HomeMy WebLinkAboutMiscellaneous - 425 GREAT POND ROAD 4/30/2018 L21
425 GREAT POND ROAD
0/037.A 0016-0000.0
PO Box 5509-8---
Boston,MA 02205-5098
55099--Boston,MA02205-5098 --
617-951-0600
:i IN
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: Insured: ANDREW BARTFAY-SZABO and PATRICIA BARTFAY
Property Address: 425 GREAT POND ROAD,NORTH ANDOVER, MA
Policy Number: HMA 0412625
Claim Number: BOS00057581
Date of Loss: 2/14/2015
Company: Safety Indemnity Insurance Company
Claim has been made involving loss, damage or destruction of the above-captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of.loss and claim number.
Allan Leavitt Claim Examiner 3/30/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston,MA 02205-5098
Phone: (617) 951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com
10051
Date
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This L- . GJ��.
s certifies that . . . . . . . . . . . . . . j . .
247
has permission to perform . . �. . ... .. . . ... . '''1'1 Q< . . . . . . .
plumbing in the buildings of. . 2. ??`.U . . . . . . . . . . . . . . . . . .
North Andover Mass,
/� . ,
G '"'� r
Fee .�5.�. Lic. No. .1�7�d, . . . . � . . . . . . . . . . . . . . . . . ...
PLUMBING INSPECTOR ,
Check# 19 S 7
b4-Z -1
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY D j MA DATE 1 - E PERMIT# 7
JOBSITE ADDRESS Lyes �°/W ✓1d /2 _ OWNER'S NAME
POWNER ADDRESS � 2'C _ TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION:Er REPLACEMENT:® PLANS SUBMITTED: YES® NOQ
FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
I
DEDICATED GASIOILISAND SYSTEM i
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER _*_( -
FLOOR/AREA DRAIN __ -1 .__._.._1 ! ( J _.__._( ._.._._-� ___..._� ( E .__._._._ _..._.._._$ 1 _ ( __._..___(
INTERCEPTOR(INTERIOR)
KITCHEN SINK —d --_--__1 ____._1 _.__.___.E..---.___i .._____1 .__._-_( _-_- _1 .___._.► __! ___._! -_-___E _.._.._-i f _____�
LAVATORY
ROOF DRAIN _._ _!L__j ____ .- —1 _--i AL.._J
SHOWER STALL
SERVICE/MOP SINK -11
TOILET --
II URINAL
WASHING MACHINE CONNECTION _f ( . _! J .._. ._.( _-. ..(
WATER HEATER ALL TYPES
WATER PIPING
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES s NO Q
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF 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.
'l
CHECK ONE ONLY: OWNER —( AGENT �+ !
SIGNATURE OF OWNER OR AGENT
B hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co59ance 'th all Perti t pr ' ' n of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME 6Ulµ lU l�l�cS� _m _ (LICENSE# = 1 _ SIGNATURE
MP _ JP Q CORPORATION O# PARTNERSHIP Pi#=LLC
COMPANY NAME �O,�t/c 907c1- IC.,6 s G�--76 ADDRESS
CITY� �5`Zc I STATE _ ZIP ®� —� TEL
FAXGn ELL .. -- �..... AIL --.... _..__. .. ._._ .
- I�
ROUGH PLUMBING INSPE(`7[°ION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �43d
FEE: $ PERMIT#
PLAN REVIEW NOTES
129
d,
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The Commonwealth of Massachusetts
Department of IndustrialAccidints
Office of Investigations
UT 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: /�,d, !�&( ��7
City/State/Zip: ASWI " 4� Al, Vr Phone
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I '
6. E]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• 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 10. 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 91 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they ace 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.
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 requiredunder 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.
Ido hereby ce"O unndde�r the pai an penalties of perjury that the information provided above is true and correct.
Signature: G%G%�:�i� (� Date: 1-1a'–���
Phone#: /? Z
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#:
I ,
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 joint 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
n' pP Y () ( ) phone number(s)along with them 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 as a reference 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 future 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 burn 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:
The Commonwealth of Massachusetts
]Department of Industrial Accidents
Offxce of Invesfig ations
604 Washington Street
Boston}MA 42111
Tel,#617-727_4900 ext 406 or 1-877rMASS.AFB
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia
I
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PLUMBERS,Ai�ID GASFITTERS
L(GE�VSEIJ ASA MASTER PLUMBS
ISSUES THE ABOVE LICENSE TO:
z
PAUL E WHITE.
4
t•r �
PO BOX 987 c�� . •�
t�
t HAM STEADI r
NEI 03841-09
11718 05/01/ 1 +
14 175068-
Fold,Then Detach Along All pe(orations
N
Date—
............
r►ORr
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ......................... .. ............................................................................................
'.� 1—'� FP'i ov cc�V-'-'5
has permission to perform ............................ ......................................................................
wiring in the building of... ....... ........
......... ..... ....................... .......
at ............ .....P.,....................
................. North Andover,Mass.
Fee:.?....`.?...."...........Lic.Noz:) .. ...Mb.................. .. .. . . .... ......
Eucn6ucZ i&�SPECMR
Check#
11741 4 '71 11 1 F�
1
l�ommonweaK o f Maas"tHi Official Use Only
cc77 Permit No. N
a[Jeparbwd o f-`ire S mice6
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 C),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: 7/2-57/ 3 _
City or Town of / /ORN {C�ttbye?e, To the Inspector of Wires:
By this application the undersigned givesnoticeof his or her intention to perform the electrical work described below.
Location(Street&Number)
Owner or TenantAw AerfAfig Telephone No.
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 I Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 2
/�31h�1�'i iPE�t�Ylta�S
Completion o the fiollowing table may be waived by the Inspector of Wires.
No.of Recessed Luminaires �2_ No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emerge-n-c-y-Lighting
rud. rnd. Battery Units
No.of Receptacle Outlets 5- No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches ( No.of Gas Burners No.o Detection and
InitiatingDevices
No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices
No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained
Totals __ .. .-.._ ._.._..____.__...._....._. Detection/Alerting Devices
-T�
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Secunty Systems:
No.of Devices or Equivalent
No.of Water KWNo.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
1 Attach additional detail if desirei4 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 VO
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ZI BOND ❑ OTHER ❑ (Specify:) 3
I certify,under the airs and penalties of perjury,that the information on this a cati true and completes
FIRM NAME: 0A110 FCEGrR"4 d>417R4cr0/4 L1-C LIC.NO.:
Licensee: 04962 WA"e" Signature LIC.NO.: 3
(If applicable,enter"exempt"in the license number line) Bus.TeL No.979-682-6262-
Address:
6162Address: 87 Ae-4M4 vT ST AbeN#4yZ 9Alt.Tel.NoR78.3 7,'J73 N
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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 El owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $ fb
•
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=' The Commonwealth ofMassachusetts CPriM Form
_ - DqarfteatofladjzhWAccrdenis
I Congress SI
eel,Sake 100
Z, Boston,K4 02114-2017
www.namLgmvldia
Workers'Compensation insurance Affidavit:Bm7ders/COBtmcton/Electririaus/Phtmbers
Applicant Information Please Print LAo'bly
Name DAVID ELECTRICAL CONTRACTING LLC
Address: 87 BELMONT S7
Cj / - NORTH ANDOVER,MA_01845 Phone f.- 978-682-6262
Are you sttr enphrpef:Check the bo= Type of prged(r"nhvd):
1-0 I am a employarwith 7 4- [3 I am a general comer and I
e�ksyees(toll aad/ar pare)_* have hired them moots b- ❑New construction
2.Q l amasoleproxidar orparmer listed an*e auadred fid. 7. ❑gmodefiog
ship and have no employees These sum haveVidil1C Demolitiong for Ute in my may- employees and have workers'
4 Buil addition
[Noworfaes'comp.' _ ce cam. _' �
netNhed-j 5.❑ We are a c rpogaion and its I0-21 Electrical repairs or adds ions
3. I am ahtmreownwdoing an work offscem,.have examsed the 11.(]Plumbing repairs or additions
myself Woworkcxs'cow hof mon per MM 17-0
e regairedj c-152, IC4),and we have no
Roof repairs
employees-[No workers' 1313 Other
comp insurance reqs-1
*'AnY apPlicaUt that cheftbax#1 mint Am 101 out&e section below*--gtheirwodM& PU1Hy mfdm a"r
llondeovv�s vrho this affidavit indicating thEy an:doingall work and thm lire owe conv=tots must MdWrta new affidavit indiratime Sam
aComtradors that dredc this boxm�st attached an additioaal sW showutg the nameof tae and statewhdher or not those entities have
'MV*em If therms have danployees,they mmst provide their workers'
P pd,lic-v tnaabed
lamP'tw is provrdmg work,Or'compemwoa h=7WZ efor my gnrMye. Below u thepofcf mrd obsim
Insurance Company Name: THE HARTFORD
Policy#or Self-ins.Uc.#; 08 WEC C18293 Expiration Date: MARCH 1,2oiqL
Sob Site Address: Z S t�/� M--) City/statrizip: A2�Y A ,/&w /of 0/09,-"
Attach a copy of the workers'compensation policy declaration page(showing the Policy number and
Failure to secure coverage as required under Section 25A of MGL c.I52 can lead to the i "Oration date}.
fine up to$1,500.00 and/orone-yew mposition of cximirtad penalties ofa.
ia4mwnment,as well as civil Penalties in the form of a STOP WORK ORDER and a fine
Of UP to$250.00 a day against the violator. Be advised that a of this
Investigations_ofthem DIA for' COPy stabeztertt may he forararded to the Of�rce of
cation.
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hdbrMuffanprovi"abaveis&wandcorrea
Phd�#:
�ckduse ank Ifo notwr&e in the areo6to hewmplaed by cziy ortowa offmiaL
Cray or Town:
I'ermi#/iacense#
bsoingAuthoridy(code ones
LBoard 6-Otherof Health 2.lig 3 t3tyli'owa Clerk 4-Electricallagpectgr phrmbing Inspector
CAW1aCtPerS= Phone
t COMMONWEALTH OF MASWHt�SETTS '
BQARD OP
ELECTR I C 1 AN;S; 4
ISSUES THE FOLLOWING`' LICENSE
q$ A 12EG JOURNEYMAN ELECTRICIAN
,Z
J .&RIJA M CHABOT
, 1 z;
49 ALAVE i'...
W
TON :.
HAUERHILL MA 01835-6952
1232 r3 : 07/311:16 56863
COMMONWEALTH OF MASSACHUSETTS;:
B(>AFD`0
E ECTRUm
ICIAN, }
ISSUES ,THE:: FOLLOWING LICENSE AS U
REGIS.TEFZED MASTER <ELE C�TRI CIA
N\\ Q
JOSHUA M CHABOT
49 AL
AVE {w
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Xv
HAVERHILL; MA 01835 6952
$ 21564 A 07/3'l 6 56862
Date.................................G
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
"SACHUS
This certifies that ................. .................................
has permission to perform ........
wiring in the building of.A. oy
....................................
at...........L./....
......... ............... .North Andover,Mass.
Fee..... No—A—'F.3.3.4...........
ELECTRICAL INSPECTOR
Check #
7068
Permit No. ®�
Department of Fire Services
Occupancy and Fee CheckF.d.
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leaveblanl:)**
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C1viR 12.00
(PLE 4 SE PRINT IN INK OR TYPE,44L INFORM TION) Date: cr-r 110 Z7 d(o
City or Town of: lr� To the Inspector of Wires:
By this application the undersigned gives notice of his or her intent'
o to pe form the electrical work described below.
Location (Street&Number) 41 1
Owner or Tenant , Telephone No.
Owner's Address
Is this permit in conjunction with a bung permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building 3o< 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:
Completion of the following table may be waived by the Inspector of YVires.
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 Outletsis No.of Oil Burners FIRE ALARMS No. of Zones
No. of Switches No.of Gas Burners No.of Detection and
-1 UInitiating Devices
No. of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
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
t 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 E uivalent
OTHER:
41tach 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 CO RAGE: 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 cover OND
is in force,and has exhibited proof of same to the permoffice.
it issuing oce.
CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains andpenaLties ofjury, that the in ration on this application is true and complete
FIRM NAME: tJ(' et,1[ LIC.NO.:
Licensee: �(( b-4, Signature LIC.NO.:
(If applicable, enter "exempt"in the license numb, li e.) Bus.Tel.No.:.
Address: CA i r 4Alt.Tel.No(-1
*Security System Contractor License required for this work;ff applicable, enter the license number here:
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.
lUwiv vr tiNDV VEx t:ommerclal: sewer Election Pump: �25.Uu
ELECTRIC&PERMIT FEES a) including photovoltaic& Signs: $25.00 each ballast
(Effective . arch 12, 2003) generating Equip Per KVA $1.00 Smoke&Heat Detectors&
IYIIINiIVI PrRT•.I PEES, b)un-interruptible power systems, Initiating Devices: i
RESIDE TIAL $2S OQ per KVA$1.00 Residential: $1.00 each }
COMMERCIAL $50 OQ c)batteries over 100 amp.hours,per Commercial: $60.00 up to 10
T O SE CABLE. ONT cell $1.00 devices over 10 -$1.00 each
OUTSIDE OF BUILD.Ni G Heat Devices: $1.00 each Space Heaters:
Air Conditioners: $40.00 each Heat Pumps: $40.00 each area heating$1.00 each
Alarm Systems Security: (for fire Hydro-Massage Bathtubs/Hot Sub-Panel: $25.00
systems see smoke/heat detectors) Tubs: $20.00 each Swimming Pools:Li titin Fixtures $1.00 each - Residential:
Commercial:: uup
Residential: LightingOutlets: $1.00 each Above Ground: $25.00
p tto 10 Devices o
$60.00 additional devices over 10- Major Appliances: (not listed) Inground: $50.00
$1.00 each $20 each Commercial Pool: $100.00
Carnival Equipment: $50.00 each Motors: (per hp or fractional part Switches: $1.00 each
Ceiling Fans: $1.00 each thereof) $2.00 Temporary Service:
Commercial New Construction or
Oil/Gas Burners: Must have Utility Authwization"€rniber
Alterations: Residential$20.00 each Residential$25.00
$100.00 per 1,000 Sq. Ft. of Commercial$20.00 each Commercial $100.00 b
Construction Space -
Office Furnishings:per circuit$10 Transformers:
Commercial Service Change/ (Relocatable Partitions/Cubicles) a)capacitors,Per KVA $1.00
Repair: Outlets & Fixture: $1.00 each b) ducts,conduit&conductors
Must have Utility Authorization Nuniher Ovens Built in/Counter Top Units: (Associated w/Padmount Transformers) $25
$100 (first 100 amperes or fraction,one $10.00 each c) each manhole$10.00
meter) Panel Change/Circuit Breaker: d) each handhold$5.00
a) each additional 100 amperes Residential: $20.00 e)per KVA$1.00
capacity or fraction. $30.00 Commercial: $25.00 f)primary feeders,$25.00 each(over
b) each additional meter$25.00Phone Jacks: See 600 volts,non-utility owned)
� g)vaults and equip. $25.00 each
Commercial Temporary Service: data/telecommunications Washers: $15.00 each
$100.00 Ranges $15.00 each N
N:I:ust haveUtilitti Authorization number Receptacle Outlets: $1.00 each p1 Waste Disposals: $5.00 each
Commercial Repair and/or Recessed Fixtures: $1.00 each i Water Heaters: $30.00 each
Maintenance Permit: (Blanket Re-inspection Fee: $25.00
Permit)up to 2 Electricians$150.00 *For Multi-Famili, &
Repair to Service Residential:
per pair of Electricians over 2$50.00 $20.00 Large Commercial Project •
Data/Telecommunication: Residential New Construction
:gee Wring11Ig eet®r forResidential: $1.00 per port (Dwelling): $220.00
Commercial: $30.00 up to 10 (with service up to 200 amps) pricing: v
devices over 10-$1.00 each Must have Utility Authorization Number � Paul Kennedy(978) 623-8306
Dishwashers &Disposals: for services over 200 amps see below (Office Hours 8 ani to 1.0 ani)
$5.00 Each a) for each 100 amps capacity or
Dryers: $15.00 Each fraction add$20.00
Emergency Lighting(Battery Units) b) each additional meter$10.00lgpe�tl0i Schedule:
$ 1.00 each unit c) each additional panel/sub panel 1 ROUGH
Feeders or Sub-feeders: $25.00 I FINAL
each 100 amp capacity of fraction I TRENCH (i f applicable)
thereof Residential Additions/Alterations:
Residential: $5.00 each $220.00 maximum
Commercial: $15.00 each Residential Service Change or ADDITION.
Gas/Oil Burners: Underground Service: INSPECTIONS *$25.00 (if
Residential: $20.00 each $40.00 applicable)
Must have Utility Authorization Number Pp )
Commercial$20.00 each i a)one meter,up to 100 amp capacity
$40.00 (revised 07/05)
b) each additional 100 amp capacity
or fraction$20.00
a
Date. .. . ... . .
a
� f HpRTN 1
TOWN OF NORTH ANDOVER
I. D
' PERMIT FOR GAS INSTALLATION
SAC14 SEt -
This certifies that . (�L! �.f . , ... �f . . . . . . . .
has permission for gas 'nst llation . ft
in the buildin sof f!�-� : ��-� .4=!. . . . L . . . . . . .
o
at . .. . . . . . . . . . . . . . . . . . . . ., North Andover, Mass.
Fee., �.Qv. Lic. No.`. . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
s Check#
S
4940
MASS APPROVAL #
MASSACHUSETTS UNIFORM APPLICATION"FOR PERMIT WFITTING
f4irtor typal //?w�o
r Maes. Gate i o—�.°�-o
Peri:t�#
Swino LOatlon Lo � owns
""Mattype of 0c=PlM R*iL,14New ❑ PAMOVabon B ❑ Plans Submllted: Yes(] No a
a
a ti a
x
a ¢ a c p a s r
Y O 0 ~ d = D O * ei i
t C O O s �•
W e. .0 t
aL p p v dc air Z < p e C
G
d �. Z .'at ♦. a �. W W
W .[ W d C .• i� �. �!1 ei Z O C r! i
` V Z < C < O O O �it t-
ee6,.1
ave-�dsrT.
s�►seM><xT
18T FLOOR I
2HO FLOOR
Ell
SRD FLOOR
4TH FLOOR
STH FLOOR
4TH FLOOR
7 T FLOOR
`TH FLOOR
Installing Company t\tarne YANKEE GAS Check one: Certificate
/Address 140 SOUTH MAIN STREET at Corporahcn 103C
MIDDLETON r MA 01949 C. Pip
Business Telephone 9 7 8—7 7 4—2 7 6 0 C Firm/Co.
Name of Ucensed Plurnber or Gas fuer WILLIAM R- HARRIS
INSURANCE COW.AAGE;
1 have a
Yes cmeM kabW Cl � policy or is suabsUnbal equivalent which rrx:►s the requiirernents of MGL Ch. 142
if you have checked yo. please Indicate the type coverage by checking the zwopriate box
A liaWky insurance policy M Other type of indemnity D Bond ❑
OWNERS INSURANCE WAIVER: I am aware that the licensee does nct have the tnstcanee coverage required by
Chapter 142 of the Mass. General Laws. and that my signature an this permit ippliation.waives this requirement.
Check one.
Signaque of Owner or Owner s Agent owne{ Agent❑ .
1 heteby cer*that all of the details and kdwm Wm I have submitted la entered)in above ao-a+catim are a and accurate to gest or my
knowledge and that aB pkxnbing wwk and�taUations performed under the permit' tits !be in eo wiU all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 cl the
BY T of License:
Plumber gnatw r or er
Titk RasBtter
a fluster timnse Nunbw 3 7 8 5
Qty/lotion Joumeyman
L
Location
No. o ? Date -2
"ORTOWN OF NORTH ANDOVER
A Certificate of Occupancy $ �6 '
a _.
• � a lFr m6.Permit Fee $
a
1 •ner^.------
s F Founbn Permit.Fee
s�cNuSE $
Other Permit Fee $
ftf Connection Fee $
# trer &AecIi66,,f ee $ ��
TOTAL $
Building Inspector
7048
Div. Public Works
4
PERM&T llo._,r 6 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
/PAGE 1
MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE
ZONE SUB DIV. LOT NO. F-
LOCATION PURPOSE OF BUILDING
OWNER'S NAME j'/,�,
� 't_To�L�/�� / /COL�-�Z NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB --
lsa] V
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME-DI L✓ /���,.�%' oyS�2K�T�r 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 /lI L' n��0•�`�� ,J �L/ 1 BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE V 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 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST 2-
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
i SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
a
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED Z�
BOARD OF HEALTH
SIGNATURE OF OWNER OR AUTHORIZED AGENT
FEE
'',,��� V D (� PLANNING BOARD
PERMIT GRANTS
^9 19
BOARD OF SELECTMEN
OWNER TEL.# A
CONTR.TEL.#
CONTR.LIC.# e�TZ�?
7� BUILDING INSPECTOR
EUW.DING DEPART HENT Y OJ/
I
t t f
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 I,_
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_
DRY-WALL
UNFIN
3 BASEMENT
AREA FULL FIN. B M T AREA _
1/. 1/7 1/1 FIN. ATTIC AREA _
NO B MT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS II 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE ��_
WOOD SHINGLES EARTH
ASPHALT SIDING HARDVJ D _
ASBESTOS SIDING _ COMMON
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I� POOR _ S
ADEpUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH )3 FIX.) _
GAMBREL MANSARD OITER CLOSETLET RM. 12 FIX.) _
FLAT I _
ASPHALT SHINGLES LAVATORY _
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR &,GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING II 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
B'M'T 2nd _ ELECTRIC - M
1st 13rd NO HEATING n { j
LL
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY saamr�eot
WF - OF ONE ASHBORTON PLACErteststtsBYilamy
MASSACHUSETTS BOSTON,MA 02105
L I C E N S Et; �faer��aoso.
EXPIRATION DATE CONSTR. "1.1 P E R V I S O R CAUTION
09/21 /1995 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
RESTRICTIONS THEFT, PUT RIGHT THUMB
NONE 06/3 J/1 ')9 3 015979 PRINI IN APPROPRIATE
° BOX ON LICENSE.
RIC10Rc J CONTE
z r 7 F L "' '}tl ? B TING O RAT
SS 016-34-1552 m I�tTHUE�i '�: tib X44 M�INCLU� PH
PHOTO(BLASTING OPR ONLY) FE r D
1-j f11. 90 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER
DOB:
09/ 21 /1945
THIS DOCUMENT MUST BESG NAMEDF L A �SAf11RE LINE
CARRIED ON THE PERSON OF IGN
THE HOLDER WHEN EN-
OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. COMMISSIONER
r" ��onimomavaul�fi of 7Ffa>saa�Fjwetts •� ,
C h RIVER'8 L I LENSE
16341552 '091 —98 — HOME IMPROVEMENT CONTRACTOR
nam �w
9-21-45 M Registration 103202
Type - DBA
ONTE Expiration 07/06/94
77CELMWD5OORD I �`
ETHUEN MrdDick Conte Construction
1644-41544
i Richard J. Conte
' 77 Elmwood Rd.
ADMINISTRATOR
Methuen MA 01844
STANDARD FORM OF AGREEMENT
kknowwo*N FOR DESIGN AND INSTALLATION
; .
& Approved by the
National Kitchen&Bath Association
Bemeen...................J.JJ.m a.nd J u 1„i.e...Needham ......................Purchaser
................................................................
Home Address...........125....great..,.�ond Road
...............................................................................................................................
Ci .......................ho......Andpypf.,....Ma.5.5..,..........State.....................................................Zi 01845
n p.........................I........................
Phone i\'umber..................................... 0
..................6893...............03............................................................................................................................
DeliveryAddress.............................................................................................................................................................................................
And Seller
JACKSON LUMBER AND MILLWORK INC.
P.O. BOX 449 - 215 MARKET STREET
LAWRENCE MA 01842
(508) 686-4141
1. The Seller agrees to furnish the materials and sen-ices set forth in the drawings(numbered........................................
and dated .. ....1.5.............. ) and specifications annexed hereto.
The Purchaser agrees to make payment therefore in accordance with the schedule of payment.
ContractPrice......................................................................................... $.
815.15
SalesTax (if applicable) ............................................................... S...............................................................................I...........................
..................................................................................................... S ..........................................................................................................
TotalPurchase Price...................... .............................................. 5.........24.,.5..1..8.. i.3................................................
..................
...........................................................................................................
Schedule of Payment:
Upon signing of this agreement ...............................................................
Upon delivers-of cabinets from manufacturer .............................. $ ...........................................................................................................
Upon delivery of ....materials to job. "-7 ��-�
..................................................... S ......../.t...............
.............................................................................
'71 Upon . _ of ...ma t.e -1.a.l s.............................. $
This contract includes the terms and provisions as set forth herein. Please read and sign where indicated.
C 1991\ABA BN1H4-A-F91-10M-UNL
e%ORTF
0 0 �� nor �, over
o f
No. 43�► Axe- ;, ;�,�, i s
JK
o Abort dower, Mass., 19 �f/
�9 A0"`ATED f P�\(;�
�a BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
01 BUILDING INSPECTOR
THIS CERTIFIES THAT.......t�..�.�.Y....rt"�t.�L�
Foundation
has permission to erect buildings buildings on Rough
to be occupied as..144Y. I...04rolt.... �j� �/!fQ J111 .�,/�/�!, �� Chimney
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 relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EMPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTON STARTS ELECTRICAL INSPECTOR
Rough
. ............. .�.................. Service
BUILDING INSPECTOR
Final
Occupancy Pen lit Required to Occupy Bitilld big GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
N' e
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTTI
(Print or Type)
C NORTH ANDOVER Mass. Date
�uilding Location /a � 6V"r )OoM14 Permit # /+&6 3 _
.� Owners Name
. Y
• - New 77 Renovation Replacement � Plans Submitted D
FIXTUP,=I
N
� W N
N trf U a t-
F
4 ta 07 tL O V ~ C S W
a N Y x Z O F Cr
~ O W Q tr a 0 a O 2 r
G1 Z mW C5 N N W W O a W
M W ul s r to > 4
N cc W Z V 01 W 4 Q 1- a W
W W 97 < •• a CC Q tL W W F' x C! t=
C1 }. z ,u r z �.. W W O ? tt t-- O O u~s S
Z d W G a f' Y- N m :. O Z W
Q ,W > C ul O Z < G Q d O O W O W t-
R .: O t� Y u. O G c7 .t U 2 y Q a F- O
SUR-BS 7.1T.
BASEMEUT
IST FLOOR
2ND FLOOR
3130 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name 70 //X/ 5Ti'� Corp.
Address ? "/t//its - 57- Partner.
f j`lyid1-1C/i/ /1 /,L [T±—firm/Co.
Business Telephone: G r(1- a 3/
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy [?D"—Other type of indemnity Q Bond
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner F-1 Agent El
1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under Permit iueed for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and tlapter 142 of the General Laws.
By TYPE LICENSE:
Plumber
Title Gasfitter Signature of Licensed
Master Plumber or Gasfitter
City/Town: ourneyman //,:z 6- (/,APPROVED (OFFICE USE ONLY) License Number �a 5
c—A
v
Date pi.
1463
,40RTN TOWN OF NORTH ANDOVER
pFt•�ao ,e 14,
o p PERMIT FOR GAS"INSTALLATION
�9SSACHUSEt�h
t
This certifies that . . .
has permission for gas installation . . . . . . . . . .. i 1 . .
in the buildings of . . . . . . ... .. . . . . :.... .`
at :. . fii✓_ . ! a '- , North Andover, Mass.
r �
F e .. .... . Lic. No.t ! �"I ,to .
— 1, �0Fl(Zl44 13:41 12.50 �,�1PECTOR.
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File