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Home My WebLink AboutMiscellaneous - 42 WEST WOODBRIDGE ROAD 4/30/2018N ate...O......... NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �S�ICMUSE� R. This certifies that has permission for gas installation,�- in the buildingsof.:..?G , nom .................... . at. r..4�...t ' . , Nort _ dover, ass. Fee.s?:q?.. Lic. No...20- %... 1 S�. GAS .ort R Check # 7994 MASSACHUSETTS UNIFORMAPPLICATON FORPERMIT TO DO GAS +FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS L Building Locations A (,jrs-+ L-j0D J LAc_ Ra Permit # Amount $ New 1:1 Renovation Ey Owner's Name J Q .e Kq +Ci r Replacement ❑ Plans Submitted El (Print or type) I, : 1 Check one: Certificate Installing Company Name U( t G p1Uk% tin4 Ci rwg ^`1 Corp. Address 51 MC4d-6a'^ S Partner. A rh t S 6vr L►'1 ✓�- O 19 i w usmess e ep one -1.78- 375-- a Firm/Co � H a C z Cn a o U C7 '� `) F z x a O C4' W F W z F z d G w¢ m F a o x> F w H x w w F w x z z H H m z O z U w o 00 x w > w r w 3 A a ° °a > o F o m o x it. SU t3 -BA SEMEN T B A S E M E N T 1ST. FLOOR 2 N D. F L O O R 3 R D. F L O O R 4 T H F L O O R 5 T H F L O O R 6 T H. F L O O R 7 T H F L O OR 8 T H F L O O R (Print or type) I, : 1 Check one: Certificate Installing Company Name U( t G p1Uk% tin4 Ci rwg ^`1 Corp. Address 51 MC4d-6a'^ S Partner. A rh t S 6vr L►'1 ✓�- O 19 i usmess e ep one -1.78- 375-- a Firm/Co Name of Licensed Plumber or Gas Fitter --BIC )+ INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes � No� If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy M" Other type of indemnity El Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent ID I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. r By: Signature of Licensed Plumber Or Gas Fitter Title Plumber X334 % City/Town Gas Fitter License Number Master APPROVED (OFFICE USE ONLY) Journeyman ,J' 4 Date ...1.2' "— / /.... ° t"`° '• "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING .•'a 0. � ...... This certifies that ............................... ...... .... ....... ............... has permission to perform .......... �P Q. r`. .....y- ...... wiring in the building of .............. K,,/�../...Tno��......... .`.'...'.......................... at VZ ......%.hG��Qt ........................ . North Andover, Mass. Fee ��,O ^.. Lic. No.,)A?.S?w ........ . .. —................ ELEcTmMcAL I PE R Check # 10530 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. ®r Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 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: L�k— J I City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice o his or her intention to perform the I ctrical work described below. b Location (Street & Number) t{ (JJ eS A- JJ 000 b, 'A' a- �� Owner or Tenant , �a C�►� (� Telephone No. Owner's Address Sam Is this permit in conjunction with a building permit? Yes ❑ No Lg (Check Appropriate Box) Purpose of Building Existing Service New Service Amps Volts Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: VVI, l�a�ta h 6, -� CAJ �U�� l�le�cS � Completion of the ollowing table may be waived by the Inspector o' 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 ADove ln- 11U. U1 L' IIICfge11Cy LIgI1L111g No. of Luminaires Swimming Pool grnd. ❑ grnd. ElBattery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges N No. of Waste Disposers No. of Dishwashers c� No. of Dryers o. of water KW Heaters o. Hydromassage Bathtubs OTHER: No. of Air Cond. Total Tons Heat Pump Number Tons >F o.................... Totals: ................... Space/Area Heating KW Heating Appliances KW No. of No. of Cianc Ballasts No. of Motors Total HP of Alerting Devices ❑iviunlcipai C,,.,.,0,.+1.,,, ❑ Other No. of Devices or No. of Devices or Equivalent ecommunications Wiring: No. of Devices or Equivalent 1 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: 1a— �3 — L l 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 ndpenalties ofperjury, that the h ormation on this application is true and complete. FIRM NAME: LIC. NO.: 2 Licensee: A�-�recQ \ 1 cattie d gnature LIC. NO.: (If applicable, enter`exe pt" in the h ense num er 1, igze.) Bus. Tel. Address: J— j Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security w rk 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 Owner/Agent Signature Telephone No. PERMIT FEE. $ ,A 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 Le.2ibly Name (Business/Organization/Individual): /4ek eJ e l/- Address: ��Y`C3�(✓yQti City/State/Zip: E6',, v t- AA L \ ,v 4 C) W) Phone #: i '7 ( q q (SZ Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ip6ployecs (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ 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' compensation policy information. f 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy. declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby/ ceert& under the the pains and Ities ofperjury that the information provided above is true and correct. Signature: �lJ� "c/ Date -Gp Phone #: � � q �q q 5,2-, Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone F N °i 0278 Date .............. `.... ..... f �aORTH 1 p ,i�aoaa tip TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 i # ;,SSACHU`�� This certifies that .........1. �. i —7/ l 1~ .� ! ,J ............................................. ........................ . has permission to perform ............140-77-7—<-16 .............................. wiring in the building of ............. . /,.I!q � ..�. ((- . tt......................:..... ~a at .....1. z~r ....... �.5% ... 0?�FP.5....... , North Andover, Mass. Fee ...... ....." Lic. No.....!...1,.. �A.7� ............. ........... EL CAL INSPECMR l% Check" Commonwealth of Massachusetts Official Use only Permit No. tp Z-7 Department of Fire Services Occupancy and Fee Checked A BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 %, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �"" 6 / / t City or Town of. NORTH ANDOVER To the Inspector of Wires: a (, By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location (Street &Number) �f'ccCli .�. �c.i�1- i�-, ie l `w Owner or Tenant Telephone No. 7;1$`-"7g^c - jCn i Owner's Address gcn- v Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Servicemps olts 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: +I\k Gr"t, vnJ, krz i- 4-00 1 - 4-00. Completion of the following table may 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 ALGenerators KVA No. of Luminaires Above In- Swimming Pool rnd. El d. ❑ o. o mergency Lighting Batter 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 No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons J.KW .. ..... .... No. of Self -Contained 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 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: �i7�, C>C:> (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 td- BOND ❑ OTHER ❑ (Specify:) (A).\\ J:::4_>e I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: /),-t39A Licensee: I k7�z. C-, J 7 a- ; S Signature LIC. NO.: (If applicable, enter "exem t" in the lice m line.) Bus. Tel. No. 9i� 9$ 7-/9/� Address: 4- �� Alt. Tel. No.: y'71T-319- �G0 *Per M.G.L c. 147, S. 57-41' 7- 1, 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 Owner/Agent Signature Telephone No. FPERMIT FEE. $ . ,, .. r i � T� ,,� - �'Y �y-� � �,�� / � �. t �_ . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 N%t�07 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly p Name (Business/Organization/Individual): /-z C, Address: 33 WONCYly- \, 1 City/State/Zip: 7!t)n.tj® ($2Z Phone #: 77 S —9'E Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors am a sole proprietor or partner- —ship listed on the attached sheet. $ and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition I O-JiaElectrical 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' 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: Policy # or Self -ins. Lic. #: Expiration Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. WMA Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Locat !on 4-1- L -Is -37 No. 3s-7 Date t A ES TOWN OF NORTH �ANDOVER [AUG TOTAL AUG 6 1993 N 6358 $ Building lnipetor Div. Public Works Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee --.0ther Permit Fee 47 14S&er Connection Fee Water Connection Fee [AUG TOTAL AUG 6 1993 N 6358 $ Building lnipetor Div. Public Works Locations Date 01 NORTH TOWN OF NORTH ANDOVER .' _. p Certificate of Occupancy $ Building/Frame Permit Fee $ � a < .�cMusE Foundation Permit Fee $ Other Permit Fee $ tKrn�irnr "b" Connection Fee $ f Wa�'er Connection Fee $ TOTAL $ :;AUG. ��6 �9`g3 Building Inspector T - ? "359 Div. Public Works PERMIl`No �7! APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. J PAGE 1 MAP K40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK '.PAGE ZONE SUB DIV. LOT NO. �I LOCATION ya%ly/= V r o PURPOSE OF BUILDING C1eoojC' u� I� N� OWNER'S NAME NO. OF STORIES SIZ.�E '6W NEWS ADDRESS L/S�' iL, ,Q BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD 'BUILDER'S NAME F_ 7,,,,rTb `` A �/�� /1'Tlr `4itJ !, SPAN DISTANCE TO NEAREST BUILDING _-- DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER - IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR )/DATE FILED V--' mac., � / . SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE �^ PERMIT GRANTED 004 1A,_ 19 9 e,5 —L 35a OWNER TEL. # CONTR. TEL. # CONTR. LIC.f- 3 PROPERTY INFORMATION LAND COST EST. BLDG. COS / OO v d �? EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 'SINGLE FAMILY.-r'SiOkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF -BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. t ' MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE a 2 I3 CONCRETE BL'K.PINE BRICK OR STONE HARDw D PIERS PLASTER DRY VJAIL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA '/, '/t 1/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 �_ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDL'J'D COMIACN VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ _ STUCCO ON FRAME BRICK ON MASONRY " BRICK ON FRAME _ , ATTIC STRS. & FLOOR CONC. OR CINDER SLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I.I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBREL A HIP BATH (3 FIX.( MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS -OIL ELECTRIC B'M'T_ 2nd't _ Ist _ 13rd I NO HEATING 1:1r5v W W s? x x LQ u o O w a ai U) �7 Or - ^o O w x °�° O a: G O U cz O X. '� 7O i � W ,.� W W W s? x x LQ u o O w a ai U) O U a Or - ^o O w x °�° O a: G O U cz O X. R. W PO r•a �' O w O w � W ,.� W a O w y cn �n O x a Q a O a �s O w z W -•i W v O w O z Cl) Q i o S cn G � : � C : C V O i yr •R O v V aC M W CA •*ter p i m Ea CD 42 M `• N as E :� me L N 01 m N c � m y ev G 0 co m U3 CD ccl J N • p� G G VQV y O i w-�Z o o p c H y d C -C ca W O r+ C Ca rte... •� �. . •� C3= v -N O V m p m c COO o. =.— O 'o = CNC i H -� O r� 1 I co J z O L- 03 L O ~ C Z O y cr- O Gm o z w ca o� �O Q La O m m ( z j CD co�U m co O i co O i Cc O Q m: =a ca O CD Cc � .0 c Z � z_ V y cc C cc W y an Q z z � � J LU W Cl -U) y i' + , 0Ike wbax�wo�otsaaldi HOME IMPROVEMENT CONTRACTOR Registration 112354 Type - INDIVIDUAL Expiration 03/24/95 GAETAN CHOUINARD GAETA'N V. CHOUINARD 152 WATER ST ADMINISTRA70R LAWRENCE MA 01841