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Home My WebLink AboutMiscellaneous - 366 FOREST STREET 4/30/2018 (3)N O O D 0 0 0 0 0 0 b l t 0662 Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Vo* This certifies that .......... ...... eqC412.D.1 ....... 7X.4 ...... has permission to perform ... . ........................................................ wiring in 14e building of ................ y ..................................................... at ..................................... ...... :� ............. A., North Andover, Mass. Fee .3K.r—.. Lic. No...��9 ....... . . LEcrRIC INSPL Check # U 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 forin. 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 of ongoing construction activity, and may be_deemed_by-the.Inspector-of_Wires abandoned-and-invalid-if-he--- or she has determined that the authorized work has not commenced or has not progressed during the precedii-1Z 12-onnth period. Capon 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. u7Ie —Permit/Date Closed: —1 --� ** Note: Reapply for new per ❑ Permit Extension Act — Permit/Date Closed: Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �. Occupancy and Fee Checked k BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave 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 PRINTININK OR TYPE ALL INFORMATION) Date: o !, City or Town of: NORTH ANDOVER To the Inspector of Wi s: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) _3 r cO /�g f -C S 577' - Owner or Tenant Owner's Address .h Oct ire— Telephone No. Is this permit in conjunction with abuildi�ng permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ;n � 4? /"Ah'! Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: fj C AU� 2 -& Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminairesy No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In -No. nd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets j No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches g No. of Gas Burners No..of Detection and InitiatingDevices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pum Totals Number Tons ......... KW ...................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers rY Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts . Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under theains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: CG �^t/ Li /cC�s; 'L LIC. NO.: U�� I Licensee: (-2_-(_e ?yC C,i•C,/ LIC. NO.: 9,0 j X0 A (If applicable, enter "exempt " in the license number line.) Bus. Tel. No.: P/372 Address: �/ (,iPr S7farV !� �,�v-S n-,� d Alt: Tel. No.• Vy- 740/ *Per M.G.L c. 147, s. 57-61, security work requires Department of Public 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. $ The Commonwealth of Massachusetts Department of Industrial Accidents t- Office of Investigations 600 Washington Street Boston, MA 02111 {' www mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: y �i'CYSI�/1^e City/State/Zip: 50c:, CIS. M19 Phone Are you an employer? Checkthe appropriate box: l �dm a employer with 3 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ I am.a.sole proprietor or have hired the sub -contractors listed # partner- on the attached sheet. ship and have no employees These su&contractors have working for me .in any capacity, workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a. corporation and its required.] 3. ❑ I din a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No•workers' comp. c. 1.52, § 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. C1 Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑.Other -rr•• - ••• •aa. -"Ab uua at L must IUso nu out the section below showing their workers' bompensation 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 their workers' comp. policy infnrmahon. lam an employer that is providing=:workers' compensation insurance for n y employees. Below information. is lite policy and job site , Insurance Company Name: 'O%7 fier—C Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: s t a /0- /Y S 7� S City/State/Zip: /7 /9�►t/�'K.�C/'-'� 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 cerci y under the pains andpenalties ofperjury that lite information provided above is true and correct. Official use only. Do not write %n this area, to he conrleted by city or town official City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other, Contact Person: Phone #: i t 27 Date. ?14RIA .. . ��- TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSA�NUS� This certifies that has permission to perform ..%..�/yi� J�.- .............. plumbing in the building of at.. ,��..rrcl.. s orth Andover, Mass. Fee.� 5. U Lic. No. �..... . PLU2INGAI�PECTOR Check # l Z i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:r'J Q —� MA. Date: Permit# lZ Building Location:2�aL&eS) , 071 Owners Name: 2 n Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential 1❑, New: glteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES c� DEDICATED LU z SYSTEMS w ti W Z V 9z En Ln En ❑ Z n w z QU F w ❑ ❑ tC z cn z d Q w C7 z W Q m vzi tr oac F in �F W Q I y 2i p z O d d W ❑ py F d y ❑ Ln o w w z H c7 u n. � V I- N y f- V Q LL aN d Z w w di O to 0 O 1- O > 00 O z z N 1- F = I d Q ti 'SUB BSMT. O Q3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4' FLOOR ST" FLOOR e FLOOR 7T" FLOOR 8TH FLOOR Address: D goo S i:lt Business Tel:•&- At 0A Name of Plumber: 1'l1A1,r/ INSURANCE COVFRnr�• L Stater Fax: c4 c on3.1:11ti• c.. . ❑ Corporation ❑ Partnership olpf-rmlCompany 1 have a current Iiabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes N If you have checked Yes, please indicate the -type of coverage by checkingthe ❑ o A liability insurance policy. [ Other t ppropriate box below. type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does` not the insurance coverage required b Ch Massachusetts General Laws, and that my signature on this permit application waives this requirement. y Chapter 142 of the >i nature of Owner or Owner's A ent Check One Only Owner ❑ Agent ❑ :-11 hereby certify that all of the details and information I have submitted (or entred) regarding Phis application are true and Knowledge and that all p!!�mbing h se and installations performed under the' permit issued for this application will he in compliance with al Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gen i Laws. a......rafe to the be; I r Type of License: .le L mber 'y/Town ster 'PROVED (OFFICE USE ONLY) rneyman Signature of Licensed Plumber License Number: my r 10 The Commonwealth ofMassachusetts Department of IndustrialAccidents Office of Investigations, 600 Washington Street Boston, MA 02111 'www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers )Dlicant TnfnrMnf;n„ Name .Y' C /k, e, Address._ / J 6 � Jl` City/State/Zip: 14hf9) C -I' Phone #: Are you an employer? Check the appropriate box: . 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Aployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner listed on the attached sheget z ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp, insurance required ] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demblition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ 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' I compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Iam an employer that isPro viding workers' compensation insurance for information_ my employees. Below is the nolicv and inh .v;iP Insurance Company Policy # or Self -ins. i,ic. 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 G. 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 it' 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. Ido hereby cer 0y er the 'ns and p aloes ofperjury that the information provided above is true and correct. Si nature: �j ff r/ Date: ` L Ili ?hone #: 0 '6 � � Official use only. City or Town: 1)o not Write in this area, to be completed by city or town official Permit/License ., Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electric Inspector 5, Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a j oint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the .commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of - insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,; please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used 2s a referenc6 number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been'officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for f rture permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: `Ahe Cor onweWth- of .l'y%assae'ausetts Department of Xndustniall .Accidents Office of Investigations 600 Washington Stoet Boston} MSA. 0211 X TO. # 61.7-7274900 ext 406 oar 1-877 MASSAFE Revised 5-26-05 Fax # 617-727-7-7-49 www.mass.gov0a. IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. A r A Date....... .-5;2z- TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1 This certifies that .t ...................................................... has permission to perform ..... -!-........................................ wiring in the building of at 1�. ........ . .....>. y .:.............. , North Andover, Mass. Feea—`.............. Lic. Nw N5' .....:....t�'``.i ................................ ELECTRICAL I2SPE R Check # �o 74"1 1 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (M C), 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5 9 D —7 City or Town of. NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his orherintentio to perform the electrical work described below. Location (Street & Number) 3(P 6�� 7 Owner or Tenant Lq ure n Q Cv Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building --z�k t1S(0 V -Cl q—, 1y- kJCk/10- `I1 nq Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps Number of Feeders and Ampacity No. of Meters Volts Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: 1�ouz -�- Sh }1 ©yvl Completion of the following table may be waived by the Inspector of Wires. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 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 Swimming Pool Above ❑In- El rnd. rnd. o mergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. S 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 ea p Totals: Number Tons KW ,.., . No. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Co Municipal n ❑ Other Co No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent 7— No. No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: -1 co (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under t e pains and pena76 tie of per ury, that the information on this application is true and complete. `� FIRM NAME: C!�C� � 6(7 LIC. NO.: OAO Ido14 Licensee: V - -, C lL P i cc w Signature LIC. NO.: 3yOc -i - (If applicable, enter " xempt" tl))e��license n,(�mber line.) Bus. Tel. No. a3- /, 7% Address: ( C (� Ldo � E 0 zc V 5US Alt. Tel. No.: I Ulc/'i 760 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public 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 PERMIT FEE. $ SignatureturaTelephone No. � 16 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ��,Cc s i Address: f �-1 �1-z p: Sausu S `��23Y- /- 13t17 1__� Ci /State/Zi V�'� (� Phone #: Are you an employer? Check the appropriate box: 1. PS I am a employer with S 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ?. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL 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. F1 Electrical repairs or additions I l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �G Policy # or Self -ins. Lic. #: Job Site Address: 3 Go `Ow -5-t s�t Expiration Date: City/State/Zip: 12 fine ver /yl fi 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 ce i y rder the pains and penalties of perjury that the information provided above is true and correct �. Phone #: ?V1 __ oZ. 3 /- 1-3 77 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 11 Contact Person: Phone #: 11 MAY -29-2007 03:48 PM LARRY OGDEN 978 352 2858 P.01 LAWRENCE H. OGDEN, A.E. 198 EAST .MAIN STREET GEORGETOWN, MA 01833 978-3528318 fax 978 —352-2858 pager 978-502-5921 May 29, 2007 Mr. Kevin Murphy 169 Boxford Street North Andover MA. 01845 RE: Residence Ms. Lauren Day,`366 Forest St, North Andover, MA. 01845 Dear Mr. Murphy Per your request i visited the above site to review the LVL Beans consisting of 2- 1.75"*9.25" LVLs supporting the first floor, span 9 feet and the LVL Ridge beam consisting of 2 —1.75 "* 18" I.,VI,,s, spanning 18 feet, and LVLs supporting the ridge beam. I have reviewed the design of these LVL beams used in the structure and can certify that the beams are acceptable and meet the loading conditions required by the Massachusetts State Building Code. Should you have any questions please do not hesitate to call. Yours truly, Lawrence 14.Ogden, P.B. Structural 27765 v � � 2 6 ��70NAL E�G� AV 1W Date.. 5-1- d 3 -e 9 ............................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. \�T has permission to perform ........ ........... wiring in the building of ............... D61Y ...................................................... at ............... 3 .... 6 ... C ........ /-'�4 S,7 .. ... 07 ....................... North Andover, Mass. Fee .��.4�7070'7.. Lic. NoMdm ................ 4-'c // " ............ X116 ... ... . . ..... -12 ;t3 ELIE&RICAL INSPECTOR IV Check # 4 Commonwealth of Massachusetts Official Use On) r Department of Fire Services Permit No, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rei, 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with :he Massachusetts Dectrical (:'ode (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALL jINFORMATION) Date: J`r/� oz City or Town of: - '�ei�—� To the Inspector oJ•Wires.- By this application the undersigni gives notice of his or her intention to perform file electrical Workdescribed below. Location (Street & Ntttnber)��,.� Owner or Tenant 1( Telephone No. Owner's Address � Is this permit in conjunction w' h a building permit?1'es ED]Nn (Cirecl(Appropriate Box} Purpose of Building C-, 5 dell e e- Utility Autltorization No. Existing Service Amps Vohs Overhead Ej [Jndgrd ❑ No. of Meters New Service Acnps / Volts Overbead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location apq Nature of Proposed Electrical W tic: No. of Recessed Fixtures _ (orrr.rlet"ton qf the follom table may be waived by the Inspector• No. of Ceil.-Susp. (Paddle) Fans No. oTotal No. of Lighting Outlets No. of Hot Tubs Transformers )SVA, Generators KVA No. of Lighting Fixtures S�Mfta r A rove ❑ In -n. � o t mergencY tg t tug No. of Receptacle Outlets t r'nd• No, of ( 1 Burners Batte Units FIRE ALARMS No. of Zones No. of Switches .vers o. of election and No. of Ranges No. of r• Cont . Total Tons Initiating Devices �No. of Alerting Devices No. of Waste Disposers If eat Pum cr Tons No.otfC111 -10 ninedo No. of Dishwashers A Space/Area Heatitrg ICW Detection/Alerting Devices Local ❑ 'u"""Pai Connection El Other No. of Dryers heating AppliancesI(W SCCUf7ty Systems: 114U. oftwater Heaters K W' No of 1\n. of No. of Devices or Equivalent Si ns Ballasts Data Wiring: No. Hydromassage Bathtubs No. of Motors Tota_ --i Ip No. of Devices or E, u Teiecomt jtioits Wir itgleut OTHER: — -- -- No. of Devices Or E uivalent S rrqjf,-- INSURANCE COVERAGE: Unless waived by the ox�ner, no permit tfor the performancerOf eleed, Or ctrical work may tissue unless the licensee provides proof of liability insurance including "completed opet•ate pc coverage or its substantial equivalent, The undersigned certifies that such coves to force, and has exhibited proof of same to the permit issuing office. CHECI< ONE,: INSURANCE EV BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work:(Expiration Date) c4�� _ Wien required by municipal policy,) Work to Start: %OA Inspections to be requested in accordance with ML•C Rule 10, and upon completion. Icc>t7ify, antler dtepains andperialties ofpet.Jur��, that the ittform�ui0 on thi,c app/icntinii is true and complete. FiRM NAME: P C of Licensee: LIC. NO.:–.tj7 Wapplicable, et .er' "exe»apr "" I'll lrce�rse n ir��t: li j Signature Address: NO.: ,Address: q t Sus. Tel. No.: Z'� 7M OV1'NER'S I SURANCE WAIVER: 1 am aware that the Lic(nsee Anes rant lxrte the liabilityiAi'sutAel, overage normally required bylaw. 13y my'stgt,ature below. 1 hereby waive this requirerjjent. I am the (deck ane) ❑ owner Owner/Agent Signature Telephone 1:1 owlrer's a renTelephone No. PERMIT FEE: $ i Location ��' •�"/ No. J 7 Date NORTH TOWN OF NORTH ANDOVER . 0 .. D Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ Ac.11% 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ , - Check # Building Inspecf6r 1.1 Property Address: - 2.1 Owner of Record Name (Print) 1.2 Assessors Map and Parcel Map Number Number: 0 0 3 Parcel NumTber �I YV 1.3 Zoning Information:✓ Zoning District Proposed Use Address for Service: 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft SECTION 3 - CONSTRUCTION SERVICES Front Yard 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Side Yard Rear Yard Required Provide R red Provided Re red EProvided Not Applicable ❑ �. Registra�on Number 3 6 1 d Expiration Date 1.7 Water Supply M.G.L.C.40.t.54) ` - 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 CL`l�TiAXT q AD A71TTTll ��i wrn>n nrrfw.. 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ —.. I J-111 z. - I ii— k -K JL 1 v - Pq zria dr/Au i num ,E D AGENT - 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor E& 5—kck�e— Zw- 1p �,-V Not Applicable ❑ Company me ZLlo -PA C- kc— Registra�on Number 3 6 1 d Expiration Date Ad ess ' 1Q3/-6 Signature Telephone 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 permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction 0 Existing Building ❑ Repair(s) (] Alterations(s) ❑ Addition 0 Accessory Bldg. 04 r Demlition ; 0 OtherSpecify x." w f Z ` �N Brief Description of Proposed Work: I SECTION 6 - FSTTMATIM VONCTRUCTION COCTc I Item Estimated Cost (Dollar) to be Completed b ermit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (8) X (b) o 1#26 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 % O0 I Check Number J14G 11U1v is UW LNBK AU 1HUK1GAIIUr4 TU BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; in all matters relative to work authorized by this building pennit application. —Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION t, I V VVVI &-V 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 of Owner/ Vs 0f Dat NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION i THICKNESS SIZE OF FOOTING X MATERIAL OF CIMANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4 0 — _ 4 � I s IMPROVEMENT. CONTRACTOR ration: 03/31/2002 �pe Private, Corporatio - Sen Mahoney �o dAiNf�S T . at MiNISTP-TOWO READING, MA 41864 Town of North Andover NoRrh st ° Building Department -a'� '_ �o ''�o y.. , 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax. (978) 688-9542 , SSACHU5�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit-# the debris resulting fr of in a properly licensed som the work shall.be disposed olid waste disposal facility as defined by MGL cIl, s150a. The debris will be disposed of in /at: O �= ere, Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for ts project through the Office of the Building Inspector. his AY STATE RoOFING, INC. 978-664-0668 1 -888 -479 -ROOF Fax:978-276-0888 Mailing Address: P.O. Box 324 No. Reading, MA 01864 June 25, 2001 Lauren Day 366 Forest St. No. Andover, MA 01845 RE: New shingle roof Business Address: 240 Park Street No. Reading, MA 01864 Bay State Roofing, Inc., proposes to furnish all material, labor and equipment necessary to perform the following scope of work: 1. Remove approximately 2,000 sq. ft. of the existing asphalt shingle roof down to the wood decking. 2. Install new ice and water shield along the 3' roof edge and in all the roof valleys. 3. Install new 15 lb. felt paper throughout the roof area. 4. Install new white aluminum drip edge along the roof perimeter. 5. A new GAF 25 year architectural asphalt shingle roof will be installed over the prepared substrate. ( pev> � q aul 1 6. All roof penetrations and flashing will be installed according to the manufacturers recommended specifications 1 and details. 7. Remove the existing stove pipe from the roof area. 8. Bay State Roofing, Inc. will properly dispose of all roof debris in our own waste containers. NOTE: Any wood decking that needs replacement will be an additional $2.00 per sq. ft. Any facia boards that need replacement will be an additional $3.00 per 11 Total price for this work: $ 4,975.00 This price is final. No coupons or other discounts will be applied to this price. Payment Schedule Stock: $1,658.00 Completion: $ 3,317.00 4' So Authorized Signature: Waste containers supplied by Bay State Roofing, Inc. are for the sole purpose of roof debris. Under no cuannstance is the homeowner to use these contamers for nersomAl refuse CONTRACT ACCEPTANCE The specifications, prices, payment schedule and attached Date: conditions are satisfactory and hereby accepted. BAY STATE ROOFING, INC. is authorized to perform work Signature: ' as specified. Payment will be made as previously outlined. NOTE: Unpaid bills over 30 days are subject to i ll rlo finance charge per month (189/6 annual) Title: PROVISIONS OF THE AGREEMENT I. PROJECT PROVISIONS e. Damage to Project: Contractor will not be responsible for any a. Guideline: The Project will be constructed in strict conformance damage caused by the Owner, or other causes beyond the control of to the plans and specifications which have been .examined and the Contractor. Owner will pay for any restoration work. approved by the Owner. IV. CONTRACTOR'S RIGHTS AND RESPONSIBILITIES b. Compliance: The Project will be completed in strict compliance with all laws, ordinances, rules and regulations of the applicable government authorities. c. Control: The Agreement plans and specifications ale intended to supplement each other. In case of conflict, the plans will control the speciijcations and the Agreement provisions will control both. d. Charge Orders: As directed by the Owner, construction lender, public body or inspector, any alteration or deviation from the specifications that involves extra cost (subcontract, labor, materials) will be executed only upon the parties entering into a written change order. Expense incurred because of unusual or unanticipated conditions will be paid for by the Owner. e. Allowances: If the Agreement price includes allowances, and the cost of performing the work is greater or less than this allowance, then the Agreement price will be adjusted accordingly. II. FINANCIAL RIGHTS AND RESPONSIBILITIES a. Labor and Material: Contractor will provide and pay for all labor and materials necessary to complete the Project. Contractor is released from this obligation for expenses incurred when the Owner is in arrears in making progress payments. b. Permits: Contractor will obtain and pay for all required building permits and licenses. c. Taxes, Assessments and Charges: Taxes, special assessments of all descriptions, and charges required by public bodies and utilities will be paid for by the Owner. d. Deposit of Payments: Contractor is required to deposit all payments received prior to completion in an escrow account. In lieu of such a deposit, the Contractor may post a bond or contract of indemnity with the Owner guaranteeing the return or proper application of such payments to the purposes of the contract. All advanced funds will be deposited as indicated under Special Provisions. Monies used in escrow become the property of the Contractor when they are applied according to the Agreement payment schedule, when a breach of contract by the Owner occurs, or when the Agreement has been substantially performed. e. Bankruptcy: If either party becomes bankrupt, the other party has the right to cancel this Agreement. III. OWNER'S RIGHTS AND RESPONSIBILITIES a. Cancellation: Owner has an unconditional right to cancel the Agreement, without penalty or obligation, until midnight of the third business day after the Agreement was signed. Cancellation must be done in writing. Upon cancellation: any property traded in, any payments made under this Agreement, and any negotiated instrument executed will be returned within 10 business days following receipt by the Contractor of cancellation notice. b. Property Lines: Owner shall locate and point out property lines to the Contractor. Contractor may, at his option, require the Owner to provide a licensed land surveyor's map of the property. c. Liens: Failure to pay persons supplying materials or services according to the terms of this Agreement may result in the filing of mechanic's liens on the affected property. Owner has the right to ask the Contractor for lien waivers from all persons supplying these materials or services. In the event any mechanic's lien is filed through no fault of the Owner, then the Contractor agrees to take all steps necessary for the release and discharge of such lien. d. Insurance: Owner will maintain property damage insurance at least equal to the Agreement price. a. Delay: Contractor will be excused for any delay beyond his reasonable control. These delays may include, but are not limited to Acts of God, labor disputes, inclement weather, acts of public authority, acts of the Owner, or other unforeseen contingencies. b. Right to Stop Work: If any payment under this Agreement is not made when due, the Contractor may suspend work on the job until such time as all payments due have been made. Any failure to make payment is subject to a claim enforced against the property in accordance with the applicable lien laws. c. Substitution of Materials: Contractor may substitute materials without notice to the Owner in order to allow work to proceed, provided that the substituted materials are of no lesser quality than those listed in the specifications. d. Salvage: All salvage resulting from work under this Agreement is to be retained by the Contractor unless other agreements are contained in the written specifications. e. Insurance: Contractor will maintain workers' disability compensation insurance for his employees and comprehensive public liability insurance policies. V. COMPLETION OF PROJECT a. Notice: Owner agrees to sign a Notice of Completion within 5 days after completion of the project. If project passes final inspection and the Owner does not sign the Notice, the Contractor may act as the Owner's agent and sign the Notice. b. Clean-up: Contractor is responsible for removing debris and surplus material from the property, and leaving the property in a neat and orderly condition. VI. CONFLICT PROVISIONS a. Arbitration: Any controversy or claim arising out of this Agreement that cannot be resolved, is subject to arbitration, with an arbitrator of mutual agreement, and all parties (including Owner, Contractor, Architect and Sub -Contractors) are bound to this arbitration. If any party does not appear at arbitration proceedings, the arbitrator is empowered to decide the controversy in accordance with whatever evidence is presented by the party(ies) that do participate. b. Attorney Fees: If either party becomes involved in litigation arising out of Agreement, the Court shall award costs/expenses including attorney fees to the party justly entitled to them. c. Limitations: No action related to this Project may be made by either party against the other more than 2 years after the completion of work. VII. GENERAL PROVISIONS a. Notice: Any notice required or permitted under this Agreement may be given by certified or registered mail at the addresses contained in the Agreement. b. Prohibition of Assignment: Neither parry may assign this Agreement or payment due under this Agreement without the written consent of the other party. c. Qualification: This document constitutes the entire agreement of the parties. No other agreements exist. This Agreement can be modified only by written agreement signed by both parties. d. Governance: This Agreement shall be construed in accordance with and governed by, the laws of the state in which the Project is located. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print 5'— aI am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Address e Company..name: . Address i Citb; Phone..#: FaiN ret secure coverage as requiretl under'Seotion 25A or' MGL 152 can lead to the irhposition of criminal penall and/or one years' i`iipnsonment_i s_WO-as_cixil-penalties.in21e%rm of aSTQP:WDRK.DR, UFR. Wd_.afine_ofJ..$'JIl( understand that a copy of this statement may be forwardedto the office of Investigations of the DlAfor coverage v I do hereby ceitiCy under the pains and penalties of pedury that the information provided above is true and correct. Print use only do not write in this area to be co4leted by city or town City or Town Permit/Licensing 0 Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other D'4"•e r'•'rYOL NORTH ANDOVER BUILDING DEPARTMENT In -rep .'� 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: G 0'5 ADDRESS: 3u ( -a �l ' ZONING DISTRICT: l \ TYPE OF BUSINESS: lYeCJ('-t,I .V^' I S 0 —Ci'c'`` At, le_ BUILDING LAYOUT PROVIDED: AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO m BUILDING INSPECTOR SIGNATURE Revised 11.5.04 BUSMi FORM FOR TOWN CLERK u, C)-Aj C c r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential )( New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition •❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer &X; [ ffuze Su (2. L,_� 4L r104_0 Identification Please Type or Print Clearly) OWNER: Name: t_aC4r-i` 11 S--Lpfu-uaaI i, Address: 3L.Co rvYe V -94-. 1 04u l t q l'1_ 9'5 – O y T 3 CONTRACTOR Name: Ph e: Address: Supervisor's Construction License: Home Improvement License: Exp. Date: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ dro FEE: $ -3(— Check (— Check No.: _ ' Receipt No.: 2 co NOTE: Persons contractin with unregist red contractors do not have access to the guaranty fund Signature of Agent/Owner _ Signature of contractor CJ