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HomeMy WebLinkAboutMiscellaneous - 43 MAGNOLIA DRIVE 4/30/2018 43 MAGNOLIA DRIVE 210/056.0-0052-0000.0 Date . .7:.Z. ._ 1. . TOWN OF NORTH ANDOVER PERMIT FOR WIRING :y This certifies that . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . T !��o0/ wiring in the building of . . . . . �0 Gk-. . . . at . .3. �? 1N!�.4! . . . . . . . . . . . . . ,North Andover, Mass. `Fee . . . Lic. No. . . . . . . . ELECTRICAL INSPECTOR Check# 10973 �i 2012MassachusettsElectrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§,3L,the p permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed- on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall he issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.T..c.143,§3L. Permits shalLbe limited as to the time of ongoing construej�on� .activity,and maybe deemed bytheJnspector of_Wires abandoned_and.immlid ne—. or she has determined that the authorized work has not c�nenced or has not progressed during th4recediE?12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.permit application. ❑ The]Permit]Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term.economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaimpermits and licenses concerning the use or development ofreal property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008. extenclingthrough August 15,2012. VI2nle 8—Permit/Date Closed: 2 **Note:)Reapply for new permit ❑Permit Extension Act—PermitMate Closed: ` ' �\ (.otnmonweaEth o�l�/a�ace#� Official Use Only cc'�� cc77 Permit No. 7-5 a1.le�artment o�.}ire�ertiic� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. l/o7] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),F7 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INT-0 TION) Date: City or Town of: / ��h /QAC/� 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) 3 Owner or Tenant r'1v ki bG 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❑ Uedgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 495rrk^ dn - ) Completion o the followinx table ma be waived by the Inspector of Wires. No.of Recessed Luminaires Na of Cell.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ a- ❑ o.o Emergency ng Errnd. d. Bait=Units No.of Receptacle Outlets 3 No.of OR Burners FIRE ALARMS No.of Zones No.of Switches Na of Gas Burners a of Detection an Initiating Devices No.of Ranges Na of Air Cond. Tuns No.of Alerting Devices No.of Waste Disposers Heat m umer ons o.o -Contained Totals: -__........_.. ._.--.---__.._....___...._...... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ mun'c'pai ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* ' Na of Devices or Equivalent NO.o ater KW o.o a o Data Wiring: Heaters Silms Ballasts Na of Devices or f&uivalent No.Hydromassage Bathtubs Na of Motors Total HP Telecommunications inngg: A Na of Devices or EquivAent OTHER: Estimated Value of E"Ical Work: Attach additional detail if desired or as required by the Inspector of Wires. Jba-D,� (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: INSURANCES BOND ❑ OTHER ❑ (Specify.). I certify,under the pains and penalties of per' ry,that the information on this application is true and complete. FIRM NAME: do,� ,Si�7 c i� LIC.NO.: �//J-1 Licensee: Signature LIC.NO.: /1 F17,6 (/fapplicable,enter "exempt"r the license nuinberline Bus.Tel.NO.- Address: 4 i,burry t��o Or n HCl,IV14 0INS Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lia No.. OWNER'S INSURANCE WAIVER: 1 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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts ; r Department of Industrial Accidents I;�; ff,a Office of Investigations � - 600 Washington Street Z.1is- i Boston,it4A 02111 wivol mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le - A�A'C'l siibIv ltName(Business/Organiaation/Individual): 9.J�L� , Yy Address: �4j *- �S U---T_ City/State/Zip: /�/"odov(� /tM ONS Phone#: (�F l-'�LQ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6 New construction employees(full and/or part-time).* have fired 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 & ❑.Demolition { working for me in any capacity. employees and have workers' insurance.t q• E]Building addition cam [No workers' comp. insurance P- required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ' 3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions myself. [No workers' camp. right of exemption per MGL 12.❑,Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box h I 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. tContructors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am art employer that is providing ivorlcers'conipetisatioit iirsurance for niy employees. Below is the policy and job site Information. / Insurance Company Name.- Policy ame:Policy#or Self-ins.Lic.#:_ GtJ x) y? / Expiration Date: Job Site Address: V3 ) )jam y City/State/Zip: _ /1/r y 0V I / l� Attach a copy of the workers'vcompensation 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 herebj+certify under pain nd p ialties of perjitry that the inforination provided above is trite and correct Sisnature: ,r Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ojficiad 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 Date. . .?//+ �1.1 s 9484 TOWN OF NORTH ANDOVER 3a ;� - •OOL �: PERMIT FOR PLUMBING SSACMUS� / ( �� This certifies that `\. . . .✓ ! �'�.!�'� L if has,perm.ission to perform . i iSmC • bing in the buildings of . . � . . . . . . . . . . . . . . . . .; . . . t at . Al . . . . . . .4, A>a Noover;Mass. V � Fee. Lic. No.. . . PLUMBING INSPEKOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY .t/ y ------ I MA DATE 7 I L PERMIT#- `i JOBSITE ADDRESS 3 '4 0 OWNER'S NAME r4% OWNER ADDRESS J TELC � FAX j *PE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES E0 NO FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM f .._.._........ J DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM .__...____I ._......._.._J _ __f .........._.J �f DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _---J .___.__._I _..__..J DRINKING FOUNTAIN _.-.__..__f FOOD DISPOSER f I ..._...__( f l FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK _-__.___I ___I ___...__._J .__----1 --------I ........._i LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION _'k. _j .I WATER HEATER ALL TYPES WATER PIPING OTHER .-_-_-J f .._-._...__( __.__! -._.___I ..._____ _.I ___.__I _...._-_I - ---___...I __.__.J _..____J I .__..__J ______( _....._.J f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0'NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Fj] BOND Q 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 0 AGENT 10 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 curate to the best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in o lianc ith all Pe inent pr ision o e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -.� -.1 , S- ,E'er►- H^- c LICENSE# �_ NATURE MPDI JP CORPORATION PW�PARTNERSHIP D# _ I LLC COMPANY NAME ! ADDRESS _— CITY U C/,rig STATE ZIP U (� — TEL O g Z j FAX �` -� 40[ �51�7 .5. MAIL __.. - ... _...... .- - -...._ I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yet- No- 00, rJ�!/ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:h W-10 Phone#: 4. 7 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. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet.I [a'l�modeling 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.] I employees. [No workers' comp.insurance required.] 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: '-'t ` Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:_ �7l f�¢ ?ie G �� City/State/Zip:-k y .A-4,4, L/-Z,— 941F- Ole Yf 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. f do hereby c tii nd ie painsd penaltie f per' that the information provided above is trite and correct. Sifznature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. i 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#: 1 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used 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 Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-7274900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass,gov/dia d Date........." "v7 tORTH 0 ,,— " - TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACMUS� This certifies that kofL--2 � !' t '?4L- F-Al . .........................-...... .............. ...................................... has permission to perform . "'/lS: wiringin the building of...........................�.................................................... at.............3....L!.k1.I p©NI ....J) ........... .. .North Andover,Mass. Fee.... ..�...... Lic.No. `..........� ... .. .. -� ELECTRICAL INSPECTOR Check # 3 � a r � 7445 S4 Commonwealth of Ma66ac1 of Official Use Only c� 21 l Permit No. 2,parfinent ofc7 ire�ervicee loom Occupancy and Fee Checked $r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 Cr 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / 0-7 City or Town of: /L/p E?/j Akj06V,-7k, 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) /1A6lJ0L_i A OtL Owner or Tenant CNR_rsroPH RL: KOCI Telephone No7S (,S;-5 607 Owner's Address SAM e 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 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n- o.o Emergency Lighting rnd. E] grad. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etechon an Initiating Devices No.of RangesTotal No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump . um er Tons W o.o elf ontamed Totals: "� " Mµ"'"" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ❑ Other Connection No.of Dryers Heating Appliances KW security yf Devices or Equivalent No.o Water o.of o.of � Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunicahons irmg: nt No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee:/2 0116kf T 41,44c4u{d�_ Signature LIC.NO.: 210 31 -F (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:9 7?- '7 /4/- Address: S-S Min STD_t/ 5)_ .4 ,4_44. Alt.Tel.No.: k 43/O *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ 6 0 I r �k ti Date. . .�. .�1 . .. .. .. ,AOR T/y Of io TOWN OF NORTH ANDOVER a : i PERMIT FOR GAS INSTAL ON ♦ p9 � �9SSACMUSEtty r' c � This certifies that . /. ./!.'. . .. . .� has permission for gas installation . . A�:'' .�:. . . . .��.`.'.`.: in the buildings of . . . .° . . . . . . . . . . . . . . . . . Fat '`` ` l�. .". . . . . . . . North Andover, Mass. CID� Fee. . . . Lic. No.31 T``. . . .`... .)) .. . . . . . . . GAS INSPECTOR Check r. 6025 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) -CuoRTft Arji0y a tZ , Mass. Date (n 4 7 Permit # Building Location_ 3 MAG OL I () Dk- Owner's Name_ CNk i ST6PNi✓dZ koC<, NQCtI AAJ VFv rld Type of Occupancy OtJ, I q New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ W U W W N tit WN UCC W a N a 0 W = H L o U m Fx J) - Q m (r z 0 W Q Q C O O r W W H :L W0 t- ~ b W W tl W W = z r' W O > W L W W W J z a = [t a fj cc W W F+ s H GC z Q O'� a C N �W. W LL W 1`' N a W J W z a W ? m z O z 0¢ W �y O tl W 3 G tl V ¢ Y G a F O SUB—BSMT. BASEMENT j 1 ST FLOOR 2ND FLOOR 3110 FLOOR _ 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone q 7!B-6 8,7-110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application walves this requirement. q nt. Check one: Signature of r or Owner's Owner❑ Agent [IOwne Agent 1 hereby certify that all of the details and information I have submitted(or entered)in abo lication are true and a knowledge and that all lumbi p ccur to to the best of my plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ T e of license: Plumber Signature of cen Plumber or Gas Title Gasfitter City/Town Master License Number_3745 Journeyman AP O C SF O BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING `c'.. NAME & TYPE OF BUILDING LOCATION OF BUILDING F PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE .19 GA13 INSPECTOR Date.... �..�.�. CJ` ... f NORTH 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SS�CMUS t� This certifies that ... �?.M!�s .....! ..(ar. ......... ....... ......................................... has permission to perform .... .......................................................................... f F wiringinthe building of........Z C 1�.......................................................... �-at.........!.3...... . .....D.R....... ,North Andover,Mass. # Fee.....357.... Lic.No5s4E C_ ELECTRICAL INSPECTOR Check # f �J 5064 Official Use On y Permit No. �/U 6 V ?W5 eM&W7M5WW 617 r�jrms ?�rAa2toxuet a��uElie Sadery '� t4 Occupancy&Fee Check _ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR. PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massaclusetts Electrical Code 527 CMR 1211 IV ' (Please Print in ink or type all information) Date To tfie Inspector of iNres: Town of North Andover The undersigned applies for a permit to perform the electrical work/described below. Location(Street&Number /��'� 14 Mut/ Ai&4 /Jr Owner or Tenant CJ''1�1 ('t7 l7 her 1�� Owner's Address Is this permit in conjunction with a building permit Yes 0 No A (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service , AU Amps_ ) Voits Overhead o/ Undgmd 9 No.of Meters New Service Amps Voits Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fndures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.ofReceptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Bumers FIRE ALARMS No.ofJZone Total No.of Detection and No_of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di I No. Pum Tons KW No.of Sounding Device NoJ of Self Contained No.of Dishwashers S ce/Area Heati KW Detection/Sounding De No.of Dryers Heating Devices KW 0 Municipal Lova! Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES�=NO have submitted v>t-lid proof of same to the Office YES= NO - If you have checked YES please indicate the of by checking the appropriate box. INSURANCE r( BOND - OTHER - (Please Specify) Estimated Value of.Ele rica ork$ (Fx 'ration Date) Work to Start Inspection Date Resquested Rough Final . Signed under the Pen Ides of perjury: FIRM NAME LIC.NO. / Licensee- Q&,,tA y Grr J e Signature LIC.NO. (�y 01 2-6 - . B 1 No. 3! if- Address ,l -Crd(1 �(i, , 60i"R el.No. Q OWNELIS INSURANCE VER: I am aware that the Licenses does not have the insurance co rage or' s b antial 6ivalen as required by Massachusetts Generai Laws.And that my signature on this permit applicailon waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ �3 (Signature of Owner or Agent) Date.�f:. �f. .. .. . . . ... . . NORTH Of ". ,°,tip E 0 '` �p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �9SS.1CNU5ES This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .T.). {.!!'. . . . . . . . . . . . . . . in thea buildings of . . . . . �.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .� ,3. . . . /.f? u l! !:r. . . . . . . , .,1 North Andover, Mass. Fee. . . i Lic. No.. . . . . . . . . . . . . . . . ... . . . . GAS INSPECTOR Check# 4120 MASSACHUSETTS UNWORMAPPLICATONFORPERMfr TO DO GAS FTrr] TG (Type or print) Date D 2. NORTH ANDOVER,MASSACHUSETTS Building Locations f Amount$ Owner's Name co ce -- NewE] Renovation F] Replacement �� Plans Submitted O AG U O A a O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR I 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) - / / CA%c one:. Certificate Installing Company Name C "'e, -t:f- !' ( { � Corp. Address /)3 o Y- �U ✓�—�' 10 Partner. Business Telephone F;m/Co. . Name of Licensed Plumber or Gas Fitter Il3SLTR,ANCE CQ +ERAGE Chet , le'. I have a current liability Insurance policy.w it's substant al equivalent Ves No Ifyou,liae checked please cate tl type ovs►etage by ding the appropriate bmc Liability insurance policy Other type of indemnity Bond 0 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 applicatcon t valves this requirnent .. ,� Check Me Signatwre.of4wnex_orOwneessAgent Owner Q Age I Hereby certify#lief alloftle details and information Ize su habmitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and. perfiavwunder Permit Issued`for ' application in compliance with all pertinent provisions of the Massachuotts Sto e d Chapt 142 of the eral Laws ature ofLicensed Pl ber Or fitter Title Q Plumber City/Town F] Gas Fitter License NumWr Master APPROVED(OFFICE USE ONLY) ❑ Journeyman a Location No. Date q-8- TOWN _8-TOWN OF NORTH ANDOVER O?O°,"•O •1hO0 • ; , Certificate of Occupancy $ Building/Frame Permit Fee $ a S� sgcNus i Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ a�d Check # /J( 165 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING gya BUILDING PERMIT NUMBER. DATE ISSUED: _ M SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: aW �s� S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: / Qj Zoning Dia6cProposed Use Lot Area s Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Requ"rid ` , , .ProuA,�ew R red Provided R red Provided 9 ® I 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomration: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT m 2.1 Owner of Record ./)Iq a2g- /)n 1-14 �'�124STO Pace('- 66(Z Ll3 tL � Name(Print) Address for Service: (� r Signature Telephone (d W 2.2 OvMeraf-1kmd: 1a Pnnt Address for Service: G5t'�nature a� 70 ��� ' �3� M natureTele hone SECTION 3-CONSTRUCTION SERVICES j 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address 4�, _49 — Q y E Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ W PLS H c�07�S Q:Dmpany Name l Q —35— �) .� 5 �( � ) {��,10� Registration Numberro Vdress t� /T /✓ Expiration Date Signature V Telephone G) 4 SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ',•,� f - SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICA :USE ONLY Completed by permit 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 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS" �p AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,O k 9611 Ph e-iZ ROGAL as Owner/Authorized Agent of subject property Hereby authorize (.Z/ Z_cs if -v�� 5 to act on My alf, ' all at' e t authorized by this building permit application.-7- 7 -63 J6 Si iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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/Age t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1ST 2ND 3 SPAN DIN ENSIONS OF SELLS DIN ENSIONS OF POSTS DINIE-NSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS +� SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND ` IS BUILDING CONNECTED TO NATURAL GAS LINE TOWN OFNORTH ANDOVER Office of the.Building Department Comm pity Development :end Services I- 27 9 2 7 Charles Street 41 +Noi-th Andoj-er,Massachusietts 01845 ' �yssAcreus D. Robert Nicetta, Telephone(978)688-9545 Budding Commissioner FAX(978)688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by'MGL c 11, s 150a. The debris will be disposed of at/in: (Site location) 7- 7-03 Signature of pe 't applic Date i i Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Dlozzi,Gas/plumbing Inspector E i f The Commonwealth of Massachusetts Department of Industrial Accidents Office or'Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit h .. _ Please Print Name: Q OnA4 6 he,1ST0 k Location: �� 3 M 14 C-no 1 1-- Phone 9-7�— iok5--4IP0 -7 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity ! am an employer providing workers'compensation for my employees wonting on this job. Company name: 60 N S Address tC'm 8 city: 140W(J•e t2 /"79 Phone# ?E ` 4W 47 I Su nce r:o. /L A�AI o k /NSPr51i . # � Vim.732- Compm name: Address ON: Phone# Insurance Co Policy# Failure to secure coverage as relluired under Lection 25A or MGL 152 can lead to the imposition d criminal penalties.of a fine up to$1,s00.oo and/or one years'imprisonment as well as civil penalties in the form of a STOW WORK ORDER and a fine of($100:00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Ind of the DIA for coverage verification. I do herby certify under the pains and penahes of perjury that the kftmatw provided above is true and correct Signature Date 7 7-,,�l.3 Print name / /��`t`fUf� U)jq( S R Phone# ?7�' --6 737 Official use only do not write in this area to be completed by city or town official' E] Building Dept ❑Check W immediate response is required Building Dept ❑ Licensing Board Contact person: PhoEl Selectman's Office ne# ❑ Health Department ❑ Ofher YORKMAN'S COMPENSATION • A.J. Walsh & Sons Inc. 55 14casaiii Sirccl North Andover, MA 01345 Mass. 1,10'NSE d 022680 Mass. IZL(iISTIlATION H 103.358 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged In home Improvement contracting,unlessspecificaliy exempt from registration by provisions of Chapter 142a of the general laws,m ust be registered with the Commonwealth or Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: This agreement is made on ( � (^v 3 between r oAf, 4- A�&� (DATE) p ,'`` 'of (CONTRACTOR) (ADDNiESS) tel./ 73-7 (PRONE NUMBER) hereinafter called"Contractor"and (Owt.U) � (ADDRESS) (P(IONE NUMBER) hereinafter called"Owner". 'i DETAILED DESCRIPTION OF WORK TO BE PERFORMED Conti for agrees to perform in a go(A and worktnanlikc tanner all work detailed]xlow. Such work c osis s o the followi DETAILED DESCRIPTION OF MATERIA S TO BE USED Z6N ttiiZ JU 11 pausts ate(] amnru s totaenuoJ r tat� alt Jlls SJaum Pa .S Q :unnm9rS s,�atu►p 'S3�VdS NNV"11 ANV 721t' 3Hg11 L 3I 1OV2I1.N07 3I11.1. NIDIS,LON OR =2I3NM03WOH •uolJupaaurD JO 03110N P343U Je aaS •Juawaa12r St4J ,Jo 2=2is ayl 3uimolloJ .cup ssaulsnq pi mll Jo 1101UPIM urt1J JWl Jou'SX)A1fap Xq jo utasutra;iilaJ.{q'Pilsod 11rul,c�rulp�o.cq yaur�q jo aag{o ulutu s14 le 3u1Ju.%u1�0);)U- luoa a4l saglJou aauAio a4J JUgj paPlAojd ljoa.ra4J 4auujq to aa!jj u1rw s14 aq Scut yar4,i jolarjjuoa ayl Jo ssalppr ur. up yl jauto aartd r-ir.-tan,un a►►, �'...,,..4..•..,,,,�......... - -- - V. NO ACCELERATION OF PAYMENTS III;T 1.St:k(►��'I.�(; ALLOWED Dic Contractor may not require paymenu to he rtivJe to advance of Ilse tunes specified in Sec tion III(Payment)above for the re son that he deems hcroself of the payments to be insecure. If,however,he dumms himself of tw insecure,he may require,as a prcrcquistte to continuing the work descnbeci herein, Uul Ilia halance of lha psymenih urxicr lido conim i that aur tit t)tr control of the Ownrr,shall Ix-placr41 in a ioint r.scaos+account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be.responsible to Owner or any third party for any property damage or Nxlily in jury caused by himself,his employees or his subcontractors in the performance of,or as a result of,the work under this Apeement. Contractor agrees to carry insurance to cover such damage or injury. VU. SUBCONTRACTING Contractor agrees that,notwithstanding any apreemcnt for materials and/or labor betwfxn Contractor and a third parry,Contractor is resp onsibie to Owner for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION-RELATED PERMITS The following cons trucuon•tela led permits will bo+necessary in order to complete the scope of work included in this Agreement: The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-rel ated petrnits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. !Notice: If the homeowner obtains his own construction-related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, Judgment and nonpayment or the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement.including the provisions relating to price(Section 11)and 1)avment schedule(Section 111)cannot be changed except by a written statement signed by both Contractor and Owner. However,cancellation by Owner is allowed in accordance with the Notice of Cancellation(annexed). X. WARRANTIES The Contractor warrants ilial Ufc work Iurni.khed hereunder shall lie Iice from defects tit mato ials and workmanship for aper toll of following completion and shall comply with the requirements of this Agreement. In the event and defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents. is duuivercd within one year after completion of any job,including cleanup,the Contractor shall, at his own expense, forthwith rernMv,repair,correct,replace,or cause to be remedied.repaired,or replaced,such damage or such defect in materials or workmanship. 11te foreeoiny warranties shall survive..any inspertion,v-rformed in cor-necrinn with tim a.•eed cunnr work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment,which shall he wtd are hcrchy passccl through directly to thr()wnrt. l metre silt It rnanidaCtnterN,will t;uuir-:,thr,0weer may lx:required to register or mail in awarranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documcntauon, which failure voids the manufacturer's warranty,shall riot aeatc any responsibility for the Contractor to warranty such equipment. Thiswarranty gives the owner specific legal rights,and owner may also have other rights which vary from state to state. Under Massachusetts law,sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. XI. COMPLE'TEN'ESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all bland;sections have been filled in or marked as void,deleted or riot applicable,gad until all exhibits fund related of referenced documents that are incorpxnrauvi herein are attached hereto, XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER 'flus Agreement is governed by dee Laws of Mtssachtuctt_s. It must be executed tit duplicate,and an original signed copy hereof given to Ufe Owner at thr,time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the owner of a dopy Ufereof. -- -- --- RIGIITS TO CANCEL, — .� 'I:]%A I./J\\.1—W■�l•\�rl..•a.,..�.J.I I��.e--.ems.... _�_A��J��...—��r�-�-J.� _ _ – T– NORTH Town o , E Andover O vw` ti q A W' O L 04 roc A dover, Mass., A0'4A T E D S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......CAAASS.............kev.c.�.../. . .................................................................................. Foundation has permission to erect...4.f)01............. buildings on ............3.......^44,..NO.<<A ......bl?- Rough to be occupied as... �� v�N S� v � w#*�e&s Chimney .............................�. ........................ ............ . ........................................................... provided that the person accepting this permit shall in every resp ct 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 Inspect'on, Alteration and Construction of Buildings in the Town of North.Andover. 6.46 /SaoO2 , o PLUMBING INSPECTOR e VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR Rough jA .............`.................................... 4. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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. p Location No. ��� Date MaRTh TOWN OF NORTH ANDOVER 9 =a Certificate of Occupancy $ CHU Building/Frame/Frame Permit Fee $ cNusE 9 Foundation Permit Fee $ cE,�w,a�� Other Permit Fee `� $ TOTAL $ d J Check # rqS 4- 16514 - 165i4 Building Inspector Town of North Andover Office of the Building Department p2o`�{. e 0- Community Development and Services Division * _ - WiIIiam J. Scott, Division Director '► • 27 Charles Street SCRds �e Heis North Andover, Massachusetts 01845 D. Robert Nicetta Telephone(978) 688-9545 Building Commissioner Fax (978) 688-9542 CHIMNEY APPLICATION AND PERMIT DATE_ Q PERMIT LOCATION A� OWNER'S NAME BUILDER'S NAME T '� MASON'S NAME MASON'S ADDRESS- 0.91.� Nc✓�-.� J� it s 0,�i4,.r� T — MASON'S TELEPHONE MATERIAL OF CHIMNEY INTERIOR CHIMNEY �^ EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES I ;;olJC L ------------------ THICKNESS _THICKNESS OF HEARTH_ ______/ Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE Q SIGNATURE OF MASON CONTR. LIC. e>a ? O t EST. CONSTRUCTION COST/ ONTRACT PRICE �C- J PERMIT GRANTED '-� FEE 7© ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES 110ARD of APPEAL 5 6RR-9541 IWHDIW688-9i45 CONSERVATION 68 8-95 30 HEALTH689-9540 PLANNING 6RR-9535 01 r 1 BOARD OF BUILDING REGULATIONS meati License: CONSTRUCTION SUPERVISOR s Number: CS 024170 Birthdate: 02/18/1957 I . _ Expires: 02/18/2004 Tr.no: 15872 Restricted: 00 SCOTT J AUDETTE 2 EDWARDS RD WILMINGTON, MA 01887 �'