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HomeMy WebLinkAboutMiscellaneous - 35 ROCKY BROOK ROAD 4/30/2018Date l� . ...�..l...1.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....� 66 ��l^A,(!o ......:.... .. has permission to perform wiring in the jbuildin of....... . at.........�...�.......�C Fee..7.�-J.15 .............. Lic. No...... Check # _ 12024 �(.1 Ute ICS North Andover, ss. ... .....�......................... ........... MLERCALNSPECTC Commonwealth of Massachusetts official Use o y Department of Fire Services Permit No. Zb 10 N 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: City or Town of: North Andover To the Inspector of Wires: C� By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 35 Rocky Brook Road Map: Lot: Owner or Tenant Diana Riccio Telephone No. 978-273-8976 Owner's Address same Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters O Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Backyard Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In -El of Emergency Lighting eg rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas.Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. 4 Total No. of Alerting Devices Tons No. of Waste Disposers Neat Pump Number I.Tons 1KWNo. ....................... of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 Od Si ns Ballasts No. of Devices or Equivalent No. Hydromassage Bathtub No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Insallation :f 0 KW Gen for Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $1500.00 (When required by municipal policy.) CV Work to Start: 11/22/13 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 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 issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Andover Electric Services, Inc LIC. NO.: 14302 Licensee: Robert 1. Branca Signature LIC. NO.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: LIC.NO.: S: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-475-4995 Address: 19 Dale St, Andover, MA Zia: 01810 Alt. Tel. No.: 978-423-8350 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Permit Fee: $45.00 Owner/Agent Signature Phone: roe an�*, tA, (fotnn:onmaaCfh_ of / w-'jachttteffd, aL parfineaf of - ira Sarvice:t BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checiced .[Rev- 11071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %vork to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLE-4SE PRINT JNJAW OR TYPE ALL DVFORALI TION} Date: ` City or Town of- Q(k,tW 4,-0 p UA-, To the Inspector of Wires; By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Loention (Street & Number)5/�OL— V Owner or Tennnt �t tivtr: _ 11►r'/-J r Owner's Address Telephone No. Is this permit in. conjunction with a building permit? Yes ❑ No (Check ApproprinteBox) Purpose of Building Rel t Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. Of Meters New Service Amps / Volts Overhend ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity; Location and Nature of Proposed Electricni Wor•ic: . 6 Completion of the fallowing table matt be tivoived by the InSpector of 1•1fire No, of Recessed Luminaires No, of Cei1.-Susp. (Paddle) Fans No. of � alai Transformers !CVA No. of Luminaire Outlets No. ofFlot Tubs Generntors ICVA- No. of Luminaires Swimming Pool Above ❑ In- ❑770 -.—O -Ml mergency tg tzng rad, rad. Iiattc Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Eo, of Alerting Devices No. of Waste Disposers Halt- um Number Tons ICW o. ofSell=Contained Totals: - Detection/Alertin Devices No. of Dishwashers Space/Area Pleating ICW Local [:] Municipal Connection ❑ Other No. of Dryers Heating Appliances ICW Security Systems:` No. of WaterNoNo. of Devices or E uivalent Beaters KW No. of . of DataWiring: Signs Ballasts No, of Devices or I; uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent oTRER: �'.., r)-�o fiL.•v ri e o 02 o t'�w (� 2 we_4 •o-�—u.�' Attach additional detail f desires:; or as required G11 the Inspector of 1 fire Estimated Value of Electrical Work /if -6 v1 co (When required by municipal policy.) Work toStart:` Inspections to be requested in accordance with IvIEC Rule 10, and upon completion. INSURANCE OVE G Unless waived by the owner, no permit for the performance of electrical work may issue unles the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. Tile undersigned certifies that such coverage is in force, and has exhibited proofof same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under lite pains and penalties ofperjury, that the inforn ution on Ntis application is tree and complete. FIRM NAME: - LIC. NO.; Licensee: Signature LIC. NO.: (!-applicable, enter "exempt" in the license number line.) Address: Bus. Tel. No.; Tel. No *Per M.G.L. c. 147, s. 57-6I, security work requires Department of Public Safety "S" License: AlhLic. 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 ❑ ont Owner/Agent wner's age Signature. _ Telephone No. P.ERlIHTFEE. ,$4S^6 � cn F -q u CIO U3 ria 6q ;E E- Ud taa GO CLi --N Town ®f �oF hx-. .Andover Massachusetts ' i «k'1 ` 36 Bartlet Street Electrical Inspector { ,5 Andover, MA 01810 Paul Kennedy (978)-623-8306 j ELECTRICAL PERAUT FEES 14 jj Fax Number. (978) 623-8320 (revised September, 2012) Office Hours: 8:00 am. - 10:00 a m. Commercial Base Fee $50+ $1 each device Residential New Dwelling Up to 200 amp service $225 Each add. 100 amp's $20 Multi -Family New Condo/Multi-Dwelling (per unit) $225 Residential - Service/cban e/ alterations 1 Rhase - 200 am $60 Multi -Family/ Single Family 3 phase - 200 am $110 Each add. 100 am 's $20 Additions/Renovations/Iteplacements (Maximum Fee $225) $50 (min. fee) + Outlets, switches, plugs, luminaires, etc. $1 each device Residential / Commercial Appliances $50 (min. fee)+ $10 each appliance Air Conditioning and Heat Pumps $50 Temporary Service 'S50 Residential Generators/Solar Panels (service additional cost) $100 (base fee) + Additional Equipment $25 each Commercial Generators/Solar Panels (service additional cost) $100 (base fee) + Per KVA $I+ Additional Equipment $25 each Residential Audio/video/data/phone-systems/ $50 Fire alarm/security systems '' Commercial Audio/video/data/phone-systems/ $60 Fire alarm/security systems Commercial New Construction and Alterations Base fee $50+ Per 1,000 sq. #t. of Construction Space $100 Service/Change up to 200 amp $150 See Electrical Ins ector Jbr price above 200 am Maintenance Permit/Repair Blanket Permit (up to two electricians) $200 Over two electricians(per air) $50 Office Furnishings/ Partition Relocations $50.00 (base fee) + Per Circuit $10 Transformers (non-utility owned) - P ti $50 Miscellaneous Carnival rides $S0 Demolition $50 Feeders or sub -feeders and panels $30 (each 100 amp. capacitor fraction thereof) Motors, per hp or fractional part thereof $q Siding (re -securing service, lights, plugs) $50 Sips $50 Meters $20 Swimming Pools In -ground $100 Above -ground $50 Commercial $200 General Fees Re -Ins ection Fee $50 Inspection after hours (minimum fee) $200 Worldug without a permit ]Double Permit fee The Coi9zrnorrwealth, of Massacicrtsetis Departi tent of Industrial At cidents Office o f'Investigations = 600 Wasltingfon Street Boston, MA 02111 wrvrv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Name (Business/Organization/Individual): Address: Phone #: Are you an employer? Cheek the appropriate box: IF 1. ❑ I.am a employer with 4. F] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 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.] ;ctri`cians/PWMb:eirs Please1Pr n$` L-eCn1 NT` Type -of project.(required):.:,.....: 6. ❑ New construction' 7. ❑ Remodeling 8. ❑ Demolition 9. [:] Building addition 10. F1 Electrical repairs or additions I LEI Plumbing repairs or additions 12. ❑ Roof repairs I3.❑ 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, =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 isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 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 Section 25A of MGL c.. 152 can lead to the imposition ofcriminal-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 WORD 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 penalties ofperjury that the information provided above is true and correct. Signature: Date:... 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): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical,Inspector 5. Plumbing Itnspector 6. Other Contact Person• Phone #: ,. '? u p a.� +- + x S f R s, s ..,,, M� t r i w � 'si�i`��°"F'•��:.�� k- k. i 1 P Fold, men Deboh AlonMol kyj g Ail moons ' . to] • ? • �` cqLe 9'SJ wI J�E5��`�'W ii NL�WIix �ir1J f ptNN,.L'.1Nit t�Aix!'lRT4 •I i i 6 Q V. M1 '�'�'.`3;�,.:o> :. . Sof": .5. 1 �.. .. S•.,. w .. :........ ....� .. ..+.�: _ ..: �~� y �a�•x�ai�#t'ns:�,tt�; -;fl:�lr.�r��nr��►t'of�:RSr�Ciil� �#t�t:�fr Ii44�+Di`�:��i4NR�'k�C�ci�e8!ri�l��!`f�,E•i�C4E4?l�.�f; A. W RT,J MWCA AND64k 4 o?9?4': . A (�iiii}i+r�arp' ire,`., The Commonwealth of Massachusetts Department of Industrial Accidents t Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AiDiplicant Information Please Print Legibly Name (Business/0 rganization/Individual): Andover Electric Services, Inc. Address: 19 Dale St Citv/State/Zit):Andover, MA 01810 Phone #:978-475-4995 Are you an employer? Check the appropriate box: 1.0 I am a employer with 5 4. ❑ 1 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 required.] comp. insurance.t 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' coma. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ 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 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 polky and fob site information. Insurance Company Name: Hartford Insurance Group Policy # or.Self-ins. Lic. #:08WECCM5940 Expiration Date:4/28/14 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 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 ceri6 under the pains and Phone #: that the information provided above Is true and correct. Offlcial use only. Do not write in this area, to be completed by city or town offlcla[ City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: �i DATE: November21,2013 LOCATION: 35 R.,ky Brook Road OWNERS NAME: Diana Riccio GENERATOR kw 20 NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS' CONTRACTOR: Anddver Electric Services, Inc. PHONE NUMBER: 978-475-4995 LECTRICAL RESIDENTIAL GAS COMMERCIAL LOCATION OF GENERATOR: *ZONING DISTRICT: Backyard *PLANNING APPROVAL (IF IN WATERSHED) TEMPORARY *CONSERVATION APPROVAL' 4- Q ,- ��.,• +V" (" o�� North Andover MIMAP November 21, 2013 #42 104.B-0054 #23 090.A-0070 090.A-0043 #31 ( 090.A-0037 104.B-019 090.A-0044 090.A-0058 ,i;-=: _- #136 090.A-0042 "?� : •`!s•. #20 a 7.7 .. 104.B-0192 #75 ..: a,. :::_ ......... 104. y^ :: - atJr� .:_._.: Biu =_'alai :-_• "• •' �,.:::_::_ �a :::_. ... ; :.._. ,til 090.A-0056 090.A-0041 #50 104.B-0193 #78 #46 iX�, #124 104.B-0203 �` A :.• 090.A-0039 j�, . 104.B-0194 i �, - 090.A-0054 i;..:_ _: -s:• \� `" ....•."a #62- ,�o -435'..\off ` R1 090.A-00.0.6 :-. :: 'iii o� 090.A-0001 104.B-02 2 0 :::_ arta :: ii: a #55 \ �u i/' #88 090.A-0052 1Q4.B-0195 #76th. • 104.B-0205 _ 09.O A-0048 �...-........... .........._M..--_--------_•^•'.._.rv..- :: •..,ala. #71 104.B-0196 :.:: #59 : ;.. 10d B-0201 :_:':.. 090.A-0049 'MJu - ..:. #81 �iP #67 % :=.= 90.A-0051 ..,�.:::_.-: •:ib4:B-0200 .. - 090.A-0050 104.B-0197 = yi,"=- : A.. #102 -i " .: =°= . #79 yjc�: '-5, .. _ •iii..:"; ..__. �..., � ........ •_••'-:_: :_:__ :_: _.. :_:__ ••.._. ... is _`;'-''.:-..:.� :': . . .-:. :, .:::• bUl'_::. ...::_: ?=f.<. \ .'._ ''_ '..:. -..._::...:_.•._.. tifr.��:_::•::��...L....�ilff....._.:��..._ _.. • .1.04 $ 01'99,.. ..._. __.-090.A-�028•-:_. ..:::_:: • Stu .::_:: .._......_. •-••_ ' :::_ ._.. ;-:::::: ..._::. a :::::1tt V. .: qtr a _..........:__. .• :::.;_ • :::•_: 'iI � .... #105 :. "- 090 a-oo7r ' :_ • ,�f,; .� .: : _. •-- .._.... -404.E-0198 u. ,r(.5 t)u ala __: 5 r �rlGr 1w? t'I►1 y• North Andover Board of Assessors Public Access # gSSACHUS�t Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors. Location: 35 ROCKY BROOK ROAD Owner Name: THE DIANA R. RICCIO TRUST Owner Address: 35 ROCKY BROOK ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 8 - 8 Land Area: 2.77 acres. Use Code: 101-SNGL-FAM-RES Total Finished Area: 3032 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 694,900 643,300 Building Value: 441,800 399,900 Land Value: 253,100 243,400 Market Land Value: 253,100 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2255612&amp;town=NandoverPubAcc 11/21/2013 Date ....� �..� �?�%............ ,Fee`.�..f1..Y........... Lic. No...... .. t / GASINSPECTOR Check #�' • W )Uv4l� /lass. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® BOND INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the setts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I 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 applicatLwill o nce with all Pertine vi ' f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.PLUMBER-GASFITTER NAME JOHN MARSHALL LICENSE # SIGNATURE MP El MGF ® JP ® JGF ® LPGI [j CORPORATION ®# PARTNERSHIP ®#® LLC ®# COMPANY NAME: EASTERN PROPANE GAS ADDRESS 131 WATER ST. CITY I DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 FAX CELL EMAIL f"yyv �- J S CITY I NORTH ANDOVER MA DATE I NOV. 25 2013 PERMIT # J013SITE ADDRESS 35 ROCKY BROOK RD. OWNER'S NAME DIANA RICCIO GOWNER ADDRESS DIANA RICCIO TE 978-258-2867 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIALLD PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: ® PLANS SUBMITTED: YES[] NO® APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER Ste" CONVERSION BURNER COOK STOVE o DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 _ GRILLE -' INFRARED HEATER LABORATORY COCKS �— MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER - - - t INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® BOND INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the setts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I 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 applicatLwill o nce with all Pertine vi ' f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.PLUMBER-GASFITTER NAME JOHN MARSHALL LICENSE # SIGNATURE MP El MGF ® JP ® JGF ® LPGI [j CORPORATION ®# PARTNERSHIP ®#® LLC ®# COMPANY NAME: EASTERN PROPANE GAS ADDRESS 131 WATER ST. CITY I DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 FAX CELL EMAIL f"yyv �- J S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Anpliea-nt=Inf r�n�tion — ---=-lease I in-t L . Name (Business/Organizationdhdividual): EASTERN PROPANE & OIL Address: 131 WATER STREET City/State/Zip: DANVERS, MA 01923Phone #: 978-750-6500 Type of project (required): 6. ❑ New construction 7.. 0 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑✓ Other GAS FITTING *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 -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 isproviding workers' compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: ENERGI Policy # or Self-ins..Lic. #: EWGCD000080613 Expiration Date: Job Site Address: City/State/Zip: 03/15/2014 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 herebv certify under the pains and penalties of perjury that the information provided above is true and. correct. 978-750-6500 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 #: Are.you an employer? Check the appropriate bob: 1.0✓ I am a employer with 4.5 4. ❑ 1 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 mein any capacity. employees and have workers' [No workers'. comp. insurance comp. insurance.1 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' coma. insurance reouired.l Type of project (required): 6. ❑ New construction 7.. 0 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑✓ Other GAS FITTING *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 -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 isproviding workers' compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: ENERGI Policy # or Self-ins..Lic. #: EWGCD000080613 Expiration Date: Job Site Address: City/State/Zip: 03/15/2014 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 herebv certify under the pains and penalties of perjury that the information provided above is true and. correct. 978-750-6500 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 #: 1-1 s 77t MF mwggkd - Huge - t �.� MWNWEALTH PLUMBERS AND GASFITI TERS ,-LICENSED AS AN -LP G=AS 1M.STALLER ISSUES THE ABOVE LICENSE TO: JOHN S COOMBS 1"41 BRIDGE S T �8 E Vt RE y MA ''01915-2t '3064 05/01/14 `1525,5+4* Location ��S t�c�L �`�uJ G No' � ?14 Date a.. SSACHUSEt 1 w �v 4� 12801 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $• �U Foundation Permit Fee $ Other PermitFee $ Sewer Connection Fee $ Water Connection Fee $ TQTAL $ 757 C Building Inspector Div. Public Works Location Date TOWN OF NORTH ANDOVER oA �? Certificate of Occupancy $ C)C)6"e; ,o� Building/Frame Permit Fee $��' • , �' °'•••�''<� cMusE Foundation Permit Fee $ j Other Permit Fee $ d Sewer Connection Fee $ a Water Connection Fee $ > TOTAL $, , �J /Building Inspector r i1 Div. Public Works 4 tet" D FA t m 'Lr N w i� Z A 0 m w G T. Y G u• v. 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Date ' TOWN OF NORTH ANDOVEFE pa o Certificate of Occupancy $ .,s Building/Frame Permit Fee $ Foundation Permit Fee $ C Other Permit Fee $ Sewer Connection Fee $ " A,(gq Water Connection Fee $ l TOTAL $ ze-o c��yzG 9193 u d' g Ins a or Div, ubiic orks Location' No. 6 Go Date t . s " t,,I*,.o .. TOWN OF NORTH ANDOVER o<,'bp 37 � a pL �. •% Building Inspector i ? 10 6 SDy/ /97 08:54 1,029.00 PAID Div. Public Works A-wimfiWilp Certificate of Occupancy $ + s Building/Frame Permit Fee $ �'T3 14 SES Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ •% Building Inspector i ? 10 6 SDy/ /97 08:54 1,029.00 PAID Div. Public Works PER31IT NO APPLICATION FOR PERMIT TO, BUILD - NORTH ANDOVER, MASS. V PAGE 1 MAr� dVO. �l/1� V LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE a SUB DIV. LOT NO.I LOCATION C.' PURPOSE OF BUILDING,ell `` CJNn r OWNER'S NAME / NO. OF STORIES SIZE V OWNER'S ADDRESS r�y. C ) I BASEMENT OR SLAB ARCHITECT'S NAME '^ ill•_ SIZE OF FLOOR TIMBERS/ IST 11� 2ND t, 3RD ,. BUILDER'S NAMEC A _ �. k e -el -Aly SPAN DIMENSIONS /OF SILLS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET J '" POSTS DISTANCE FROM LOT LINES - SIDES ' /% REAR y- GIRDERS ✓ cz AREA OF LOTS FRONTAGE HEIGHT OF FOUNDATION �y THICKNESS A IS BUILDING NEW ''//Y -S i SIZE OF FOOTING '�',p % X IS BUILDING ADDITION4n^ MATERIAL OF CHIMNEY IS BUILDING ALTERATION n /b IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE %' l IS BUILDING CONNECTED TO TOWN WATER j/ S BOARD OF APPEALS ACTION. IF ANY A'I• "I, IS BUILDING CONNECTED TO TOWN SEWER �/ IS BUILDING CONNECTED TO NATURAL GAS LINE /y INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS i - 12 - ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BErFILED AND APPROVED BY BUILDING INSPECTOR DATE FILED - I,Y� lk o, / . / 61'� / SIGNATURE OF OWNER OR AUTHORIZED AGENT i`er,_ • im PERMIT GRANTED y 19 m om PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQOr. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY NUILDING INSPECTOR OWNER TEL.# CONTR. TEL. # � CONTR. LIC. #��9 J- H.I.C. # I OCCUPANCY JGLE FAMILY STORIES ATI. FAMILYOFFII (-FS CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH )NCRETE x�l t )NCRETE BL'K. --II PINF I—d II2 I UNFIN 3 BASEMENT AREA FULL N. B'M'T' AREA _ Y. 1/2 1/1 FIN. ATTIC AREA NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDV,'D }FI_ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON WkASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORPOOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD - TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER i BUILD*ING RECORD 12 .� l` THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. \ �+ �•'i� VWAMMAMP, 30m nm , 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE,j3�''� FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS B'M'T_Q 2nd _ is1�I 3rd I I GAS OIL ELECTRIC NO HEATING NO HEATING a CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 4 � G Date ZZ - THIS CERTIFIES THAT THE BUILDING LOCATED ON 6 MAY BE OCCUPIED AS / y IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO .. �. G c p ADDRESS i r 2 y CA CD d d 'v O C CDO 'O 06 d C C CL y CD CD O CL c� =r �•C CD CD o CD C CD y� —' CD CL v y -• O 4 CD I F v H O 'CD Z O CD C CD c w -PIC g d _ O -�NOQ H Om O m n H O a n m m 01 o CL 0CL y CD U2 �� o o O N� !09 W O m M C =r== v n O a 0 A r 1 O /�^ O O y 1�y �^ C Q m V V' H 3 J O d N Q yY O co N V J p �1 <\CD y CA ate+. m O 2 � Ul JJ o rn �0 T Q=r � Z om n .. . m v s �' ►-� Cn �c N 0 C c G : c. b o :v c o. o � : 0 co 7d 6 0. c O o� O a o 0 c O O n ).:r-,. o 0 0 C g v v , 7C I 0" O :8 Ip' 4" Vr �% e FORM U - VERIFICATION 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***************** APPLICANT: Phone LOCATION: Assessor's Map Number 0 9 0 Parcel " 0, l Subdivision Street Lot (s) St. Number ************************O icial Use -Only************************ RECOMMEN TIONS O AGENTS: ✓ _ Date Approved Conservation. Admin' rator Date Rejected Comments /1�V-A rQ p Date A pproved f f Town Planner Date Rejected II Comments Food Inspector -Health r > Septic Inspector -Health Comments Date Approved Date Rejected Date Approved_ h Date Rejected Public Works --s•awe-rywater connections - drivewpermit ;7w, Fire. Department %,GTd/L.�—'�.itg . ✓-Z3'�7 Received by Building Inspector Date 'CI Cp C � �■ d CA CM) 10 A CD Z t=ip CD oCD CZ. = y NN A O v CD CD O CZ c .9 CD CD o CD C CD t/� CL C y �CD CDo CA A CD Z o CD 0 C CD O Q O 2 O Nl e O cr fA S m .O ti c=a a0 0 Oco CL C2 m Z �= CL 0 =r CL..► O �O O O p H fA � 'O O m 0 - : a > > N O an O O a p co on r a CL 0.m G*)� `o O�� V/ 1 0 0 . n 1�1 d N z -V/.�CV•i C4, d L Q C c co = C/)C .c a cob CCD O ' ^ b �. C H 1 1 �CO3 c cli �z y C! co, oC co on E ° o 0i �E M v y 0 0 c 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. Name of Applicant on Building Permit (below) Address of Property for Permit below) Ma and Parcel': Purpose ppf�Application (check below) Phone Number of Applicant: X Single Family _ Two Family _G S 6 n '9V 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 is 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 exls ence 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 information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Sig ature f Owner 6r Authorived AgeFntAuthorize who signed the Attached Building Permit / ate This form must be attached to the Building Permit upon application for such permit. WbAUHUSE n S UNIFORM APPUCATION FOR PERMIT TO OU F't_UNttilrU IPfinl or Type) NORTH ANDOVER, Mast. Data 71 '??f — Building Permit�7cf`Gf Location GO / 7 - Ae). -7? 06 /fes �3l�00� /IO Owner's Name New lrl� Renovation p Replacement p Plans Submitted: Yes p No. ❑ FIXTURES Check one: Certificate Instilling Company Name /24 411-5 7`%¢ A1- a 117'C ® Corp. Address_ __4/ % //?CHWOO/a y1a ❑ Partnership Tr' S /3 U -,7, Y Al11 Firm/Co. IWO-ess Telephone 95-/ VG 5�-a .. NNoma of ,. Licensed .Piutnoer _ . _G,,E'U t3,/�;,�, . /��} �j vim= T7f=.. ..� •.._...... _.._.� _...rc.....__ .. ..� .. "..w ...,... .. I have a current liability Insurance policy or its substantial equWenL Yes Qom_ No p If you have checked y". please Indicate thwlype coverage by checking the appropriate box A Itabllly Insurance policy 5,- . Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee 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. Check one: Owner p Agent p signstuts o et a Owner s en I Mreby certify that all of the delalls and Information I have submitted W entered) In above application are true and accurate to the best of my knowtedpe and that al umbinq work and Inslaflatlons performed under the pefmit Issued for this applcatlon wil be in oomplance with all pertinent provisions of the Massachusetts State Pknnbfnq Code and Chapter 142 of the Garmai laws. B This ChylTown APffr O (OFFICE USE ONLY) ice. .rLiftL� License Nurrtlier / 5 41, O Type of Ptumbing License: Master ❑ Journeyman �f MEMO on Check one: Certificate Instilling Company Name /24 411-5 7`%¢ A1- a 117'C ® Corp. Address_ __4/ % //?CHWOO/a y1a ❑ Partnership Tr' S /3 U -,7, Y Al11 Firm/Co. IWO-ess Telephone 95-/ VG 5�-a .. NNoma of ,. Licensed .Piutnoer _ . _G,,E'U t3,/�;,�, . /��} �j vim= T7f=.. ..� •.._...... _.._.� _...rc.....__ .. ..� .. "..w ...,... .. I have a current liability Insurance policy or its substantial equWenL Yes Qom_ No p If you have checked y". please Indicate thwlype coverage by checking the appropriate box A Itabllly Insurance policy 5,- . Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee 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. Check one: Owner p Agent p signstuts o et a Owner s en I Mreby certify that all of the delalls and Information I have submitted W entered) In above application are true and accurate to the best of my knowtedpe and that al umbinq work and Inslaflatlons performed under the pefmit Issued for this applcatlon wil be in oomplance with all pertinent provisions of the Massachusetts State Pknnbfnq Code and Chapter 142 of the Garmai laws. B This ChylTown APffr O (OFFICE USE ONLY) ice. .rLiftL� License Nurrtlier / 5 41, O Type of Ptumbing License: Master ❑ Journeyman �f ... ��'�.=r../ - �..:4�+�.r^'�i+•�5.—v_�s,w.a.:..i xW�,�V�.-.rays,.-tip.:.. a�.w�.��„ ,..,�---.vt.. 2984 Of ,NOR7M q O0 1- F ,SSwCHUS Date .���l.' �!. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform .f........:`.......... plumbing in the buildings ofa. x ..... at. 6-7. foe -Ay,.. 13P.(.(vi........kNorth Ando Mass. 0 Fee38-/." .. Lic. No../ ). U .7 NSPECTOR WHITE: Applicant CANARY:. Building Dept. PINK: Treasurer GOLD: File 1Ptlnt a Type) U, NORTH ANDOVER, . Maas. Oate _I- Budding.Permit 33j -e Location//d, .3 5 /?OGlt V /1/�ealr A3 , .t��3o v Owner's Name 0z;61//g61 IT h6lll'b3 New ®--- Renovation p Replacement p Plans Submitted: Yes[] No. ❑ �iXTUAE$ •-• i MEN NUNN _ _ Check one: Certificate Installing Company Name AV, 6'1,5-7'7F— p Corp. Address ❑ Partnership fiE tyx el ' f3 vA 4 ❑ Firm/Co. Business Telephone Name of Ucensed Plumber INSURANCE COVERAGE: ChecX one 1 have a current Ilabllty Insurance policy or No substantial equivalent. Yes E3-- No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy QY 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 Mass. General LAws, and that my signature on this permit application waives this requirement. Check one: Signature of Ownu of owner's 4ent Owner p Agent p I hereby certify that all of the detalU and Information i have submitted for enteredl In above appRcatlon we trw and accurate to the belt of my It nowledge and that a1 plumbing wwk and Installations performed under the p rmil Issued for this appacation wit be in cotnp8anc$ with aN pedinen provisions of the Masuchusetts Slate Plumbing Code and Chapter 1jZ d tM General laws. By ThN gFgn&tLxo Cttyff own APPI'"IED (OFFICE USE ONLY) lkense Number / LSD Type of Plumbing Lkanse: Master ❑ Journeyman ©� 3-358 Date .C�/. . 9f.7... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4 This certifies that . P11. ................. has permission to perform .. A). e- .. P. .. , _ _ .... . plumbing in the buildings of at ..3J .&r.A/,1m iVA ....A/. /� , North Andover, Mass. Fee4 �' . + 7 . Lic. No../Y.`/` ``4` 2 .............................. PLUMBING INSPECTOR Ef 3 3 Ofi/03/97 14:29 260. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer � G! �- Date.. /.......... . 3558 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION A s 1 This certifies that ...................__.. ................... has permission for gas installation".. • • • in the buildings ofuJyy��` .�..��........................ . at . . !`�/;, �?.' . , North h Andover, Mass. Feer.. Lic. N . f a j ... t yG'a X-� ...... . C� G�3 ~GAS INS41 C�QR WHITE: Applicant CANARY: Building Dept. PINK/: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) . ,MA Date. 1, °�1 10,&WReceipt# Permilt# Building Location 5 )_ K u� rcbK OwneesName t ' h �' ld-- �` KF__U'-' Map: Lot: Zone: Type of Occupancy `1� �c c&Y) CC G New Renovation 0 Replacement O Plans, Submitted: Yes 0^ No O Installing Company Name 1`AS6-rn Rome Qo-nl= C►95 , ir1C Checkone: Certificate Address is I l r -D anysr-a YY► v4 0 i � 3 3 - ' CK . Corporation EstimateValueofWork: ❑ Partnership Business Telephone I- T00 - 3 �L a. - Co (e ❑ Firm / Co. Name of Licensed Plumber or Gas Fitter IT -66t"1 CT. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9 No ❑ If you have checked Xes please indicate the type coverage by checking the appropriate box. A liability insurance policy 511' Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I 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. Checkone: Owner ❑ Agent ❑ Signature of owner or Owner's Agent I hereby certify that all of the details and information 1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theVnlLaw' By Type of License: - Plumber. Signature of nsed Plu r or Gas Fi " Title Gasfitter n a G Master License Number / 7 City /Town Journeyman APPROVED (OFFICE USE ONLY) Illllllllllllllllll��illllll MEN Installing Company Name 1`AS6-rn Rome Qo-nl= C►95 , ir1C Checkone: Certificate Address is I l r -D anysr-a YY► v4 0 i � 3 3 - ' CK . Corporation EstimateValueofWork: ❑ Partnership Business Telephone I- T00 - 3 �L a. - Co (e ❑ Firm / Co. Name of Licensed Plumber or Gas Fitter IT -66t"1 CT. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9 No ❑ If you have checked Xes please indicate the type coverage by checking the appropriate box. A liability insurance policy 511' Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I 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. Checkone: Owner ❑ Agent ❑ Signature of owner or Owner's Agent I hereby certify that all of the details and information 1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theVnlLaw' By Type of License: - Plumber. Signature of nsed Plu r or Gas Fi " Title Gasfitter n a G Master License Number / 7 City /Town Journeyman APPROVED (OFFICE USE ONLY) µu Z a � I N 9 - Z N - 7C m -1 A m w _ a m C O Z 3. D m a a I '++ m -�•; �, ems T � N _C O 2 11 m p 0 a 0 0. 0 s �" ce _ N r Ti J � k l a '4 The Commonwealth of Massachusetts Department of Public Safcty occup"c) S Ire Cheered BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 7/90 e ked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance with the Maeeachusetu Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INF•ORHATION) Date 1,0224-97 City or Town of /V0e2W H,0,6 To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) 3S /RaCky 23,206 WoAD 0-ner or Tenant ozee ( WqL <ee Owner's Address SAME (978J 487- 47LY Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undgrd n NO. of Meters _ flew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Tot ,Al No. of Lighting Fixtures Swimming Pool AboveIn- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners , Batteof r Emergency Lighting UniNo. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. ofSelfContained Detection/ding Devices Local Municipal 171 ❑ Other Connection No. of Ranges g Total No. of Air Cond. tons No. of DisposalsNo. of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, ofNo. of 114W Ballasts Wir Voltag No. Hydro Massage Tubs No. of Motors Total HP VIREK: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S Work to Start //-/O - 97 Inspection Date Requested: Rough Expiration Date Final //-/S' 97 Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY-SVSTFMS NORTHEAST INC. LIC. No. 1231C Licensee DONALD A BROOKS Signat e N0 1231C Address 60 William Street, Wellesley; 8 s• el. No.413-732-4400 Alt. Tel. No. UI /-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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. PERMIT FEE S ,{Soo Signature of Owner or Agent X42 1256 yORTM pt t�ao ,e �ti0 0 A - ,SgACMUSE� Date......... �� TOWN OF NORTH ANDOVER PERMIT FOR WIRING _a This certifies that T— has permission to perform �t ��� SSP ........................................................................... wiring in the building of ......C�.:..� f �G / �7 �" .............................................................. at ......15............UC......y. 4,11/Uu%...... ............ . North Andover, Mass. Fees: ... Lic.No...J�C................. ELEC...................................... RICAL INSPECTOR pa`t+ .. C i`f�f WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (� Office Use Only u4E (�QIlitliunwentO of Masgar4uun,6 . Permit No. %(�? Ilepartmrnt of public %fttq Occupancy & Fee Checked (y BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3M0 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date J 2 7 4Gjjr or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) i�Z0/9) 3 �C a�L Pa�12 Owner or Tenant Cil A/0V/Z /^ 6U :j Owner's Address Address STE�/Fi✓�Ta2E Is this permit in conjunction with,, ��a building permit: Yes 0 No ❑ (C(ion Appropriate Box) Purpose of 'Building ffG� Utility Authorizao. 7ci� �'BdExisting Service ��`'Amps _ t Volts Overhead C1UndgrndNo. of Meters /� New Service L Amps / /240 Volts Overhead ❑ Undgrnd ify No. of Meters . L. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No: ,of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- grnd. F-1grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets. No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges g No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals Na.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑ Other ❑ Connection No. of Dryers I. Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Complet� Operations Coverage or its substantial equivalent. YES Ivo I have submitted valid proof of same to the Office. YES y NO = If you have checked YES, please indicate the type of coverage by checking the appro to box. INSURANCE , .tte. OTHER. = (Please Specify) (EX aton Date) Estimated Value of Iectri al Work $ J Work ,tp Start Inspection Date Requested: Rough / Final Signed under the Penalties of perjury: FIRM NAME C LIC. NO. Licensee G Signature Z20 A ,�1 V Bus. TelNo(7` 2' / ro-i 1 Address `�F// 1,-,7-1 �W 7-`V�S��T 4 Ql ,� AIL Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ' Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-6565 Date...—...�. 4 967 NORT/{ '{ TOWN OF NORTH ANDOVER .�? e° a ... . •° OL 0 PERMIT FOR WIRING �,SSACMUSE� . -W 4. This certifies that .. .. . ...................h.W��.... ........................:...... has permission to perform .... r......... V ........... ....... wiring'wiringA*n the building of ..,�,}.../PO4. a .... 101140-7< �:.. at. ��'-L ..r.. ,NorthAndover, Mass. Fere;t l.Vg �CTRICALINSPIEC'AOR Al- � r WRITE: Applicant CANARY: BuTding Dept. PINK: Treasurer 4 "A 3427 Date./).. :. GU .... . TOWN OF NORTH ANDOVER PERMIT. FOR GAS INSTALLATION This certifies that....( .�r......... . has permission for gas installation ........... in the buildings of .. i,&AI........................... . at .. �.�..<...�. `r!..�? ` j't�.... ,North Andover, Mass. �` Fee. ?. �..:.. Lic. No... ' .>.: .. ..... .!:::. ::..... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Renovation ❑ Replacement ❑ Submitted: Yes ❑ No ❑ Installing'Company-Name EASTERN PROPANE & OIL, INC. Address 131 WATER ST DANVERS MA 01923 X EstimateValueof Work:. ❑ Business Telephone 800-322-6628 \ i (3Name of Licensed Plumber orGasFitter GeAC s z �AAV Checkone: Certificate Corporation Partnership Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked /des, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner C3 Agent❑ Signature of Owner or Owners 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 underthe pe sued for this appli�n will in mp i with of all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 , r L By Type of License: Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter �� Master License Number City /Town RJoumeyman APPROVED (OFFICE USE ONLY) Revised 05/17/00 V m x m A 2 m cn m m m Vo V V r a O z r O m v z m a c O v O A a co m z a x m A 2 m cn � &M • ■■ No nd lu lb /I v r AP An I /. 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