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HomeMy WebLinkAboutMiscellaneous - 325 STEVENS STREET 4/30/2018It 11'033 I A This certifies that .............. ....................... I? .................................................... has permission to perform ........... ............................................. ...... ... ..... plumbing in the buildings of..... . .................................................. at ......... ... .. I Ir North Andover, Mass. .. Fee3P.. . ......... Lic. No�.!�T� .. ........................ ........................................................ PLUMBING INSPECTOR Date ... ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Check# MB' TI MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK F1� "'AAAiii CITY OF J/ -<-F -11 MA DATE PERMIT# I JOBSITE ADDRESS OWNER'S NAME_,_.°_ _ P OWNER ADDRESS TEL __FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL © RESIDENTIAL] PRINT CLEARLY NEW: F RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES ® N0Ar FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ,_... _f :_ _€ ._ -_ � _( ._ __._. ._,. -_) € J DEDICATED GREASE SYSTEM E € _._ I _ f ..._.._..� € J ---- ---- _..€ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM.._—j ..__J DISHWASHER DRINKING FOUNTAIN _I ( _--- ... 1 ._._._€ _( --__-__I _....,._ J FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) ! f _. i _.__. I _.___ KITCHEN SINK___ -- LAVATORY -- ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WtTERPIPING OTHER _ � ( f 1 ._._._..._.1 ) f I ._..�._f ....._..__( _._._€ J ,.—._-f M _ INSURANCE COVERAGE: Ell 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ]i NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY © BOND Q 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 Q AGENT �® SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to thpbest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit all Pe ' nt provision of the (Massachusetts State Plumbing Code and Chapter 1442 of the General Laws. t PLUMBER'S NAMEtC�> Of la. kl,7 _ ..1 L'iy iC� LICENSE # : _ SitNATURE MP El JP R CORPORATION []J #r- �PARTNERSHIPO# ; LLC D]ft E:= COMPANY NAME ; ADDRESS CITY 2 J STATE ZIP c7C� —II TEL _. 3 _1�–� --- � Ay FAX � p CELL �� 1 EMAIL , - 1 N1 ❑ W M Cd w Th e Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/ludividual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with employees (full and/or part-time).* 7. ❑ New construction 2. ❑ I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity. [No workers' comp. insurance required.] iii.."iwr,7 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 10 ❑Building addition Th e Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/ludividual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with employees (full and/or part-time).* 7. ❑ New construction 2. ❑ I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity. [No workers' comp. insurance required.] 9. EDemolition 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 10 ❑Building addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Electrical repairs or additions proprietors with no employees. 12. ❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. ❑ 13. ❑Roof repairs These sub -contractors have employees and have workers' comp. insirance.t 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 14. Other ❑ 152, §1(4), and we have no, employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. t 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 state whether or not, those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: 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 required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Official use only. Do not write in this area, to be completed by city or town official. 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 #: 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 defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint 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 subdivisions 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does 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 returned 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. Please 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 filled 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia T'I Date................................................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 4�A ..�evD *1 i,,j .............................. has permission for gas installation ... ............................... in the buildings of ....... 61 ..,"5-1 e- X— ............................................................................................ at ................ ............................................ . North Andover, Mass. 1� . ...... -�-:? Fee.*.. ....... Lic. No:3�-G ...... --- Cheek# � 6W 10551 GASINSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY,&i✓`e_ MA DATEy �fS PERMIT JOBSITE ADDRESSIOWNER'S NAME _ OWNER ADDRESS) S TEL_—_ FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL J1 CLEARLY NEW: E] RENOVATION: Ej REPLACEMENT: ® PLANS SUBMITTED: YES F---] NOM APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERrl BOOSTER CONVERSION BURNER®r— COOK STOVE DIRECTVENT HEATER DRYER FIREPLACE-- FRYOLATOR FURNACE —A - -- -- -_ —i GENERATOR GRILLE INFRARED HEATER1 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER I _ �— UNVENTED ROOM HEATER WATER HEATER OTHER_ — - -- - — '._........4....�..........-........... ...,-. `_ I - _ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYOTHER TYPE INDEMNITY © BOND E] 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit II ertinent provision of the Massachusetts State Plumbing Code and ihapter 142 of the General Laws. I PLUM BER-GASFITTER NAME n. _ Lv� 2✓�j lid LICENSE # S GNATUR MP 0 MGF] JP 4 JGF LPGI 0 CORPORATION Ej# PARTNERSHIP ©#= LLC E]#= - COMPANY —ADDRESS CITY STATE.?ZIPTEL M FAX CELL EMAIL AA Vl O z U r, z Z°❑ O N� W � ~ W OF a Z �* a F- 3 � a w w c a o a a a U J IL a � w x w F- LL O z z 0 H U a C�7 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA. 02114-2017 www.'mass.gov/dia Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHOi2T?- —, ;, I Name (Business/6iganization&dividual): Address: City/State/Gip: / / Are you an employer? Ch( the appropriate box: dry Phone #: 1.[] I am a employer with employees (full and/or Part-time)'* 2.jQ I am a sole proprietor or partnership and have no employees v✓orkingg forme in any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself (No workers' comp. insurance required.] t <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no e"mployees. 5.r] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. s have employee's and have workers' comp. insurance.t These sub-contractor 6.[] We are a corporaafiori and its, officers have exercised their right of exemption per MGL c. 152 §1(4), and'vre have no empldydes: [No workers' comp. insurance required] cell I - 7r, T — r � D Type oftproject (required): 7. ❑ NdVd6nstrd6Hon 8. (l Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.[] Electrical repairs or additions 12. [0 `Plumbing repairs' or additions 13•. [] Ro6f repairs 14.Other *Any applicant that checks boxoi must also fill out the section below showing their workers' compensation policy information: homeowners who submibthis affidavit indicating they aze doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those,entities have employees. If the sub contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andyob site information. Insurance Company Name: Expiration Date, Policy # or Self -ins. Lic. #: / � � S Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un r tl pains n iies-ofperjury that the information provided above is true and Date: Si ature: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Ji 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 defined as "...every person in the service of another under any contract of hlr'e, express or implied, oral or written." An employer is' defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver'orr trustee d 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•whd has' not produced -acceptable evidence of compliance with the insurance coverage rrequiired." Additionally, MGL chapter 152, §25C(1) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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=contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The afCdavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of IndustrialAccidents. 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 PIease 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. Please 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 "lob 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 Rama permits or licenses. A new affidavit must be filled 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 burn leaves etc.) said person is NOT requited to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia r _._ __ --h nlona All Perforations No 1909 .0 Date ...... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......................................... .............. ..... . - . er- has permission to perform ....... OV. -4 . . ............. wiring in the building of ............................. ;:: . ...... ... . ................. ,- �2 74— e�l at ........... �.z ........ ............. ............ . North Andover, Mass. :�� "fee ... . ...... Lic. Nolr,)j/g. ELECTRICAL INSPECTOR 10/06/99 16:04 35-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer a e (40mmonweal of MUSUc lcsets Separtmeot of Vublic $ofttU BOARD OF FIRIk PREVENTION REGULATIONS 527 CMR 12.'00 011ke Use Only e Permit No. J 4a—_ Occupancy A Fee Checked r, 3M peeve Wank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All worts to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 9/13/99 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersIgned applies for a permit to perform the electrt'cal work described below. Location (Street b Number) 195 RTRVFNS RTRFFT Owner or Tenant OLIVER & LINDA SCHNIEDERJANS Owner's Address (978) 685-6466 Is this permit In conjunction with at building permit: Yes ❑ No LO (Check AppropriaiS 130511) Purpose of Sulid rig ExlstinpfServIce , Amps _! Volts New Services Amps _J Volts Numttr of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of LIghting Outlets No. of Ughting Fixtures tato. of Recsptade Ou" No. of Switch Outlets No. of Range* r No. of Disposals 1 NO. W Olshwas1wrs No. of Dryers No. of Water Heater* No. Hydfo Massage JUm OTHER: No. of Not TWs Utility Author radon No. Overhead ❑ * UndSmd ❑ No. of Meters Overhead ❑ Undgmd ❑ No. of Meters Swimming Pool In- ❑ gmd. ❑ No. of ON Burners . No. el Gas Burners No. of Air Cond. 1bw ton* TOW No.of � Toms XW SoacelArea Headw KW Heathp owing KW No. of No. of KIN SWW Baum No. of Motors TOW HIS No. of Ttnsformers Generators . No. of Emergency t Battery Units lbw KVA KVA .,. FIRE ALARMS No. of Zones No. of Detection and 1NWWq Devices No. of SoundkV Devices No. of self Contained cg_11R198 F n Ong as-clig- pap OevlCa troeal ❑ cr.-.-.Xb.n ❑ O"W LOW Voltage VAft BURGLAR ALARM a► Z. INSURANCE COVERAGE: Pursuant to the tequksnwnts of Mawadumils genWW two 1 have a *went UablNty Insurance Policy NekWM9 Cornpleted Operations Coverage or Its substantial equivalent. YES G NO O 1 have submitted valid proal of soma to the Office. YES O NO O If you how oltecked YES. please Indicate the type of ooverage by Choddng the appropriate box. INSURANCE O BOND. O OTHER Q (Please Specify) (ExPkatio^ Date) Estimated Value of ENebkal Work S 124.00 Work to Start s9 / 10 /9. Inspection Date Requested: Rough Final 9/14/99 Signed under the Penalties of pe4ury: FIRM NAME 00!UC. No. , 9 Z,r..1 P Ucensee _ Del"Al A 1 _ Brankw +nature t.IC. No.. 12316— Address 111 14orsa Streat. Norwood, MA Ana �.INdoo. 7d1.400tt OWNER'S INSURANCE VYMVtR: 1 am aware that the License does not have No Insurance oowrage or N* wbsantiat equivalent a8 is' quked by Massachusetts General Laws. and that my signature, on this POMA applbaaon waives this requirement. Owner AOM (Please Chock one) 35.00 .» Telephone NO. PERMIT FEE i (S►onstur• or Owner at Agontl ..apes l / N- o Date..�.���. /. . 1 b�7 r l^ NORTot TOWN OF NORTH ANDOVER PERMIT FOR WIRING i • i ^ 3 �u����� This certifies that....................tt....,,......:�.................Y.,.�.�..:�.c?:. �.C:f ................. has permission to perform ......!F'�... �"'..�.�.�..: .............................. wiring in the building of ......1r...::.A.� ....�`D� 11 FS ......... �� ..... . �t�� ti. /.. , North Andover,,Mass. Fees C ... Lic. No..t.�............... ;rr��l�..�'�"!1.,..... LECTRICAL INS ECTOR CA 11 ( 3b � o5/27/99 11:33 275.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Depmtr xc ad Pallia S�dq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Aii work to be performed in accordance with the Massachusetts Electrfpi Code 527 CMR 12:0(0/ Q�} (Please Print in ink or type all infonnadon). Date l / / To the inspector of Wires: Town of North Andover The undersianed aoalies far a oermit to oerfonn the electrical work described below. Location Owner a Ownees is this permit in conjunction with a building permit Purpose of 3 02 No ❑ (Check Appropi ife Bok) Utility Authorbmtion No. E>Iting Service v Amps C% -JVoib Overhead Undgmd C3 No. of Meters New Service U Amps u ?' O Voits Overhead Undgmd ❑ NcL of Meters Number of Feeders and Ampacity AA Location and Nature of Proposed Electrical OTHER: INSURANCE. C VERAGE. Pursuant to the I have a cu bility Insurance Policy i ha valid proof of same to -the I SURANC = BOND = OTHER j( Estimated Valu of a c Work$ Work to Start — Signed under thy Penalues of perju FIRM NAME G. r jy c�� a �� daft of Massachusetts General Laws 6pleted Operations Coverage or its substantial equiva t Y — NO = = NO -=It you have checked YES please indicate coverage by checking the appropriate box ---r-- (Expiration Date) Inspection Date.Resquested- Rough 4)1&ra LIC. NO. NO. 151 Sus: Tel No. Address o, ty_ %12 �A (�� Arc Tel. No. OWNER'S INSURANCE W VER: i am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General taws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) r PERMIT FEES �V3 � � Total No. of Li Outlets No. of Hot fuse No. of Transformers KVA Above 17 In ❑ No. of Liqhtinq Fixtures Swimminq Pool qMd ❑ gmd p Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners SaftftMM Units NO of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total f%p. of Ranges No of Air Cond Tons initiating Devices 11 Heat Total Total No. of Diaosal No. Pumps Tons KIN No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Soace/Area Heaung KW Detection/Sounding Devices Q Municipal Q Other No. of Dryers Headnq Devices KW Local Connection No. Of No_ of. Low Voltage No. of Water Heaters KW Si s Balases Wirinq No. Hlom Message Tuds No. of Motors Total -HP OTHER: INSURANCE. C VERAGE. Pursuant to the I have a cu bility Insurance Policy i ha valid proof of same to -the I SURANC = BOND = OTHER j( Estimated Valu of a c Work$ Work to Start — Signed under thy Penalues of perju FIRM NAME G. r jy c�� a �� daft of Massachusetts General Laws 6pleted Operations Coverage or its substantial equiva t Y — NO = = NO -=It you have checked YES please indicate coverage by checking the appropriate box ---r-- (Expiration Date) Inspection Date.Resquested- Rough 4)1&ra LIC. NO. NO. 151 Sus: Tel No. Address o, ty_ %12 �A (�� Arc Tel. No. OWNER'S INSURANCE W VER: i am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General taws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) r PERMIT FEES �V3 � � t� F LIcation ✓ c�c� �¢ /j to 'Q �J Date 44�� I MORTh TOWN OF NORTH ANDOVER Certifi±fe of Occupancy $ Building/Frame Permit Fee $too d� -� cNust� " Fou�rdR $ AA Other Permit fee . $ �-- A{Q! 3`3 Sewer Connection Fe $ •,, 14 WatOMM&M"Fee $ /°$-Z'V TOTAL $ E m Buil ' g g i 08 - Eo 11000.00 Inspector„ Div u is Works Q a J � V 3 o o V I O U UOD � � W Z h � C O Z � 0 L1J = p m w W O 0 J m � m p 0 �w W W 0 �e rc *r < W N x ` A Qrcf O t 93 w J_ C O w W Z Im�g0 O N In Z 0 H X W IL !V Z 0 vP Z u ►- IL I� 0 Z O 0 J UI 0 r W < 0 N„ A r ;) k 0 a 0 O Z II N Ae l\ \ ,1 w w rc a W m m o z J ~ C 6 0 0 f, J Z W W LL i 0 W W w N ' < m w j E- 0 w W z I Y U x < ` ry a wZ Ix 0 JO F J N C < w d Z 4 0 O w W O 0 w W O I O 1O W K W~ ¢ Z 0 Ix M J W M F _Z m W J W III ¢Ix 0 < N J z 0 0 0 W W W u u u 4 z z Z O < ►< < w w w W K O O O < N e� v v W x z O ai J in 9 z t 4 Z 0 F u t YI J t W IL aL 4 0 O Ix t 0 m N Z 0 H u D m Lq Z OF 0 O 0 U O z J r+ i 81 C J � V 3 o o V I O U UOD Q r t= A. L1J Cy O f U W L. w Z O \O z 0 J m � m f Z W u < O W 0 �e rc *r < N x ` A Qrcf O t 93 w J_ C O w W Z 4 W m OW 3 J w L 3 0 0 ? ~~ < O H Z < K V W < J O z e W L a 60- Lla CL (?v rn V� o V ui am o VI O N � 1C O i v V n c ev � : _m c :oma Ea � m •+ N .l ^V i lVc a m c E N y n �'E m m o0 CL C.) o Q ym� L o cm ^i �-w' 0 c l54 c_ 0 CZ m m O� V y Z O c � o s � n = m : CL. A o E- Vj o m z w co c +- Evyi as E z E = 4- y o CO2 CL Z c �" o s n... in �qll y coy .9 co L GD CDV Q. CO) O O ACL CO) cc O CO) 0 V 0 CL CA C GD CM O �C D � Co CID m 0 co H = CD 3� D i La oa os Q tom•• C !O .O CD Z cs co C. CA C O 0 v w o w W � O ow v w w z C v oa c .fan E GW. m aX W roo "foo " v t4 wa C2 U w 00 ' Li wo' t�i w rL w co V) cn V� o V ui am o VI O N � 1C O i v V n c ev � : _m c :oma Ea � m •+ N .l ^V i lVc a m c E N y n �'E m m o0 CL C.) o Q ym� L o cm ^i �-w' 0 c l54 c_ 0 CZ m m O� V y Z O c � o s � n = m : CL. A o E- Vj o m z w co c +- Evyi as E z E = 4- y o CO2 CL Z c �" o s n... in �qll y coy .9 co L GD CDV Q. CO) O O ACL CO) cc O CO) 0 V 0 CL CA C GD CM O �C D � Co CID m 0 co H = CD 3� D i La oa os Q tom•• C !O .O CD Z cs co C. CA C MAScheck COMPLIANCE REPORT M�acsachusetts Energy Code MiOheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1., or 2 family, detached li HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 5-13-1998 DATE OF PLANS: 4/5/98 TITLE: 30' x 38' Cape with Two Car Under PROJECT INFORMATION: Lots 2 & 3 Stevens Street, North Andover, Ma 01845 COMPANY INFORMATION: Brookview Country Homes, Inc. Permit # Checked by/Date COMPLIANCE: PASSES Required UA = 516 Your Home = 506 Area or Insul Sheath Glazing/Door -0 ---------------------------------------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS 1465 30.0 0.0 52 WALLS: Wood Frame, 16" O.C. 1031 15.0 3.0 69 WALLS: Wood Frame, 16" O.C. 1150 15.0 3.0 77 GLAZING: Windows or Doors 374 0.490 183 DOORS 21 0.220 5 FLOORS: Over Unconditioned Space 1499 19.0 71 FLOORS: Over Outside Air 18 30.0 1 BSMT: 8.0' ht/6.0' bg/0.0' insul. 164 0.0 48 HVAC EFFICIENCY: Furnace, ------------------------------------------------------------------------------- 90.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must.be O provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ) All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ) Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ) Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids Obelow 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- S�`✓e f . FORM U — IAT REMME FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section******************* fipoo APPLICANT: pd"v f -0 J7 0^ e' S Phone LOCATION: Asse=sot's Map Number Parcel 36 Sucdivision Street S %eu?N S S Lots) 4z St. Nu:.jcer �z Use Only*******************xx*** RECO IONS /Of F,, TOWN GENTS: Date Approved Ad-_nistratcr Date Rejected --!� C0=en':s F coo; _nspeC- :iealth Co-..._....Sz Date Arnroved Date Rejec-ed Date Annroved Date Re-;ecte,4 Date Apprcved Date Reject== Wcr�:s - set•rer,'wa-er connections _ <-1 LtJ 4/'7-�5/`7ea - dr_ve:aay permit `�-�t e� -44- '2�* Fire 0ecart.:,ert paaIl 'Vr-� c,/"� --T�C`l�� �n�tl-3-0-iUVROC� �2 1— rz�or _'ia %V 10:vji W✓'--�- if/24ly Received by Building Inszector Date N® 1303 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19 ` 02 Application by the undersigned is hereby made to connect with the town sewer main in 5 Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. 1 G7 or subdivision lot no. r' �ll C Owner Contractor Address Addre s r �C Ap Ii nt's Signatu PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to r/ e Street to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of ubl' Works a By � Inspected by Date See back for rules and regulations �� f �Ile ¢lam o �2Ge riK /I k RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). N2 810 APPLICATION FOR WATER SERVICE CONNECTION D North Andover, Mass. te 19 Application by the undersigned is hereby made to connect with the town water main in �`'�� Street, subject to the rules and regulations of the Division of Public Works. sJ The premises are known as Nn_ �,5 Sf-e C -- or subdivision lot no. A2 Owner Address Contractor Addre Ap icant's Signa ure PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to�bCJ�7i 1z' � to make a connection with the water main at J�G'`'+�y Street subject to the rules and regulations of the Division of Public Works. i JoarcJfof Public Works By Inspected by Date See back for rules and regulations r RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be V type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug type cover. GEORGE PERNA DIRECTOR TOWN OF NORTH ANDOVER. MASSACHUSETTS DIVISiON OF PUBLIC WORKS 384 OSGOOD STREET, 01845 NOPTh O r O �} �SSACfHU5Et F DRIVEWAY PERMIT Date: 2�8 . � ? Telephone (508) 685-0950 Fax (508) 688-9573 LOCATION: 3 BUILDER: phone: OWNER: t),`ec�c) vv� dewne-5 phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: 4 "Ti 14 0Ctl: iic 0 OD 10 5• 3 �g S V/• J. uv _ •, ` � f 4' /+���� �'F e_ s+� '�' ' � .. g# k 1 } i '� F{ 1 �r ..;tii. A ,Y �'- a _ ' t t � 5�t+��%.�,',.�/. � t ?., i. tom. ;! 4 ti � � f 4.. t •J '� ; '34 * .Y. t. �,` rf � c� > sr;• � •3. 1=, r"'f �rt+tu # �'�:" . 6 t �r ^st �. z •r n. a. J:. 1 . ✓. a �"' r 4 ' >` T .:.. �]! 7k . '' I r k < :: 'i 4�'.' 4 �', " v, ',. s i,�a«r 4',t t � .i,} } +•:fit• q ..i '..a :�"t` 6: 7" ,rt. iu j, _?,I'..:. -. a�' t .,ti mer: ,..'}(t"', .,.a4` 9 `-•' '�,a .' 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F �k se 1 ,� r�' r It ,�.� J' w•.i .'ti ;i 1 Y a -. r t �,. :• t! - +r r, y dear S” x �.• i e i� I ✓lie w-mvwquvea1M o1 -Azdjac11t(JeCld DEPARTMENT Of PUBLIC SAFEIY CONSTRUCTION SUPERVISOR LICENSE Number Expires: Birthdate: CS .,. 805693 '01�13r1080 01113/1954 Res ttRted :To.i,{, 00 DAVIDA; ONDREO 30 MILL POND POBX 531 1 N HOOVER. MR 01845 156635 Restricted � Restricted To: 00 00 - 35,000 cf enclosed space (MG[ C.112 S.GBL) 1A - Masonry.only 1G - 1 6 1 Family Homes failure to possess a current edition of the Massachusetts State -Building Code is cause for revocation of this license. Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Na Address of Property for Permit (below) a of Applicant on Building Permit (below) _a���e� 25� 57-eve,/5 S% Map and Parcel: Purpose of Application (check below) Ph,p�pum��p9JApplic t: x Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit iq issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c.,are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. �This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate ' ation, or the c eckiM off of an above item which does not comply, whether done to my knowled a or n t, is -grounds fo refusal by the uilding Department to issue a Building Permi Sigwafure of Owner or Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. z O LU LU 4-1 Q Z CZ Ln LLC<t c� Z M ❑.. 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I d' 44 I .a I , I a , l I I I I �z I ►• 441 I LJ J , �► 1 .a I I •� CD3 I 1 I Q• rn 11 I 44 • L---- �� -- — — — — ------«���---- J ,D «i£ — — — — — — — — — — — — — — — — — — — IJ L- — — — — — — — — — — — — — 9I Q O X N a h- LLJ _oz^ w (, o S CLC) UcwCc) 't z i 3 6i -1 Lii W Awa zoo-cno � � g a � p � ju- mo h aw j;'>W-1 ru :j a2o-wx �aJa ZI-;ja anz� dpmw� �g0 U�- u� x �� up�0.d—di o�°o 0 oLzoCi, W -w . < 4 . . < . �. �oWa a X� g W sLox jo Lam`" ���� �IIIII Iilll illlll IIIII . t- CCI �a ........... a0 .� • n0 �� nOL n0—,8 0 J CERTIFICATE OF USE & OCCUPANCY Town f North Andover Building Permit Number/ Date 9' 91 THIS CERTIFIES THAT THE BUILDING LOCATED ON dmf o? ��aS� (S MAY BE OCCUPIED AS (S//VA°%e Fm111Z C7IS/97// 11"V41t2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO /^oo /�l1 / cv tr c AS/ 174/,) S ADDRESS ?0 30 x,3/ ,o. X vda&e z A4, ►q b"^n .N",�i '$^`""' Building Inspector rYF w (tz� O z ri cc S71 G+� Cn z O F� P-� CO z O z O U g M NMI V) 1 Oil L _O V z CL O. © CoF) CD Om O co CD E mm CL CL fi Ca c a C ccC CO CD CA c ca 0 C O .4 W C^ a C)w z ® u L \ W 2 V) w V)w° 0 cz v ..T.tl G c� CALF" OO0 co U w ,..� `7., \ M1 "� (� U W r� V .L• W Q v Z v P2 r} aG wo cn cn Cn z O F� P-� CO z O z O U g M NMI V) 1 Oil L _O V z CL O. © CoF) CD Om O co CD E mm CL CL fi Ca c a C ccC CO CD CA c ca 0 C O .4 C C i VO Ca •dam ' ac Cc CD c :s o Cc o CD y � Ea V o m o a y c o �v cm ® C a:. E m o y� tm ® 9 y C m ,may La aw C O L ®off .O m N O Z R ® C w C O Q9 C ti ® y m C •® Q : .2 N f" toJ ®o m s •yLU O � •CL' C as O v+ O •y O CD CIO CA O f- s S aim Cn z O F� P-� CO z O z O U g M NMI V) 1 Oil L _O V z CL O. © CoF) CD Om O co CD E mm CL CL fi Ca c a C ccC CO CD CA c ca 0 3174 Date . 5 ............... . � NORTM - TOWN OF NORTH ANDOVER n 'PERMIT FOR GAS INSTALLATION This certifies that . . c ..:... E... '. C `• ...... • • • has permission for gas installation ... �! e ` . �G `1 in the buildings of ..1s 4 L c /-r v : r at . ...... ..................... . , North .Andover, Mass. Fee. Z�5W1714#..03 _o.. 70.00 PAID GAS INSPECTOR r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I/ MASSACHUSE I TTS UNIFORM APPLICATION FOR. To DO GIASFUTTING (Print or Type) ass. Dat - NORTH ANDOVER I N", 9 bLjilding Location Permit t ovir, .,ets New-` Renovattoo- 7-1 '-Jubrnitted j N e (Print or Type) one: Cert TiCa e Installing Company Mar -,ie Corp. Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or i-77iL'or k -IC -3-C> Insurance Coveraq —et ire of i�,suranc- coverace by checking the appropriate boy: Liability insurance policy Czi-ier- type of indemnity blond Insurance Waiver: 1, the unc-'er-sicnec,, have been ii-,ade aware that the licensee of this application does not have anv one o� the above three insurance coverag S. Signature of owner/agent, of proper-ty i Owner C—i Agent I hereby c,:rtiry tilt all ar the d-cuile and infortnitzi,3ri I terve w1hrrit"ci (or catered) in .17,lw.- xorflcAtian are true Ind #xClitInte to the. b"t of tett'',.; owicdgr vid it"t tU plumbing -arl; and LntrA112tioml -'rTformd U"err f'tr-,.it ;z:.%,cd Cor snvi;c---1:4on v;If b -c In complirnr* -Tith a3- pertLacu yrovixiafts or tile SIM,- Cst Cade snd Currtcr 141. c:C u-. i;,cntr7J LA -r, By r U P 3 Signature of Lioens-er as er A .4- 4- e ' Plt=nber or Gasfitter C4 - t 0 urneyman A 0 1"R 0 VIE D (OFFICE USE ONLY) L1. n s LU lu ju 07 al w(j cc Ul C9 ul U.9 CI Jca0 UI 0 C 5 1-- ul > C: w to0 (:3 > US I = C3 0 0 w G M I -C < G 0 0 w Q 0 t tj Q M C) RASEMEDIT 1ST. FLOOR .2ND FLOOR aRn FLOOR I 4TRFLOOR STRFLOOq GTH FLOOR 'T'r I . (FLOOR TT F"71 ELTR FLcon. (Print or Type) one: Cert TiCa e Installing Company Mar -,ie Corp. Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or i-77iL'or k -IC -3-C> Insurance Coveraq —et ire of i�,suranc- coverace by checking the appropriate boy: Liability insurance policy Czi-ier- type of indemnity blond Insurance Waiver: 1, the unc-'er-sicnec,, have been ii-,ade aware that the licensee of this application does not have anv one o� the above three insurance coverag S. Signature of owner/agent, of proper-ty i Owner C—i Agent I hereby c,:rtiry tilt all ar the d-cuile and infortnitzi,3ri I terve w1hrrit"ci (or catered) in .17,lw.- xorflcAtian are true Ind #xClitInte to the. b"t of tett'',.; owicdgr vid it"t tU plumbing -arl; and LntrA112tioml -'rTformd U"err f'tr-,.it ;z:.%,cd Cor snvi;c---1:4on v;If b -c In complirnr* -Tith a3- pertLacu yrovixiafts or tile SIM,- Cst Cade snd Currtcr 141. c:C u-. i;,cntr7J LA -r, By r U P 3 Signature of Lioens-er as er A .4- 4- e ' Plt=nber or Gasfitter C4 - t 0 urneyman A 0 1"R 0 VIE D (OFFICE USE ONLY) L1. n s Date.3... C7- 4427 r il 0.1f ,NRTPI ORT1� h ? TOWN OF NORTH AND o PERMIT FOR PLUMBING cm� �`� This certifies that .. a . t ..��. h? .S. �.. � r �'...... , . . has permission to perform ............ plumbing in the buildings of r< v ! ° ................ AL at . �.5�..5� 57 -.<�.� ............. L ... , North Andover, Mass. Fee .d. .70.. Lic. No..,F..� o z- ..... PLUMBING INSPECTOR 05/17/99 14:03 230.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer oZ 3e, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mal sS. City, TowrtaJ/ Building �'' AT: Location AR 7 �' \ e.t*m Date _..- 1.9 9?—'..... Perm t N 02 % Owner ) Nam`V e ' ��� L•ei TyI1e of Occup aucy : New Renovation ❑ RCIA.acetuent ❑ Plans FIXTURES SkIbut i t_Led : YeS ❑ No El (frim or Type) Check One: Certificate Installing Comp:any Nantc S—d•�����—�-�C3E�i�\�--- — ❑ Corp. -- ------------ Address _e 1i(�,�' f_ ❑ Partnership �_1__�P'cs ifl' Firm/Company Business 'I elepholle - — Nat to of Licensed Plt tuber or Gasfit 18717 1 hereby certify that all of the details and information I have submilted (or entered) in above application are true and accurate to the best 111 my 1,11owkilge and that all plumbing Work and installations pclfortncd under Permit issued for this application will be in compliance whh all pertineot plovisious of the hiassaehusets suue Gas Code and Chapter 142 of the 6eucrnl I aws. have inlonned the owner or his agent ilial I do not have liability insurance including completed operations cerclage. Siµuntwc I have a current liability insurance policy to include completed operations cordage. ❑ By e ture of Licensed I'hunbcr Title ' - �j� 4 .� I Ype of I'llimb' tg License City/Town — –X,�_ Master ❑ .luurncynuut APPROVED (OFFICE USE ONLY) License Number Fonts 1240 1ionnS a WAIMEN. INc. 1989 x X v) Z k a to N N O Z> ]e W N W N Z V! d a d ~ O Cs z W 0e g rC o O W ♦• N W Z N a i ~ U W N N- Y 'L N p x a - a Z d 1-- K u tz m N a ,. d F a W z_ q x q O Ix W= W F 1=.. W 3 d ac N o x 3 J N cc CC 1- J d Y 4 K w d n„ cc 1' d V y x 1.- o x er z to 1' Y x a o p C, a x z d w 1- LL o k w x 3 W Q d O d J . a cc tr a a o a r Y J m N A A J x ♦• N Y. O a A d 3 4: m I O SUB- BSMT. _ _ BASEMENT 1ST FLOOR l 1 2ND FLOOR a 3RDFLOOR e ATH FLOOR STH FLOOR 6714 FLOOR TT11 FLOOR 8Tit FLOOR (frim or Type) Check One: Certificate Installing Comp:any Nantc S—d•�����—�-�C3E�i�\�--- — ❑ Corp. -- ------------ Address _e 1i(�,�' f_ ❑ Partnership �_1__�P'cs ifl' Firm/Company Business 'I elepholle - — Nat to of Licensed Plt tuber or Gasfit 18717 1 hereby certify that all of the details and information I have submilted (or entered) in above application are true and accurate to the best 111 my 1,11owkilge and that all plumbing Work and installations pclfortncd under Permit issued for this application will be in compliance whh all pertineot plovisious of the hiassaehusets suue Gas Code and Chapter 142 of the 6eucrnl I aws. have inlonned the owner or his agent ilial I do not have liability insurance including completed operations cerclage. Siµuntwc I have a current liability insurance policy to include completed operations cordage. ❑ By e ture of Licensed I'hunbcr Title ' - �j� 4 .� I Ype of I'llimb' tg License City/Town — –X,�_ Master ❑ .luurncynuut APPROVED (OFFICE USE ONLY) License Number Fonts 1240 1ionnS a WAIMEN. INc. 1989