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Miscellaneous - 455 STEVENS STREET 4/30/2018
455 STEVENS STREET / 210/096.0-0017-0000.0 I Date.... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 33�C c HU Thiscertifies that ............................................................................................................................ has permission to per ............................. form ..................... wiring in the building of...... . ............................................................... .............I at ......... .... ...... ... �7........................ Nort"ndo ve.r,Mass. W(Fee .. ................. Lic.No. . .....A'' a? 4FC .......... .ELECT� i �o Check # ,p Official Use Only Commonwealth of Massachusetts �f Permit No. Department of Fire Services ' p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS IRM 1/071 (leaveblank 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 RV NK OR TYPE ALL INFORMATION) Date: 6 ?4� — /:s— City S^City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) t/'P nl S ST N ' Owner or Tenant _(�t C 14-i te4j C5 f 4 m N Telephone No. Owner's Address rl,97=° Is this permit in conjunction with auilding permit? Yes ❑ No [A--- (Check Appropriate Box) Purpose of Building 5/N G-1-c�n'1� !,1.e`/.' Utility Authorization No. - Existing Service 2;�)o Amps ZIA /Zyy 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: j , ©aQ U&J �- d- Z►-jQda) 191 it. /2AN0�'-, /u ✓u J)U// 1pW✓IPW}�A�� � Nu1l� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus .(Paddle)Fans No.of Total P Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency Lig ting No.of Luminaires Swimming Pool rnd. rnd. El 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 No.of Alerting Devices g Tons HeatPum Number Tons I.KW...,,,. No.of Self-Contained No.of Waste Disposers Totals - Detection/Alerting Devices Municipal ElOther No.of Dishwashers Space/Area Heating KW Local 11Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No,of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: /'`Sb V — (When required by municipal policy.) Work to Start: G -Z(. -/ -'5- 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 covera e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) S°6�e I certify,under the ams and penalties ofperjury tl at the information on this app cation iS true and complete. FIRM NAME: . Ka L� !2 S� tl� LIC.NO.: Licensee: f.-,e w^t/c, 12 S'12-iij! d'rj Signature LTC.NO.: (If applicable,enter " emppt"in the license number line) Bus,Tel.No.: Address: O!/ Y 0 0-J'J `w, ✓tiP f+l !►?/�. Alt.Tel.No.: *Per M.G.L c. 147 s.57-61, ecurih' requires uires Department of Public Safety"S"License: Lic.No. q 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. The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 .,�. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual): Address: S t:, ST City/State/Zip: 0VYV%p a.J /V1 d 1 HY Phone#: 6 �3 Are you an employer?Check the appropriate box: Type of project(required): 1.�am a employer with employees(full and/or part-time).* 7. []New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. �Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition ❑4.FJI am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I L P�eCtrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.F1I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.Q We are a corporation and its of�cers.have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam 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.Lie.#: Expiration Date: Job Site Address: J�e Im ki-N 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u er the pains an en s of perjury that the information provided above is true and correct. Signature: r, Date: G Phone#: f 2 is 3-25 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#: .r r/ '0-x.COMMONWE4LTH OF MASSACHUSE $, • BOARD OF EfCTl'!RICIANS ISSUES THE FOLLOWING ;LICENS _ AS A RE ]OURNEY,MAN .:E LECTR I-C IA (¢`' F,REREAICK R;,.SKAF III I OW29 R0LL--K NEADS I W � HAVERM L1 a MA 01832-88T5 2440207 07/31/16 39174 pk° Z6 - Glens Falls Regional Claims Office 5 Encompass, FO BOX 660187 ..,. CreaUng protection around you DALLAS TX 75266-0187 GERALD BROWN; NORTH ANDOVER INSPECTOR OF BUILDINGS 1600 Osgood Street Apt/Ste: 2035 #20 North Andover MA 01845 June 08,2015 I INSURED: Suzanne Martin Gramly PHONE NUMBER: 800-262-1145 DATE OF LOSS: May 30,2015 FAX NUMBER: 866-253-1296 CLAIM NUMBER: Z6239852 VL OFFICE HOURS: Mon-Fri 8:OOAM to 4:30PM PROPERTY ADDRESS: 455 Stevens Street,North Andover,MA POLICY NO.: 196589844 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws.Ch, 139.See.3D TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen CITY/TOWN HALL: Building 20 Suite 2035 ADDRESS: 1600 Osgood Street CITY/TOWN/ZIP CODE: North Andover,MA 01845 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 3D is appropriate,please direct it to the attention of the undersigned and include a reference to the captioned insured,location,policy number, date of loss and claim number. On this date,I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. SIGNATURE AND DATE Kim Roberts June 08,2015 PROP054 Z6239852 VL 1000020150608ET002000141001001000241 i i I i -71 �j 40 n —A—o -5p e 1�� P � b 47d LJL- �1 ��61 _ � -► f %%ORTH O SS�eo �6'9.y0 O A LSSA USEt 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: a�'�I�. 1 Aynl1 Tel #: CPb 7�l 1 FROM: de-cl-v'I ADDRESS: %P-j� 'Pei Complaint Against: ELECTRICAL: P UMBING: BUILDING CONTRACTOR: PROPERTY OWNER: OTHER: 1(53(7) 4tyo, eo Signed: &J 76 7 Date.3. ."��.. .. .. HpRTM of �' 6 6 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACHUSES t; This certifies that . . . . . �f�: . . !.'�G has permission for gas installati n . ` . . . . . .. . 7� in the buildings of . . . . h i . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .��. . ,. 7.. . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.5.0. . . . . Lic. No. '.T. . . . . . . . . . . .. . . . . . . . .. . .. Check# V GAS INSPECTOR �/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: L(If, MA. Date: 1I! Permit# Building Location: Owners Name: 602400 Lk/ Type of Occupancy: Commercial ❑ Educational FI Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement. Plans Submitted: Yes❑ No FIXTURES � v7 w Lu Q _ M W O W = cn iri m = O W W U CO) 0 w I— Q 0 �. CO) O 2 w y CO) Z W m 1O Q 1L W W w x U) C) W rn 0 Q w y O61-- 0 = > v w Z 0 -1Cn _j 1— 1— 0 Z J (D � = W W W 0 W u_ (7 0 W W m > 0 Z 0 W Z Z w Q � ; 0 a I— > > > 0 SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR 4 T H FLOOR 5I HFLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: J�Corporation Address: City/Town: D State: / ❑Partnership Business Tel:T D r�'1T Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVE : 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 Signature of Owner or Owner's Agent Owner ❑ Agent El By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Plumber 0AIRA &Q-&4A-.A T'-ai-. Title Gas Fitter Signature of Licensed Plumber/Gas Fitter aster Cityrrown Journeyman License Number: 19ST7 APPROVED OFFICE USE ONLY ❑ LP Installer Datef-d 4. . 88 ' 4 0'<"��':��c TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING ,SSACHUS� This certifies that . .�G,rh� . .+ a/.lL �. 1 . . . . . . . . • . . . . has permission to perform . . . . . . . . . . . . . plumbing in the buildings of . . .�? m. . . . . . . . . . . . . . . . . . . . at . . .�,rj- .. . �'v�!t47.�.S.T-7. . . . . . . . . .. North Andover, Mass. Fee. J. ". .Lic. No.. 1" . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. PLUMBING INSPECTOR Check LIS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town• l[•�l p, AA1W* _ MA. Date: ;IZ8111Permit# Building Location: �� S77tt+t-1� s1-1 Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential I �F• New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No TTT FIXTURES DEDICATED w Z SYSTEMS i- z z H O �n z of 0 c Q Z W (7 z Z to 2 �n Q w z H W z Fa- N 2 H z m vai w W 0 F- 0 Q Q z 0 0 W z W _z U d LL Q Y 2 O 0 = Z ~ LL 3 H J Q = W W 0d O to W W U F- Ln c F- U Q O a Y z of F- H w 1 a >' F- Q Q v1 to O F. �>r > O = p Q y. Q Q Q �_ U Cn Q z a a m m o o LL x Y S g ac Ln N 3 3 3 o -SUB BSMT. BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR ST"FLOOR Check One Only Certificate# !•'1 Installing Company Name: kJE1rl�Qec�AL,,,,,�►„� 1.��•� �1 Corporation Address: 'P(,L7yg) Cit Y/Town .t-.AAAWLJOL State:_ ❑Partnership ' Business Tel _ . "o1 Fax 7 �Y701 ?j ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes�No E]If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title Plumber Signature of�Llcense�dPlum"ber Cityrrown Master APPROVED OFFICE USE ONLY Journeyman License Number: ' V I 9996 Date,54 /I/ ............. t �aOR7M� 3:;•_'�`` 4,�0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� - This certifies that ....................... 1• ...s:...................................... has permission to perform ..........S ...`....� wiring in the building of....'71!x' ...(T�7.m ................................. at.l J.... ....................S✓......"...................... , orth Andover,Mass. s�- Fee Com'..r..... Lic.No ............. ....................... ELECTRICAL INSPECTOR Check # .� q�� r` CommonWll&of M466acl elb Official Use Only 2epartmeat o f—7im Service, Permit No, anc BOARD OF FIRE PREVENTION REGULATIONS [Rev.1107�y and Fee Checked 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: City or Town of:� �/l To the Inspector of Wires: By this application the undersigned gives no ice of hts or her intention to perform the electrical work described below. Location(Street&Number)--, Owner or Tenant Telephone No:q�� Owner's Address C' — Is this permit in conjunction with a building permit? Yes ❑ No lai (Check Appropriate Box) Purpose of Building `��C/�2'�//� _ 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: i Completion of the- ollo,vin table May be waived by the Ins ector o Wires. No.of Recessed Luminaires No.of CeU. 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.o mergency ig ng end. rnd. Batt= Units No.of Receptacle Outlets No.of Oil Burners FIRE�ALAMRM�SNo.of Zones No,of Switches No.of Gas Burners / No.of Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons Totals: KW No,of elf-Contained Detection/Alertin iy Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [I Other Connection No.of Dryers Heating Appliances KW ecurity Syystems:* No.of D v' No.of Water0.0 = ices or E uivalent Nf No.of r Heaters K��' Data Wiring: Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiri OTHER: No.of Devices or E uivnalentg: ��D ,� 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:,'?&/Lfi4a// 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 F] OTHER F] (Specify:) I certify, under the pains and Ides of perjury,that the information on this application is true and complete. FIRM NAME: Aries Electrical Service and Controls LLC LIC.N015650a Licensee: Nor and Michaud Signatu,• 34594e (If applicable,enter"exempt"in the license number line.) _ C.NO.: Address: 290 Broadway suite 117 Methuen ma 01844 Bus.Tel.No.: 978 687 0544 *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt Lici 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: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_.ARTZS.iELECTRICAL SERVICE AND CONTROLS LLC Address: _299 RROAnWAY SIITTR 4r IJ-7-- City/State/Zip: -MPt110 17City/State/Zip: -MPth»Pn Ma (1i Rdd Phone#: 97f3 687 0544 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 I am an employer with 4. ❑ I am a general contractor and 1 6.❑New construction employees(full and/or part time).* have hired the sub-contractors 2 :am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no erppleyees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurancecomp,insurance.$ 9. ❑Building addition required] 5.0 We are a corporation and its 0 Ikklectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their X myself [No workers'comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions r' insurance required]t c. 152,§ 1(4),and we have no 12.❑Roof repairs parrs 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. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indican $Contactors that check this box must attach an additional sheet showingthe name of ng such. the sub-contractors have em to �e sub-contractors and state whether or not those entities have employees !f ces,the const provide com[!-Poficynumber. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: � J j�'" �� XZ 5&,o,?4 Policy#or Self-ins.Lic.#: Expiration Date: 7- �J Job Site Address: 5 S eA_)S S City/State/Zip: / Att ach a co of the a workers compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 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 an d a fine of $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Print Name: Normand Michaud Phone#: 978 687 0544 V Official use only Do not write in this area to be completed b city ty or town official City or Town: Permit/license#: Issuing Authority(circle one): I.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 6.Other 5.Plumbing Inspector Contact person: Phone#• 4n A r Date."-:. . . . . . . . . . 0.4 4 .0 R'M�4, TOWN OF NORTH ANDOVER h A PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform, . . . . . . . . . . . . . . . . i plumbing in the/buildings of .✓. .-': '?-1�: . . . . . . . . . . . . . . . . . at . ` `� . . t^�-^-p. . -'�' . . . . . . . . . , orth Andover, Mass. Fee. -7. .... .Lie. No.. .. 7. r .. . . . . . . . . . . . . PLUMEI G INSPECTOR Check # � V 5146 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date OZ—Z-0 -02- Building Location S5 Sf e 1/e h 5 S+ Owners Name Q L Cala I'd G rcat�!y ,.,permit# Type ofOccupancy / / Amount j / I New Renovations Replacement 0 Plans bmitted Yes No El FIXTURES r d sx 0. W w . W a Q A Smsm >�L4I4II�II' >sT;QaaR t r l 4M R= M r1oat s]HR 710EI bUM sIll3 FLOCK (Print or type) WHITE ROCK PLUMBING&HTG. Check one: Certificate Installing Company Name R9. ROX:A^ Corp: _ /(o O Q'C Address NORTH ANDOVER, MA. 01845 '175- q 7 S - 4 2 Q n Partner. Business Telephone Firm/Co. Name of.Licensed Plumber. - Ro b e r+ Q lan c`l e ff-je- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1Z Other type of indemnity D Bond ❑ Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have anyone of the above three insurance yrgnature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the�ac setts. tate bing Code d 142 of the General Laws. rBy: igna o icens um er Type of Plumbing License e8 Sq7 y/Town icense um er Master JourneymanPROVED(OFFICE USE ONLY I Date. . . . . . . . . . . . t HpRTM 1 �,<. •° �o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r Y This certifies that ., .;�..�. .... . . �' . : . . . . . . . . . . . . . . . . . . . has permission to perform . . . . ` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i plumbing in the buildings of . . ..�. - ' at . .S�iS-S/. <- .- �-!.4-- . . . . . -: . : . . . ., N rth Andover, Mass. Fee 4� .�. . .Lic. No.. AS.? �:. .. - / PLUMBING INSPECTORf Check # 7163 MASSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING (Print or Type) 0 r A tl doLV , Mass. Date 20 00 Permit # Building Nation fESS ST*JeA '7 Owner's Name L Type of'Occupancy �Z Auxfe- New,0 RenovationX-• Replacement 0 Plans Submitted: Yes❑ Noy FIXTURES ;SEWER# SEPTlC # z �- Ln 8 ¢ > w LQ Z w l¢— u, 4 _ z 0 z z z a LL, U N m to ¢ W. a . C7 �; g WLLJ 0 LU Lr) LU z O Q LL LL > O U LU u E— z o o z z ¢ O U o = 2 m v=i D _ Q vi u C¢7 ¢ m .O SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH.FLOOR 8TH FLOOR Installing^Conpany Nam,ejLA4jYf_ umL PtW4QK14, � Check on Certificate Address _7. Corpora � tion N► , wh4'-. 0 18 a 0 'Partnership . Business Telephone %� )_+ 1_7D- (793 . n ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter I�OBr - VA AIGH" o le COVERAGE: i hae�e a current liability insurance poii.cy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No . 0 If you have checked yes, please Indicatethe<type of coverage by checking the appropriate box. A liability Insurance policy Other<`ty:p.e of indemnity 0 Bond 0 OWNER'S INSURNACE WAIVER- I am aware that-the.lic.ensee:does not have the insurance:coverage.required by Chapter 142 of the Mass.General Laws, and that:my signature on this.permit applicafion.vvaives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 hereby certify that all of the details and-information l have submitted (or entered)in above application are true and accurate to the best of -ny knowledge and that all plumbing work and installations:performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code annd�Chapter Title 142 of the General Laws.' BY Signature of Lic sed Plumber City/Town Type of License: Vfaster' ❑Journeyma.n APPROVED(OFFICE USE ONLY) :License Number 8"S *7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print Gyps) F as Amt D�IrL,_._, Mass. Date / 12 _� 06 Permit A + Building Location k-T S111L&il 'Sr Owner's Name �7 a V Type of Occupancy L New Renovation Replacement Q Plans Submitted: Yes © No r U W rA Y Z Cr U) U U U � t... x to 2 cc w Cr OOQ z Z ►x- w m U x Z 0 W o.. :'' W F- u Q x U W p. W W W. U W Z Q 2 W ►-' W ~ Y U. tr U' H Z Jj H- Z F- W W C7 > u : l U _j W W . z o o = cc z LL D 3 0 8 8 > o a. � o SUB-BSMT. BASEMENT I ST FLOOR 2ND FLOOR 3RD FLOOR i 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name (. ITS 121 ; DLIMA''�)S) Check one: Certificate # Address F1.0 4 Corporation ❑ Partnership Business Telephone ❑ Firm/Co. Name. of Licensed Plumber or Gas Fitter -INSURANCE COVERAGE: have a current liability insurance policy or.its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1�" No ❑ If you have checked yes, please indicate the,type coverage by checking the appropriate.box. A I(abi'lity 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 waives this requirement. Check one: Owner ❑ Agent ❑ Slgnature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application'are true:and accurate to the beat of my knowledge and that all plumbing work and installation performed:under the permit issued for this application will be-in compliance with all pertinent.provisions f the Massachusetts usetts State Gas.Code and Chapter 142 of the General Laws. By Type of License: piam I�I(Plumber Title 17 Gasfitter Signature of Licensed Plumber or Gas Fitter City/Town Master SS`37 APPROVED(OFFICE USE ONLY) 7 Journeymen License Number Location 41S-,S- l / , , E No. 0 � Date y' 2 NpRTh TOWN OF NORTH ANDOVER 0. 9 +� Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ `3 7 s�cwust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15321 / Building Inspector i ii F TOWN OF NORTH ANDOVER s BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLI.NG. BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: A/W Building Commissioner/I for of Buildings Date PECION -SITE INFORMATION erty Address: 1.2 Assessors Map and Parcel Number: qw(J1�/ MaP Numberg Information: 1.4 Property Dimensions: Proposed Use Lot Area Frontage-(11)., 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Provided Requilrd Provided t.7 water Supply m -C.40. 54) 1.5.' Flood Zone Infoimrtlon: 1:8` Sewerage Disposal System Public 0 Private ❑ Zone Outside Flood Zone ❑ MraoicW ❑ Ortsit.Drsposal',Syst. ❑ SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name(Print) Address fo Service: 7.0 70 Signature Telephone 2.2 Owner of Record: Nam nt Add for Service: r7 r" / Si r Telephone J SECTION 3-CONSTRUCTION SERVIUS. 3.1 Licensed Construction Supervisor. Not Applicable . Q Licensed Construction Supervisor: License Number Address Expiration Date Signa-erre Telephone 3.2 Re Nstered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone N6RTI' An o - •� 4 over ovm - f O 2` LA o h dover, Mass., o� I� COCHICHEWICK V 7,ps RATED 1''\p �y 7 ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System NN � � GP4 �t� BUILDING INSPECTOR THIS CERTIFIES THAT..... a..... Foundation has permission to erect.... 'PS.. buildings on .. ..S5S Rough ... ............................................................... to be occupied as � F-/000P BA� N Cj0 &4 S Chimney ......f... ....... ............ ...................................... ............................................................... y 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. 9116//f7 391.* PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAELECTRICAL INSPECTOR �&S Rough 04 ................................ ..... ...... Service ......... .......... ........ ....... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. x Town of North Andover ��°.a;�*• "�"o Building Department 27 Charles Street # z North Andover, MA. 01845 ': D. Robert Nicetta 'ss15cfn,s Building Commissioner (978) 688-9545 ....1978) 688=9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION Sjfil f`e r7 f s�- . Al, A/e,,,e Number Street Address Map/lot "HOMEOWNER �.! OS-.r7� � �0 Name Home Phone Work P ne 6/d PRESENT MAILING ADDRESS S ' City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such horneo"em to engage an individual1br hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which helshe resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be'considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he understands the Town of No.Andover Building Department minimum inspection res and requirements an that he/she will comply with said procedures and requir en HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Date. ..... .1. .. .-. . f. ... .. °f 40RTH 1ti TOWN OF NORTH ANDOVER o��..... 1- A X PERMIT FOR GAS INSTALLATION 9 �ISS SEI h This certifies that . . (. ... . '� has permission for gas installation . G. .G'.! ,/C in the buildings of . . . at . . . . . . ?. . . . .1 (:. s . . . . . . . . . . , North Andover, Mass. Fee. . ?. .' Lic. No.. . . . r . . TY'?: . . . . . . GASINSPECTOR Check# c v� j�q((TT,'pe MASSACHUSETTSUNIFORM APPUCATON FOR PERMrr TODO GAS FITTING or print) ! Date 07— /7 2.oo l NORTH ANDOVER,MASSACHUSETTS Building Locations 4- 55 S-f ey P. i S S-f' Permit# 2-- Amount$ A10, 19 n do f e,1— M Q, Owner's Name I Chard (r r/M /4 New® Renovation ❑ Replacement ❑ Plans Submitted ❑ w c o rA F w a H a o 3 A U SUB-BASEM ENT n A S E M ENT 12S T. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Q2&k one: Certificate Installing Company Name WHITE ROCK PLUMBING&HTG. Corp. /E'0 4 Address NORTH ANDOVER, MA. 01845 ❑ Partner. Business Telephone q78— Q75— 4 2Q Q ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter RC o b e r-E Q . G l Q n c-h e r+ INSURANCE COVERAGE Check one: I 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 El 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 waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for thi application will be in compliance with all pertinent provisions of the Mas hus s State s Code and Chap==Z?E> �• By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber t9 5 Q 7 City/Town ❑ Gas Fitter r'177 a um er Master APPROVED(OFFiCE USE ONLY) Journeyman 3 3 61 Date,a—�/- NORTH TOWN OF NORTH ANDOVER pF4��ao ,^1't'O PERMIT FOR GAS INSTALLATION p �^ �,SSACHUSEt This certifies that . . . . . . . . . . . . . . . has permission for gas installation . . . .C."�F. . . . . . . . . . . . . . . . . . . in the buildings of . . .G 12^ n l`/. . . . . . . . . . . . . . . . . . . . . . . . . . ` S$cve.n5 at . .!-/.�:�' . .�/I �'�?r. . . . lG . . . . , North Andover, Mass. Fee. �r Lic. No..j�l .?. . . �ls 7. . . . . . . . . . . -14 GAS INSPECTOR 1 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 0 (Print or Type) _ 1��✓G , Mass. Date l© � �_� permit # 3 6 Building Location_ � �I1Pt1 r- Owner's Name____� /nl Type of 01-11-an New [ Renovation ❑ Replaceme t ❑ Plans Submitted: Yes❑ No ❑ N N2Qcc to {n YViAmW7 NFa' N Z ct-C N V OC M ul W 0 J W - cc Z = Op Om O ww w d JWF- 1 f- w O W W W Vf J Z Q S a: a W cc W r W N Y tl F- Z J F- Z r.. W W tl 0 > LL }- W J W Z a W Q a < >- N W z O z a O x a u, > W z. Q ¢ Q aC .x O tl 2 U. n 3 c tl v ¢ Y e a M- O SUB—BSMT. BASEMENT 1. 1ST FLOOR 2ND FLOOR 3RD FLOOR • 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �❑ Corporation 1862 LAWRENCE, MA 01840 El Partnership Business Telephone -68,7-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9, No ❑ If you have checked Ves, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity❑ Bon ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner[] Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accuWe to the best of my knowledge and that all plumbing work and Installations performed under the permit iss f r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. U i Type of License: Title Plumber Signature o Licensed Plumber or Gas Gasfitter City/Town Master License Number 8697 O IC S _ONLY Journeyman 6 c. Date./A ,�ORTM TOWN OF NORTH ANDOVER pF ��ao �n1tip PERMIT FOR GAS INSTALLATION f F • i • SACHUSES i This certifies that . . ' ,`!.S '' . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at � . . .. . .. .�. . . . . . . . . . . .. North Andover, Mass. Fee. . Lic. . . . . . .... . . ... . . . . .. . GAS INSPECT04 WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ��= A6f-f��laV��. , Mass. Date /d �cMDl) 3 It _ Permit # Building Location , �� F ,� Owner's Name_ h~ Type of Occupancy YQSi,yelfgfi .-L New ❑ Renovation p Replacement ❑ Plans Submitted: Yef p No E] N N 4: X W N z cc N a N a 0 CC }- f W O 7 N = F 0 N w Fo, m z a F- Q >' z ; O t- w Q m y y o ° O H " N arc N C7 W w = z t- rn o > w W W O J x Q = X rX W rt W f' W F- Y n a z Q W : Q C F' P >• N m z 0 z W 0 �y X oaC 'X O 0 7WG u'. n 3 C 0 .ai V y a a F O SUB—BSMT. BASEMENT I+ 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET XJ Corporation 1862 LAWRENCEf MA 01840 ❑ Partnership n Busi e ss Telephone •6 8 7-110 5 P ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: 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 N Other type of Indemnity❑ Bon ❑ OWNER'S INSURANCE WAIVER: 1 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'sAgent Owner❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and aaxu to to the best of my knowledge and that all plumbing work and installations performed under the permit pertinent ovisions o Pe d iss f r this appficaGon will n m Ilan pr f the Massachusetts State Gas Code and Cha P ce with all Chapter 142 of the Gene - s. / (� � Type of License: Title Plumber Signature of censed Plumber or Gas Gasfitter City/Town Master License Number 8697 O IC S _ONL Journeyman Say State Gas Company GAS INSTALLATION AUTHORIZATION at Issued to Address For Installation of: BTU Input Restrictions BSG Representative PERMIT ISSUED BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range . ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR