilcip?l
— Connection 0 Other
No. of Drvers
Heating Appliances
Securl*EV bliStems:
No. of Water
-%V
INO. of f
1
No:ofbevices or Equivalent
Heater's K
'o
Siglis Ballasts
Data Wirino:
-
No. of 6�viccs or Equivalent
No. Hydroinassage Batlitubs
No. of Motors Total I -IP
I elecommunications Wirina-
-
No. of Devices or Eguivta'len
OTHER:
Allacil aaanionai delaij ydesired. or as required b,Y the Inspector of ;Vires.
INSUF,1A.NCE COVERAGE: Unless waived by the o,,%-ner, no permit for the performance of electrical work may issue unless
the licensee provides proof of Ii bilit ' r nce including "completed operation" coverage or its substantial equivalent. The
-tied certifies that such Y2'� "a force, and has eNhibited proof of same to the p rmit issuing office.
undersi, cove s
CHECK ONE: INSUI�ANC ND El O'1'I-IER [] (Specify:)
��01 In
E 1�xens— �A I
(When required by municipal policy.) (Expiration Date)
Work to Start: -- Uv-�11 Iiispcctioiis to be reques ted in accordance with IVIEC Rule 10, and upon completion.
I certifj,, linder the pains and pena I es o perjury, t tat t te ill orillatioll oil this application is trite and complete
F110I NANIE: L/ LA LIC. NO.:AL5 3 -3
Licelisee: 6 10A Si-naturea,
LIC. NO.:
(If applicable. entcr 111PCI I/ h ense number hnc.,)�g LT 3 —;T 37 -
Address :_ '0 L. -FZW"2 2 Bus. Tel. N
5 K0 Z7?*q Alt. Tel -No.:
OWNER'S INSURANCE NVAIVER: I ani -aware that the Licensee doey a 21 have the li�—bility insurance coverage normally
required by law. BN-,iiy signature below, I hereby waive this requirement. I am the (check onc) E] oxvncr [] o-vnicr's zil-,ent.
Oiviier/Ag,ent
Signature Telephone No. LLij--Rilf _fT 1--E- E: S
Estimated Value ofElcctrical Work:
Date...
04 "ORT"
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ................
has permission for gas installation ........................
..........
in the buildings of .......... ......................
- q
at Cz). . 1� ... (�aJ44A, North Andover, Mass.
FdeAoe e-
. Lic' 6/ GAS INS
,PEar,OR
Check# Ili -J7111
01
5330
RASSACHUSEY11S LNEFORNI APPUCATON FOR PEMIrr TO DO GAS FrMNG
(Type or print) , Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations Z 9 APPLE TO t-� Permit #
Amount
Owner's Name
New Renovation Replacement Plans Submitted 0
(Print or type) one: Certificate Installing Company
Name,11214L, AIK e��Y511 M3 10-1 C, Cff Corp.
Address - _L10 mAlt--s ST� 01 �� 4q Partner.
t..3. KkM0jt--N(, rV1 A
BusinessTeleptione . vi -7 gi 6Cli So -&3 Firm/Co.
Name of Licensed Plumber or Gas Fitter — N-I�rj Auf�. 71 *(- I T� —1
INSURANCE COVERAGE - Check one: No [3
I have a current liability Insurance policy or it's substantial equivalent. Yes In
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 0 Bond 13
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 Agent Owner 0 Agent 0
I hereby certify that all of the details and information i nave suonuttea kor entereu) in avuve appjicauon are true anu accurate LU Me
best of my knowledge and that all plumbing work and installations performed under 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.
ty/Town
(OFFICE USE ONLY)
E3Signature of Licensed Plumber Or Gas Fitter
Plumber SIZI
MI Gas Fitter License Number
0 Master
[3 Joumeyman
1--TH. FL
(Print or type) one: Certificate Installing Company
Name,11214L, AIK e��Y511 M3 10-1 C, Cff Corp.
Address - _L10 mAlt--s ST� 01 �� 4q Partner.
t..3. KkM0jt--N(, rV1 A
BusinessTeleptione . vi -7 gi 6Cli So -&3 Firm/Co.
Name of Licensed Plumber or Gas Fitter — N-I�rj Auf�. 71 *(- I T� —1
INSURANCE COVERAGE - Check one: No [3
I have a current liability Insurance policy or it's substantial equivalent. Yes In
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 0 Bond 13
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 Agent Owner 0 Agent 0
I hereby certify that all of the details and information i nave suonuttea kor entereu) in avuve appjicauon are true anu accurate LU Me
best of my knowledge and that all plumbing work and installations performed under 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.
ty/Town
(OFFICE USE ONLY)
E3Signature of Licensed Plumber Or Gas Fitter
Plumber SIZI
MI Gas Fitter License Number
0 Master
[3 Joumeyman