HomeMy WebLinkAboutMiscellaneous - 347 HILLSIDE ROAD 4/30/2018 (2)Date .... n7......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... a........ r G.-.: ...... ...................................
has permission to perform ... ::..a�
wiring in the building of............°:Q..,-...........................................
at :% .`.�7.'. �.....:�!�..... iv: R ............... . North Andover, Mass.
Fee ............. Lic. No9Z/ '� ;' Z� �. .
.j�..................
ELECTRICAL INSPECTOR
Check # r--i0-�,� V
7220
ti
Commonwealth of Massachusetts Official Use Only
�� a dit No.
Department of Fire Services Perm
�
BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy and Fee Checked 3 �
Rev. 1/07] 1pi Ileave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: li% a6o
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice ofhis or her intentign to perform the electrical work described below.
Location (Street & Number) S C/
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Telephone No. ct-7 � _ 60 Y-
C> /6
Yes pJ No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
Ir -
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑o.
rnd. grnd.
of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of neterfu and
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Totals:
Number
I
Tons
KW
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
No. of Water
Heaters KW
Heating Appliances KW
No. of No. of
Signs Ballasts
Security Systems:*
Data Wiring: No. of Devices or Equivalent
No. of Dvices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail ij desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: Jq00 (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 V BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: -Ro Signature LIC. NO.: &:;;z -
(If
applicable, ente "ern t- in the /ice se num erline.) Bus. Tel. No. 'Sb8-'Y5'6-92 /3
Address: Alt. Tel. No.: Sim yAI-/ sr t 9
*Per M.G1 c. 1471 s. 57-61, security wor req'res Department of Fuglic Safety "S" License. Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
_kation 1 ✓--� -
w
o. S"v fi Date z"
r
w°RTh TOWN OF NORTH ANDOVER
ol,...0 :•14,
Certificate of Occupancy $
s' cMu s <� Building/Frame Permit Fee $
�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
,� L' J i / Building Inspe85
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
ADD7 i!'�AT[AAiTA !'Y1TUC'TDiT/'�r' DIIDAiD DIIATAVATII AD TC1lAr r
B1 DING PERMIT NUMBER:
DATE ISSUED:
Teo) S
r.
/ O
SIGNATURE:
Building Comn-dssioR2ELnEL=tor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
b.2 Assessors Map and Parcel Number:
aq
Map Number
Parcel Number
1.3 Zoning Information:
1.4. Property Dimensions:
Zoning District Proposed Use
Lot Area Fla
ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
red ;, Provided
:
'red
Provided
3 (D
�t�
'0
+ ,
1.7 water supply N.GLC.40. 34)
1.3. Flood Zone Infouns ian:
1.8 Sewerage Disposal System:
Public ❑ private ❑ Zone
Outside Flood Zone ❑
Municipal 0
On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSIOP/AUTHORIZED AGENT
2.1 Owner ofRecordRecord n J
411 YV1tS� `f` /`1 I C U f
3q/
Name (Print)
Address for Service:
1-7'97975--/o7--7
Si re
Telephone
2.2 Uwner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Constructio Supervisor. Not Applicable 0
r
Licensed Construction Supervisor:
t License Number
Aj.dress
IMU 3
Expiration Da e
3.2 Registered Home Improvement Contractor Not Applicable 0
Company Name 3
Registration Number
Address `l
--I/
y — / Expiration ate
Si nat6re �` /
Telephone
V
M
M
Z
0
Crr
Q
0�
SECTION 4 - WORKERS COMPENSATION (M.,G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building unit.
Signed affidavit Attached Yes ....... No ....... 0
SECTION 5 Description of Proposed Work check all a licable
New Construction ❑
Existing Building ❑
Repair (s)
❑
Alterations(s) ❑
Addition JV -
Accessory Bldg. ❑
Demolition 0
Other
❑ Specify
Brief Description of Pro�ppoosed Work-�
tJ �(�T
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
(a) Building Permit Fee
Multiplier
ler
S.v
1. Building
2 Electrical
d Gud
(b) Estimated Total Cost of
Construction
�� �% •'��
3 Plumbing p 000
Building Permit fee (a) x (b)
4 Mechanical(HVAC)„�
5 Fire Protection
6 Total 1+2+3+4+5 e71, OU0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, A7h A. -O 4c c j rA , as Owner/Authorized Agent of subject property
Hereby authorizeto act on
My behal a tters relative to work authorized by this/building permit application.
[Slign-a Owner Date '
SECTI-ONN 7b OWNER//AUTHORIZED AGENT DECLARATION
-
1, _ � - - m -- 3 6 eAll as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief J
Print Name
Signature of Owner/A Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 NU 3
SPAN
DIlv1ENSIONS 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 - e�A a �.
U LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all nec
essary 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.
q ments.
*****************************APPLICANT FILLS OUT THIS SECTION
APPLICANT
Q%�►-er-
11'F1� 1
N'h@N YPHONE
�C�li` 1� � r J
LOCATION: Assessor's Map Number s q /
PARCEL
SUBDIVISION— 0
1� LOT (S) �_ �^�`►+�
STREET 3-1 y� S/r/�{ L�R �� Q ST. NUMBER 347
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
INSPECTOR -HEALTH
SEPTIC
TH
Le P ° - k- `-(.+�A
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
AA') .
Pk) 59PT-1 c A,u p w664_
PUBLIC WORKS - SEWER/WATER CONNFCTtntuc
DRIVEWAY
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9197 jm
DATE
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 42111
Workers' Compensation Insurance Affidavit
- Please Print
Name: fir',-� Un2���..� �G..-,�a /r`�✓�1
Location:
=ama
M
pefrorming all work myself.
Df am a sole proprietor and have no one working in any capacity
L -t am an employer providing workers' co
Company name•I - r� I C2 h0"'
Address
);:>-3-c/ y 1,
for my employees working on this job.
City:s ✓Yl
r�tsuranceCo �5�,lI/yh��,rLu� ct Porc., I> C(,,00AW, 5m
Com ame:
Address
City: Phone #
Failure to secure coverage as required under Section 25A or MCL 152 can lead to the irnposition of criminal penalties.of a fine up to $1,5W.-6-0
and/or one yearn imprisonment as well as civil penalties in the form of a SWOP WORK ORDER and a fine of ($100.00) a day against me. 1
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification
I do herby certify under tha oeirts and
Signature,
Print
Of perjury that the information provided above is true and correct
Official use only do not write in this area to be completed by city or town official'
❑Check if immediate response is required Building Dept
Contact person: Phone #
d WORKMAN'S COMPENSAriON
Date C)
Phone # �S►i -�-g�� r�yy
❑
Building Dept
❑
Licensing Board
❑
Selectman's Office
❑
Health Department
❑
other
COSTELLO INSURANCE AGENCY
2 South Kimball St.
PO Box 5248
Bradford, MA 01835
NSURED Beal Carpentry
James Beal
27 Jasper Street
Saugus, MA 01906
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE
INSURER A: Associated Industries of Massachusetts
INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DD/YY)
DATE (MM/OD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) S
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [--]OCCUR
MED EXP (Any one person) S
PERSONAL 6 ADV INJURY S
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG S
POUCY JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY
(Per person) S
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY S
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY . EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC S
AUTO ONLY: AGG S
EXCESS LIABILITY
EACH OCCURRENCE S
OCCUR' ❑ CLAIMS MADE
AGGREGATE S
S
DEDUCTIBLE
$
RETENTION S
$
WORKERS COMPENSATION AND
VWC600246901200
04/19/2000
04/19/2001
X I TORY LIMITS Ir I ER
EMPLOYERS' LIABILITY
04/19/2001
04/19/2002
E.L. EACH ACCIDENT $ 100, 000
A
E.L. DISEASE - EA EMPLOYE S 100,000
E.L. DISEASE - POLICY LIMIT S S00,000
`
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
1---- I I AUUI I IUNAL 1NJUKCU; 1KJUKCK LC I I CK: I. -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
icia Fillio
' North Andover Building Department
Tel: 978-688_954;
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:
U`� 1 ►iA awn GSC 1 l
' (Location of Facility)
Signa Permit Applicant
i
Date
NOTE: Demolition permit from tide Town of North Andover must be obtained for
this project through the Office of the Building Inspector
PROPOSAL
W hereby propose to furnis the mit rials and perform the labor necessa for the completion_ `of '
Q , i.U:) d 1 G( ILI
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' 1 +I!?=LI.,— ✓lam/
3 I fliff
! , y?i
h
e j it
of 1 G4- J_ --f & IC
i !
all.. fijpkt tS 0, Of 4.-9;A
- All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and
s ecifications sy itted for ab ve work and completed in a substantial workmanlike manner for the
/sum
fof:
�j/
�� Dollars ($. v ✓v ��
with paflents two be as follows
Any alterations or deviation from above specifications involving extra costs Respectfully submittec��
will be executed only upon wdtten order, and will become an extra charge
over andabove the estimate. All agreements contingent upon strikes,
accidents. or delays bevond our control.
Per
Note.- This proposal may drawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will
be made as outlined above.
SIGNATURE
DATE SIGNATURE
9450
PROPOSAL NO.
SHEET NO. �- :1
DATE
PROPOSAL SUBMITTED TO:
WORK TO BE PERFORMED AT:
C o� a
NAME
ADDRESS M
ADDRESS /
CITY, STATE
CITY,STATE
DATE OF PLANS
PHONE NO.
ARCHITECT
W hereby propose to furnis the mit rials and perform the labor necessa for the completion_ `of '
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' 1 +I!?=LI.,— ✓lam/
3 I fliff
! , y?i
h
e j it
of 1 G4- J_ --f & IC
i !
all.. fijpkt tS 0, Of 4.-9;A
- All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and
s ecifications sy itted for ab ve work and completed in a substantial workmanlike manner for the
/sum
fof:
�j/
�� Dollars ($. v ✓v ��
with paflents two be as follows
Any alterations or deviation from above specifications involving extra costs Respectfully submittec��
will be executed only upon wdtten order, and will become an extra charge
over andabove the estimate. All agreements contingent upon strikes,
accidents. or delays bevond our control.
Per
Note.- This proposal may drawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will
be made as outlined above.
SIGNATURE
DATE SIGNATURE
9450
PROPOSAL
PROPOSAL SUBMITTED TO:
WORK TO BE PERFORMED AT:
PROPOSAL NO.
SHEET NO.
DATE
tom_.
NAME Q
ADDRESS
ADDRESS
CITY, STATE
CITY,STATE
DATE OF PLANS
PHONE NO.
ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of
rJ
&..- ( ,ad—
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and
specifications submitted for above work and completed in a substantial workmanlike manner for the sum of:
with payments to be as follows
Any alterations or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge
over and above the estimate. All agreements contingent upon strikes,
accidents, or delays beyond our control.
Dollars
Respectfully subm
Per
Note - This proposal may be withdrawn by us if not accepted within days
ACCEPTANCE OF PROPOSAL _
The above prices, specifications and conditions are satisfactory and are hereby accepted.. ou a authorized to do the work as specified. Paymen U—
be made as outlined above. -�
SIGNATU
DATE
945
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(PROPOSED 2nd FLOOR ADDITION)
NORTHERN ASSOCIATES INC.
401 SOUTH BROADWAY, LAWRENCE MA.01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336
1
N/f TROMBLY
�2
'4s�
Q LOTS
SCENIC EASEMENT
\ LOT D2-1
N 4205f±
(y
�coo /690
•00, ,----, �6•SdK=yS S
SCENIC EA5EMENT
O \ LOT C2-2
4205f±
5-701
F-0 No
PREPARED FOR:ANTHONY f- SANDRA TRANFAGLIA-ACCOLA
LOCATION:347 HILLSIDE ROAD
CITY,STATE:NORTH ANDOVER MA
DATE:MARCH 3 1 ,2002 SCALE: I "=GO'
JOHN
RUFiM
M t. Property/House is not in Flood Hazard.
O 2. Property/House is in a Flood Hazard Area.
O 3. InJbrnation is insuffirent to determine Flood Hazard.
Flood Hazard determined from latest Federal Flood
Insumn.ce Rate Map Panel 250098-000GC
Date G-2-93 Zone y-UN511ADIE)
6• ;>
.MORTGAGE INSPECTION PLAN
' NORTHERN ASSOCIATES, INC.
342 N. MAIN STREET ANDOVER MA 01810 TEL: (978) 474-4410 FAX.- (978) 474-5067
MORTGAGOR: ANTHONY � SANDRA TRANFAGLA DEED REF: 1408/545
AGGOLLA
LOCATION: 347 HILLSIDE RD PLAN REF: #8118
CITY, STATE: N. ANDOVER, MA
DATE: .9/22/99
Rt.'V 15 ED y�za��rrr
/
N
e'er
LOT d L
�� � 57,J✓OT/�J'1•
0 0 t
\� 26
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SHED
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/ 105';
ol�`bo
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'
HILLSIDE ROAD
GE,TIFIED TO: STONEHAM SAVINGS BANK
•yaye a��spea: yawn was pcapereo
specifically for mortgage purposes only end
Is not to be railed upon as a lend or property ��'(0 OFAf4n_
line survey, used for recording, preparing deed
deacriptlone, or construction. Ila corners were G
sat. Building location end ot[aets era CARMEN
approximately located on the ground end p A.
are shown :peclticelly for zoning determinatlon CD TESTA
only end are not to be used to establish proper
lines. The matters shown hereon are based all 4 N0. 1846 R,
client -furnished in[ormetion end may be subject 9p
ogate
f wayto chand otherlmettersio[srecordmandsandprescrIptive ���QfsT,gPS�PJ4,
or other rights. Northern Associates, inc, assumes no NALLAN�
responsibility herein to the lend owner or occupant, /
accep
I its no responsibility for damages resulting from said (/
reance by anyone other than the said mortgagee and Its assigns
In connection with Its proposed mortgage financing to said mortgagor.
JOB #: 9907945
SCALE:
2�6
LOT G1
This mart -gage Inspection wns pteparnd In nccordance
with the Technical standards for Mortgage loan
Illapectinll6 as adopted by the IlnsSachusetts Ruerd of
Ileglnt:rutlon of Professlcuial engineurs and Land
Surveyors 250 CHR 605.
1 further state that In my protesslonal opinlon that
the atructures shown conform with the local zoning horizontal
dlmenslonal setback requirements at the time of construction m
are exempt under provislons of N.G.L. Cit. 40-A sec. 7.
O.I.Property/(louse is not in a Flood Hazard.
❑2.Property/(louse is in a Flood Hazard Area.
[]7.Information is insufficient to determine
Flood (lazard.
Flood flazard determined from Tates Federal Flood
Insurance ;tate 14ar Pane]_Z�Oo [DQ3�o G
Date & —Z-9zone X—' 1.tiasi-d4IQ�tTD
MORTGAGE INSPEGTION -PLAN
NORTHERN ASSOCIATES, INC.
342 N. MA.7N STREET ANDOVER MA 01810 TEL: (978) 474-4410 FAX.' (978) 474-5067
MORTGAGOR: ANTHONY � SpANDRA TRANFAGLIA
DEED REF: 1408/345
AGGO PLAN REF: #8118
LOCATION: 347 HILLSIDE RD
CITY, STATE: N. ANDOVER, MA
JOB #: 99O7°J45
SCALE: 1'-80
DATE: 9/22/99
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 075111
Birthdate: 01/05/1965
ow
Expires: 01/05/2003 Tr. no: 75111
x , - •- Restricted To: 00
JAMES S BEAL _
7 FAIRMOUNT PLACE
SAUGUS, MA 01906 Administrator
92-
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Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration --130727
lug "? Expiration 4/1,1/0.4
Type =DBA'
BEALCARPENTR' ._- ._ -t
JAMES BEAL
1 27 JASPER ST.
SAUGUS, MA 01906 G `
�. Administrator
�+ J ' Date....:}... T!,........
A
_NORTN
TOWN OF NORTH ANDOVER `
A PERMIT FOR GAS INSTALLATION
o
This certifies that r.. ^? f.. r.. ! .... ! ...............
has permission for gas installation ..... ! .::.................:
in the buildings of ............. ............................
at .... r ..'... ..'. �............... North Andover, Mass.
Fee..:...... Lic. No.. .. ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
G
.+a%irvtilyl APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date %�./
19� Permit
Building Location 317 �) r� ,
}y,� Owner's Name
Type of Occupan Jin � vG�
New ❑ Renovation ❑ Replacement
o Plans Submitted: Yes[] NoV
SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name. BAY STATE GAS : COMPANY
Address 55 MARSTON STREET
LAWRENCE, -.MA 01840
Business Telephone 508-68,7--:1105
Check one:
X7 Corporation
❑ Partnership
Certificate #
1862
Name of Licensed Plumber or Gas Fitter Francis X.Corker 11Firm/co.
INSURANCE COVERAGE:
1 have a curre`n# liability insurance policy or its substantial .equivalent which meets the requirements o
Yes � No O f MGL Ch. 142.
If you have checked yes. please Indicate the
type coverage by checking the appropriate box.
A liability insurance policy $(
Other type of indemnity ❑ Bond ❑
OWNER'S. INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owners Acc entCheck one:
Owner❑ Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) in abo
knowfedge and that all plumbing work and installations performed under the permit iss f r isceb� are We and accur to to the best of my
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene application wil
n mpliance with all
6y
T of licen
Gasfdter se:
Title Plumber Signature o cense um um r or Gas
C,i�ty/Town Master license Number 8 6 9 7
A"":�7�'Fv tvr c Ugg ONE 9Joumeyman
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Installing Company Name. BAY STATE GAS : COMPANY
Address 55 MARSTON STREET
LAWRENCE, -.MA 01840
Business Telephone 508-68,7--:1105
Check one:
X7 Corporation
❑ Partnership
Certificate #
1862
Name of Licensed Plumber or Gas Fitter Francis X.Corker 11Firm/co.
INSURANCE COVERAGE:
1 have a curre`n# liability insurance policy or its substantial .equivalent which meets the requirements o
Yes � No O f MGL Ch. 142.
If you have checked yes. please Indicate the
type coverage by checking the appropriate box.
A liability insurance policy $(
Other type of indemnity ❑ Bond ❑
OWNER'S. INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owners Acc entCheck one:
Owner❑ Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) in abo
knowfedge and that all plumbing work and installations performed under the permit iss f r isceb� are We and accur to to the best of my
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene application wil
n mpliance with all
6y
T of licen
Gasfdter se:
Title Plumber Signature o cense um um r or Gas
C,i�ty/Town Master license Number 8 6 9 7
A"":�7�'Fv tvr c Ugg ONE 9Joumeyman
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Date. AL. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
T f Jam✓
This certifies that ............. ...... ��,:-�.�.... r... .. .
has permission to perform ..!: ............. .
plumbing in the buildings of-. . e. -t :!................ .
at. ....... , North Andover, Mass.
Fee .,�YY..... Lic. No.r] ...... .
PLUMB INSPECTOR
Check #
5258
—'d
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS /� _
�`7 /`r U U " Date
Building Location � i � r � r Pie � Permit #
n /// Amount
Owner A, d q y /7 C'_ C o //Q
New Ef Renovation
Replacement
FIXTURES
Plans Submitted Yes 11 No
(Print or type) i' Check one: Certificate
Installing Company Name11N1 e e 1, 1T Corp.
Address '2'q�fSO ^ ST /E3 Partner.
truax s1174, Cd/i'15
Business TTe ep one -;2n? 1- p 6 6 1) / El Firm/Co.
Name of Licensed Plumber: A14--1 (11 aA /i4
Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity E—] Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner El Agent
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 Massimo♦ u e�tts State lumbing ode and Chapter 142 of the General Laws.
By: Signature or Muenseau er
Type of Plumbing License
Title le 61;7
City/Town r3cense Nuinuer Master Er Journeyman ❑
APPROVED (OFFICE USE ONLY
3Ui5
Date.. J� ...0 4? Q -
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
AfS`NAI T� C/P
Thiscertifies that..%.........................v........................................................
has permission to perform � vti S r
wiring in the build' in of.
.................................................................
at .... ...............................................�, North Andover, Mass.
! Del
Fee ....... ��....... Lic. No.. y3�.H....... J.:. c ...... .................................
r� ELECTRI AL INSPECTOR
Check # 3;2-y(
Official Use
QOnly
`
Permit No. ��
7� 6/Wa W Xry?j 7X4SS4fin, 7J
aoMf,-4 4 P -R& S404 Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
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 . _62
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number -7 / �Cs� & 2
Owner or Tenant G
Owner's Address
Is this permit in conjunction with a building permit Yes B-__ No ❑ (Check Appropriate Box)
Purpose of Building — Utility Authorization No.
Existing Service /00 () Amps zvAVoits Overhead aK— Undgmd ❑ No. of Meters
New Service 00 Amps /eL0 JYOVoits Overhead UK' Undgmd ❑ No. of Meters l
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER =.(Please Specify) (Expiration Date)
Estimated Value of Electrical Work$ �l ��� d ,v/Z,
Work to Start Inspection Date Res ested Rough r/i« Final
Signed under the Penalties of
FIRM NAME i7/S7y f7fG'/�/��G��% // �— LIC. NO.
LIC. NO.,C—
y ter, �v/ Jv�
Address _J ,�/������Cf'r � /��r/ /) Alt Tel. No. O `.32
OWNER'g INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one)
Telephone No. PERM17-TEE $ `�
(Signature of Owner or Agent)
Total
No. of Lighting Outlets 6,2
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Lighting Fixtures
No. of Receptacles Outlets
Swimming Pool grnd ❑ grnd ❑
No. of Oil Burners
Generators KVA
No. of Emergency Lighting
Battery Units
No. of Switch Outlets 1,12No
of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER =.(Please Specify) (Expiration Date)
Estimated Value of Electrical Work$ �l ��� d ,v/Z,
Work to Start Inspection Date Res ested Rough r/i« Final
Signed under the Penalties of
FIRM NAME i7/S7y f7fG'/�/��G��% // �— LIC. NO.
LIC. NO.,C—
y ter, �v/ Jv�
Address _J ,�/������Cf'r � /��r/ /) Alt Tel. No. O `.32
OWNER'g INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one)
Telephone No. PERM17-TEE $ `�
(Signature of Owner or Agent)