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Miscellaneous - 316 JOHNSON STREET 4/30/2018
316 JOHNSON STREET 210/037.D-0025-0000.0 Date.......!.O. 4 NOR71{ 3jp�j�``D-•e1'I'pp` TOWN OF NORTH ANDOVER PERMIT FOR WIRING � ��SS�cHusE� This certifies that �� l!;�'. . ..a .�........................... ... has permission to perform ,. f!. 1,........ /p%v ............. wiring in the building of...... . .........:: ................ ... .. .......................... at -�/ ..... ... . . �'.��. 1 .:�................North Andover,Mass. Fee..4`. .f........ Lic.No./9 ........................................................... ELECTRICALI pECTOR Check # /V +� .1 !_ 7 Commonwealth of Massachusetts Official Use Only Department of Fire Service Permit No. Sjr 7 Occupancy and Fee Checked 6b BOARD OF FIRE PREVENTION REGU TI NS [Rev. 11/99] leave blank , APPLICATION FOR PERMIT TO P FORM ELECTRICAL WORK All work to be performed in accordance with the Massac etts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK ORk INF TION) Date: —] C)/ ) Ll /0 Ll City or Town of: 9�fk nr 0 V LY To the Insp ctor ofWires: By this application the under d gtves notice of is or her intention 19 p rform the electrical work described below. Location Street&Numb l Owner or Tenant? (A Telephone No. Owner's Address _ (g' — 0 j-Q�- Is this permit in conjunction with a building permit? Yes ❑ N ` (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table ma be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o. o mergency Ig ting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No. of Alerting Devices No.of Waste Disposers Heat Pump Number I Tons KW No. of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal ❑ Cann tion Other No.of Dryers Heating Appliances KW Security Systems: r Equivalent No.of WaterNo.KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent w OTHER: Attach additional detail if desired,or as 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. CHECK ONE: INSURANCEA BOND ❑ OTHER ❑ (Specify:) (Expiration Date) 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. I certify, under. ains an penalRse)01y7s fury, that the information on this plication is true and complete. FIRM NAME: . S LIC.NO.:1 5 9a C Licensee: S 0L Z Signatu C.NO.tSSCO 000 aq (If applicable, enter " empty"in th li ns�num r l' e.) Bus.Tel.No.:� Address: -' (� �� Alt.Tel.No.: OWNER'S INSURANCE WAIVER: am aware tha e Li ensee 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)❑ owner ❑ owner's agent. Owner/Agent x Signature Telephone No. PERMIT FEE: $ t 'i IRE CUA MUNWPA"HUFMASSACHUSE77S Office�� ni DEPARMEW0FPUBMICSAFElY Permit No. BOAROOFFIREPREVEMONREGUL47YONS527C11M12.W �3 Occupancy&Fees Checked dial r APPLIGATIONFOR PER1VIll'TO P ORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA ACHUSSTS ELECTRICAL CODE,527 CMR 12:00 / LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date `� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w rk d cribed�bellow. Location(Street&Number)f --�� -' KL aV Owner or Tenant I I Si Owner's Address -SOVVV� Is this permit in conjunction with a building permit: Yes= No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amp§L/)V�olts OverheadIff Underground No.of Meters New Service ,�=— Amp�22 /c,!L45Volts Overhead r,_1 Underground No.of Meters T� Number of Feeders and Ampacity ,"r-tion and Nature of Proposed Electrical Work Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA Lighting Fixtures Swimming Pool Above Below Generators KVA round El gronrid Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units Switch Outlets JIIJJ No.of Gas Burners Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices ishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices ryers Heating Devices KW Local Municipal Other Connections Water Heaters KW No.of No.of Signs Bailasis ro Massage Tubs No.of Motors Total HP Wrdgz.l?uW tDthetEC erne&ofMaSSa"MGffimWLm Iiabllyhmi�loeA�licyinclld�gCotnplate Covaageaitssubbtialequivalat YES NO v3WrWof0fsM1olheOlfioe YES E:p If)uftwdter WYES,plea9eit&*therypeofco%uWby BOND E] OTHER ( y) EstiM*dValteof9ec7"Wctk$ W0&0'1;hast kMegiMD*Re400d RaO Fatal FIRMNAME l S LioenseNo. Li�r�e iyyJ C4W eA 1/ Sign ue LioaneNo �� QQ ) l BusrmTel.No. 3-WE— / AiirirFcc. yG /��� Qlb�f� / A1tTCLNo. '?ER'SNS'URANCEWAIVER IamawarethattheLio wdoesnothavethem nw=oDw georitstrialegrminitastagtmedbyMassadn sC,,,, lLaws ,imysgwhueonthispemitappbcabmwantsthismgz nt (Please check one) Owner a Agent Telephone No. PERMIT FEE i Vv signature or Owner or Agent Date...... ..�D`7 NORT1� °f'"•�:• '"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING # Y �7S++r.o��` (•� S,OMUt, �. This certifies that ....... / ........... ...... ..................... ................................ has permission to perform l/ ,�I.../I...�...:........................................ wiring in the building of. pJ! //.... .. . . . .......... // � � at -� r . .... ,North Andover,Mass. ...... ,............. ...,... . .... .. . �'�'�LECTRICAL INSPECTOR Neck # % I nE UU1V11V1U1V VVC- LUJ n UP YL45IMCHUJK11 J 3 jV 7l)ffice Use only DEPARTMUTOFPUBUCS4FM Permit No. ' BOARDOFFMPREVE1MONREGUTAH70NSM70MI20 l3 Occupancy&Fees CheckedC APPLICA77ONFOR PERMITTO ERFORMELE=CAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T ASSACHUSSTS ELECTRICAL CODE,SZ7 CMR 12:00R�o — /OY (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: P The undersigned applies for a permit to perform the elect 'cal ork described below. Location(Street&Number) w7t Owner or Tenant v Owner's Address 4S Is this permit in conjunction with a building permit: YesZJ No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service 1--� Amp§�olts Overhead 0, Underground No.of Meters New Service Amp�s��olts Overhead M Underground No.of Meters Number of Feeders and Ampacity.^^�•'on and Nature of Proposed Electrical Work Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA Lighting Fixtures Swimming Pool Above Below Generators KVA round _13round Receptacle Outlets�j� No.of Oil Burners No.of Emergency Lighting Battery Units Switch Outlets L) No.of Gas Burners Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices )ryers Heating Devices KW Local Municipal Other Connections ater Heaters KW No.of No.of Signs Bailasis ro Massage Tubs No.of Motors Total HP vt�.RHa><ttYb[hetegln[altetysof�adl>s�IsC,Q1aalLaws Liab>byh>StnatoePblicyirrh>gConlple>eCovaageailssub�tarialequivalai YES NO vaidptoofofsanetothe0l£ioe YES IfyvuhawdlededYES,pleaseudcal dr peofocmWby BOND r7 WEER r7 (Please Spe fy) Fxpaafiml)* may. Es ffWd VaYa dRcftial Wc1k$ WodcmStat CO`� l kq)ec6MDe1eRegreWd Rao Final sgriedunder-ie of _ FIRMNAME Sbdu.► Lioa>seNo. ►►� C46f v Lias si 7 7 tgna�tte �o LtoalseNo BusinmTeL Na 6d13-W9-1711 AIL Tel.No. OWNERSINSL ANCEWANFR;Iamawwdatdrlxmdoesnothat firma»ameooverdgroritsabsianWe4nvalatasm4medbyMassadalsell cvrnalLaws and drats cn tltis waives dw my gttatiue pearffiappltcahort teqmartat (Please check one) Owner Agent Telephone No. PERMIT FEE Signature or Owner or Agent L tits W[VllV1V[V YY/.`iL.L tl Vr DZ9J.)A(;HUJI✓'L'L J O>°Use only DEPARTA1W0FPUBI1CSAFEjY Permit No. BOARD OF F1RE PREVFI M0N REGULATIONS 527 CMR 12.'(X1 upancy&Fees Checked J3 r �i APPLICA71ONFOR PERMIT TO ERFO ° ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T ASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 f (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date C� Town of North Andover /To the Inspector of Wires: The undersigned applies for a permit to perform the elect 'ca ore AS below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes= No Q (Check Appropriate Box Purpose of Building Utility Authorization No. Existing Service Amp�olts- -,—'Ov'erhead Urdecground No.of Meters New'&ryice •ti Amp Its` .yOverhead Underground No.of Meters T� Number of Feeders and Ampacity 1—tion and Nature of Proposed Electrical Work s Lighting Outlets No.of Hot Tubs No.of Transformers Total ki KVA Lighting Fixtures Swimming Pool Above M Below Generators KVA round and Receptacle Outlets 59 No.of Oil Burners No.of Emergency Lighting Battery Units Switch Outlets lJ No.of Gas Burners -w Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices shwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices ers Heating Devices KW LocalMunicipal Other M Connections ater Heaters KW No.of No.of Signs Bailasis ro Massage Tubs No.of Motors Total HP VW,W Plrtsam 1Dftl0#ffnMaF.Masadt SGffzdLaws LtaethybM=Pbkymcb&lgCM#* Co,,uWu'iLSsubdWapvain }SES � NO bodvaIdpedof ffixmhaveched®BYES,plea9eilyditMfttA cfwvwWby i � D* Es>i *dVakxdE6=cdWc&$ � Fvig > C120heA v S>gnaa><e _ LioalseNo ,� 771q BtnurssTelNa 30 -- / AltTei Na -- 1NSURANCEWA1VEIt;IamawaethattheLioauedoesnotha�+etheinAraltaeoaraageailsarb6rarrialegtrivalaitastagtritedbyMG�alaalLaws agnabaeondmpeon[appkabmwaieesthisraquaem I eck one) Owner Agent Telephone No. PERMIT FEE i vv0 Signature of Uwner or Agent NN, . n 5 Y _ Re-OJAI _ � ��' �Qe e+K S �1,�-.w �a v5 �" —�C QTc�•.� �-g A7��� G9r �-Asea 'PA, v Smou- /RftA!�ae S((7L- l.. © 3 ln� L(Iqr Tn- pORTM'1 o:;.<�``°;•:"�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS� This certifies that ..�o.#!J CR r� .............�...��.................................................... g n 4V D I%toll ,4�b S�R�ce has permission to perform .......... ............... .............................................. wiring in the building of.... . .r:....96..�(Y...................................... at y�A1tp...tZriP IRA&I......,!.�!.. .. ,North Andover,Mass. Feer. z� ... Lic.No. .4� ( .......... / ;2.!. :.�.'fi,,-1.:��V.- ELECTRICAL INSPECTOR iV Check # 54. 55 TBECOAMONIVE4L7HOFM4SS4CHUSE77S Office nly� DEPARTA1EW0FPUBIICS4FM permit No. BOARDOFFIREPREVEMONRFGULWONS5rCMR12.OID l3 Occupancy&Fees Checked VPUCATIONFOR PERMIT :cribed / ORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH STS ELECTRICAL CODE,527 CMR 12:00Akloy RK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical Aelow. Location(Street&Number) r Owner or Tenant Owner's AddressY Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of BuildingUtility Authorization No. Existing Service Amp§)���olts Overhead Underground No.of Meters New Service Amp�2L/c2L--.Wolts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round El ground No.of Receptacle Outlets S0 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices ff Dryers Heating Devices KW Local Municipal r--J Other _ Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- h>Sm rd=CovWdW-RnaanttotheW=r&ofMassa hjMGffied1 aws IhavtraomatLiattlyh>a>tarrePbLcyinchidumgCornQleeCovt�ageoritsst>> rialegtrivala�t YES NO Ihavestl niWdvafidploofofsametodr0ffi=YES � ff)mtuNedrdodYES,plea9em&&therypeofmreWby drdmlgthe INS RANiM KI BOND r7 MIER a ftmSpetfy) �Iy EstirrlatedVahleofDecmtalWc�k$ WodcroSrdrt �" t _ h�ec�mDa�Re�d Rtx��m Fuel Signedutr�rt�ie � of l — \ S FIRMNAME btu UmwNo. Yvy C eA v signaaue Lio=No BttsinessTelNo. 3Y818'-- Alt Tel No. g- 3 770 OWNER'S INSURANTCEWAIVER;Iamawmethatthelxel>sedoesmthavethem uarremr$ageoritsakstaltialopvalaYasmgzedbyMassadx>seltsC,enerdllaws and that my sgnattae on this pemmrt gocaboll wants this tegtluerrtalt (Please check one) Owner Agent Telephone No. PERMIT FEE signature ot Owner or gen Date. NORTH TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION CH This certifies that . A P I A�.6. . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .��r°'`�'. �}�"t -` in the buildings of . . ?a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . n, North Andover, Mass. Fee. Lic. No.. L ASINSPECTOR 0 Check# G i. 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Date l� 20 ®f Permit # Building ` Owner 's AT: Location / Name Type of occupancy:GNewE] Renovation Er000, Replacement ❑ Plans Submitted Yes ❑ No ❑ N YW it ; Z OC N N V N N N W O O N S W J N a O Q m H Y to W H X O W Z = f- Q 0 Z W Q m 0 H W W O 0 a oOc W ~ W Q = l- N Q t W W N W z a x a 0 W Q m O O r x C7 H = J Y F- W W O O > LL H W J N W Q W W a Wcc Z Q ¢ Na m X O X Ed O' N z ct = O O Y LL 3 O _j U m > o a., ,-, O SUB,—BSMT. BASEMENT 1ST FLOOR r 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR TTH FLOOR 8TH FLOOR (Print or Type) Check One: Certificate Installing Company Name Uptack Plumbing & Heating, Inca Corp. 1415 Address 32 Rochambault Street ❑ Partnership Haverhill , MA 01832 ❑ Firm/Company Business Telephone 978 372—8503 Name of Licensed Plumber or Gasfitter Leonard A. Hall 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under 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. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. (� By LICENSE: Signature of Licensed Title /Plumber / Plumber or Gasfitter City/Town 3:5G liter APPROVED (OFFICE USE ONLY) Master 8678 ❑ Journeyman License Number FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS F FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING ElLOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED .A Date 19 A Gas Merc. Final Insp. __+---- Date. „pRT: ,�•° -41+ TOWN OF NORTH ANDOVER pt PERMIT FOR PLUMBING SSACMUS� This certifies that . . i r. ✓. . . -. . . . . . . . . . . . . has permission to performs / A. . . plumbing in the buildings of . . �!t.�,c - . . . . . . . . . . . . . . . . . . at . . `3.l . . . . . . . . . . . .-r.•. . , North Andover, Mass. Fee�S�. �Lic. No. ,:C,... n PLU BiN INSPECTOR Check # / 'tax ` v 63313 MASSACHUSE TS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Pr}nt or ype) . Date Permit # < Buildin Owner 's g Name AT: Locaiton Type of Occupancy: New ❑ Renovation Replacement ❑ Plans FIXTURES Submitted: Yes ❑ No z N a z Y �. > N W N N O Z U) W Y J N a N z O IL Z m 3Q°F=' Z O WN ' W N 0 OE at3W) YrX Z W QN N Z m W 0 C J = 1- Q Id ) y p a as Q QJ , o J M N Y. Oa 0 W ttX W a 04 OW o wQ SUB-BSMT, BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check One: Certificate Installing Company Name Uptack Plumbing & Heating, Inc (2 Corp 1415 Address 32 Rochambault Street ❑ Partnership Haverhill , MA 01832 ❑ Firm/Company Business Telephone 9-78 372-8503 Name of Licensed Plumber or Gasfitter Leonard A. Hall I bcrcby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the bat 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. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Sipuwrc of Owwj Agent I have a current liability insurance policy to include completed operations coverage. L`7 BY Si re of Licensed Plummer Title Type of Plumbin cense City/Town 8678 Master ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number i Date....' .l '.`f'� .... J f HORTM 1 3:°.t�`"-;•�"�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that has permission to perform ......,t __ ..E wiring in the building of J . L L r at............ ......... North Andover,Mass. Fee... �.�.�... Lic.No..IL'y77��......�'".' .�... -'17 � .... Is ELECTRICAL INSPEC�oR Check # 6 �� 6 - Commonwealth of Massachusetts Official Use only — Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MEC),127 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A L INFORMATION) Date: S ©� City or Town of: f�l+i�tg-J"�-- 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) �1 moi'_ N Sam S7` Owner or Tenant ��GT��' �t' Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: saq S� n7� i � CXi-1`lP�S Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1:1 o.o mergency Lighting rnd. rnd. .Eattery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons K No. oSelf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mun'cipal ❑ Other Connection No.of Dryers Heating Appliances Kir Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:c:�17 &X-50•(:�o (When required by municipal policy.) Work to Start: PS 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 succ verage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANC BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pe allies of perjury,thal the information on this7ylication is true and complete. FIRM NAME: �pILrGW) LIC. NO.: Licensee: )� Q�v Signator LIC. NO.: ( 7 (If applicab er "ex t"in the i ems` er ' .) Bus.Tel. No.: Address: / Alt.Tel. No.: 3�ta *Security System Contractor License required for this work; if applicable,enter the license 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)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 66.db Location^ 1 +; �o Som S� No. Date pGRTh TOWN OF NORTH ANDOVER cp Certificate of Occupancy $ + - ; : Building/Frame Permit Fee $ ,T$ Foundation Permit Fee $ CNusE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ / Building Inspector i J 1 G 06/15/99 14:35 84.00 PAID Div. Public Works r vow PERMIT NO. 0-8 APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA N]AP NO. ✓3 1 LO"r NO. 2. RECORD OF OWNERSIIIP DATE 130011 PACE ZONE Still DIV. LOTNO. LOCA PION /_ PURPOSE OI'B1111.111NC �d ` OWNER'S NAME- NO.OF STOItIES SIZE OWNER'S ADDRESS 0 BASEMENT OR SLAB ARCIIITECT'S NAME SIZE OF FLOOR TINIBE:RS 1'1 2ND 3RD BUILDER'S NAME /,/nn_ ff eV c,• (�� SPAN DISTANCE TONE:ARESTBUILDING w LcJ�tl�^ DINIENSIONSOFSILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL.OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIRENIENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWVN SEIVER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCT IONS 3. PROPERTY INFORMATION LAND COST EST. BLDG. COST PAGE 1 FILL OUT SECTIONS I-3 EST.BLDG.COST PEN SQ. FT. EST. BLDG. COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. \TrAC11ED GARAGES NIUST CONFORNI TO SPATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FLIED OWNERS TE L# CONTR.TEL# 0 737 u� Mrd SIGNA"TURF. OF OWNER OR AUTIIORI"!_ED AGENT coNTa.1.Lc# 2Z 6 All FEE $ � � / LI.I.C.# PER NIITGR:INTE1) '�Z 19 Revised 5/5/99 JN1 \ The Commonwealth of Massachusetts ?" ( Department of Industrial Accidents — Mice 91I M5992aans - 600 Washington Street e Boston, Mass. 02111 Workers' Compensation Insurance Affidavit ;;III I 1111n 3z-- 4 e, .� I am a omeowner performing all work my elf. [I I am a sole proprietor and have no one working in any capacity r7 I am an employer providing workers''�compensation for ymy employees working on this job. coingaliv address: 2honc;07 7J -.7 I am a sole proprieto general contractor, o homeowner(circle one) and have hired the contractors listed below who have the following worka�w�, olices: comp2nyname: C? Mo ow add cis: "a"0,4.1 inlu USM Lc�G L' company name: addren- cite phone a Insurance cn,. ao.'iC _ Failure to secure coverage as required under Section 25A of,WGL 152 can lead to the imposition of criminal penalties of a fine up to SIS00.00 and/or one years'imprisonment as well as civil penalties in the form of:t STOP WORK ORDER and a fine of5100.00 a day against me. I undemmad that a copy of this statement may be forwarded to the Office of Investigations of rhe DIA for coverage verification. 1 do hereby cervi under the pains and eennalties of er.ury that the information provided above is true and correct Of Signature '' L �/ Date Print name ��/ /' 4/ f W SH �/_ f� Phone �IN - 7- of ficially do not write in this area to be completed by city or town official permit license p fl Building Department C]Licensing Board mediate response is required CSelectmen's Office C]Health Department phone tl: 10ther 1 (rwum 3/95 PIA) L Town of North Andover NORTH OFFICE OF 3a o�`" y° COMMUNITY DEVELOPMENT AND SERVICES ° . 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSACHUS�� Director (978)688-9531 Fax (978) 688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number a is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of ermit Applicant 7/ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 'J^ BOARD OP APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.10 PL.kNNINC 688-9535 "NORTH ' Town of OL dover No. a ~ v Z * 3 ) A-0�A-�o� L �E Q dover, Mass., BRAT E D p`P �C S 5F BOARD OF HEALTH PERMIT T Food/Kitchen Septic System �+ ;? BUILDING INSPECTOR THIS CERTIFIES THAT.......�i�►.1�1... ..' N�..���.................1►....�.......... ...............................................................4+'0' Foundation has permission to erect.. . . ....... %316 S O v/1� Ag p buildings on ................................. Rough • ��` Chimney to be occupied as.................................. � wV� ...................................................................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ' A UNI-ESS CONSTR,UCTI -1 ELECTRICAL INSPECTOR I Rough ............ ...... .... .................................. ...... ............... ......... .... Service BUILDING INSPECTOR Final - Occupancy Permit Required to Occupy .Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. J 4 Date... ....0 ......"-/... 975 f NpRTM 1 3?;•t�`"- "�� TOWN OF NORTH ANDOVER 77' F A 7 PERMIT FOR WIRING �sS�cNusE� a This certifies that ........ ../.... ... . has permission to perform .i�... .... .� ��. wiring in the building o .. .,r................................................. � ..... .. ................... .North Andover,Mass. 9 Fee...14........... Lic. . ...........................:............... .....:.: ELECTRICALINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer *., Office Use Only / u�E LQtltiriDlilUEttl {tt Bit U �r Permit No' Equrtmtnt of Public %fttg Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMA 12:00 3190 (leave blank)lug „ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 /� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _ %j* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) � f "^ Ir /� Owner or Tenant /' /j 'l�� - - 6 Owner's Address SQ"ke ,-/ Is this permit in conjunction with a buil ing permit: Yes No ❑ (Check Appropriate Box) Purpose of'Building Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ . No. of Meters New Service Amps .J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity / Location and Nature of Proposed Electrical Work L✓r�h / h� "/Llr - ' / K ,ielU 6-1V m 6114A No. of Transformers Total No: of Lighting Outlets No. of Hat Tubs KVA No. of Lighting Fixtures =P I Swimming Pool Above In- g 9 - grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. a} Air Cond. Total No. of Detection and 9 tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Heating Devices KW Local Municipal Other No. of Dryers 9 ❑ Connection ❑ No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 2--_N0 r I have submitted valid proof of same to the Office. YES Z�_NO = If you have checked YES, please indicate the type of coverage by checking the approp to box. Z:,- _/ 7 INSURANCEBOND � OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work S s a 7 Work.W Stan 5 }V--7 7 Inspection Date Requested: Rough Final Signed under the Penal' s.of pe PIRM NAME �17 LIC. NO. Licensee Signature LtC. NO. /a �, � � � .,lJ Bus. Tel. No. Address l / Att. Tel. No. i OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-5565 Location No. • f Date i "ORTN TOWN OF NORTH ANDOVER n Certificate of Occupancy $ a. Building/Frame Permit Fee $ -, Foundation Permit Fee $ s�C ust Other Permit Fee $ p Sewer Connection Fee $ co i Water Connection Fee $ a R TOTAL $ f N Building Inspector " • = , 092, Div. Public Works MIT NO. LLT APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE MAP KJO. �-� I LOT NO. _ 2 RECORD OF OWNERSHIP - DATE (BOOK :PAGE ZONE SUB DIV. LOT O. LOCATION ( )tel PURPOSE OF BUILDING / OWNER'S NAME ro c Q NO. OF STORIES SIZE OWNER'S ADDRESS / ' , BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ,/1 o c - n SPAN DISTANCE TO NEARES 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 MATERIAL OF CHIMNEY k IS BUILDING ALTERATION 15 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 3 PROPERTY INFORMATION LAND COST SEE BOTH 61DES EST. - BLDG. COST /O PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER• . FT. PAGE 2 FILL OUT SECTIONS t - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 0 � 9 --�n ■UILDtNO INSPtCTOq SIGNATURE OF OWNER OR AUTHORIZED AGE T C, FEE OWNER TEL.# ��- Q 74 PERMIT GRANTED CONTR.TEL.N 19 CONTR.LIC. �-�` of 33 H.I.C.k �3 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I SiOI? E5 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH w` T �� CONCRETE vFw CONCRETE BL'K. PINE __ _ BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL //' r/-�/--- �• 3 BASEMENT I 'C AREA FULL 11 FIN. B M TAREA _ Yr % FIN. ATTIC AREA _ NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDY-D _ ASBESTOS SIDING COMIAON _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICKY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR (� NPOOR ADEQUATE ONE 5 ROOF 10 PLUMBING s GABLEHIP BATH 13BATH13 FIXE _ GAMBREL MANSARD TOILET RM. FIX.) ) FLAT SHED_ WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK $LATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT "'T'G UNIT.HEATERS 7 NO. OF ROOMS GAS IL O B'M'T 2nd ELECTRIC lot _I3,dNO HEATING g1g. HOME INPROVENENT ONTRACT Registration 108982 #,RIVATE CORPORATION 08/25/98 WIMP ,Avid Mita" PO 171f a M80: AD IS MTDR, X. r.- � � ✓!ee L�anwrtar2��rea�Llt o�✓tGG�10cu'�iu.1e�3 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Huber. Expires: Birthdate; CS 023365 1210411991 1210411957 Restricted To: 00 DAVID REITANO -4 56 PLEASANT ST POBX 316: { IIETHURN, MA �.lORT . own of _ _ over No. Z* . * Z - dover, Mass., 0 it LAKE w 9 COCNICMEWICK i�'�• , qO�, S o BOARD OF HEALTH PERMIT T Food/Kitchen Septic System 60, BUILDING INSPECTOR THIS CERTIFIES THAT ............... 5.� :.. ......�... .. ,,.r,.. ................................................... Foundation has permission to ares#:-...4.4 . . buildings on ....../...6.........TQ . .�.5'.Q....�.........4................. Rough to be occupied as.........................................P44--o-t o.� .�.�............. .—raA.t?�... ..... .................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes-and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MON ELECTRICAL INSPECTOR UNLESS CONSTRUCTTO Rough ........ ....... ....... ...... ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building- GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. Date "OR':��a TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACMUS /ILW� � This certifies that . . ... . . .has permission to perform . ) . . plumbing in the buildin�gss off at. ��? �'j�` �� �i . . . . . . . . . . ., Forth Andover, Mass. +: Fee-5/1' .Lic. N0G. . . 1C. 1. � 1. .'�. . . . PLUMBING INSPECTOR/ `l Check # / 7( f/ 6 U7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Pr}nt or Type) Date MAWA Z�j 1005 Permit # IV- ��� �• Building I _L Owner 's EVG� s �Ub� �CLLY AT: Location ohne ' Name �. � Type of occupancy: New \1 Renovation Replacement ❑ Plans FIXTURES Submitted: Yes [INo ❑ = y a Z 1C • Vj N N N O Z Z W W F� N J } () d y (7 Cr W W J N OC N Z W Z = 0. f- O W i- W N 1- G� W to x Q N CL 0 to 0: 02 N N W !- N to = p Q N 0. Z 0: a cc W Z O O x a N Q W N W. A G W ¢ �C W x W F h', W D . 3' J cc f. Q Y } V y r O Z a }. Z O O Vf x z W �' C v Y Y J m N D O J x !• N U. O SUB"BSMT, BASEMENT J 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR :--H J1111 8TH FLOOR I : I (Print or Type) Check One: Certificate Installing Company Name Uptack Plumbing & Heating, Inc Corp. 1415 Address 32 Rochambault Street ❑ Partnership Haverhill , MA 01832 ❑ Firm/Company Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter Leonard A. Hall I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under 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. I have informed the owner br his agent that I do not have liability insurance including completed operations coverage. sipnum of OwclAjent I have a current liability insurance policy to include completed operations coverage. By Signature ofnce&eil Plumber Title Type of Plumbing License City/Town 8678 ❑ Master ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number t Locations 14 J o 4 M_5na► No. Date eo-� 1 --6/ NaRT� TOWN OF NORTH ANDOVER O'�t�ae ,a'�ti0 10.? • a C9 ` Certificate of Occupancy $ Building/Frame Permit Fee $ y AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 5 9 6 ale 6:v,Building Inspector J � iP) br,4w TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING Trial$eltee fer Jgse 0 rn BUILDING PERMIT NUMBER: j DATE ISSUED: © M ic SIGNATURE: ic Buildin Commissioner/I for of BuildingsDate Z SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: risoj �JA^S J Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Rapired Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 ---I SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT :l"'LU 1 i fi t . YC;'7_1!o M 2.1 Owner of Record r, K -4-, ud ti IC1~ _ ,��(� �1a�in�J'or� S7� A/D• Alludwe, Ql� Name(Print) �— AA ss for Service � 'f J✓ .Signature Telephone 0 r1 -2.2 Owner of Record: Name Print Address for Service: o Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ t, N ve` �� ��� r- k C7L S Lt Construction Supervisor: 612 411 0 �O/OdG'v �'(�,(�14 License Number � Addre GG Expiration Date icic Sig re V Telephone r•• 3.2 Registered Home Improvement Contractor Not Applicable ❑ v i>'�1'rc�yv� ���� �Cirit:/�hJ ��c• /z�3�' Company Name Z m Registration Number r Addre r u/ 2106 7� y Expiration Date ^Z Si atu u Tel hone �+• 4 SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) f 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 buildig permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building K Repair(s) ❑ [Alterations(s) &K Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposer�f /�/.w lt�iN d tx�.� f l��f•'meq SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of O 0 U 0 Construction 3 Plumbing Building Permit fee(.) x(b) 4 Mechanical HVAC o0 5 Fire Protection 6 Total 1+2+3+4+5 - Check Number SECTION 7a OWNER AUTHOR12 4TION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. i Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si afore of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 FORM U - LOT RELEASE FORM r ' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. **' ** ***********************APPLICANT FILLS OUT THIS SECTION*********************** Il APPLICANT_EUCCwc_TT(/dX �Gt//!"' PHONE LOCATION: Assessor's Map Number PARCELS SUBDIVISION LOT (S) STREET _TA fiDtc) ST. NUMBER **********OFFICIAL USE ONLY *********** EC MENDATIO S TOWN AGENTS: % CO S ATION ADMINIS TOR DATE APPROVED DATE REJECTED COMMENTS /TOWN ANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED GS I N150ECT -HEALTH DATE APPROVED a Pt 6OvN^' `t l Uj +0 DATE REJECTED _iv stca�� COMMENTS �� 074- PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT `�`e ��� RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: n oc"k (Location of Facilit ) ignato Permit Applicant ur ate 1, NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector G Y The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 °�d,M Sye"�0w Workers'Compensation Insurance Affidavit Name T Please Print Name: Location: 3 6 -To h 14 Sy 0-J Sf City • 4lu�ay ev- Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one.working in any capacity I am an employer providing workers' compensation for my employees working on this job. Com an name: ANJOV4, erf Ira— Address City: A. bveo A ac Phone#: !78 ' '{70"' '17S3 Insurance.Co. ASs OCA AIL V-w1 D" nx. Co• Policy# W c C S'00,3`f 10( 2 0004 Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 andlor one years'imprisonment_as_well_as_civil.penattiesinlhe.fnrmofa..STOP.WORK_ORDER..arnd..afineof_($100.00)-a-day-against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify and e p ns and pen o e 'ury that the information provided above is true and correct. Signature -- Date y Print name_ y j2a,S e Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing EJ Building Dept r-1 Check if immediate response is required F� Licensing Board E] Selectman's Office Contact person: Phone#: E] Health Department Other JUL-22-04 12 :07 PM ROB BRAMHALL ARCHITECTS 970 749 9659 P. 04 07/22/2804 09:28 15782828232 SUN ENGINEERING PAGE E�2 Permit Number f REScheck Compliance Certiftate checked VrDete Mss uchuset>ts Energy Cade REScheckSoflwaee Version 3.S IZeleaeo lc Data 9lenasie:C:1PrograntlrikslChecltlRESt9tecicViEILLY-7.20.04.rt1� i TITLE:REScho*Calmledon i i i CITY.Notch Andover 9TA7E;Massec>:aft IDD:6322 CONSTRUCTION TYPE:I or 2 Family,Dataabed HEATING SYSTEM TYP - 1 ce Gtiltta on E aconic RRsistae (N ) 1 DATE:07/=04 DATE OF PLANS:07-09.04 PROJECT INFORMATION, Reilly 1Roaldraco Ntrth Andover MA COMPANY WFORMATION: SUN Entginewing bc. 95 Easters Avenue (1loaaester MA 01930 i COMPUAKE:Pam Maximum UA-136 Yaw H>mw UA■)2$ 2A%Baser 111aa Cada(VA) trove cluing Arta or Cavity Cont. of Door perfm R-V die R•Velue U-Facia UA Celiing 1:FW Celling or 3ciseor Truss 1501 30.0 0.0 53 Wall 1:Wood F1' W,IV o.c.. laid 19.0 0.0 92 Window l:Wood Frame.Dakic Pates with Low-E 311 0.360 112 Door 1:Solid 42 0.300 21 Floor 1:All-Wood WwTntss:Over Unoonditicned Space 1323 30.0 0.0 44 Floor 2:Al!-Wood J*Wrruse;Ovar Outside Air 176 30.0 0.0 6 COMPLIANCE STATI6MENl': The proposed build dolga 4cooibed here is crosWent with the baildisg plana,specify end other catetayt ws aaballt ite permit ipplicuim, 71c proposed huitd'ing has beast dcsigned t;o moot the Mumb Faeev Code ratiaiaetsalts In cVassim 3.3 Relow 1c (farmtrly MBWwc4 and to damply with dna MandatwY E regnirwmtj listed In the RESchocxllttltecdon Cbeal iW. The treat u load for this buildhtd,atld the eooloag feed if appropriate,has been determined using the apFtliotblo Standard Des ygs Conditions O and 1n the Cade. The HVAC gqu1Vnmt sokcW to Twat or sool tats buitdins istl be so Wwtar dkaw 17gei.at" dalpt bad as specified in Seciicas 78DC1Wt 1310 and]4_4. JUL-22-04 12 :08 PM ROB BRAMHALL ARCHITECTS 978 749 9659 P. 05 09;28 1978282d232 SUN EPJGINEEkINa FRGS �5 f� I l But Qnsk astlao; E J I AD aoeessibk ,..:;. .bintrg,awns,wad ootanettioms ofauppty and return ductwork located amide oondit ted apax,In stay boys or joist cavltWipscas used to ttantport slt.&half be sealed 1 nshsg aaasslo wad Sbmaaa bodkS tape Instaflod at cor&j to the meAufig wren's w"llagoe ( fl4OL Mae6 tape away be omitted wbpv grpa are less iban iB in& No tape is not perwitted. i J I 'tbe HVAC ryst=const provide a MM,far balancing air Brad+rater sysi W. - I Temperattae Coehwls: I l ! TbwmostabM required fsr eacb soptvaae HVAC systata. A mwueJ or automatic mans oo l pttrpally reatl ar sbvt o#ftbe hadiad"or coolb4 input tomb znc ar flow till be provided. I Hades ane CooUsy Fpulpatent SWOV. I. 1 J I ROW outyut capacity'of the bating/rmoling system is not greater dw M%of the design toad as E f8ad Section us � s'>sOCM 1310 gad J4,4, f I Clrcttlmft[lot water ( lasulate dreaS&tlo J I bot �in water �the leve Table 1, S � i Swimming Poole: I AN belled swbtnmint pools must have an on/off heater switch and require a cover unless over 20% of the heating a wa is*=won-dtpletnbte sources. Pool pumps require a time clock. Hades&atd C"Npbsq blediera: HVAC pipiatg 0onve*8}lulft above 120 Of or chilled fluids below SS If mm be lnrtlated to the ( levels in Table 2, i { , f , 1 , i 1 . { I I I i y L. I i JUL-22-04 12 :09 PM ROB BRAMHALL ARCHITECTS 978 749 9659 P. 06 y.:.::>' t7ri 1111884 t09:28 15782928232, SIfiI ENGINEER3NG PAf£ 5 TWO 1: A/Mbnm IMW"rkkk wfor CA►awal*t Her Wider Pis. JlatiQa-7bid Mj In lnclus k Plae Sixes fieatod Watrt Nan Cie+ew}t, a ftwtv Cir�ut��NlAin_ s and.AMtsts 1y0�1tQ 1" IA* 0.5 1.0 1.5 2.0 140.160 0.5 0.5 1.0 1.5 100.190 0.5 015 0.5 1.0 radre r I+milia 7i/akwu for RFAC Akvs l>�9�deu Tyeer Fluid Temp' bUbtion T165Mgg In jVW by fto%AK `` INE C F) K PJPMU I rand Lacs 1. "to2" 3. •to 4" Aagstj Symism Law Pressure/Twpetwo 201-250 1.0 1.3 1.5 2.0 Low Tempest= 120.200 0.3 1.0 1.0 I.S j St"M CmdMide(far hod WSW) MY 1.0 1.0 1.5 2.0 i Cow"9ylum i CEBIed Water,Ragannr, 40-55 0.5 0.5 0.75 1.0 Below 90 1.0 1.0 1.5 1.5 i i. NOUS TO MID (Bulking Dembow Use Only) I - c I I � i F I i I i e I i i _ - acleuaellb �. �/e �aminon�ueaC o�✓ BOARD OF + Res#ri REGULATION License ONS RUICTION LDING SUPERVISORS Num ' �. umber: C'S, 012411 � BUttidab' 05/1611958 { E�pim:MiS/2006 Tr.no: 26540 _ Gt*&' 00 1 _ _ - t � KENNETH M LAROSE' 53 PORTER RD ANDOVER, MA 01810 Gommiasioner 7k Board of Banding p egelstiew ami Sta,dirds HOME IMPROVEMENT CONTRACTOR Regisbaltl0ir. 126392 Eros: W25/2006 - Typo= Ptiwe Corporation ANDOVER EQUITY BUILDERS INC KEN LAROSE 53 PORTER RD GL�-.�' ✓ ANDOVER,MA 01810 Admisistrator Andover Equity Builders, Inc. Kenneth M. LaRose President Fifty-Three Porter Rd. Andover,Ma. 01810 Tel: 978-4704753 Fax: 978470-0258 August 20,2004 Andover Equity Builders submits the following: • To execute and manage the building of a new 3-stall garage, with attached link containing a new mud room and laundry room. Also includes a kitchen remodel,a new screen porch on the first level.with a second floor master bath and walk-in closet to your home on your property at 316 Johnson Street in North Andover,Ma. • The project is outlined to the plans drawn by Rob Bramhall Architects of Andover Ma., dated 7/09/04—Pricing Set;to include pages L100, A100-103, A201-202, A301-303,A401402, A501, A601,A701-702, S101-103 • Andover Equity Builders will perform these duties as discussed for the cost of all Materials and Labor plus a management fee of 18%. •. There will be periodic requisitions based upon the amount of construction activity, which will include copies of the actual current costs of all materials, labor, and management fees as well as an outline reflecting the current total costs to date,which will be due upon receipt. • The actual cost of construction can increase or decrease depending on the various types of finish choices that you will make during the course of construction. Signed: ' G Date_111�� Signed: / /0 r10RTH TOANM of L Andover No. e _ M. y h � o Lo Y LA E C�.OVer, Mass., A_ COCMICHEWICK 7�AORATE0 PPS` C7 `S BOARD OF HEALTH s Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...�i+. V A� �• 7400� �� .............�................................ ..�......... //Y....................... ............... Foundation ,3� �.. .�+ aN has permission to erect....0�.�it...,��8........ buildings on ... ..... ...... .... .......t..,,,,..........�......'............. Rough C R ra L� �./� Ips I�Mr/Y A4 to be occupied as...3...... ....... ... ......... �...........4�................ !` Chimney provided that the person accepting this permit sh311 in every respect' onform to he terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. Rr,0jA Cw% 0%+' 63" S VA#t0 ow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. /' /!V/�00 Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ' ELECTRICAL INSPECTOR Rough .......................................... .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. AS - f3UlL7 — , U_. fQ'a, Co2. � -- cv,C_ � 6 Bl.t��. oto � !"u , Z51,z6 S•`r"h�(.� t.(�r�) ZS•5' z3,o' — ,, Ir !JJCP-S-7� = Zsl, o3 p-E'�>c 33 5" 3�.�' ►� 11 ►► G�vT"�s:7T' sa, o F� T2 AZ 00-5' ►► Iu E'-�-BoX - Zso..$S ' �� �� ►� �� ovT"&- q-13Dx = ZS-0.38 1A'(0 PMF. BCH-SID P.VC, I A-E\% e WL. 72#L = 2So•3Z. 11 11 1% 11 „ 1, T2+�2 -25'0.37 st Teo- = 2 Ji`l,7q 4 ►► 11 n n n " Tw* " PMr- SCt+,Llo Rv,C, 1liV az Tlz4t1- = Z-To.o3 TR*2= 11!9.8 7 11z*3 ZJ�9.Jq T2+'J.(_ ?14 9. D Zs- Ac. a D B Exi ST' �5ACPW6 7(z Cly l ('itcP e'" J q.0,0.0�TyPJ �\Jj y I •uT .EX I ST. 15-,nn 6 A J,. SEPTIC TAi_�}< v L AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN KJORT R AMDOVER) M AS PREPARED FOR QARRENJ G, 06 DEU TIE• DATE : SEPT: 21, )9qS SCALE: 1"=20 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS: 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (5*) 475-3555, 373.5721 Pip:_ Date. . . . "� a.' 3317 �aORTh O?Of,,��'°„•'40 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUSE� N This certifies that . . . . . . . . . n has permission to perform . . . . L 3. / ,. l plumbing to the buildings of .5.f. . . . . . . . . . . . at. . . 1.��. �j�?L.z�Gs-tYi� . . T. : . . . . ., North Andover, Mass. Fee. . . . . .�.. .Lic. No.. .//O'Z. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer M"SACHUSE?TS UNIFORM iAPPUCATIOBI FOR PERMiT TO 00 PLUMBING tft of Typal 4Ncle,v - --.--, Mat ode„^ Permtt #t BtJOdMQ�.00stlOtt hn.r5o.•J � OWt90rs Name �e G'_� �� � -...Type d Ocapsw L°e a New p Aenolrstton D" Replacane d ❑ Pbm Stt w9 ted: Yes❑ No M— B.P.# SEWER# FMAES SEPTIC# a as w at = d xc a x = W y y i 3 M : a < N < u ~ s a = M d Y Sze 04 : 44 49 W (J W s �' �' r 3 o a 3 ,a a i[ J a ee o a f+ I- v < S 3 s a. _ a t" < x N W is x 0 iC d • w O O .</ al k ao a a O < ; aC Into d a+ O SUn—sour. saSL'ti1ENT IST FLOOR 2NO FLOOR h �• 1, 2ND FLOOR 4TH FLOOR STH FLOOR 4TH FLOOR • 7TH FLOOR 4TH FLOOR Ift"Ing Company Name_�f�{2i�t ('rLQ,�;fZ Check atwe: C4+tltlata ;� Address .96 S' "I0"barpmuon 7c_ p PPidnerShlp Buahesa Tdephone��,.� - _ ,,y 1 l ❑ ignWCo. Name of Lkensed Plumber INSURANCE COVERAGE: have a CUMeM Ilabtfty kaUrlma polcy ter b VANtU tats equMONd whkh meet:Ow rsquh herds of MGL Ch. 142. Yea cr NO 0 0 N YOU haw docked Aj, pleue lndksdo the type covor>tpa by ft sppMXJd• b= A Ilabtltty huvanca pdky D' Other QM d Indamnity ❑ Bond ❑ OWNER'S INSURANCE wAJVER: 1 stn aware OW the Ikwuve dos!eat Mve ttls Insurance coverage required by ChWcf 142 Of the Masi GanaM laws, and OW My aWatura an Oft psrnyt apptkX&M WOM this requirement Mede one: curs of0WrWOf L7»ew t Qww Q AQant 0 n«.or O&MV(ha as of the data u and lntormwdon I ham.uottNt m(w aft N ab"aa;N. He "trw and aoau,ta to ow bw of my t +.00• ina tlw a0 t)srrnak,0 Tort,nd h�aaatlons v.rton,,.a uMr t}fa pamtR tewud tar tltia appiloalton VAI tea In aornD+l,noe With ut vw*wn Dmrwont ct ft Maumnuxtu 5,ta PturnDinq Coda and C www 112 d fila Gwwal taws _ yorun:.�-cr skltclifs BELOW FOR OFFICE USE ONLY ►*ocRtss �► F EF NO. A"UC►TION FOS rE>tJMIT TO DO PLUMBING NAME a mE OF BUILDING LOCATION OF BUILDING PLUMIER ►ER1b11T CRANiED Date �s U.C. Insp. Roves Insp. FITW Insp. 4 271 �a�L Date.. ....... ..... yORTF� �� "'° '•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING L i �SSCHU This certifies that ............. ..........f. ... . ...... has permission to perform ........... ............................................. wiring in the building of �..P�7 c!.'. „�.. �? Jf Q� ....... . .......... . .............. ................. at.......� �.! ........5!......... ,North An eer Fee l�:..�.... Lic.No?�G��......... �. � ...... ' ?. .. �' ELECTRICAL NSPECTOR Check # THECOAMOAWEALTHOFMASg4CHUSENS Office Use only DEPARTMEATOFPUXJ'CS4FETY BOARD OFFPXPREVVVW0NREGU W0NS527CM12A0 [Permit No.ccupancy&Fees Checked APPLICA71ONFOR PERMIT TO PERFORMELEC'TRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICALCODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location(Street&Number) .� L 1S0 Owner or Tenant ,P,4 Owner's Address � LiJS0AJ Is this permit in conjunction with a (Check No building permit: Yes �,` � � Appropriate Box) V � Purpose of Building Utility Authorization No. .�2•/ t3J Existing Service (>U Amps /Z Volts Overhead Under ound �' No. of Meters l i New Service Amps / Volts OverheadUnder 'ound No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Belowrators KVA KVA round No.of Receptacle Outlets No.of Oil Burners Gene round No.of Emergency Lighting Battery Units No.of Switct%i Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and No.of Dishwashers Pumps Tons KW Initiating Devices Space Area Heating KW --� No.of Sounding Devices No.of Self Contained _ No.of Dryers Detection/Sounding Devices Heating Devices KW Local Municipal ^ Other --- � Vo.of Water Heaters KW No.of Connections ILJI No.of Signs Bailasis T. Hyp^Massage Tubs No.of Motors Total HP 14R 'C uameCoVMage Ptualartttotheregimema�s M d>z>s GertaalLaws veacuneltLiablkYbmm ePbkywixhTCDWr,WoritsmbsUtiaiegt&aht YES NO esu nia2dvalidptoofofmriotheOffim YES 3angttle LLJJ r7p E ouhaved�ec'lwYES,plmw nhc*thetypeofcoverdgeby URANCE� BOND O RIER SPecyy) EVkafimDak k to StartEst m*d Vain of artuca Wodc$ AunderTrftnakiescfpetjt k D*ReWeshDd Rough Fmal 4NAME LimmNo d R! P" Signatiue -- LicffwNo S /p r „ BusirmTel Nb. "R'SINSURANCEWAIVFR;IamawarethattheLicensedoesnothavetheinuuancewveta�oeorilssubstu�tial was ARTel No. reqLfu�atmysignatuteondmpmmapphatmwaivesttrisrsplm—:nt �M&WdMls ms's se check one) Owner ® Agent Telephone No. PERMIT FEE a rgna ure of Uwner Or Agent 401 ' W The Commonwealth of Massachusetts Rl( d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: cily EJI am a homeowner performing all work myself. Phone # I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Com )anv name: Address Ci : Phone#: Insurance Co. Policv# Com an name: A Address Ci : Phone#: Insurance Co. Poli # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the and/or one ears i imposition of criminal penalties of.a fine up to$1,500.00 Y mpnofthis t_as_r+cell_as_civil.penaftiesin.lhe-fmmnfa_STOP.WORK_ORDER,nd..a.fine_d.($1DOM)��y.a � 1 ,► understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. d Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town ..PermMcensing El Check a immediate response is required El Building Dept 0 Licensing Board Contact person: [j Selectman's Office Phone#. E] Health Department E] Other Date 3431 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHU T, is certifies that .T' �%a IFl3 tin A. . . . . . . . . . . . . . . . . . . has permission to perform . . . .pot'.L,c.rt . . . . . . . . . . . . . . . . . . . . . . . plus ibing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . ., North Andover, Mass. Fee?Ti" . . .Lic. No.//0 2 7. . . . . . . . . . . . . . . PLUMBING INSPECTOR 10/07/98 09;10 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Date 11,11f 19 66 Permit # �3 BuildingOwner's 4,M Sv'y'y t AT: Location ?ZZ -7,5,1 V Name UR 68:1-09<6 Type of Occupancy: New ❑ Renovation ❑ Replacement Plans ❑ FIXTURES Submitted: Yes ❑ No z z m Z a Y O Z z W W W Y J N ! V Q N L7 Q N Z N Q m Q ~ = O Z N d tr N <L Z Z J N N N Y Cc ~ V W N Y Q N d 3 X t) Z CC m N W >- Q F- N z o 1L Q W O m 4 W O W0 O W a N x Q W N cc J p O J W = Q Y O a -1 LL cc z Y te a 00 ~ Q Y Q W M Y W F t) y t- O Y a = N 1. Z O O N Z Z W 0 0 Y Q l' G Q = y N Q Q O Q J J Q tY C: W Q 0 Q l- 3 x J m N c c J LL, c� o Q 3 oc m o SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) / Check ,_,One: Certificate / Installing Company Name z.- // �� � `� �T�/ 0 , Addres; ..76•` 0l 4.,� Sr�_ ❑ Partnership 12%f el/ Firm/Company ZBusiness Telephone J2dP�-T Z2' ,,VFl Namq of Licen§ed Plumber or Gasfitter s 9&,- /, I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under 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. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Siputure of Owner/Agent -1 4 I have a current liability insurance policy to include completed operations coverage. By Si tur Licensed Plumber Title Type of Plumbing License City/Town Master ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number