HomeMy WebLinkAboutMiscellaneous - 299 MIDDLESEX STREET 4/30/2018Commonwealth of Massachusetts
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D —1 NuRECEIVED
Asbestos Notification Form ANF -001
MAY 27 N14
TUWN OF NORTH AfQOVER
'HEALTH DEPARTIMIRNT
Important: A. Asbestos Abatement Description
When filling out
forms on the
computer, use 1. a. is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied
only the tab key residence of four units or less? R1 Yes [] No
to move your I
cursor - do not b. Provide blanket decal number if applicable* Blanket Decal Number
use the return
key. 2. Facility Location:
FRESIDENCE -ESEX STREET —
a. Name of Facilii;7 b. Street Address --
NORTH ANDOVEI J 101845 1 19788523551
c. City/Town d. State e. Zip Code f. Telephone Number
INSTRUCTIONS 3.
1. All sections of this
form must be
completed in order
to comply with 4.
DEP notification
requirements of 310
CIVIR 7.15 5.
and the DhAsion
of Occupational
Safety (DOS)
notification
requirements of 453
CMR 6.12
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6.
7.
8.
9.
Worksite Location:
IRESIDENCE I
I
[--- - -- I IBASEMENT
a. Building Name/Building Location
b. Building #
c. Wing d. Floor e. Room
Is the facility occupied? F,71 Yes
F]No
Asbestos Contractor:
EE&F ENVIRONMENTAL SERVICES LL�=
1,86 CAROLAN AVE
a. Name
JHAMPTON
b. Address
16032345581
c. Citv/Town
_J
d. ZJp_Code
e. Telephone Number
N/A
IGUILLERMO A MARGARIN FRIAS I
IN/A
a. Name of Project Monitor
1ASBESTOS IDENTIFICATION LAB
61212014
92-rio�e-c—tll
8-4
c. Work hOL
10. a. What type of project is this?
Demolition Renovation
Repair Other, please specify:
11. a. Check abatement procedures:
F1 Glove bag
Enclosure
Cleanup
n./ Full containment
E] Encapsulation
E] Disposal only
[] Other, specify:
g. Contract Type: F] Written E] Verbal
REMOVAL
b. Describe
b. Describe
12. Is the job being conducted: n7 indoors? EJ– outdoors?
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Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
A. Asbestos Abatement Description (cont.)
1100199376
Decal Number
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
encaDsulated:
1195 0
a. Total pipes or ducts (linear ft) . Total oth-ersurfac�§js&-u—ar-e-ff)
14. Describe the decontamination system(s) to be used:
[FULL CONTAINMENT
c. Boiler, breaching, duct, tank
d. Insulating cement
surface coatings
Lin. ft.
I =
e. Corrugated or layered paper
f. Trowel/Sprayer coatings
pipe insulation
Lin. ft.
h. Transite board, wall board
I
g. Spray -on fireproofing
Lin. ft.
Lin. ft.
Sq. ft.
i. Cloths, woven fabrics
Lin. ft.
L
j. Other, please specify:
k. Thermal, solid core pipe
--j
So. ft.
insulation
Lin. ft.
14. Describe the decontamination system(s) to be used:
[FULL CONTAINMENT
1. Specify
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (a):
JALL METHODS WILL COMPLY I
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
a. Name of DEP Official b. Title
c. Date (mryVddtyyyy) of Authorization d. DEP Waiver#
e. Name of D09 Official f. DOS Official Title
g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver#
17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project?E]Yes 2 No
B. Facility Description
[RESIDENCE
1. Current or prior use of facility:
2. Is the facility owner -occupied residential with 4 units or less? EVI Yes EJ No
3. FLORIHAYES I F299 MIDDLESEX STREET
a. Facility Owner Name b. Address
INORTH ANDOVER, MA j 10184
c. City/Town d. Zip
4. a. Name of Facility Owner's On -Site Manager
I— I F—
c. City/Town d. Zip
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Asbestos Notification Form - Page 2, of 3 0
d. Insulating cement
Lin. ft.
Sq. ft.
I =
I
f. Trowel/Sprayer coatings
Lin. ft.
Sq. ft.
h. Transite board, wall board
I
Lin. ft.
Sq. ft.
I
L
j. Other, please specify:
Lin. ft.
--j
So. ft.
1. Specify
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (a):
JALL METHODS WILL COMPLY I
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
a. Name of DEP Official b. Title
c. Date (mryVddtyyyy) of Authorization d. DEP Waiver#
e. Name of D09 Official f. DOS Official Title
g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver#
17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project?E]Yes 2 No
B. Facility Description
[RESIDENCE
1. Current or prior use of facility:
2. Is the facility owner -occupied residential with 4 units or less? EVI Yes EJ No
3. FLORIHAYES I F299 MIDDLESEX STREET
a. Facility Owner Name b. Address
INORTH ANDOVER, MA j 10184
c. City/Town d. Zip
4. a. Name of Facility Owner's On -Site Manager
I— I F—
c. City/Town d. Zip
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Asbestos Notification Form - Page 2, of 3 0
Note: Transfer
Stations must
comply Wth the
Solid Waste
Division
Regulations 310
CIVIR 19.000
M
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Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
B. Facility Description (cont.)
5.
a. Name of General Contractor
-7- F__
c. City/Town d. Zip Code
f. Contractors Worker's Comp. Insurer
6. What is the size of this facility?
11 1
Decal Number
b. Address
I
e. Telephone Number (area code and extension)
I I I
g. Poliev Number h. Exp. Date (mmfdd/yyyy)
I I [ I
a. Square Feet b. Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos -containing material from site to temporary storage site (if necessary):
JE & F ENVIRONMENTAL SERVICES, LLC
a. Name of Transporter
IHAMPTON, NH 03842 1
c. Cityrrown d. Zip Code
F86 CAROLAN AVENUE
b. Address
16039742503
e. Telephone Number
2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site:
ISERVICE TRANSPORT GROUP, INC.
a. Name of Transporter
INEW CASTLE, DE
c. City/Town
19720
d. Zip Code
3. 1
c. Positionfritle
a. Refuse Transfer Station and Owner
I I
c. Citv/Town
d. Zip Code
4. IMINERVA ENTERPRISES INC
e. Telephone Number
a. Final Disposal Site Location Name
AROLAN AVENUE
19000 MINERVA ROAD
c. Final Disoosal Site Address
e. State
E 4468=8
f. Zip Code
D. Certification
The undersigned hereby states, under the
penalties of perjury, that he/she has read the
Commonwealth of Massachusetts regulations
for the Removal, Containment or
Encapsulation of Asbestos, 453 CMR 6.00 and
310 CMR 7.15, and that the information
contained in this notification is true and correct
to the best of his/her knowledge and belief.
F58 PYLES LANE
b. Address
18779999559
e. Telephone Number
b. Address
I
e. Telephone Number
I I
b. Final Disposal Site Location Owners Name
IWAYNESBURG
d. Citvrrown
g. Telephone Number
IFRANKBALO:G=H= JFRANKBALOGH I
a. Name
b. Authorized Si nature
[PWNER 77
15/19/2014
c. Positionfritle
d. Date ( im1ddb1yy),
F67035742503 I
JE & F ENVIRO
e. Telephone Number
f. Representing
AROLAN AVENUE
q. Address
JHAMPTON, NH 1 103842
h. Cityrrown i. Zip Code
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Environmental I Demolition Contractors
Commercial / Industrial I Residential
May 22, 2014
Town of North Andover
Health Office
1600 Osgood Street, Building 20, Unit 2035
North Andover, MA 01845
RE: 299 Middlesex Street, North Andover, MA
Dear Sir/Madam:
Please be advised that we will be at the above captioned property for Asbestos
Abatement on June 2, 2014. 1 have enclosed a copy of the notification filed with the
MASS DEP.
Kindly contact us with any questions or comments you may have.
Very truly yours,
Susan A. Pappalardo
E & F Environmental Services, LLC
/Enclosures
129 NEWTON ROAD, PLAISTOW, NH 03865
(603)974,2503 FAx: (603)382-3376
Date....... .....................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
"'
�Iiis certifies that
...... ..........................................................................................
has permission for gas installation ..............
in the buildings yff 1.. -44 A \-I aA--
. ........... f ........ ...............................................................
** ****" i **'**'*
................................................. 4 . ......... I.? .........
K ............. North Andover, Mass.
at .... .... . <
Fe e .... Lic. No. .............................. ..................
AS INSPECTIOR
Check#
9231
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
i INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 11� NO Ej
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 4 OTHER TYPE INDEMNITY E] BOND 0J
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 El 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 be in coMpliance with all R rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
J(A'LIC E
PLUMBER-GASFITTER NAME ENSE# SIGNATUR
MP EP MGF EjI JP 0 JGF [ij LPGI CORPORATION []# PARTNERSHIP 0#= LLC E]#
COMPANY NAMEI& , LO
11ADDRESS
CITY ZIP
STATE ]TEL
FAX CELLFNT , EMAIL
V
I
IFA
06
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
vp
CITY -11N MA
DATE RMIT #
_I _JjPE
JOBSITE ADDRESS
OWNER'S NAME .1 &Z I
L4
GOWNER
ADDRESS L
TE ----IFAX
TYPE OR
PRINT
OCCU PAN CY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL -Q
CLEARLY
NEW:E] RENOVATION: REPLACEMENT:
PLANS SUBMITTED: YES FO NO
APPLIANCES
FLOORS---� BSM 1 .2 3 4
5 6 7 8 9 10 11 12 13 14
BOILER
==Z�
BOOSTER
1::j
E:j E:� ED E:j
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
),P
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
i INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 11� NO Ej
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 4 OTHER TYPE INDEMNITY E] BOND 0J
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 El 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 be in coMpliance with all R rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
J(A'LIC E
PLUMBER-GASFITTER NAME ENSE# SIGNATUR
MP EP MGF EjI JP 0 JGF [ij LPGI CORPORATION []# PARTNERSHIP 0#= LLC E]#
COMPANY NAMEI& , LO
11ADDRESS
CITY ZIP
STATE ]TEL
FAX CELLFNT , EMAIL
V
I
IFA
06
0
zo
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15
The Commonwealth ofMassachusetts
Department of IndustrialAccWnits
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1d1a
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectriciansfPlumbers
Applicant Information Please Print Legibly
Name (Business/Organizatiordlndividual): �3 rcP�� PU&6�, AIC
J 1i _V
Address: ti� _bl�
City/State/Zip:_ L,(/ AM WS Phone#: -44 7 7 Ll
4 LA P��
Are you an employer? Check the appropriate box:
I.M)Iamaemployerwith
4. El I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 am a sole proprietor or partner-
listed on the attached sheet. I
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3.0 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comi).
c. 152, § 1 (4), and we have no
insurance required.) t
comp. insurance required.)
Type of project (required):
6. El New con.struction
7. F1 Remodeling
8. E] Demolition
9. n Building addition
10.F1 Electrical repairs or additions
11. n Plumbing repairs or additions
13.0 other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
Iam an employer that isproviding workers' compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Policy # 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 requiredunder 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 statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c4rtpi, 7uder thepains andpenalties ofperjury that the information provided above is true and correct.
Sianature: Date: I � \ I L(
Official use only. Do not write in this area, to be completed by c4 or town official
City or Town:
PermitfLicense #
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 M
Information and Instructions -
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defirred as "....every person in the service of another under any contract ofhire,
express or implied, oral or written."
An employer1s defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi . sions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to c ers' compensationinsurance. If an LLC or I I I? do s have
employees, a policy is. required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retained to the city or town that the' application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Pleas ' e be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one, affidavit indicating current
policy information (if necessary) and under "Job Site Address"* the applicant should write "all locations in -(City or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fille.4 out each
year. Where a home owner or citizen is obtaining a license or"permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The, Commonwealth of Mossachusetts
M,partment of Industrial Accidexits
Offtee of Investigations
600 Washington Street
Boston., MA 02111
Tel, # 617-727-4900 oxt 406 or 1-877rMASSAFF,
Revised 5-26-05 Fax # 617-727-7749
_wwwmass,gov1dia
0.1845-2-5l.V:`;:'
05: O. -JA
6
S -c),V- �,, 7
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
.... ......
This certifies that ......
has permission to perform
wiring in the building of ..... ..........................................
at .... C$4,9 �? ................................. ......... ... ............. . North Andover Mass.
Fee�7� .... . ..... Lic. No
................ ...................... ..
ELEcTi��A-L* *iN'*S* P*'E* R
Check #
7407
Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services
OrJ
BOARD OF FIRE PREVENTION REGULATIONS 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 (MEC), 527 CMR 12.00
(PLEA SE PRINT IN INK OR TYPE ALL INFORMA TION) Date:. QSA-C-1/6)
City or Town of. NORTH ANDOVER To the Inspe"cl-or of [fires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) r�� mxt� 4 0 atfp R -
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjimetion with a building permit? Yes ff No (Check Appropriate Box)
Purpose of Building _IQCI Ujpt�tkj Utility Authorization No.
1 4 -
Existing Service 30(1 Amps W / �� � 4ts Overhead El UndgrdE1
No. of Meters
New Service Amps Volts Overhead El Undgrd R No. of Meters
Number of Feeders and Ampacity 1-1-OWPt
Location and Nature of Proposed Electrical Work:
V 0,+, 0 t"
Comnletion of the following, table mav he waived hv the 1n.vnP.rtnr nf Wirpv
No. of Recessed Luminaires '6
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 o In- E]
grnd. grnd.
Wo -.-off Emergency Lighti-n-g
Battery Units
No. of Receptacle Outlets ') 1%,
O�U
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Totaf-
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
umber
J.N ......................
I Tons
I ..................... ]
KW
.................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
LocalEl Mun'c'P!il 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 HP
Telecommunications 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: (When required by municipal policy.)
Work to Start: /0) Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such co)4rage is in force, and has exhibited proof of same to the permit issuing,office.
CHECK ONE: INSURANCE [K] BOND El OTHER El (Specify:)
I certify, underjAc.,vains and penalties of perjury, that the infor t' , on this a7�*(atjon is true and complete.
FIRM NAME: ;4<ead �kfbft- cul ILL LIC. NO.: �)q9
Licensee: �VOLV � :2eced y Signature_ LIC. NO.:
(If applicable te "exem� I §t � ense number line
he
Bus. Tel. No.:
Address: Alt. Tel. No.: 941 - 15)�F
*Per M.G.L c. 147, s. 57-61, security Nkork 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) F71 owner El owner's agen .
Owner/Agent
Signature Telephone No. PERMIT FEE:$
1-� I I
I'm
110-
m
Date.:V4?/—" 2.
TOWN OF NORTH ANDOVEA
PERMIT FOR PLUMBI
S US
This certifies that �rk .... S� .� ....... ... ............
has permission to perform .... Ac K .(> .'r%o ................
plumbing in the buildings of . . .5 .. .......................
at . .,?. cZ:.�-7. d I/., F —. I ........... I North Andover, Mass.
Fee.,;��-.'. Lic. No../.) .......
PLUMBING INSPECTOR
Check # �- 3 1
=I**
11
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Prin orTyp
-7
Pat z: 200 eceipt# I Permit#
Building Location Owner's Name Llaxw,4
Map: Lot: Zone: Type of Occupancy
New Renovation 0 Replacement Cl Plans Submitted: Yes4/ No Q
FIXTURES
Installing Company Name _Y�� &m heckone: C
Address U\J�10,2snsj j
A -vcorporation
EstimateValueof Work: \j Q Partnership
Business Telephone D Firm / Co.
Name of Licensed PluMber or Gas Fitter
INSLIRANC�CO E , RAGE:
I have a CL liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
,eE3
Ye Q No Q
If you have checked yes, icate the type coverage by checking the appropriate box.
A liability insurance poli 7 Other type of indemnity U Bond U
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.
Checkone:
Owner Q AgentQ
Signalure of Owner or Owner's Agent
I hereby certify that al I of the details and information I have submitted (or entered) in above applicati9p are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the pern�xsuegfc;tv application will be in compliance with
all pertinent provisions of the Massachusetts State P!umbing Code and C Laws.
By
Signature of Licengllzax�,Mt)4?
Title Ir Journeyman 0
Type of License� Mastv
City/Town
APPROVED (OFFICE USE ONLY) License Number
AwAwd 05117100
ONES
Installing Company Name _Y�� &m heckone: C
Address U\J�10,2snsj j
A -vcorporation
EstimateValueof Work: \j Q Partnership
Business Telephone D Firm / Co.
Name of Licensed PluMber or Gas Fitter
INSLIRANC�CO E , RAGE:
I have a CL liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
,eE3
Ye Q No Q
If you have checked yes, icate the type coverage by checking the appropriate box.
A liability insurance poli 7 Other type of indemnity U Bond U
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.
Checkone:
Owner Q AgentQ
Signalure of Owner or Owner's Agent
I hereby certify that al I of the details and information I have submitted (or entered) in above applicati9p are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the pern�xsuegfc;tv application will be in compliance with
all pertinent provisions of the Massachusetts State P!umbing Code and C Laws.
By
Signature of Licengllzax�,Mt)4?
Title Ir Journeyman 0
Type of License� Mastv
City/Town
APPROVED (OFFICE USE ONLY) License Number
AwAwd 05117100
Date ... ).—/,/ 74
TOWN OF NORT"NDOVER
PERMIT FOR GAS INSTALLATION
This certifies that jL!, f. n ... 5!:� �. 77.
has permission for gas installation .
in the buildings of . ..........................
at ... C9 ...... North Andover, Mass.
Fee. Lic. No./.3,�.)
INSPECTOR
Check# �-� j(
5990
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) I
Z
�Ojj
k Roos q, 20' Receipt# Permit#—
Building Location OwneesName ct.�
— V�J-k )
map: Lot: Zone: Type of Occupancy ) L'4y
New '�Q,- Renovation U Replacement U Plans Submitted:
A
5-71T 0
No 0
Installing Company ame
--R07
Address �/() . U�
Estimate Value of Work:
Business Telephone
Name of Licensed Plumber or Gas Fitter
heckone: Certifinato
C Corpc T
orporation C�Lij
0 Partnership
0 Firm/Co.
INSURANCE COVER�GE:i
a curre'3 - policy or its substantial cquivalent which meets the requirements -jf MGL Ch. 142.
it
I hav, ty nsurance
Yes I le No C3
If you have checked ves, pie indicate the type coverage by checking the appropriate box.
'e
y
A liability insurance po �r Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does nol have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Checkone:
Owner Q Agen(D
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to t�e bestof
my knowledge and thatall plumbing work and installations performed underthe permit issued for this applicate6ill tv in iancewith
all pertinent provisions of. the Massachusetts State Gas Code and Chapter 142 of the General Laws. /,-'
By T e License: — 5 2r
Plumber �ignatwrof ld�sed Pltnbeir or Gas Fitter
Title sfitter
aster License Number
Jou
City/Town Journeyman
APPROVED (OFFICE USE ONLY)
Revnwd (&17=
Date .............
0
0
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that 9.4 .........
.......................................
has permission to perform ........
SPwiring in the building of,-,-, ).4 ...... ...........................................
atr29.9da.ce.'r ...... . 02041. North Andover, Mass.
Fee ... ?-5 .......... Lic. No .......
15� .......... Eil�ii'[C*A-L-I' N**S'P-E'C'T0R....
Check #
6�942
J Completion of the following able may be waived by the Inspector of Wires -
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Undgrd 1:1
Undgrd El
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL INFORA1ATION) Date: O�� (P
City or Town of- Npf4) AplkfT 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)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes L"
Purpose of Building'I L)n 'Fu"Ai k!n
4
Existing Service Amps Volts Overhead 11
New Service Amps
Utility Authorization No.
Volts Overhead 1:1
(Check Appropriate Box)
Official Use Only
Permit No. 9 Ll
Occupancy and Fee Checked A�
I [Rev. 9/051 (leave blank)
No. of Meters
No. of Meters
Number of Feeders and Ampacity - � -;)p N � - IsA I - c3ug. Yj A
Location and Nature of Proposed Electrical Work:
% Z I . I i A
I
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 El In- — W-0—.01 Emergency Lighting
grnd. grnd 0 Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones
No. of Switches No. of Gas Burners No. of Detection and
Initiating Devices
No. of Ranges No. of Air Cond. Total No. of Alerting Devices
Tons
No. of Waste Disposers -umber Fons KW No. of Self-Conta-'jn-eU—
Totals: [ Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local [I Municip�l El Other
Connection
No. of Dryers Heating Appliances KW Security Systems:*
No. of Water -No-. -oT— No. of - No. of bevices or Equivalent
Heaters KW Signs Ballasts Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP Telecom munic-ations 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: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURA 7BOND 0 OTHER F] (Specify:)
I certify, under the pains andpenalties of perjuty, that the info t' on this &7*oin�s true and complete.
91 ff cu;�t�t C1 rkc
FIRM NAME: J LIC. NO.:&'�))�Cl
77 �V/117
LIC. NO.
Licensee: Signatul� : 11-2
(If applicable, enter "exempt n the I se number line.) Bus. Tel. No.: cl-I)LI-3
4
Address: Alt. Tel. No.:)� I- 5b`�
*Security System Contractor License req d for this work; if applicable, enter the I icense number here:
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)E] owner 0 owner's agent.
Owner/Agent y
Signature - Telephone No._ FEE: $ ":�— — I
R&..,4
r, -G44,, &-1 &9 /-C j (9-9 7-0 � 1�-2,-�
I
Date. 1? -14.
141111
TOWN OF No ANDOVER
X PERMIT FOR GA INSTALLATION
r
This certifies that Ik� r7"
is:�W ........................
has permission for gas inktallation . . ................
in the buildings of . . .........................
at . ,)-. .'� .9. . t . North Andover, Mass.
Fee. -I?.... Lic. No../.?
INSPECTOR
Check# Lf .5 )''5
5753
N
COMPLETE ALL INFORMATION 36
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) F V Check #
TOWN )LkA�) Date —
T1
Buildinq Location Owner's Name
e
Type of Occupancy
New RenovationV Replacement Plans Submitted: Yes El Nko'lp
APPLIANCES
InstallingComp yName-- ml-lvl�ol TX4 1,
11 ne.
Addre C :�(rporation
Co
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-)/Certificate
dw
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Name of Licensed Gasf itter -- /-5 10AIII/I
INSURANCE COYERAGE:
I have a cyrren�Wability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R/ No El
If you have checked YES, plZ� /-dicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond El
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 11 Agent El
I hereby certify that all of the detailsand information I have submitted (orentered) in above application aretrue and accurate tothe best of my knowledge and that
all gas wori(and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the M achusetts State Gas
Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage,�
7
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ANO UCENSE
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Yes R/ No El
If you have checked YES, plZ� /-dicate the type coverage by checking the appropriate box.
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OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage required by
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Check one:
Signature of Owner or Owner's Agent Owner 11 Agent El
I hereby certify that all of the detailsand information I have submitted (orentered) in above application aretrue and accurate tothe best of my knowledge and that
all gas wori(and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the M achusetts State Gas
Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage,�
7
FITTER
ANO UCENSE
EXPIRATION
Datv.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
e�
This certifies that ...............
has permission to perform ..................
plumbing in the b .....................
uildings of r.4 Is .6;1111'
at North Andover, Mass.
Fee.9.�-. Lic. No./7 ....... ..... Q�. �R'
PLUMBING INI�
Check #
7149
CK I --
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMB114G
Typel
nint or
Date P rmit
M
as
Building Location_a9 lig_�Qwnees Name D
Type of occupancy
New [I Renovation Replacement 0 Plans Submitted: Yes 0 No El
B. P. 4 . SEWER# FIXTURES SEPTIC#
nstalling, Compan
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kddre'ss Q'V U/Corporaticri 2LI
4\1 V\O NA aYY7 E] Partnership
3usiness Telephone IAJ hrm/Co.
6-4a —SLIM
4ame of Licensed Plumber
NSURANCE C ERAGE:
have a curr. rit lability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
you have cVcked yes. pI Icate the type coverage by checking the appropriate box
I
k liability Insurance policy 77 Other type of Indemnity 0 Bond 0
)WNER'S INSURANCE WAIVER: I am aware that the licensee.does not have - the Insurance coverage required by
�hapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
owner El Agent 0
hereby cer' that all of the details and Information I have submitted (or entered) In above applicatio a ' true and accurate to the best of rny
permit ls_sl;ed for th S'
nowledge an% that all plumbing work and Installations performed undier the licration will be In compliance with all
ertnent provisions of the Massachusetts State Plumbing Code and Chapter 142 oJAK e
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Type of Ucense' Master Journeyman [:]
Ucense Number 1-10;?f
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6-4a —SLIM
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NSURANCE C ERAGE:
have a curr. rit lability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
you have cVcked yes. pI Icate the type coverage by checking the appropriate box
I
k liability Insurance policy 77 Other type of Indemnity 0 Bond 0
)WNER'S INSURANCE WAIVER: I am aware that the licensee.does not have - the Insurance coverage required by
�hapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
owner El Agent 0
hereby cer' that all of the details and Information I have submitted (or entered) In above applicatio a ' true and accurate to the best of rny
permit ls_sl;ed for th S'
nowledge an% that all plumbing work and Installations performed undier the licration will be In compliance with all
ertnent provisions of the Massachusetts State Plumbing Code and Chapter 142 oJAK e
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Type of Ucense' Master Journeyman [:]
Ucense Number 1-10;?f
20
80iSE" Double 1-3/4" x 7-1/4" VERSA -LAM@ 2.0 3100 SP Floor BeamXF1301
BC CAIC& 9.2 Design Report - US 1 span I No cantilevers 10/12 slope Tuesday, September 26, 2006 11:39
Build 141
Job Name: A -
Address: 299 middlesex st
City, State ip: north anclover, ma
Custom : Mike Loranger
ort ESR -10
Code reis: t40
1611�.: __ __ -
BO, 1-3/4"
LL 1050 lbs
DL 371 lbs
File Name: BC CALC Project
Description: window header
Specifier:
Designer:
Company:
Misc:
B1, 1-3/4"
LL 1050 lbs
DL 371 lbs
Total of Horizontal Design Spans = 05-10-00
Load Summary Live Dead Snow Wind Roof Live
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trilb.
1 Standard Load Unf. Area Left 00-00-00 05-10-00 30 psf 10 psf 12-00-00
Controls Summary
Value
% Allowable
Duration
Load Case
Span Location
Pos. Moment
2072 ft -lbs
24.7%
100%
1
1 - Internal
End Shear
1091 lbs
22.6%
100%
1
1 - Left
Total Load Defl.
L/1 226 (0.057")
19.6%
1
1
Live Load Defl.
L/1 659 (0.042")
128.9%
1
1
Max Defl.
0.057"
5.7%
1
1
Span / Depth
9.7
n/a
1
Notes
Design meets Code minimum (L/240) Total load deflection criteria.
Design meets User specified (L/480) Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
Minimum bearing length for BO is 1-1/2".
Minimum bearing length for B1 is 1-1/2".
Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing +
1/2 intermediate bearing
Connection Diaaram
T b --d
a
c
a minimum = 2" c = 3-1/4"
b minimum = 3" d = 12"
Member has no side loads.
Connectors are: 16d Sinker Nails
Page 1 of 1
Disclosure
Completeness and accuracy of input must
be verified by anyone who would rely on
output as evidence of suitability for
particular application. Output here based
on building code -accepted design
properties and analysis methods.
Installation of BOISE engineered wood
products must be in accordance with
current Installation Guide and applicable
building codes. To obtain Installation Guide
or ask questions, please call
(800)232-0788 before installation.
BC CALCO, BC FRAMER@, AJ S TM,
ALLJOISTO, BC RIM BOARD TM , BC10 ,
BOISE GLULAMTM, SIMPLE FRAMING
SYSTEMO, VERSA -LAM@, VERSA -RIM
PLUS@, VERSA-RIMO,
VERSA -STRAND TM, VERSA -STUD@ are
trademarks of Boise Wood Products,
L.L.C.
toil
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A,� i�:
Location
Date 7?4 - 21
�!2 630,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee,// $ ."C' k, �S- 0
Sewer 0
fonnection Fee $
Water.Connection Fee
TOTAL
Building Inspector
Div. Public Works
PX-R-IfIT NO.
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. VIPAGE I
G
MAP +40.
LOT NO.
12 RECORD OF OWNERSHIP IDATE
BOOK "PAGE
nE
SUB DIV. LOT NO.
Z�-
LOCATION f,�'PURPOSE
OF BUILDINGV,��/
OWNER'S NAME AM- 13k 1 &&:5
NO. OF STORIES SIZE
OWNER'S ADDRESS 0) ry)j'bDjfSey
BASEMENT OR SLA13
A!,ql�ITECT-S NAME 1394)C*C Cota,
SIZE OF FLOOR TIMBERS IST 2ND 3RD
16UILDER-S NAME -6ROogs c4mT.to. A/Faw DA �mAJU
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DXAFI V �Q 4 /) ,
-0
SIGNATURIOOF OWNER OR AUTHOR IZES- AGENT
F E E
PERMIT GRANTED ER, TEL 0. P6 6'
� Mm
TR. TEL, 6 oov, o
e:��7 19 TONTP. LIC.
41 #-2zto:=-
3 PROPERTY INFORMATION
Lt��COST
'EST. BLDG. COST
60
EST. BLDG. COST PER &Q. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
MANNING BOARD
BOARD OF GELECTMEN
BUILDING RECORD
OCCUPANCY 12
�.INGLE FAMILY
S-ORIES
MULTI. FAMILY
APARTMENTS
CONSTRUCTION
FOUNDATION
8 INTERIOR FINISH
CONCRETE
PINE
3
1
2 13
CONCRETE Ill. K,_
BRICK OR STONE
_�ARDW D
PIERS
�LASTER
D RY WALL
_GNFIN
3 BASEMENT
AREA FULL
FIN. B'M'T' AREA
1/1 1/2 1/1
FIN. ATTIC AREA
t!O 8 M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
WOOD SHINGLF___
_�ONCIZETE
iARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_�ARDVV D
COMMON
_;�SPH TILE
STUCCO ON MAS67NRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
ERIOR I I POO'R
ADEQUATE 17 TONE
10 PLUMBING
5 ROOF
GABLE
I
BATH 13 FIX.)
G A M B:R::E: L
-tip
MANSARD
TOILET RM. 12 FIX.)
FEAT:
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
I I HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COILS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B*M'T 2nd
10 1 -id
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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The Commonwealth of Massachusetts
Department of Public Sofety
BOARD Of FIRE PREVENTION REGULATIONS 527 CMR IZOO
11,10
0111ce Use Only
permit No. 6 4
occupancy & Fee Check*4_-------4
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be Performed in accordance with the Massachusens Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TrPE ALL INFORMATION) Date 4,117 C*
City or Town of om/-A To the Inspector of Wires:
The undersigned applies for a permit to pprform the electrical work described below.
I
Location (Street & Number)
Owner or
!01
Owner's Addres's 3 a/-Y� I I
Is this permit in conjilnction with a building permit: Yes 11 No 9 (Check Appropriate Box)
Purpose of Building Utility Authorization NO.
Existing Service '!�Q_
_a 0 AMPS I d Volts Overhead Undgrd 0 No. of Meters
New Service AMPS Volts Overhead Undgr4 0 No. of Meters
Number of Feeders and
Location and Nature of Proposed Electrical Work -
No. Hydro Massage Tubs JNo. of Motors Total HP I
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabili�y Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 0 NO L] I have submitted valid proof of same to this of f ice. YES 0 NO 0
If you hav hecked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND [] OTHER C3 (Please Specify)
tExpiration Date)
Estimated Value of Electrical Work $ st, �v
Final
Work to Start Inspection_,D.ate Requested: Rough --
signed -iin-der'ihe peniiiies of perjury:
/X///� LIC. NO. 21�
FIRM NAME'- be
Licensee 117 S i gna t ure LIC. NO.
Address 4Y A BbCs. Tel. No. 6ylb
—Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its suD-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit '3
application waives this requirement. Owner Agent (Please check one) — -t / r6
Telephone No. PERMIT FEE S � r, _WD
(Signature of Owner or Agent) 30,66
V.
No.
oi Li6ting Outlets
No.,of Hot Tubs--,
mo... -of 'Trans formers Total
KVA
No.
iI I I
of Lfjh�t'inj. Fixture
Above M In -
Sl�imm in& Pool grnd. LJ grnd.
Generators XVA
No.
of Receptacle Outlets
No. of 01 1 1 1 Burners -INo.
of Emergency Lighting
Battery Units
No.
of Switch Outlets
No. of Gas Burners
FIRS ALARMS No. of Zones
Total
No. of Detection and
No.
of Ran ges
lNo. of Air Cond. tons
Initiating Devices
No.
of Disposals
Heat Total Total
Of Pumps KW
No. KW
No. of Sounding Devices
No.
of Dishwashers
Space/Area Heating KW
No., of Self Contained
Detection/Sounding Devices
No.
of Dryers
Heating Devices KW
Local [] Itunicipal []Other
Connection
KW
No, of F0—. _0
Low Voltage
No.
of Water Heaters
Siens Ballasts
Wirinit
No. Hydro Massage Tubs JNo. of Motors Total HP I
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabili�y Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 0 NO L] I have submitted valid proof of same to this of f ice. YES 0 NO 0
If you hav hecked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND [] OTHER C3 (Please Specify)
tExpiration Date)
Estimated Value of Electrical Work $ st, �v
Final
Work to Start Inspection_,D.ate Requested: Rough --
signed -iin-der'ihe peniiiies of perjury:
/X///� LIC. NO. 21�
FIRM NAME'- be
Licensee 117 S i gna t ure LIC. NO.
Address 4Y A BbCs. Tel. No. 6ylb
—Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its suD-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit '3
application waives this requirement. Owner Agent (Please check one) — -t / r6
Telephone No. PERMIT FEE S � r, _WD
(Signature of Owner or Agent) 30,66
4
nxjw�'Ui
Date .....
609
to
TOWN OF NORTH ANDOVER
to
PERMIT FOR WIRING
3 CHUS
This certifies that ... —A .. T ....... 4 .........................
has permission to perform ....... A.Mt.�'�j ........ S..YS.�A!..� ......... UR
wiring in the building'of ....... 0 .. ......... ...........................................
at ... )f1V ...... ;? Si ....... . North Andover, Mass.
CU
FeJ7........... ................
..0 ....... L i c. No ...............................................
ELEcrRicAL INSPEc-m
1� \ � ft- —� 4 � ;4
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Date. . �A/
\0
A TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies
has permission for ga, installalion .........
in the buildings of
atCRH. . , . .. . .,. . . ..... North Andover, Mass:
Fee— t Lic. No. . . I � . A)l4w..V6
GASINSPECTOR
,, Check #
-�Sl 50
MASSACHUSETTS UNIFORM APPLICATION FOR -P IT TO DO GASFITTING
9AI;(Print or Typ
or
1AP—*1,^Mass. D to 20,
--A Permiti.
Newo Renovation 0
uj
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
6TH FLOOR
installing Company Name
' kddress -
lusiness Telephon
la.me of Licensed Plumber. or C . as Fitter A
wriers "me
,Type Of OCCU a
Replac nt Plans SUbmitted: Yes o No 0
T
co� CEO
F- Z Z
0 5
CL ce
LU 0
LU
Lu
0 W
21 =75 1 0 (D 8. 2
T—T—T— 7-1
Check one: Cerdflcate
D Corpolration
0 Partnership
&-f,'MVC 0.
a cufTen!�lablllty InSurance Policy or Its Substantial equivalent, Which meets
Yes NO 13 the requirements of MGL Ch. 142.
If you have Checked Yes, Please Indicate the type of coverage by checking the appropriate box.
A liability Insurance policy &,--, Other type of indemnity 0 Bond . 0
OWNEWS INSLIRNA�E WAIVER: I am aware that the licens . ee does - not have the Insurance coverage required by Chapter
142. of the Mass. General Lam, and that my signature on ffffs PerWfff—aPPIIc2t1On Walves this requirement
I SignatUrvuruvmeror.owners Agent
Check one: '
Owner 0 .. Agent 0
iereby certify that all of the details and InFormation 1 have submitted (or enteredi In above application are true and accurate to the best of
y knovAedge and th2t all Plumbing work and Installations perFormed under the permit IpdR*r this 213plicadjon be In compliance %*Ath
u OrCas F tt r
mis JP
I pertinent provisions of the Massachusetts S t3te C2S Code and Chapter 142 of th a " I be In compliance vAth
a e L
By Type of License:
TWe [i Plumber S 4gnr9 Of L 4cenms ed ber or Gas F tter
o Casfltter
License Number
-APPROVET(OFFICE USE ONLY) &MM te r
0 JOUMeyman
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