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Home My WebLink AboutMiscellaneous - 35 BRIDLE PATH 4/30/2018 (2)2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and maybe -deemed -by the7nspector_of-Wires abandoned.and-invalid,if he—_.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. n —Permit/Date Closedp`1-2-0 —/ �Z * * * Note: Reapply for new permi 11 Permit Extension Act — Permit/Date Closed: 9656 Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... A has permission to perform ............ wiring in the building of 3.. ............... Ku��.W. .............................................. at ........ 3.5......... .. ........... A n.t/. ............. No. Andover, Mass. Fee -6P ............. Lic. No. a :Y-3. . 0 . . 7— ................. 114(67 AL Check #/6 6 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. "f nfG'3 BOARD OF FIRE PREVENTION REGULATIONS Date Issued: 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: 9/1/10 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 35 Bridle Path Map: Lot: Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Residence Existing Service Amps / Volts New Service Amps / Volts Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity same Location and Nature of Proposed Electrical Work: KI`�G�� Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures 10 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o. of Emergency Lighting rnd. grnd. Battery Units No. pf Receptacle Outlets 2 No. of Oil Burners FIRE ALARMS No. of Zones No. 6f Switches 6 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers I Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers 1 Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Kms, No. of No. of Data Wiring: ` Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Eg uivalent OTIJER: Reconnection of washer & dryer unit Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $2150.00 (When required by municipal policy.) Work to Start: 9/4/10 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 licen- see 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 ismsA office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ I certify, under the pains and penalties of perjuty, that the inj FIRM NAME: Andover Electric Se application is true and complete. Licensee: Robert J. Branca Sig e *Per M.G.L. c. 147, s. 57-61, security work requires/De ent o ublic S "S" License: (If applicable, enter "exempt" in the license number line.)Address: 19 Dale St Andover MA Zi810 OWNER'S INSURANCE WAIVER: 1 am aware that t icensee does not have the liability insurance signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Phone: LIC. NO.: 14302 f1n _ LIC. NO.: LIC.NO.: S: Bus. Tel. No.: 978-475-4995 Alt. Tel. No.: 978-423-8350 coverage normally required by law. By my Permit Fee: $ This certifies that ...I. �! �.`T ... ..... .............. . has permission to perform ..../?.° .° `" plumbing in the buildings of ...r"..` ' Aj at ... �... /..! .. <... , ......, North Andover, Mass. Fee. /..... Lic. NOW!!. . L. ...... . ....: , ...`.-, ......... ` PLUMBING INSPECTOR Check # 7z 26 E.6G� Date.( %'3 NeR,N 01 TOWN OF NORTH ANDOVER - p PERMIT FOR PLUMBING j SSACHUSE This certifies that ...I. �! �.`T ... ..... .............. . has permission to perform ..../?.° .° `" plumbing in the buildings of ...r"..` ' Aj at ... �... /..! .. <... , ......, North Andover, Mass. Fee. /..... Lic. NOW!!. . L. ...... . ....: , ...`.-, ......... ` PLUMBING INSPECTOR Check # 7z 26 E.6G� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes. V Nd If you have checked Yes• please indicate the type of coverage by checking the appropriate box below. A liability insurance policy;rr/: Other type of 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. Ch _ _ eck One Only Owner Agent Sianature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By! Type of License: .: Signature of Li e'dPlumber Title; -.: Plumber _..._, Master Cityrrownj.._ ___ ___. License Number: -'13258 APPROVED OFFICE USE ONLY)Journeyman j__ ____ MASSACHUSETTS UNIFORM APPLICATION FOR. PERMIT TO DO PLUMBING CityRowrr'— N.:Q �n� _ _'.. - MA. Date: , :. o� �i��o _ .Permit# . _ ..__. '. Building Location:: _ FIXTURES Owners Name: ; C ` Type of Occupancy: Commercial; Edu�onal : Industrial: Institutional ; Residential New. ; Alteration:: Renovation/-7:_Replacement:; Plans Submitted: Yes ; No INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes. V Nd If you have checked Yes• please indicate the type of coverage by checking the appropriate box below. A liability insurance policy;rr/: Other type of 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. Ch _ _ eck One Only Owner Agent Sianature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By! Type of License: .: Signature of Li e'dPlumber Title; -.: Plumber _..._, Master Cityrrownj.._ ___ ___. License Number: -'13258 APPROVED OFFICE USE ONLY)Journeyman j__ ____ FIXTURES Z z Y O V LU N a ix z_ z H Y } J Q = v Fy- w W o � W a it ~ W O Za t- rn Q � z m QZQ Q I m to z a d C W Q to a Q +o Y Z to W Z v a X n. u_ Q W g 00 w v U.30 W ap J <IJJ_ n F Q M m o o 01- W O 2 Y m> J 0 W z z I-- .3 to rn FQ- O SUB BSMT. BASEMENT 1 -FLOOR 2"u FLOOR 3 FLOOR 4'H FLOOR 5 FLOOR WH FLOOR 7 FLOOR 8 FLOOR :........._....... ......... _ -.-. _----...--__--_--_-- ---._._^_, Check One Only Certificate # Installing Company Name:; Kevin Scott Plumbing & Heating Inc_ 0 o Corporation C rp 2438 Address:' P•O Box 446 City/Town! Wilmington State:;.'' 4• Partnership Business Tel: 978-988-3632 :: Fax:: 978-694-9977- - — -- -- - - Firm/Company Name of Licensed Plumber:.Kevin Scott .:.:_.._..._.:..-::...:___ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes. V Nd If you have checked Yes• please indicate the type of coverage by checking the appropriate box below. A liability insurance policy;rr/: Other type of 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. Ch _ _ eck One Only Owner Agent Sianature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By! Type of License: .: Signature of Li e'dPlumber Title; -.: Plumber _..._, Master Cityrrownj.._ ___ ___. License Number: -'13258 APPROVED OFFICE USE ONLY)Journeyman j__ ____ OP ID K1 ACORQ„ CERTIFICATE OF LIABILITY INSURANCE KEVIN -1 DATE (MMIDDIYYYY) 06109110 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. 601 Edgewater Drive S235 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER Wakefield NA 01880 Phone: 781-914-1000 rax: 781-246-2601 INSURERS AFFORDING COVERAGE NAI C # INSURED NSURERA: Peerless Insurance Company 24198 INSURER B: Kevin Scott Plumbing & Heating Inc. PO Box 446 Wilmington lei 01887-0446 NSMER C. INSURER D: INSURER E: COVERAGES 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. 3K U0' NS TYPE OF INSURANCE POLICY NUMBER FECTIVE DATE MMIDO POLICY DATE MMMD LIMITS GENERA. LIABILITY EACH OCCURRENCE S 1,00,0000 �t TIIR PREMISES (Ed' $100 , 000 rA X cOIviMERCIALGENERALLIABILITY CBP3185448 05/15/10 05/15/11 MED EXP (Any — perste) $5,000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENLAGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $2,000,000 POLICY jEa LOC A AUTOMOBILE LIABILITY ANYAUTO BA3185446 05/15/10 05/15/11 COMBINED SINGLE LIMIT (Es accident) $ 1,000,000 BODILY INJURY {Par person) $ ALL OWNED AUTOS X SCHEDULEDAUTOS BODILY INJURY (Per accident) $ X HIREDAUTOS X NON OWNED RUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EAACCIDENT $ OTHER THAN EAACC $ ANY AUTO A= ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A X OCCUR CLAIMSMADE CU8777929 05/15/10 05/15/11• $ DEDUCTIBLE $ RETENTION $10,000 WORKERS COMPENSATION AND X TORY LIMITS ER E.L. EACH ACCIDENT $500,000 A EMPLOYERS LIABILITY ANY PROPRIETORIPARTNER/D(ECUTIVE OFFICERIMEMBEREXCLUDED? WC3818445 05/15/10 05/15/11 E.L. DISEASE -EA EMPLOYEE $ 500,000 It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 50 0 , 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS .-coTint-Air unl nFR CANGELL.AI AVIV CITYMEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 25 COMMONWEAL I H Ur MA„AlMUJc1 10 IN AS A MASTER PLUMBER ISSUES THIS LICENSE TO KEVIN A SCOTT PO BOX 446 - WILMINGTON MA 01887-0446:, 13258 05/01/12 754252:'. .W7515 i i 9. . ---------------------- r JCOMMONWEALTH OF MASSACHUSETTS-!- . IN AS A PLUMBING CORP ISSUES THIS LICENSE TO KEVIN A SCOTT KEVIN SCOTT PLB & HTG INC PO BOX 446 WILMINGTON MA 01.887-0446 2438 05/01/12 754250 r.. r COMMONWEALTH OF MASSACHUSETTS LICENSED AS A JOURNEYMAN PLUMBER ISSUES THIS LICENSE TO S -' KEVIN A SCOTT m ~'P.O. BOX 446 m: -WILMINGTON MA 01887-0446:.: 24877 05/01/12 754251".. L': The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Print Form www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizational & HEATING Address: P.O. BOX 446 WILMINGTON, MA 01887 tMlo Citv/State/Zhx Phone#: ' b Arey an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Vectrical repairs or additions 11. Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box #I 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. tContractors that check this box must attached an additional sheet showing the name or 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 Name: Policy # or Self -ins. Lic. #: Job Site 3S I Expiration Date: City/State/Zip: N� A011ox- M 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 hereby certify under the pains and enalties of perjury that the information providedve if true ana correct. Sivnatnre- � Date: J J °J d 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 ,t— _ J P.O. BOX E. RAMP; (60M 329 FAX (603) TITLE SUBJECT DESIGpED BY DATE PZ4 CSECLED BY PROFESSIONAL STRUCTURAL ENGINEERING DESIGN SERVICES, 5:5- tmLiL fkTH flb . kW�la f..i , me EST -) JOB .ir N0 .. 24.11 °••"..� SBEET NO. „ BP -DZ �o $�c.cr— �. S v iJ1t-c Knr� cip,vAc-, Lp.* , 4— 0/4ry.1 `14=' Lill-. i�►"tf,,es, Qoon�l AA[ -y- T ca >La w ar a��M E3ti�a,,a PC�Fwv*��X,I-rvC�ca,tiTaz:�cI'E.mew�. c� .TAL.-Ac..K.ti�LLo� P a ataT�-�Lt ZArt'-i` q 4P TKm T• 6L -r% E+'2 OC, 5a=2Ew �Atk $os-r� o S-r+ta€i Emg,o Tor irro, rbm �T`-tPl t1u m +l PROFESSIONAL P.O. Box me s vn STRUCTURAL WONEUM E. MWPSTEM, NH 03126 R 6 DESIGN SERVICES (6M) UMA 329660 CT FAX (W) 329-64M RESIDENTIAL COML*p NO. 33V1 13S b?-%oLrL- %.TV4 NAL Q koo& %I to , me TITLE-R-mv LEM.! . EST) P-c� SUBJECT qw-oft VtXN!&t JOB 3 NO - DESIGNED BY "-IA-F- 2aam SHEET NO. DATE Q%6t It' CHECKED BY DATE 55f Nq4 7�u?oUTtvVq 5AK.r, y X m 4&wzh4&d74r/ c. P.O. BOX E. RAMP; (603)329, FAX (603) TITLE SUBJECT -\--\�ix PROFESSIONAL STRUCTURAL ENGINEERING DESIGN SERVICES 5s be-1Ouf-- Fh-TV4 Q,b - k� � T -,e , Mr\ EST) JOB 3 no. SHEET Wo. DESIGNEDDAT EP�7�WO CHECKED BY DATE .pkrLA��IfWj V.0 f)c--r-1 cf,-M(A� " C) VC n L file a S? L -f - A -L ero \AjVTh 4M- ol P.O. BOX E.HAMP%c (603) M FAX (603) TITLE SUBJECT DESIGNED BY, czx PROFESSIONAL STRUCTURAL ENGINEERING DESIGN SERVICES 5s b?-vouE-- Vk-TVA Q'b - k� � ve , M c� EST 7 JOB No. ry SHEET NO. DATE 51-iA hL to CHECKED BY DATE oe" � s V 1\t -T HAD tk'ry v OK f'7 \ I VA wb U At - WO P.O. BOX 958 E. HAMPSTEAD, NH 03828 (603) 329.5540 FAX (603) 329.Fi�06 TITLE SUBJECT I:F-Slc*mn& a m Krz\t�%y5) PROFESSIONAL STRUCTURAL ENGINEERING DESIGN SERVICES EST 140. SHEET NO. DESIGRED BT-2� DATE CHECKED BY DATE rn q 04/ UwronA-- Lo,^�t)�At� VA cr,—= \,-l; 4 � 6�- Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS i Permit vo. Occupancy and [Rev.905] �....... APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %wrk to he performed in ;uccorkkmce %\ ith 11001.101 Code (\IF( .2 .110 WLE'.ISE PRI;\T I\ 1,1K OR TYPE,ILL- 1,\FOR,l1.1TIM) Date: 3 - 7 - P`; - City or Town of: �, ygrc� u(z, TO 1170 h7S1?eC/0r 1)! :I 13y this ilppliCatlon the undersigned Bites notice of his or her intention to perturnl the electrical 'd below. Location (Street & Number) (honer or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check A,r,,ro; 'ate Box) Purpose of Building .a to S" h rc�r _`v, Utility Authorization .No. ExistingService )L -0c, Amps `1 _o / .r14 0 Volts Overhead ❑ Undgrd err. ,d' Meters i - New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tv (� «] _r�� • /� d ._ s , No. of Recessed Luminaires S No. of Coil.-Susp. (Paddle) Fans No' of Transformer No. of Luminaire Outlets No. of Hot Tubs Generators No. of Luminaires kbove In- S:vimming Pool (11,1111d.El rnd. . o. o me ,, „; Qatte L ils No. of Receptacle Outlets No. of Oil Burners ;FIRE AL:111. 1S No. of Switches No. of Gas Burners No. of DE t inn m Initiating oeN i No. of Ranges Total No. of Air Cond. Tons — No. of Alcrtinl, Due No. of Waste Disposers Heat Pump Totals: Numher .. Tons KW _ _ No. of Self -01116111 Detection/A Icrl int No. of Dishwashers' Space/Area Heating KW ❑ \Ii'i"ull' LLocal (�nlinl'Ctl No. of Dryers Heating Appliances KW Security .5y.Ntems:* No. of Dc� ices , No. of WaterKW No. of No. of - -- Data Wiring: "caters ^ -- _Signs. Ballasts No. of l)c> ices 1. No..ydrrnn httibs ( No. of wlotors Total HIP felecominunicmim No. of Denies r, le hispec-tor Tow KVA KVA .;nrtug r. of Zones n �..cs u )Cyic'c's I ❑- Other_ Equivalent I Equivalent . �Vir -_.__._. I Fquivalent OTH E R: . I /lur:III hh.11/ ,waw ,IL'l.11l ;/'.lr.+ilvd, .))'Us r, .111. Estimated Value of Electrical Work: /�%j�v, 4?; Olken required by municipal policy.) %ork to Strut: OR -7''1)6 Inspections to be requested in accordance with MEC Rule 10. and upon mplution. INSLRANCE COVERAGE: L;nlcss waited by the owner. no permit for the performance of clectriC; l unity issue unICS: the licensee protides proofof liability insurance inc lLid in(; "'_'ontplctcd operation" cover lye or its ,.il",I;mti;; quitalcnt. !'h,. undersi erred certitiCS that ;uch cokera;;e is ill force, mid has c>.hihitcd proot of:arle to the permit I, .I;in' r X. (11ECKONE: INSL'RANCl 2' 13om) ❑ !)t lkiz ❑ Itipccily:! .I ierfr1 % under Nle Ynti/l.v and pemiir1('.s- ol'p rjuly, ,71al the Nnp)rh+lllriwt on lflJ' ,1.Ilr)/iC'!l11nN /,r /1't!rt.' I'Iltlll `$AIiIE:_Q&I Licensee: _ ;)i nature ll,/,1�'l:/h'•71."k. t l'j••tiil.l III(/l'/,i,. L: .'l.filll%7 r!•rI C, Address: ( 1 UC.r �e J. J2 . �A�E' S't i� r.f l it 0(&(. Bus. I .I. 4 S Alt. Yv1. *SCCllrity system Contractor License required tur this �4)rk; ifapplicable. enter the license number hot.: OWNER'S INSURANCE NNAIVER: I ant aw,u'e that the Licensee Jvrr!ml /rove the liability insurance _r;a`c 11c,—mal lv--- Iccluired by law. By ntysignature below, 111CI'Lby Waite this rcduiretnurt. 1 .1111 the (check one) ❑ o\vm:r ] owner":; ,agent. Owner;Agent cicr "` .iiKnature a.-"'ci➢';:;a� �i<>, �F,�?,4/��' �'7 ' , �'..� Date'. /'. k........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...............,,er.-....J................................. has permission to perform ....... r�� wiring in the building of ....... ..,....................................................... it ................................................ . North Andover, Mass. Feeb.. ......... Lic. NoP� ,.. .... ?'u . if. ..-: .... ...... ELECTRICAL INSPECTOR Check # �� 6446 Commonwealth of Massachusetts Department of Fire Services l)Ilicial I :,e ( )Ili Permit No. 7 �� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS '[Rev. 9 O5] Heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .\II .pork to he perforated in accordance %%ith the \lassachusettS HC01•iCA Code t \IEC). 527 (\1R 12.00 1PLLISE PRLAT 1XIAW OR TYPE, ILL I.tiFO)RJLITIO,V) Date: 3 - '7- 06 Cih' or Town of: �, IA40uc-c' TO 111C j7speC101'uj il'irc'.s: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street & Number)—s S- 0 (- �X i't- po"VV, Owner or Tenant �-k)�P_ n 4 Telephone No. Owner's Address S ---- Is— Is this permit in conjunction with a building permit'' Yes � No ❑ (Check Appropriate Box) Purpose of Building S,vj! e 1rcNr !A Utility Authorization No. Existing Service as0ca Amps \Z0 / orf -a Volts Overhead ❑ Undgrd New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity 3 Location and Nature of Proposed Electrical Work: No. of Meters I No. of :Meters f ',imnlrlinn „l llr'. !.alio i„t. n,hl„ u . /— , ..l h ! il— l„ 1,1. —,• ,a IF - No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA .No. of Luminaires above ❑ In- ❑ Swimming Pool No. o Emergency Lighting orad. o-nd. Batter L'nits No. of Receptacle Outlets No. of Oil Burners �1FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners iNo. of Detection and Initiatiniz Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices j g No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/, k lerting Devices No. of Dishwashers Space/;area Heating KW Local LlMunicipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No.—HZ�d,=!LU. R:r—tubs No. of Motors Total HP _ I clecommunications Wiring: No. of Devices or Equivalent OTHER: lllo,11 ,1,hbn,,na ,/ci,ni r/ Jrsrrc cl, orus rr,ltrrrul l;, lit, 1h.S/,tLl,;r If , Estimated Value of Electrical Work:`9no. w (\khen required by municipal policy.) \bork to Start: 'R Inspections to be requested in accordance with \lEC Rule 10, and upon completion. INSURANCE COVERAGE: L,nlcss waived by the owner, no permit for the performance of electrical work may issue unICS: (hc licensee provicles proof of liability insurance including ol-onlpletcd operation" covera�,c or its substantial cquivalCnt. HP: r,ndcr�i ned ccrtitict: that such cokerage is in force, .nld has c`.hihited proof of aurae to the permit is;uin z oltice. I IECK ONE: INS( RANO-: 2" 11w l) ❑ m-11FIZ ❑ (Srucily:) ! -er1 5,,rrtder 1/1 rrttt► tnd peau fi,v /f perjury, 3taf 1he infim.-nation vn his ,ipp!icr dmi is n•rrc ru,r/ conrplefe. F1RiNI NAM� E: (�Iv^ S �a\Tlt�� LIC. N0.: 5—Ty Licensee: _'signature_—_'; _ r.,IC.:J(L: _ r•:1;1r,�� rvlr�.-S��r� "c: �rr,r/.� � ur 11�, Lr, r,r-�� r urnh� r � � !'� ,thus. Tel.. No.: ot� Address: UAL e Je.��S'T�Zir 4 U« Alt. Tel. No.r: Y, 2-8?a? "Security Sy:,tem Contractor Liccnse'r quircd for this 40(; if applicable. enter the license number hare: OWNER'S INSURANCE WAIVER: I and awu'e that the LICenSeC 10�.Y r/rr1 /ruvc the liability insurance nc:rnlally--- lequired by law. By my si`,naturc below, I hereby waive this requircni, nt. I and the (check one) ❑ Owner ❑ owner's Owner,'Agent — 0cl i�;natu,e lti)Ile>rt: `i,?._ PFR.LffT FFA' Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .................. ... ... ,.. has permission to perform CL .` '.............. plumbing in the buildings of )-� ...................... . �..... . ,North Andover, Mass. Fee 5j q.': !O. Lic. No. it 3 oL. t •'.r ,r .:........ . r PLUMBING INSPECTOR { � V Check # )7,3o 6R6u MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (please type or print) 1yd AvDo wek Mass. Date: _3,60 6 Building Location: 35 C i cider 1 IcA ) �, Permit: Owner's Name: W( D ,EtJ (, Renovation Replacement ❑ Plans Submitted ❑ FIXTURES Installing Company Name: /229M) SS2eEr f' + 14 Please Check One: Certificate Address: 1 oz .,�/a1 o sT Corp. 04-3S4�135 3)> 2-2 ❑ Partner. Business Telephone: "l 7B` ❑ � Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability Insurance Policy Q Other Type of Indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the license of this application does not have any one of the above three insurance coverages. Signature of Owner/Agent of Property Owner 1-1 Agent 1:1 I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code Chapter 142 of the General Laws. (OFFICE USE ONLY) By: Title: City/Town: APPROVED Signature of Licensed Plumber Type of Plumbing License: Master 0 Journeyman ❑ License Number: 1 2-63 z ■■■■■■■■■■■■■■■■■■■■■■■■■■ ..._ ®■■■■■■■■■■■■■■■■■■■■■■■■■ ....- ■■■■■■■■■■■■■■■■■■■■■■■■■■ ... ■■■■■■■■■■■■■■■■■■■■■■■■■■ .. _ ■■■■■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name: /229M) SS2eEr f' + 14 Please Check One: Certificate Address: 1 oz .,�/a1 o sT Corp. 04-3S4�135 3)> 2-2 ❑ Partner. Business Telephone: "l 7B` ❑ � Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability Insurance Policy Q Other Type of Indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the license of this application does not have any one of the above three insurance coverages. Signature of Owner/Agent of Property Owner 1-1 Agent 1:1 I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code Chapter 142 of the General Laws. (OFFICE USE ONLY) By: Title: City/Town: APPROVED Signature of Licensed Plumber Type of Plumbing License: Master 0 Journeyman ❑ License Number: 1 2-63 z The- Commonwedth of Massachusetts Department of Indusidd Accidents Office of Investigations ' 600 Washington Street Boston, M4 02111 v4 www.mass govMa Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers - Applicant Information -PIease Print Legibly Name (Business/organization/Individual): r rP414 Address:r UZ mA/N Sr City/State/Zip:_ 13y5I& o 2m a )o,22 Phone #: 4_Z -3-.j-7;-7 Are you an employer? Check the appropriate bog: I. I am a employer with _,..- 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet: t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' c6mp. insurance 5- ❑ We are a corporation and its: , required.] officers have exercised their 3. ❑ I ani a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. .\' Remodeling 8. Q Demolition 9. ❑ Building addition 10. El Electrical repairs or additions> 11.❑ Plumbing repairs or additions 12.E] Roof repairs 13.❑ Other *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 worse and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub -"contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: -rte ,. � �z�?s Policy # or Self -ins. Lic. 6 4'UJL CU649CR 4- 7- 05 Expiration Date: 5-9,04 - Job Site Address: :3 f � c� I c CA, PCr%h City/State/Zip: IVO, AAllhyU�- _Attach a copy of the workers' compensxtfon 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 np to $1,500.00 and/or one -yea 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 maybe 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 3i=ature: Date-.. D .0, ?hone #: q 7 - Of vial use only. Do not write in this area, to be completed by city or town offic&L City or Town: PermitlUcense # 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 # COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS p� LICENSED AS A MASTER PLUMBERy ISSUES THIS LICENSE TO WILLARD F WENDT III 102 MAIN STREET PO BOX 703 BYFIELD MA 01922-1101 12632 05/01/06 913337. COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS .ICENSED AS A JOURNEYMAN PLUMB ` ISSUES THIS LICENSE TO WILLARD F WENDT III m r_ 102 MAIN STREET PO BOX 703 BYFIELD MA 01922-1101 24150 05/01/06 913336 l ,'% CERTIFICATE OF Tf~ to ray -•oma sl:al. . ,�F;fy ::C�;: Certifica�a No. li i .tit r � � �•,� z�.j- ,' NpRTH pf •v ,•1ti 3r .•'i. '• A0 ° p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION SSACHU54 Permit NO: Date Received'" Date Issued: C2_T__d IMPORTANT: Applicant must complete all items on this page I LOCATION 3 5/ PROPERTY OWN MAP PARCEL i1T1TT T TILT If, Print nt ZONING DISTRICT: U11Q'MA1C MQTRIfT VFC n i rrC. Ann uaE yr - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential —,New Building Trine family u Addition C Two or more family C Industrial te<lteration No. of units: L Repair, replacement L Assessory Bldg ❑ Commercial Demolition Moving (relocation) ❑ Other C Others: F1 Foundation only it s n YJ / DESCRIPTION OF WOKK t U t3t rtcr,rism i ( Identification Please Tyne or Print Clearly) OWNER: Name: lifJe ' C/% Phone: t��'✓?�?� lSieature Address: �✓r l��d P �� CONTRACTOR Name: Address: 20 � � �/�� e- /0 Supervisor's Construction License: 0791) 2 Y/_ Exp. Date: _ Z -i r b0_c Home Improvement License: /�Exp. Date: b'--` 2_c� pv 6 ARCHITECT,+NGINEFR Name: Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ � �� O 6 x10.00 --FEE:$ ��'— Check No.: /6133 Receipt No.: �