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Miscellaneous - 41 MIFFLIN DRIVE 4/30/2018
`_.__-�41 MIFFLIN DRIVE X0000.0 210102-_ _ _�_�� � Date... !A!........................ NORTH OFA,..° '•,ti0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 83�cHus� ' This certifies that `:..}1........., /�-, ..rJ.. �..�.................:........................................ _.. has permission for gds installation .�....... :r: "y:��. ......... in the buildings of,} r . ( � rr'..� a �. ...at.....: ........1'1:�.!. : L ..r�.. . ......... North Andover, Mass. Fee.irL?... ..... Lic. No.o...... . ....... !....!., ..................................................... GAS INSPECTOR Check#�I ��GU l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — CITY North Andover MA DATE 4/1/2014 PERMIT# JOBSITE ADDRESS 41 Mifflin Rd j I �� OWNER'S NAME GOWNERADDRESS Same TEL[-- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL® RESIDENTIALD PRINT CLEARLY NEW:Q RENOVATION:Q REPLACEMENT:Q PLANS SUBMITTED: YESQ NOQ APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -� BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I _-- ---- DRYER - --- -_ -_ - -, _ FIREPLACE FRYOLATOR FURNACEj _ _ GENERATOR GRILLE INFRARED HEATER -m LABORATORY COCKS MAKEUP AIR UNIT j OVEN ; POOL HEATER E { ROOM/SPACE HEATER RQOF TOP UNIT TEST u 1 UNIT HEATER UNVENTED ROOM HEATER 3 x 3 WATER HEATER _ OTHER Replace Gas Mete R -- and Piping as Needed I INSURANCE COVERAGE 1.have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE INDEMNITY Q 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: 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 application will bjin o pliance with all Pertinent provisionMassachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME Joseph Marino LICENSE# 8736 ATURE MP Q MGF® JP Q JGF® LPGI® CORPORATION Q# 3285C PARSHIP❑# LLC❑#0 COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIP 01501 TEL 1(508)832-3295 FAX 508-926-4347 CELL 508-832-4614 JEMAIL JMarino@RHWhite.com >I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES , Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 2 G i . :co � ETH OF MASS - ` PLUNJBERS AND C�ASFIT`1' .RS::.== _ i - AG.MS•ED AS"A.Mr,STER R,E f5SUE5 T- f'--A66VE'LIG6NSE • - - - - -- -=_:,' MAR.I N 0 AR.R,INGT0N ST -'�WIIRG'E`'STER MA 01" '. 3L09=`' ' 05/01/14 2 -. 6b32T; :G34OlM_JNWEALT � OF MASSA ::. `€ LUNtBERS AND GA5FI7TERS:,:. ' ' _";•_ :=i Lf"CEIV`SE'D AS A JQII.RNEYAk-AN`';.PI.---N1� 1 - = =�5$UES THE ABOVL LICENSE :MARINO' `FAF2R1=NG fQN ST == ' _ >••y�pR G,�;sT�R �. i�A 0 1�'`�.4"=37:-'C1=9`'= '. _ - }} 05/01/14 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 ACVRD DATE(MM/DbNM) CERTIFICATE OF LIABILITY INSURANCE Page 1 oQ j 08/29/2013 TRIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)murt be endorsed. If SU13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certif late does not confer rights to the Certificate holder in lieu of such endorsement(s), PRODUCER CONTACT 9villiq of Maeanchu Otte, Inc. PHONE c/o 26 eQx,tusy sive. _No_F�- 877-! 45-7378 PAX'No): 888-467-2378 P. 0. Box 305191E-MAIL N&Mhville, TN 37230-5191 DARF$,S_ a extificate�(�willia.Gom INSURER(S)AFFORDING COVERAGE NAIOP INSURED INSURERA: The ChAxtOr Oak size ineurano9 Company 25615-001 R. H. White Construction Company, Inc. INSURERS:Travo7,g;e Property Caeualty Company og Am-T5674-001 41 Central Street INSURERC:NAti0AAl Union Piro Ineuranao Company of 19445-001 P. 0. Box 257 Auburn, MA 01501 INSURERD;Travelera Indamaity Company 25659-D01 INSURER F; INSURF,R F; COVERAGES CERTIFICATE NUMBER!20287680 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INr)ICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DO SUB p POLICY EFF POLICY EXP OLICY NUMBER LIMITS A GENERAL LIABILITY VTC20Co 977X9948-13 9/1/2013 9/1/2014 EACH OCCURRENCE h 2,000,000 X COMMERCIAL GENERALUABIL17Y pqM TORENTFD PRE $.(Eeoceu,nncrS _ 300,000 CLAIMS-MADE OCCUR MED EXP(Any one arson $ 10 J 000 PERSONAL&ADV INJURY $ -2,001) 000 GF_NERALAGGREGATE $ 4_,_Q00,000 GEN'LAGGREGATELIRITTAPPLIESPER; PRODUCTS-COMP/OPAGO $ &00,000 POLICY-FiLOC B AUTOMOBILE LIABILITY VT,TCAP 977K955A-13 9/1/2013 9/1/2014 �acNN $ ED $ 2,000,000 X ANY AUTO ALI,OWNED SCHEDULEDBODILY INJURY(Perperson) $ AUTO$ AUTOS BODILY INJURY(Peraccident) ;R X HIREDAUTOS X NON-OWNED AUTOS ersccldenl $ X Co Defl X Coll Ded $ C UMBRELLA LIAB 7C OCCUR BE8766140 9/1/2013 9/1/2014 EACHOCCURRENCF. $ 5'_o 0 0 0 0 a EXCESSLIAe CLAIMS-MAGE AGGREGATE $ $ 000,000 DED I $ IRETENTIONS 10,0 0 S D WORKERS COMPENSATION VTRKUB 8205A16S-13 9/1/2013 9/1/2014 X O - AND EMPLOYERS'LIABILITY YYY��INNN TAr{Y LI 13 ANY PROPRIETORIPARTNFRIEXECUTIVE N N(A VTC2KUB A208A71A-13 9/1/2013 9/1/2014 E.L.FACHACCIDENT -S 1, )OO OQO OFFICERr/YMEMBER EXCLUDED? IMyyeetldeadtlboundar E.L.DIBEASE-EA EMPLOYEE $ 1,000,000 UEtSUKll+1IUNUFOftRATIONSbelow G.L,DISEASE•POLICYLIMIT S 1,000,000 DESCRIPTION OF OPERATIONS(LOCATIONS/VEWICLES(Agach Acord 901,Addltonpl Remarke 3chodvin,Imam speeo Is raqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EvxdAnce of Inmuxance AUTHORIZED REPREaENTATIVE C*11:4197604 xp1:1694012 Cert:20287680 ®1988-2010ACORD CORPORATION.All rights reserved. AGORD 25(2010105) The ACORD name and logo are registered marks of ACORD TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �B�cHuss This certifies that ................................................................... has permission for gy installation in the buildings of at..�JA......I................................c................r.... ..........., North Andover, Mass. Feel ;.. ...... Lic. No. ........ ............ ..................................................................... GASINSPECTOR Check# r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover I MA DATE 3/2412014 DPERMIT# JOBSITE ADDRESS - f V1 i �i1�_ &12- OWNER'S NAME GOWNER ADDRESS I Same I TEQ FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL© RESIDENTIALE] PRINT CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOQ APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE - ...-... -177 IL --_� DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR -...-. .-.. FURNACE GENERATOR GRILLE INFRARED HEATER -- --- - -- --- --------- LABORATORY COCKS MAKEUP AIR UNITE OVEN _ �E77 ;F. POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _1 _ T ST UNIT HEATER - - - -- -- - -- - - -- + ---. UNVENTED ROOM HEATER WATER HEATER ; ^1 OTHER --- --- ---- -- __ —r _ Replace .Gas Meter and Pipin as Needed s 1 A INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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: 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 applicatqbepliance with all ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.PLUMBER-GASFITTER NAME Joseph Marino LICENSE# NATURMP❑ MGF❑ JP® JGF❑ LPGI® CORPORATION[j# 3285C IP❑#0 LLCE3# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508)832-3295 FAX 508-926-4347 JCELLI 508-832-4614 !EMAILI JMarino@RHWhite.com E ZI ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 _ =:C1JNjtIO`NWEAL.TH OF MASSAG.HtI `'f F!LUBERS 'ANDGASFfT75:=._ LfC SED ASA-W STER PL.T ',=ISSUES TH6`A i6VE'LICENSE v. =-�3:•-�FA�R_R;ING7-QN S7 Cls/01/i4 � �6(J��=T:•V: GOitIiM0NWEALTH OF MAS SA PLUMBERS AND GASFI7TRS ' : :i' ENSE'D AS A JOU.RNEYNFIN;:f?Lt1_If :' ''"ISSUES THE ABOVL'LICENSE -- :::.' :M-AR INQ FARRT=NGTON D5/01/14 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 ACCORD CERTIFICATE RTI F I CATE DATE(MMIDDNyyyl � —. OF LIABILITYINSURANCEpag� 1 of � 0e,29/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willia OL Massachueette, Inc. PHONE C/o 26 OX 3051tury 731vA. No.Qaj: 877-945-7376 F�No�. 8B8-4�7-2379 P. o. Hoye 305191 DDRE cextifiaatJ �willia.com Nntghville, TN 37230-5191 -- INSURER(S)AFFORDING COVERAGE NAIOtr INSURED INSURERA: The Charter Oak Tiro Insurance Company 25615-001 R. H. White Construction Company, Ino. INSURERS:Trnva7,gCS property Casualty Comlipany of Am-25674-061I 41 Central Street INSURER C:Natfondl Union Firs Inouranca Company o£ 79445-001 P. 0. Box 257 Auburn, MA 01501. INSURERD;TravelerB Indemnity Company 25658-D01 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:202e7680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 16-SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYpE OP INSURANCE DD' SUB POLICY EFF POLICY EXP POLICY NUMBER LIMITS A GENERAL LIABILITY VTC2000 977X9948-13 9/1/2013 9/1/2014 EACH OCCURRENCE fi_ 2,000,Q00 X COMMERCIAL GENERAL LIABII.ITY p M rr�� TORENTF,O PE '88(Esocewnnc�) 300_000 CLAIMS-MADE OCCUR MED EXP(Any one person). $ 1p,000 PERSONAL&ADV INJURY $ 2 000,000 GFNERALRGGREGATE QQO 000 GEN'LAGGREGATF $ 4,LIMITAPPLIESPER; PRODUCTS-COMP/OPAGG Is ]000 000 IrTPOLICY PRO LOC AUTOMOBILE LIABILITY $ >9 vx3CAP 977K955A-13 9/1/2013 9/1/2014 oag�reosINGLI:IrMIr nt) $ a,000,000 X ANYAUTO AILOWNED SCHEDULED INJURY(Perimmon) $ AUT08 AUT08 BODILY INJURY(Peraccldent) % HIREDAUTOS X NON-OWNED AUTOS eraccldent $ X Cv Defl X Coll Ded $ 0500 C UMBRELLA LIAS OCCUR 836766140 9/1/2013 9/1/2014: EACH OCCURRENCE $ 5 000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ S,000,000 DED X RETENTIONS 10,000 S D WOREMPLOY RS'LI AILIT V7;RRUB 8205A185-13 9/1/2013 9/1/2014 X 0 - AND EMPLOYER8'LIABILITY Y/N TARY,I,I 11 ANY PROPRIETORIPARTNER/FXECUTIVEn NIA VTC2RUB A203A71A-13 9/3,/2013 9/1/2014 E.L.FACHACCIDENT s 1,000 000 OFFICER/MEMBEREXCLUDED7 NI (Myyend well NN) E.L.DISEASE-EAEMPLOYP_E s 1,000,000 UE5 Kill I IUN uF UPFRATIONS below F,L,DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AtImII Acord 101,Addltonpl Remarks Schedule,If more eD eeo la roqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Evidence of InmuZance Col1:4197604 Tpl:1694012 Cert.-20287680 ®1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Date./ZAA . .. .... .. TM Of TOWN OF NORTH ANDOVER ` PERMIT FOR GAS INSTALLATION : . � a ,SSACN0 P7 USEt t This certifies that . . . . . . . .S1- U� . . . . . has permission for gas installation . �``. . . . . . . . . . . . . . . . . . in theb//uildings ,J o Si r e J� at . .yf. . No. h A Ao s., Fee.-;k. . . . Lic. No.. /3t??. . . . . GAS INSPECTOR Check# 7D5t, J J MASSACHUSErISUNIFORMAPPUCATONFORPERMf 'TODOGASFrr] NG (Type or print) Date -' NORTH ANDOVER,MASSACHUSETTS Building Locations 141 M 1 PC 11* &j �`�J�- Permit# Amount$ Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ � a V\� z 0 N O O a O W F wc� x � w H 292 G zC4 z o W w 0 a° > a Oo A 0 Ua n1 SUB -BASEM ENT ` BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR STH . FLOOR 6TH. FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Cjlimk one: Certificate Installing Company Name SA1f*A&E Pio S H'R1 Corp. Address .r—u►Qox �q SA12rw. N N 03019 ❑ Partner. Business aep one _AoQ —1 i so PkFirm/co. Name of licensed Plumber or Gas Fitter 6Aj qU SA V A(TC— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy MOther type of indemnity 13Bond ❑ 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 Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass s S e as C aShapter 142 of the General Laws. By Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber M ( '344 D'? City/Town Gas FittericenL� seem er Master APPROVED(OFFICE USE ONLY) Journeyman Date.....�.I-. .2?—.../...I..... .... .. ....... ,40RTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING US This certifies that ........141.1- Pt 4) 7� 5,�gz .................................. ........................................ has permission to perform ......... Av... wiring in the building of.......... ....................... at...... ..v........................... . And M S. : No..I�X�X-�............... . i�;� ........ . Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 12 -7 - 1 i City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ( ►N\�.-��[�'� Ro+ 1 Owner or Tenant os int � �� Telephone No. 9 Z rL, - i.b7 . J(D / Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building �!nmllr- Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd [J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: � �� Completion of the ollowing table may be waived by the Inspector o Wires. 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- E:] o.of Emergency Lighting 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Npmber Tons KWNo.of Self-Contained Totals: 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 Signs Ballasts 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: '7 C>U b ' (When required by municipal policy.) Work to Start: 1 2- �c- 11 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 ,1 BOND ❑ OTHER ❑ (Specify:) I certify,under the pins andpenalties of perjury,that the information on this application is true and complete. I A u FIRM NAME: nt �� -fir,Ls- St*'t1i z�, ct.,..0 LIC.NO.: 4/5�'2 Licensee: Signaturey LIC.NO.: A t S'�trj (If applicable, ent exempt:'in the license number line.) Bus.Tel.No.: U37 -431-4q66 Address: rf '*-r-�,i1Z SkrtLj-- , KAk Q)ISO S Alt.Tel.No.: Gbx-- 2-33- '7ISY *Per M.G.L c. 147,s. 57-61, security work requires Department of Public Safety"S"License: Lic.No. A 1SC,21 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 Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents 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): C,_ u.g,,� Address: City/State/Zip: 03--79 Phone #: (a-c3- q52— - Are employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7. E] Remodeling , ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *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 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. CC Insurance Company Name: f'tSbnc Policy#or Self-ins.Lic.#: WCC.5��� �tG'� t,1 ZoZ`( Expiration Date: — 12-- t Job Site Address: 14� KI Vk fA_ Nf om-- 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 ce I under te pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: 12-1?^ l Phone#: C9-2,— Ct 2 — 1-4�;_(.6 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#: Date A)...Vi=i.......?......... NORTH °���``°;•�"� TOWN OF NORTH ANDOVER f A PERMIT FOR WIRING ACHU 10 This certifies that ...............................:..........:........ ...................................... has permission to perform ......... . ................ ... ... .......G........ ..f.............. wiring in the building of.................. <.............................................................. at........................... .......................... North Andover,Mass. Fee.....�............. Lic.No. ......: ......... .+.... .... ... ELECTRICAL INSPECTOR ' Check # -�� N Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. /.If(� Occupancy and Fee Checked C;b 47 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( LLO 5 7 R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4� City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives noticeof i or her int tion to perform the electrical work described below. Location(Street&Nu ber), Owner or Tenant Telephone No. �CL Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters b Number of Feeders and Ampacity Location and Nature of Propos lectrical Work: OW Completion ofthefollowing table inay be waived by the Inspector of Wires. 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- ❑ o.of Emergency Lighting 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 Initiating Devices No.of Ranges No.of Air Cond. Total Tons g o.o No. Alerting Devices I. No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: 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 WaterKWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent A OTHER: :1 �Q Attach additional detail if desired,or cis requij ed by the Inspector of,"Vires. Estimated Value of E ectric 1 Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C6*ERAIA 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 co rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t sins an penalties of p ry,t at the information on this application is true and complete. FIRM NAM em into IfLIC.NO.: 9 .13 Licensee: ignatur LIr NO.: (If applicable nter "xem t"int a/icen unsber/ ) s us.Te.No.: Address: Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Depa tment 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: $ Signature Telephone No. • Date,lG�/. NORTq 3?�.<� •°;.,1�ao� TOWN OF NORTH ANDOVER IN PERMIT FOR F,6MBING ,SSACNUS� This certifies that .�. .. .�..�. .. . . . . . . . . . has permission to perform . . . . tP.� . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . S .�T. t (1} at. .�./. 1.�.t�. . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee.3 �. �.. . .Lic. No../k...7.Z.). . . . . . .P, .L-.� .-a. . . . . . . . . PLUMBING INSECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ' City/Town: (!Y i/ ,MA. Date: Permit# W0 Building Location: Owners Name: jos;i°. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Pians Submitted: Yes ❑ No ❑ FIXTURES z z o Y U W N Q N U) = H W rn NW N rnaQ Z DZ ZoEF- N WW a RO m I— Z Z W zo V M Q Y = 3 0 0 3 = z a LL 3 a Y a = W W W u� Z N H H Q Q y ° a o t O z ° a a a a a m CO O 0 LL 0 r Y � � � fn rn I— X 3 3 3.10 SUB BSMT. BASEMENT 1 FLOOR --i'FLOOR ' 3 FLOOR 4 FLOOR --5'FLOOR 6 TH FLOOR 7 FLOOR 8 FLOOR Installing Company Name: m6rrIMael< Check One Only Certificate# !�G//�G/ [,Corporation Address:v2o �� City/Town: Z140A State: Ted 20-- � ❑Partnership Business Tel: -- /o dD� O� Fax: 971949,2-1470 ❑Firm/Company Name of Licensed Plumber: �/ r INSURANCE COVERAGE: I have a current liability,insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 2-1�0❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's 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 application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of he Gen er Laws. By Type of License: Title Q"Plumber Signature of Lied Plumber` City/Town Gnse Number: /aster Lice APPROVED OFFICE USE ONLY []Journeyman FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED❑ DATE: PLUMBING 1NSPECTIOR Date. NORTH pf ,�.0 1ti0 TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION s io s s a _ ,SSAGNUSE� ` i This certifies that . . ��!�. �.i'.'./fir!?.'�. .(,�1. .��,�' l has permission for gas installation . t �� . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .W.l. . 1'r.�.r�f.�' h . . `? !. . . . . . . . .�1 North Andover, Mass. Fee. . .?P .. Lic. No. `.'.7 '. . �., L! .- �r!1. . . . . . . . . iGASINSPECTOR Check# e� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: N Date: Permit# to 7 ti Building Locatic Owners Name: f Type of Occupancy: Commercial Educational Industrial Institutional Residential X New: Alteration: Renovation: Replacement: X Plans Submitted: Yes No. FIXTURES W W Y vi D WW 0 fn = fn W y M 2 1-- W V to F- fL' F- W 2 W 0 E N Z :3 W CO L m 0 a a W a x w Q = U a LL W I- Y Q W W W Z 9a to = w R- w o a UJ > W W Z O J H H O Z —! (� t+- f„ Z H H F- _ O Q W W m > 0 Z O W Z W 0 0 0 1- 0so c� _ = g0a > > 30 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 RD FLOOR 4 FLOOR 6TH FLOOR 6 Tm FLOOR 7 FLOOR 8 FLOOR ,//.. / 1 .. Check One Only Certificate# Installing Company Name: C'�'1'i/'J'lr� � l/l/lac _ Q� r X7� 0/ Corporation Address: �� n �r,. %/ City/Town:�X � n State: MA Partnership Business Tel:. 7 '9:.D f Fax: 7 ,� �-3�7U Firm/Company Name of Licensed Plumber/Gas Fitter: 1e QrW - AaA-r� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes , Na, If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking this box ;1 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 application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. pe of License: By, Plum4er �, Gas Fitter Title Signature of Lice Plumber/Gas Fitter Master Cityrrown Journeyman License Number: APPROVED OFFICE USE ONLY LP Installer ` FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER,GASFITTER.LP INSTALLER LICENSE NUMBER: PERMIT GRANTED❑ DATE: GAS FITTING INSPECTIOR Location 7/ r Y t ffil k) _��� No. Date g`� O NORT1y TOWN OF NORTH ANDOVER 3 O 10. R • s }�o Certificate of Occupancy $ Building/Frame Permit Fee $ �CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /(J Building Inspector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLIH A ONE OR TWO FAMILY DWELLING 'lis fbr- ' -- .-1 krn BUILDING PERMIT NUMBER: DATE ISSUED: r ic SIGNATURE: ic Building Commissioner/12yfor of Buildin Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 41 ;tom.; 1�1�i'w� D At,to- 2-13 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2. ner of Record f ame Print) J, Address for Service: I Signature r Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1 �C a67 Licensed Cosnstructton Supervisor: O ^/ ft tR 1 o> e44 n License Number Address /1,11 B-0--ote IMP. rotjfgae-ke— "11 14/ `� C ff ✓ ; expiration Date Signatu Te ephone r 64 o - -< 12JWtered Home mprovement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r Z Expiration Date G) Signature Telephone Y� SECTION 4-WORKERS COMPENSATION(NLG.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.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 11Addition [I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by pennit'applicant 1. Building (a) Building Permit'Fee Multiplier 2 Electrical & (b) Estimated Total Cost of 'Construction 3 Plumbing Building Permit fee(,a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number Q/ofj SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING 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 pen-nil application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name • Signature of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 ST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I d�'IGHT OF FOUNDATION THICKNESS SVE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND [S BUILDING CONNECTED TO NATURAL GAS LINE �rze�omvnwouuea� ��� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 136105 Board of Building Regulations and Standards Expiration:,6/10/04 One Ashburton Place Rm 1301 Type.. DBA Boston,Ma.02108 DIMITRIOS GENERAL CONTRACT BUTRIOS KARAGIORGOS 91 HIGH ST. "- LAWRENCE,MA 01841 Administrator Not valid without signature ���� Q ' North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number_ is that the debris resulting from this work shall be disposed o in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: LAA (Location of Facility) Sign ture of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Dimitrios General -Contracting 91 High Street Lawrence,MA 01841 1 (603)433-9948 11978)685-7573 MA Contractor Registration ID; 134145 July 27, 2002 Proposal To: For work to be performed at: Ms. Stella Sams 41 Mifllimrive North Andover,.MA (978)683-9104 We hereby propose to furnish.materials and labor for the completion for the following.work, Specifications Roof will be stripped Roof will be prepared with 3 feet of ice water seal on eves and valleys. 15 pound fillpaper will be applied, 30 year Architectural shingles will be installed. 8"aluminum white dripedge will be installed, Roof ridge vent will be installed. Contractor will dispose of all debris, If chimney's flashing needs to be replaced it will cost an extra$100 that is not included in.this contract. Customer is responsible for protecting any items in the attic from fallen dust and debris as roof is stripped, Cost of all materials and labor is $9,000. 25%upon signed contract. 25%is due upon startinSproject, Balance is,due upon completion of the work, Dimitrios General Contracting 91 High Street Lawrence,MA 01841 1 (603)433-9968 1(978).685-7573 All material is_gualanteed to be as spe-Cified, All workmanship is guaranteed to be for a period of one (1)year from date of completion. All work areas.are to be kept-clean by contractor, All insurances are to be carried by contractor. Respectfully Submitted, Dimitrios Karagiorgos Acceptance of Proposal The above prices, specifications,and conditions are satisfactory and are accepted. Dimitrios General Contracting is authorized to,do work as specified. Payment termsare accepted and will be made as outlined above. Signature Date Z RAe Signature Date. NORTH Town of over No. ~ _ y —Z O T C%O -LA o - dover, Mass., s COCHICMEWICK ORATED 1 F ` BOARD OF HEALTH PERMI. T .T D Food/Kitchen Septic System 6 BUILDING INSPECTOR THIS CERTIFIES THAT....... !v���.�►.............. 1".... ...... . .. ........................................................................ Foundation has permission to erect......5*6 ....A...:.. buildings on ..... ...... . � 0) L 4V P9.... Rough ................RV /' 1to be occupied asChimney ....0 � ��� ....................................................................... ....... ............................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws elating to the Insp ction, Alteration and Construction of Buildings in the Town of North Andover. Z / IV �m' �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids is Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.