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HomeMy WebLinkAboutMiscellaneous - 31 JOHNSON CIRCLE 4/30/2018 31 JOHNSON CIRCLE 210/097.0-0062-0000.0 Date.5*--X— "oR7M' TOWN OF N=ORTH ANDOVER hoot P, RW FOR PLUMBING SSACMUS� This certifies that . . . . . . . .!. . . . . . . . . . has permission to perform H-e-.q .. . . . . . . . . . . . . . . . . . plumbing in the buildings of . . */?e- �!-t . . !!. .. . . ... . . . . . L at —.�i. . .`�.Ujt/�, .on. . Ci t3G... . . . . . . ., North Andover, Mass. Fee. . . . .Lic. No.. '�-1? . . . . . . . . . . . . . . . . . . . . . �. . . Check # PLUMBING INSPECTOR t� 7694 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) QoA , 'Arnd0Lv_y- Mass. Date 0.2 200 Permit# �® i- Building Location / , )�, h,�c�,,,� ; rc J Owner's Named;,S G/yo r •t Type of Occupanry_ New [ Renovation O Replacement O Pians Submitted: V Yes ❑ No � FIXTURES y z X < .. F. pq N in O z ►- ° W le J y V < y 2 W W 0 W F• W ° ¢ z C y Oz z = a ° J y tlf h S Q F V W y x < y U. d F- ¢ W O O ICW W a i W Z O < ar z a a- ccO '` < s z s t > F• O g b O W E. z O Q y _2 = .W F• O V S s X J m y 0 0 -K 3 0 j- J J p ¢ ¢ or < O < F• O SUB—BSMT. BASEMENT ' IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR I STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Na ✓� ✓� Check one:. Certificate Address corporation .0 Partnership Business Teiephone 0 h milco v Name of Licensed Plumber ��-• INSURANCE. CE COVERAGE: I have a current Ilabiiv Insurance ce policy or its substantia( equivalent which meets the requirements of MGL Ch. 142. Yes a If you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy Er— Other type of Indemnity 0 gond 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this penult application waives this requirement. Check one: 54nature or Owner or Owner's Agent Owner 0 Agent 0 I hereby certify that all of the details and information I have submitted(or entered)in above knowledge and that all plumbing worts and installations performed under the Permit oppilation are true and accurateandthis application Compliance the best of my pertinent provisions of the Massachusetts State PlumbingMull be in compliance Math all Cod r 14 of oral to rue ature o Lcen umbe City/Town Type of License;Master Journeyman[�� �1�) (0 Nl License Number- / i I BELOW FOR OFFICE USE ONLY PROGRESSINSPECTION FINAL INSPECTION SKETCHES FEE NO. -- APPLICATION FOR PERMIT TO DO GASFITTING NAMES TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC, NO. PERMIT GRANTED DATE — 20 a OAS INSPECTOR � t Locations ,_ nIn c l? No. n Date If 3 " 124 NORTh TOWN OF NORTH ANDOVER F0, 9 + ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ s�cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #a13 (0 40 (—K, evvwi[� P-71-tV Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPRENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �� rn BUILDING PERMIT NUMBER: DATE ISSUED. • ,r 3 SIGNATURE: 2a=264/� aaaal Building Commissioner r of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3( ; hn 600 ci rc)f, V 2 Map Number Parcel Number q ,� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided red Provided v 1.7 Water Supply M.GL.C.40. 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-P /ABENT Historic District: Yes— No— rn 2.1 Owner of Record Name(Print Address for Service V wj6dl wWo -1 s- , S D 7 t Signature Telephone 2.2 Owner of Record: +Name Print Address for Service: O Z { m Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 tcensed Construeon Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O i 1 I1 T Q l m4 to- k o-it a- License Number an Address /110f1107 D q7 5 �� 5' Expiration (DJs ic Signature Telephone 00000 3.2 R7istered Home Improvement Contractor Not Applicable ❑ 0 a0`4 bole-caro � Company Name I V I L ( rn Registration Number r AddressI r f Q � Signature Tel E��Dafthone G) L ' SECTION 4-WORKERS COMPENSATION(M.G.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.......❑ SECTION 5 Description of Proposed Work check all appficable New Construction ❑ Existing Bui ding ❑ Repair(s) Alteratio )Ar,,p ,Addition ❑ Accessory Bldg. ❑ - "Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: aA P40C) alcvr SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFftCIALUSE ONLY Completed by permit applicant 1. Building q o Q eo (a) Building Permit Fee V 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) ---'--' 4 Mechanical HVAC 5 Fire Protection 6 Total1+2+3+4+5 ' © Check Number 9.D p SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT s r �+ I, as Owner/Authorized Agent of subject property s' Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, Dcod 6 J I�-rN n as Owner/Authorized Agent of subject ti property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief , � V ��- Cilewan Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1Sr2 ND 3 FD SPAN DEMENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Tovm- of : Andover 0 1 L- L dover, Mass., / ` 3 • COCMIC EWICK ORATE D PY 7 S BOARD OF HEALTH PERM ..IT . T D Food/Kitchen Septic System 1BUILDING INSPECTOR DAW.W.Fee THIS CERTIFIES THAT..... .... .... . . a F ounddation has permission to erectl*l. -to....vok..' d60.............����.....����y.6.011....C. 1.e... Rough to be occupied as.....S.. .4 !t. m-6 him ''!M , ...Y.*31 �r..ht . .......................... ................... Chimney provided that the person accepting this permit shall m every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and dy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 9 7/;6* PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI0 STARTS Rough ...... ..... ...................... .. .. .. . ........ ... . .. ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous -Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: Uf5 54hi 0 (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date The Commonwealth of lVlassaehusetts Department of Industrial Accidents t r ''I Office of Investigations 600 Washington Street - � Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information tPlease Print Legibly Narne Rewoo Address: City/StaterZip: 440VUL M 40 ©[M7 Phone #: 7? 7 Are you an employer''Check the appropriate box: Type of project(required): 1.Lr l am a employer with a 4• ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.* 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box 0 t must also till out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1� Insurance Company Name: Policy 4 or Self-ins. Lic. It: / / Expiration Date: �d�9 Job Site Address: yem CI�G°L �� d�� Ci /State/Zi /'t q% ( 5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line 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 tine 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. !do hereby eerdfj un r e pains and penalties oj'perjury that the injormation provider/above is trete and correct. 01 e: [gate: 7a h � o b Phone 't q�j -6 OI ficial use only. Do not write in this arca,to be completed by city or town oJlicial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: • R te 04!27!2005 08:25 1783276517 i OA1'E(I 4412712 CERTIFICATE OF LIABILITY sNSUR�NSUEASA {y�pTTER �E ttCER�p.f: %7 .43 THPA_CORD,. DUCER ONLY AND COtIFERS Nt) RIGHTS UFO EXTEND IFIC' CFRT WILLOWS 'INTERNE-fA1k�., =AG.INC HOLDER. THIS CERTiFIGAT� 00ES NOT AMEND, ALTER THE COVERAGE AEFOROED BY THE POLICIES BEI 522 CHICKERING ROA MAIC# 4 NORTH ANDOVER INSURERS APrG CoN'EFU.GE -- - Lam` -_ 7;j D.G.CONTRACTING. {��" Ai aCti PpC1 t+�! y.Oi N&NORFOLK DAVID GULEZtAN TNSRER _ D INSURERD.AIG (N§URANCE -- _ ---. - 428 PLEASANT STREET _ - - - hIOR 1 H ANDOVER,MA 01 545 i INSURERS. NG CQ g pCALC $ g EN ISSUED TO T--1E WSURED NAMED A80vE FOR THE POLICY PERIOD IR`��A EED; MAY BE ISSUEOiOR HE PC vIES OF INSURANCE LISTED D BEL}W HAVE= T TC WHICH TNIS CE-- Y Tri= h'_iCi!S DESCRIBED +EREIN 1S SUS1=G4 T=7L4$.EXCLUSiC'�-AND CONDITIONS(}F SUCH ANY 4E� pEYENT,TERM OR GONDITIOid OF At?' laNTRACT OR O�EP DOCUMENT WIT! R MAY Pcrt't,� _WE INSURANCE AFFORDE}8 - CLAIMS. - " POLICIES = 3?EGAT7 LIMITS SHOWN MAt HAVE Bc=k',EDUCED BY PAID � - uMITs'.- INSve AO t - - - _ Pp{ECY l9U#L$8� — QATE �z,C h OCCUR E>;CE S 1.Os 10,0U0 TR GERr=eALLIAMLITY07/61?cC+C,4 ., 5 A X ,;mmERCIALGENERALLIABIL" R0401'rG3�. !MfDEXP(kvrtp!Tl'l'% _. -- �- ti,_iiMSMADE X OCCUR PERSONA1 aADV..:a� t�k-�R.QLAGCiREGj'E _ 3 - _ )CTS>c01APC,91 5 !NCLUDED n^ t EkLonREGATEIMdITAPPI+_S?°<. — �yM } nY� I `-* #' ` - ,;:,71i:tJEL�+�tiNGL.E iIMIT ; �{;VUV.�� I wc TOM �^ OS/12'2t;44 � Q6l1t�7€k5 J - 4 a ! — -ANY AUTO ^aiyiN.lt✓p' F ALL-,H+rSCA;TO5 I ' }((SCHE'Jl.i•D.4lfTCS - - - - HtREDAUrp$�NE _.- DAUTOS i.xn-r::�AGE ter. t7ONLY,E1 BQliY GARAGELiA ( -:*SPTKAN — - j �, t.ANY�O i >�.-05NLY: ASG 5 _-r,tt1Rpsw_E_ I S _ Tool)G o 'EXCESWM9RELLA LIAgUTY 0001370 12/10(2004 ( 6/10/2005 AGGREe Tc _ I s-. 000,006 - C X OCCUR CLAIMS MADE ' - !'T ---- -- '--- DEOUCTIBL¢ --- - $ TEitTI`Jk ! _ - STATU, I "0TH+ WORKfiW COMPENSATION AND Tc�Y LIKMS. €R C3 F OVERS"Lui�ILm WC333-27-74 I G3�3tt1t10; 133 3 i 2LY _t E Ac^OZ-NT s 10G,OQ0 ANYPROPRIETORIPARTHERrKS—.JTIVE : RENEWAL 3/31 �� 3131!16�3 _- ' E•:A -EMPLOYEF E 104 (OFFICER*AEU9EREXCLUCED - .-_ It pascribeufld8f - 500,000 SPECIAL PROVI$IONS belay OTHER i 1 DESCRIPTION OF OPERATtOss I LOCATIONS I WEHICLES f EXCLUSIONS ADO EO BY EN 7 SPECIAL PROVISIONS CERTIFICATE HOLDIER CANCELLATION SHOULD ANY OF THE ABOVE OESCRISED FOU0195 U CANCELLED BEFORE THE EXPIRATV DAIS THEREOF,THE 15$UINO!I$UREA WILL ENDEAVOR TO MAIL 10 DAYS WATT NOTICE TO THE CERTIFICATE HOLDER NAUED TO THE LEFT,BUT FAILURE TO DO SO-` IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGE' REPRUEKTATIVEld AUTNORQE@ EHT ZB{ ACORO 20011" 'ACQRQ CORPORA" Date....... N� 7 ...... .............. NORT►1 °!t"`° '• '"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ScHu f�� N This certifies that .!`>...!. .1.......................................................................... has permission to perform 'f wiring in the building of.. >./:...':...'...`...:....... . ........................................... A at..... ......................................................................- ` ' ,North Andover,Mass. Fee ...:�........ Lic.No............. ... r i �....� f'.�........................ 7 • .ELECTRICAL INSPECTOR Check # ,m ./ A/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Official Use Only Department of Fire Services Pcrmit No._ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked P Jig ev. 111991 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MECJ 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: u �- 14, City or Town of: A)Olt7- t To the Inspector ofWires: ;`t= By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) / TD tlti S r� Owner or Tenant S t✓' F' vp e, Telephone Na 97f- Ow•nees Address Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building Utility Authorization Na Existing Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters New Sen ice .Amps / Volts Overhead❑ Undgrd❑ Na of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: '�'et`rq Cont letion of 1lte folloxin table tnav be waivedby the Itis eetor 9f Wires. Na of Recessed Fixtures Na of Cert-Susp.(Paddiej Fans Na of Total Transformers KVA Na of Lighting Outlets Na of Hot Tubs Generators KVA Above ❑ ❑ a o mergency inng No.of Lighting Fixtures Sw imming Pool gmd. grnd. Battery Units g b b Na of Receptacle Outlets Na of Oil Burners FIRE ALARMS No. of Zones Na of Switches Na of Gas Burners INo.of Detection and Initiating Devices No.of Ranges Na of Air Cond. Total No.of Alerting Devices Tons b No.of Waste Disposers Heat Pump Number ITonsNo.of Self-Contained Totals. `Detection/Alerting Devices Na of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other onnectron No.of Dryers Heating Appliances KW ecurity ystems. s or Equivalent X02 Ivo.of Water KIN 0.0 o.o Data Wiring: Heaters Signs Ballasts Na of Devices or Eauivalent No.Hydromassage Bathtubs Na of Motors Total HP Telecommunications Wiring: Na of Devices or Eouivalent OTHER Attach additional detail if desired,oras required by the Inspector of Wires. 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CBECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (specify:) Estimated Value of Electrical Work /o� (When required by municipal policy.) (Expiration Date) Work to Starr 4 /-�1 4-0 Inspections lobe requested in accordance with MEC Rule 10.and upon completion I certtfy�,under the pains and petralfies of perjury,that the information on this application is true and complete FIRM NAME: ADT Security Services 111 Morse Street,Non4oMA 02062 LIC. NO.: 1533C Licensee: John S.Bassett Signatur L1C. NO.: 1533C (If applicable,eater"czentpt"iu the license rnnuber line.) Bus. Tel. No.: - - Addn= Alt Tel.No.:603-.594-519 lresi OYSTER'S INSURANCE WAIVER: 1 am aware that the Li ensee doesnoi have the liability insurance coverage normally ONLY required by lair. By my signature below.l hereby naive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERAHT FEE: S,35 �'�