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Miscellaneous - 387 MASSACHUSETTS AVENUE 4/30/2018
w N_ C-40 Op_ � A � � D �D = o c O C.0 (o m,- o -+ C) cn o � o M, z m',' .0 't 91 b9 Date.. TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING This certifies that .Il ')- ! ...�5 ('��'"! .�.'� ... Q:t.� ..... has permission to perform . ... 4e'!! T—e-- `........... . plumbing in the buildings of .. !L �e '!'!t.".4p MX at 3�S...... P". ....... North Andover, Mass. uf OS4 Fee3. Lic. No.. .. .............................. PLUMBING INSPECTOR Check # I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town.- -0; MA. Date: Permit# Building Location: 3 �,,�s �2 k(j� Owners Name: t .e L/x Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential (� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [fi plans Submitted: Yes ❑ No ❑ FIXTURES �-: qE01 Address:_ S S—f City/Town:'h �orpa'ationBusiness Tel: - `7 Partnership �III Fax: S o7-0+ r - eirm/Company Name of Licensed Plumber: rS'v l% I�Icr�oW, %,uVtKAbE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ®- No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. 2r Other type of indemnity ❑ Bond ❑ - OWNER'S INSURANCE WAIVER: I am aware that the licensee does. not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that mysignature on this permit application waives this requirement. Check One Only >i nature of Owner or Owners A ent Owner ❑ Agent ❑ 1Know hereby certify That ail of the details and information I have submitted (or entered) regarding this application are true and , a Pertinent edge and that all plumbing �; er k and instalfatior,s Performed under the permit issued for this application will be in compliance with all provision of the Massachusetts State Plumbing Code and Chapter Pe of the sued for Laws. A ate to thebast of my ral r' Type of License: :le 91MV lumber y/Town aster 'PROVED (OFFICE USE ONLY) I ❑.lourneyman of Lice ed Plumber License Number: �'I � I � DEDICATED H z SYSTEMS 1u � Z titz d. W N J U I.N. W ❑ in QrY Ct] N a W V7 F W F¢-• N w N z ❑ N Q � Ln W d � x Q ❑ x OU Q Z w a ❑ 0 I ❑ W z N¢w y - (7 Z c H ¢ 3nm W a c "a¢ w wLL Uj dx OIw 'SUB BSMT. m onO lu 0 o U WN°4¢LLI iy BASEMENT ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5T" FLOOR 6T" FLOOR 7T" FLOOR 8' FLOOR �-: qE01 Address:_ S S—f City/Town:'h �orpa'ationBusiness Tel: - `7 Partnership �III Fax: S o7-0+ r - eirm/Company Name of Licensed Plumber: rS'v l% I�Icr�oW, %,uVtKAbE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ®- No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. 2r Other type of indemnity ❑ Bond ❑ - OWNER'S INSURANCE WAIVER: I am aware that the licensee does. not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that mysignature on this permit application waives this requirement. Check One Only >i nature of Owner or Owners A ent Owner ❑ Agent ❑ 1Know hereby certify That ail of the details and information I have submitted (or entered) regarding this application are true and , a Pertinent edge and that all plumbing �; er k and instalfatior,s Performed under the permit issued for this application will be in compliance with all provision of the Massachusetts State Plumbing Code and Chapter Pe of the sued for Laws. A ate to thebast of my ral r' Type of License: :le 91MV lumber y/Town aster 'PROVED (OFFICE USE ONLY) I ❑.lourneyman of Lice ed Plumber License Number: �'I � I The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Invesfigations 600 Washington Street SY � Boston, MA 02111 www.massgoy/ciia 1pllCari$ rtlfnrm aiinn Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: -City/State/zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed 6. ❑ New construction partner ship and have no employees on the attached sheet. t These sub -contractors have 7. El Remodeling g, 0 Demolition working for me in any capacity. [No workers' comp, insurance workers' comp, insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL 10 El Electrical repairs or additions 11.❑ Plumbing repairs or additions Myself [No workers' comp. - insurance required.] t c. 152, §1(4), and we have no em Io ees. p Y [No workers 12 ❑ Roofrepairs comp, insurance re wired ] 13.0 Other *An applicant q y pp scant that checks box#1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. Iam an employer that isproviding workers' compensation insurancefor my employees Below is tlaepolicy and job site information, Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: -Tab 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 uhder Section 25A ofMGL c.152 can lead to the imposition of criminalpenalties 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. De advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. do Hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. v��ccrac use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License m T.ssuing.Authority (circle one): Y. Board of Health 2. Building Department 3. City/To 6. Other wn Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Date .. �./4- .. /! ......... V TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. r `.: ".. `.....J !...1'. .. ....4� .� has permission for gas installation ...L`'' ... r.- e o -r -k-- in the buildings of ......`'! ..'..... A at .337 .... � 4.s 5 ...... �,/ North Andover, Mass. Fee.Lic. No.. FV 3. GASINSPECTOR Check # It 30 i ! , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:_ MA. Date:_ Jl �i �� � Permit# Building Location: ��'. Owners Name, I P (,l Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential B New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 9-- Plans Submitted: Yes ❑ No F1 FIXTURES co Z W Y Q co CO V WN m= 0O W W L) (n 1�. a5 W W W g M O W WtoV Z rn O w a ~W c~i Q W W w Z v� = W I�iZWWOJHHOZJ0 W W xW m W O Z 0 (0 HZ_ o a° °�LU>>> o SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 61H FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing /Company Name: /� a� l S, *44 ^Z",Zs /%x.14 Check One Only Certificate # Address: !°� 6 -�^ f ty d ©�rporation Ci /Town:_N� '^State: �-�-: Business Tel:f 7 Fax: rs/-dZZ C El Partnership Name of Licensed Plumber/Gas Fitter: ❑ Firm/Company INSURANCE COVERAGE: .i I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes H'06`0 El If you have checked Yes, please indicate the type of coverage by checkingtheappropriate ppropriate box below. A liability insurance policy Er' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ By checking this box ❑; I hereby certify that all of the details and informatio�have submitted (or entered) regarding thisapcation are true andaccurate to the best of my Knowledge and that all plumbing work and installrtormed under the permitssuedforthis application will be inompliance with altPenentprovision ofthe Massachusetts State Plumbingd Chapter 142 of the General Laws. By Type of License: L lumber Title ❑ Gas Fitter D -blister City/Town OJourneyman APPROVED (OFFICE USE ONLY) I ❑ LP Installer Signature of Licensed License Number: a Q 1.1 e—, L`�-�d � � Location j`'�'�'�``� ' No. �� Date MORT� TOWN OF NORTH ANDOVER p Certificate of Occupancy $ # Building/Frame Permit Fee $ Foundation Permit Fee $ s^CMUSE i9— Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ u TOTAL $ `'3 Building Inspe6f r ! JO6`7 Div. Public Works M C z LW A z z � C C — C U U = z C^ ¢ � 4 C z �e ;c < F G -;c Z � ' w z z L C Q,C i ,cCi Z C c U C < U c Q C G Ci z 0 U -� 444 ¢ f V ` � z C G V Iz — _ C z LW A z z � C C — C U U = r Town of North Andover NORTH OFFICE OF °� "`° '^tio COMMUNITY DEVELOPMENT AND SERVICES ° ..� °b 27 Charles Street North Andover, Massachusetts 01545 '� °°q,• ° °"`�5 WILLIAM J. SCOTT 9S SAC Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MCL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined_ by MCL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE Demolition permit from the Town of North Andover must be obtained for this project throng -h the Office of the Building Inspector N BOARD OP-3PEALS 688-9541 BUILDING 683-9545 CONSERVATION 683-9530 HEALTH 688-9540 PLANNING 688-9535 4' F �`_... � ;/iie �omvneonu�ea�l� o�✓�<+aaruiu�aedb. ;i HOME IMPROVEMENT CONTRACTOR - Registration 104569 Type - PRIVATE CORPORATION t; Expiration_ 07/14/00.. r ' DAVID CASTRICONE ROOFING, SID,: David T. Castricone illside Road'' AL. :iSTRATOR Boxford MA 01921 t '•�,�'� 4� 4,{h h h Cr V� YhS hah . ' ki1:+� Y k•' l 'v t { t♦ l t V� YhS hah . 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