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HomeMy WebLinkAboutMiscellaneous - 34 CHARLOTTE WAY 4/30/2018i K� I DateAA f.'�."�.. . TOWN OF NORTH. ANDOVER PERMIT FOR GAS INSTALLATION This certifies that...........e.v G' Jt. ...... ..... has permission for gas installation .... --> 'i-- ........................ in the buildings ......... ^-.!..1ti............................................................................ at 3........CA(Ae- (t ............. North Andover, Mass. Fee:36.�. 6 ...... Lic. No..A.a. ... .. .Ir .................................................... GASINSPECTOR Check # Z 01PL-) 9050 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATES.. _ . ........ PERMIT # U JOBSITE.ADDRESSOWNERS NAME OWNER ADDRESSTE ' JFAX=.� TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY _ NEW: � RENOVATION. El REPLACEMENT: �,_,l` PLANS SUBMITTED: YES NO,,„A� APPLIANCES I FLOORS— BSM 1 2. 3 4 5 8 7 8 9 15 1 11 12 13 14 � BOILER-ra-•.. BOOSTER {-` - --- CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I DRYER €'-i I .. _.._ . � P- - J FIREPLACE FRYOLATOF2 FURNACE ... . GENERATOR _ ......_ GRILLE . INFRARED HEATER.... `;�-�- LABORATORY COCKS f MAKEUP AIR UNIT r 1 OVEN �� ...........__ POOL HEATER �- ROOM / SPACE HEATER ROOF TOP UNIT TEST � UNIT HEATER UNVENTED ROOM HEATER VNJER HEATER --- - OTHER. - - 1 } , INSURANCE COVERAGE iiabili insurance its MGL. Ch. 142 YES O I have a current policy or substantial equivalent which meets the requirements of �* I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURAlICE POLICY_,, OTHER TYPE INDEMNITY BOND , 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. � AGENT' � S SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are trud accurate to the bes m nowle and that all plumbing work and installations performed under the permit issued. for this application uy'll be in coal mice with all, hen rovi ' n of ffae i Massachusetts State Plumbing r' Code and Chapter 1442 of the General Laws. eL PLUMBER-GASP{ITER NAME..... _ .....: -� -- t`LICENSE# SIE MP FIX MGF D JP )GF PGCORPORATION . .J.._. � COMPANY NAMC�da'tfc5 ADDRESS�if..,`. CITY . _.? . C3 9, -..._ ...,,. 9 STATE ZIP�4.. TEL FAX`/� CELL, r-�_���r EMAIL? N. �1 ,4 Y • r� cn. t7 c°z r� s n ra, m Co. CA Gn r� e .. El I � x A y The Commonwealth ofMassachusetts Print Form r - s Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information Please Print Leeibly Name (Business/Organization/Individual): �� 1Df�l pmj L�S N l., Address: i ip Cf�:Vcj7- C -T) City/State/Zia:—WHATV U fn ft 00-035 Phone #: -508 << V Aree u an employer? Check the appropriate box: Type of project (required): 1. IBJ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction employees (full and/or part-time).* 2. El I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. [J Remodeling ship and have no employees These sub -contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: 5. E] We are a corporation and its to al repairs or additions 10.Mumbing required.] 3. El am a homeowner doing all work officers have exercised their 11. repairs or additions myself. [No workers' comp. right of exemption per MGL. 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they 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 -contactors 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 Name- J Policy # or Self -ins. Lie. #:-I Ca 65 "D -Cl I a 0 11 —Expiration Expiration Date::1 'n) ci-" 3 Job Site Address: �!fi G �P lki t� I 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebtcertifv under Ike pains and penalties of perjury that the information provided above is true and correct. Phone #: `7 01� —\� 4 8_ — t L Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone _ f r �r' FiR�-K ,•sn<�N '*. .1. ti3, G(rp� yT•'.� i T... _- - P ICfMBER ° AND GAS HSS ED AS k JOURKrzYMKAM P. LICEPISc 10. 1=r' ` tai LESAt®$: IA OZIWW�jiV� �s:.•�.` $GS eta '. .�+ ,L� M-0, 1 per PLU G P, AND CASE -' ljcENSED ASl CMR PLUMS lbw ISSUES M F �BOlit UCEM MCia: ��; ;o _ - ^R►C V sAg ,�57: �Ga7d+Ce9� � , - - - _ ;.y.' � _ . 3. i may.: ..--�:•_.S . _. R-+ia=_":. s �.; - --- = - y'ADN MA 0271 5 691QiAl�t z- X0549 04 1 -a J.l Lilm DATE: ) c)- - T q — "3 LOCATION: v� Ji (,�H-� >z 1—C)` 1-�Q *W f� -\ OWNERS NAME: ��kT[4 GENERATOR kw-. ) 1+ NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR:'� � ev()S PHONE NUMBER: 5 H V ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: Io I Flao-m �E— *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL f' on CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 12 Date: November 17, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 34 Charlotte Way MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement Community 575 Osgood Street North Andover Ma 01845 Building Inspector • nr' H 'v C d d CO3 Cl) 10 O CD n Z y CSD O 'C 0 FS _ � O Q =. CO) to00CD CDCL O Q ? %C d CD CD o CD C CD y CD n0 y I r co CD a v y O 'O Z CD O CD G CD I C c? -o ori = O -• to O Q W _coca ti CA mL3aO O Z ?-o h .►m o T Er m .gym y m CO Go o IE Ir 0' o a O Z �•CO9 p O 0 : O m co o C COL m t O H W. � :� N O. d C O __ C CL m C � m V! H mIt fG Cmi � m o cl D 0 lox 0 co =CO) d a m Im0 o ^; 1 C O Crt (F1 A 7J c Irl 0 w A bi O c '�1 O m c c r� b .� n r" r.r n GO x n .?l co W M O O C DSA Dewing & Schmid Architects November 16, 2009 30 Monument square Property Address: #34 Charlotte Way Suite 200B Concord, MA 01742 Edgewood Retirement Community Tel 978,371,7500 North Andover, i'NIA 01845 Fax 978.371.3388 Subject: 1~inal Construction Control Affidavit 280 EIm Street South Dartmouth, MA 02718 Tel 508.999.0410 Fax 508,999.7709 In accordance with Section 116.0 of the Massachusetts State Building Code, I Allen Dewing:Jr., TNL, Registration #4301, being a registered professional inww.dsarch.corn engineer/architect certify that I and/or a representative of Delving & Schmid architects, Inc:_was present on the construction site on a regular basis an(] obserx ed that work was completed.in accordance with our Construction Documents and the State of Massachusetts Building Code and the requirements of the Town of North Andover and its officials for the construction of the dwelling referenced above. the ca 5tnxctcori. site on `a r#iasii the dcacum�nts atoned fore ba' specified m �ecuo3f L: Review for conformance to t1i snEsmiitaIs, which Me s -a inittF �priate t quality- er cons irecl ,materials:. ne gerietall}= ie a1, that the:.ivoik nts: _ APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # l ADDRESS/LOCATION OF PROPERTY ��'q 01 I Map Parcel Lot Number C SUBDIVISION _ EES Pi'iv! nt,P94/&JA,,, ._-�� / DATE REQUESTED FILED/READY FOR INSPECTIONJJ�-aj 09, CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE. CHARGED IF THF STRI icT1 Or - DOES NOT MEET ALL APPLICABLE CODES. D f EIIIIIL Issued tai. Address SIGNED ROUTING CONSERVATION (IIZI PLANNING DPW - WATER METER F71 /al -Z''1 6r SEWER/WATER CONNECTION [Z] NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST , DPW Signature File: Application for OC form revised Jan 2007 inI D -VD y NORT�y o � A �,SSACee MUSfc� Date.... .'. n "q.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that......:.............................................................:.:�`.'"............. has permission to perform ..._............................................. wiring in the building of . �...% .....................:.. r4�� .,%- ... �- �"- ......... ........ ............... ........... North Andover, .Mass. pp � 'i Fee ... fjyl..r%. Lic. Noh.4. ............... _ LECTRICALINSPECTOR Check # 8960 •za. 411111\, Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS official Use Only O C Permit No. / 6o Occupancy and Fee Checked"' [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrica4,lor'of EC 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:1 i City or Town of: A) i A A) i�Y E K To the Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) A rte jib LJf`iy Owner or Tenant 1EZQEW(3.0 3J Telephone No. Owner's Address®© S1. Is this permit in conjunction with a building permit? Yes Sr No ❑ (Check Appror��jj'ate Box_ )_ Purpose of Building –N?9ELL) � Utility Authorization No.�5 I & —_-- Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service ,oO Amps Lu /Z O Volts Overhead ❑ Undgrd No. of Meters �_ Number of Feeders and Ampacity Jpo A M Q Location and Nature of Proposed Electrical Work: LA) S 10 Ci! fE 15AMI L�1rb6AL2.W& Com letion the fnllnwinQ table nrav be waived by the Inspector of Wires. No. of Recessed Luminaires - -g No. of Ceil.-Susp. (Paddle) Fans J No. of Total Transformers ., KVA No. of Luminaire Outo No. of Hot Tubs Generators KVA No. of Luminaires Above ❑ In- ❑ Swimming Pool 2-- .4 Qrnd. o. o mergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners � Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Tons_ KW No. of Self -Contained No. of Waste Disposers Totals: J.Number " ........... .... Detection/Alertin Devices No, of Dishwashers Space/Area Heating KW Municipal Local Connection ❑Other No. of Dryers 1 Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW N-0.0 No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring, No. Hydromassage Bathtubs No. of Motors Total HP I No. of Devices or E uivalent OTHER: Attach additional detah q aesirea, or as requtreu uy u,c —y -- Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjun,, that the information on this application is true and complete. FIRM NAME: Interstate Electrical Servi , s ,orporat ', LIC. N .:A-521 7 Licensee: Pasquale A. Alibrandi Signature ' 1 (If applicabl titer 'ex i t" in the license number line,) F Bus, Tel. No.:9 7 8 - 6 6 7 - 5 2 0 0 address: 41� Tre'gie Cove Rd., N. Billerica, MA 01862 Alt. Tel. No.: *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 I PERMIT FEE: --� Signature Telephone No. c i I Date./ .0. q.... TOWN OF NORTH ANDOVER-," 0 PERMIT FOR GAS INSTALLATION �,SSACNUSEtt This certifies thatpx� .................. has permission for gas installation j.� c%,J. el ....... in the buildings of .4- ...................... at North Andover, Mass. 10 Fee.. 00.. —Lic. No.,. I��' INSPECTOR CheckCheck 5, 6991' I YA3SACHUSEi'TS a a F 9 Y z 0� oa11 0 o 10119.a Ag IL all=agoda acs ->>30 Now of Lk=md PhM69dGn FMC iIWU—A COVERALM rYltich n ,q the of MOL -CIL la Yes o No p I have a dmmm i o11 par ft � you ilaveldfedo®d YsA ple i�w�d �!►�edUN bm bdm A 8abMLy Invomance pill ❑ Cow type of indannft ❑ Bond ❑ oyMOMIGURAMZWANM t moommodW20�oat�ee �ffis nos ooze t 67► ul of e ftnoW Lm^madudnnrsignaaeeonftsnm- Check One Only Owner ❑ Agent 0 By his twlc C� t b Ue�lat�a erana®�s� w,o..u�+....o..a...o....._.-------- ----- - 11, wA ba in or Up bW*ofmy-rd I M a ana + air tars. � alt PSR prorotsiott of�eN�daa Sts�a Pitmbire Coes aM tapbs 41s afore Genmat tars. pSaflioE BY ra.tda ❑ t 1nm of m od0fis FWm _-,-- ttaa ❑ LP VAUSK tNdFOW APPL rATM FOR PEROT TO DO GAS RUM . 1. f6w IDa3 /oE_ Penni Ownw8Nttme: Type of OocUpMWCatnMeN ❑ 6 0 6 &MbW ❑ MWm*nvg ❑ R New: Mi Atom ❑ ftwm on: ❑ ❑ Plans : Yes 0 No 0 a a F 9 Y z 0� oa11 0 o 10119.a Ag IL all=agoda acs ->>30 Now of Lk=md PhM69dGn FMC iIWU—A COVERALM rYltich n ,q the of MOL -CIL la Yes o No p I have a dmmm i o11 par ft � you ilaveldfedo®d YsA ple i�w�d �!►�edUN bm bdm A 8abMLy Invomance pill ❑ Cow type of indannft ❑ Bond ❑ oyMOMIGURAMZWANM t moommodW20�oat�ee �ffis nos ooze t 67► ul of e ftnoW Lm^madudnnrsignaaeeonftsnm- Check One Only Owner ❑ Agent 0 By his twlc C� t b Ue�lat�a erana®�s� w,o..u�+....o..a...o....._.-------- ----- - 11, wA ba in or Up bW*ofmy-rd I M a ana + air tars. � alt PSR prorotsiott of�eN�daa Sts�a Pitmbire Coes aM tapbs 41s afore Genmat tars. pSaflioE BY ra.tda ❑ t 1nm of m od0fis FWm _-,-- ttaa ❑ LP VAUSK Date. TOWN OF NORTH ANDOVER C PE,4MIT FOR PLUMBING This certifies that . . . 'k- ......*-C-ta. ' ... has permission to perform,,,-.'. plumbing in thebljdings of ... at....... 4-)4/ Fee. Lic. No/ ...... Check # 8174 . . . . . . . . . . . . ... . . . . .............. .......... ........ ... .,.North Andover, Mass. P L U. 4B144/G. INSPECTOR ......... MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: A16 r v42.- W,,07Jie t,, MA. Date: 0 10 p Pennit# 1 Building Location: Owners Name: 0 / Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: [Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑