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Miscellaneous - 49 BRIDLE PATH 4/30/2018 (2)
49 BRIDLE PATH \ / 2101063.0-0005-0000.0 \` I I Date.. !..I �. ................ � NonrM TOWN OF NORTH ANDOVER PERMIT FOR WIRING 88ACHU3� Thiscertifies that ............. ..............................................................:......................................... has permission to perform ....... Y`^o. �.................. wiring in the building of..........i�:.a..`'�. ............................................I..: ........................... at .......... .... .� !A�t.. ! ..!...!!..:........................... oith Andover,Mass. Fee..-�. ".........Lic.No. I.�jj..... .M�.............� ...... .. .... :. .... ELECTRICAL INSPECTOR Check it i2u ��, :�- Com -� Z � 't� � 113 � Commonwealth of Massachusetts Officia Use 0 ly ffa Department of Fire Services Permit No. Occupancy and Fee Checked h BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/071 eaveblank �. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC)'527 CMR 122. t (PLEASE PRINT INIIVK OR TYPE ALL INFORMATIOl9 Date: / 7 City or Town of: NORTH ANDOVER To the Inspector of fres: By this application the undersigned gives notice of hiA or her intention to V rm e ecal work described below. r Location(Street&Number) Owner or Tenant Telephone No. Owner's Address P, SAO 512 • ox Is this permit in conjunction w' a build•ng permit. Yes No ❑ (Check Appropriate Box) Purpose of Building � /V t` Utility Authorization No. �Q�v G I P g i - Existing Service�,-4'-9"5� Amps Zz2 ��Wolts Overhead❑ Undgrd'❑— No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature o Proposed Electri l Work: r r Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lig ting rnd. grnd. Batter Units No.of Receptacle Outlets Z No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas]Burners No.of Detection BudInitiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: .............................................. Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other R P g Connection No.of Dryers Heating Appliances KW Security Systems:* Y 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: ditach additional detail if desired,or as required by the Inspector of Kres. Estimated Value f lectri 1 Work: (/�• (When required by municipal policy.) ; Work to Start: 2 Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: . kle, (c C o- LIC.NO.: Licensee: c�C-P��_Q,��� f� ( c ��5 Signature LTC.NO.:A �tfl (If applicable,enter "exam t"in the license number line.) Bus.Tel.No.: Address: 1/o u 12ccS u w f Sf by f .. Q w 0 td" lt.Tel.No.: Gl 7X AL3'��G 3 J_ *Per M.G.L-. 7,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 PERMIT FEE: $ Signature Telephone No. G11Ni( II�EALTH OF MASSQO • • • ..s • • . s I:ECTRRAANS R "t R D MASTER EL -Tib A [SSUESHEA } CENSE it y Y ■� / NN, VER ,1''7'�e O�LY '' 07/31/13 &1t , • Date . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 2 469 This certifies that . . �.I.. . . . . . . . . . . . . . . . . . . . . . . . . f has permission to perform . . . . . .I�. .P C:' . . . . . . . . . . . . . E plumbing in the buildings of. . . . .h.A y.'s. . . . . . . . . . . . . . . . . . . . .��, at . . .4 .C9 . . . . . . . . . . . ,North Andover, Mass. t� A� Fee '. . . . Lic. No. la.I. . . ') . . . . . . . . . . . . . . . . . . . . . . �. PLUMBING INSPECTOR I ' Check# 2 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . a CITY 1.NORTH ANDOVER MA DATE 4/19/13 �D PERMIT# -I JOBSITE ADDRESS 149 BRIDAL PATH OWNER'S NAMEJ RAYES POWNER ADDRESS TEL ` FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:® REPLACEMENT:Ej PLANS SUBMITTED: YES® 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 DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK 1 LAVATORY 1 1 ROOF DRAIN , SHOWER STALL SERVICE/MOP SINK TOILET 1 1 y URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY[j OTHER TYPE OF INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT El SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurateLo the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MIKE CAPELESS LICENSE# 15851VvF --`-&6NAtURE MP EJ JP Ej CORPORATION®# PARTNERSHIP®# LLC[I# COMPANY NAME I BOILER-GUY/MIKE CAPELESS ADDRESS I 160A PLEASANT ST CITY FNORTH ANDOVER STATE 'L..,:�- ZIP 01845 TEL FAX I CELL 978-382-1017 EMAIL .aco v® CERTIFICATE OF LIABILITY INSURANCE DA04/1 l/OD/Y 04/18/20133 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERA Matthews Insurance Agency Inc NAME: 182 Parker St PHONE , (978)681-1112 ac No:(978)685-3855 lh-MAJIL Lawrence,MA 01843 ADDRESS: INSURERS AFFORDING COVERAGE NAIC Y INSURER A: Atlantic Casualty INSURED Michael Capeless 105 Tyler St INSURER 8: Arbella Methuen,MA 01844 INSURER C: INSURER D: INSURER E- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD (MONY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 COMMERCIAL GENERAL LIABILITY L143000684 08/0]/2012 DAMAGE TO RENTED 08/07/2013 PREMISES(Ea occurrence) S 100,000 CLAIMS-MADE EIOCCUR MED EXP(Any oneperson) I$ 1,000 PERSONAL 8 ADV INJURY 1$ 1,000,000 GENERAL AGGREGATE IS 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS•COMP/OP AGGE 1,000,000 POLICY 7 PRO- LOC y AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden ANY AUTO I HC357357 08/30/2012 108/30/2013 BODILY INJURY(Per person) $ 300,000 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ 300,000 HIRED AUTOS AUTTOSSWNEO PROPERTY DAMAGE $ 300,000 Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 EXCESS UAB CLAIMS-MADE x1111463 02/23/2013 02/23/2014 AGGREGATE $ 1,000,000 DED RETENTION S WORKERS COMPENSATIONWC STATU• OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECLITIVE 890911-0937696 11/17/2012 11/17/2013 E.L.EACH ACCIDENT S 100,000 OFFICERIMEMBEREXCLUDED? ❑ NIA ImanIf tory In NH) E.L.DISEASE-FA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Heating or combined heating and air conditioning systems or equipment,installation,servicing or repair,plumbing CERTIFICATE HOLDER CANCELLATION Town Of North Andover North Andover,MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATN C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD y � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations qu 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual):�� C Address: City/State/Zip:AQ(7A4 DCkJ Phone#: � Q AreJbu an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_� 4. El am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 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.]r employees.[No workers' 13.[i Other 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 ire 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. 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: j Job Site Address: City/State/Zip:GouQ y �VhLt i 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 cert under the ins enalties of perjury that the information provided Pove is 4e and correct. - Si a r . = Date: Phone#: W4-- �d- b 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#: Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ...............................................................................................................................................................................................................................................-................ ....................... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency LICENSEE More... Name:MICHAEL N. CAPELESS REFERENCES& METHUEN,MA RELATED INFO Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS 8 GASFITTERS Glossa of License Status License Type: MASTER PLUMBER Codes Glossary License Number: 15851 More... Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 9/16/2011 Exam Date: 9/16/2011 School: This web site dis las disciplinary actions dating back to 199 P Y P rY � 3. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday,April 24,2013 at 11:21:51 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board code=PL&type class= M&1... 4/24/2013 U %; 958 / Date LF,U TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . . . has permission to perform . . Pt� . . . . . . . . . . . . . , , , , , , , plumbing in the buildings of. . <. at . p. . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee . .�5.�.� . . . Lic. No� -'. '�/�G 'L �O"`( . . . . . . PLUMBING INSPBCT�R Check#/235 .[7 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY NORTH ANDOVER I MA DATE 5128/13 PERMIT# JOBSITE ADDRESS 149 BRIDLE PATH OWNER'S NAME RAYES P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL F-1 EDUCATIONAL RESIDENTIAL 0 PRINT CLEARLY NEW:E] RENOVATION:❑ REPLACEMENT:F-., PLANS SUBMITTED: YES❑ NOQ FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER x DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK x LAVATORY x x ROOF DRAIN SHOWER STALL ,SERVICE/MOP SINK TOILET x x URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 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 0 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. CHECK ONE ONLY: OWNER [:1AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of m knowled e e9 9 PP Y 9 and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I MIKE CAPELESS LICENSE# 15851 SIGNAT MPS JP© CORPORATIONO#PARTNERSHIPQ# LLCQ#0 COMPANY NAME I THE BOILER GUY/MIKE CAPELESS ADDRESS I 160A PLEASANT ST CITY NORTH ANDOVER STATE® ZIP 01845 TEL 9783821017 FAX CELL EMAIL A CERTIFICATE OF LIABILITY INSURANCEDATE(MMI DNY ) 1 04/18/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Matthews Insurance Agency Inc NAME: 182 Parker St PWC.No.HONE (978)681-1112 yC No):(978)685-3855 E-MAIL ADDRESS: Lawrence,MA 01843 INSURERS AFFORDING COVERAGE NAIC 9 INSURER A: Atlantic Casualty INSURED Michael Capeless 105 Tyler St INSURER B: Arbella Methuen,MA 01844 INSURER C: INSURER D: INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL SRR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY MM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY L143000684 08107/2012 08/07/2013 PREMISES cEa occurre ce $ 100,000 CLAIMS-MADE 71OCCUR i MED EXP(Any one person) s 1,000 PERSONAL BADV INJURY I$ 1,000,000 GENERAL $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOC j I $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea a.".n ANY AUTO IHC357357 08/30/2012 08/30/2013 BODILY INJURY(Per person) $ 300,000 ALL OWNED SCHEDULED AUTOS AUTOS I BODILY INJURY(Per accident) $ 300,000 HIRED AUTOS NON-0WNED PROPERTY DAMAGE AUTOS L.LP-eracciden $ 300,000 S UMBRELLA LIAB OCCUR LEACH OCCURRENCE $ 1,000,000 EXCESSLIABCLAIMS-MADE X1111463 02/23/2013 02/23/2014 REGATE g 1,000,000 DED RETENTION i S WORKERS COMPENSATION I WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N IMITS 1 , ANY PROPRIETOR/PARTNER/EXECUTIVE890911-0937696 11/1712012 11/17/2013 E.L.EACH ACCIDENT S 100,000 OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Heating or combined heating and air conditioning systems or equipment,installation,servicing or repair,plumbing CERTIFICATE HOLDER CANCELLATION Town Of North Andover North Andover,MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATN ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . has permission for gas installation . . �?. .��. in the buildings of. '�. !a�2 ./�. at . . . . .11Q-e¢-'! . . . . . . . . . . . . . . . . . . . . . . .North Andover ass. Fee-5o,.> d J. Lic. No./',, 55 5 J . G, ./. . . . . . . GASINSPECTOR n Check# 9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE5128/13=PERMIT# JOBSITE ADDRESS 49 BRIDLE PATH OWNER'S NAME RAYES GOWNER ADDRESS �TEL FAX „ TYPE OR OCCUPANCY TYPE COMMERCIAL.0 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:( REPLACEMENT:Q PLANS SUBMITTED: YES NO[,' APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE X DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE t,{ GENERATOR _ GRILLE f Lr_ ' }'INFRARED HEATER _.. i. ' e.. h f LABORATORYCOCKS _. _ _ _t _. MAKEUP AIR UNIT � --�.-- _ .�_ __ ,-� OVENS r POOL HEATER ROOMISPACEHEATER ROOF TOP UNIT 1, TEST UNIT HEATER _.a ~ UNVENTED ROOM HEATER WATER HEATER OTHER i v. .,. ..,. ' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with in nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME MIKE CAPELESS LICENSE#55851 NA RE MP Fj MGF® JP[j JGF[j LPGI CORPORATION[J# PARTNERSHIP[,J#�LLC D# COMPANY NAME:j THE BOILER GUY/MIKE CAPELESS ADDRESS 160A PLEASANT ST CITY NORTH ANDOVER } STATE MA ZIP 101845 TEL FAX CELL 9783821017JEMAILI _ 1 i %.vwiniwim vv c;mL in yr iwimoam%,nuac s i J PLUMBERS AND GASEITTERS LICENSED AS A` MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: TICHAEL W. CAPELESS 105 TYLER ST METHUE14 MA 01844- 1905 15851 05/01/14 176378 ' a I i NORTh V BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION b Permit NO: Date Received ° p°RAVID P''Vgo Date Issued: 9VSgc►+us�t PORTANT: Applicant must complete all items on this page r, LOCATION �0/ &l b64 / PROPERTY OWNER �Print Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building gone family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial i PRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer 1rf,�I , �,rrvU�r1 1/,t1,3 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: i ISb 5 �• ��y CONTRACTOR Name: Phone: 2n Address: 154 50;Zz AWv9- VW Supervisor's Construction License(,S �oy�3$� Exp. Date: Home Improvement License: �l n Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. & FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C ST BASED ON$125.00 PER S.F. Total Project Cost: $ a FEE: $ Check No.: L.1 Receipt No.: NOTE: Persons contractnng ith unregistered contractors do not have acces o tip iv aran nd / Signature of Agent/-- Signature of contractor Location No. — Date • - TOWN OF NORTH ANDOVER 4 �, . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $_ Other Permit Fee $' TOTAL $ Check# 26241 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 38,5500.00 m $ - $ 462.00 -Plumbing Fee $ 57.75 Gas Fee 100 comm. 100.00 Electrical Fee $ 57.75 Total fees collected $ 677.50 49 Bridle Path 634-13 on 4/1/2013 Kitchen Remodel, Den/LR to Stud /Bdrm �1, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 M ,Y www.mass.gov/Zia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): / ICz►=!� L-� L�- 1� �/ 9i�. Address: !&X City/State/Zip: 6L& D-�>V y Phone#: 6a3 kre you an employer?Check the appropriate box: Type of project(required): ❑ I am a employer with 4. PI am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors (�I am a sole proprietor or partner- listed on the attached sheet.t ?• P Remodeling ll 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 10. f Electrical repairs or additions required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL 11.9 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 1311Other comp.insurance required.] iy applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. Fn an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site ormation. urance Company Name: .icy#or Self-ins.Lid.#: Expiration Date: Site Address: City/State/Zip: :ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 ip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. i Izereby rt lint, the ai d e lties ofperjury that the information pro ided bo a is true and correct. nature: % ' `��� Date: 122 ane.#: )fficial use only. Do not write in this area,to be completed by city or town official. ' I �ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector �.Other FORTH � s oven ol' _ 6 ndover No. _ - I �` Z % LAK, h ver, Mass, .F coc��cHewlcK �7' A0'V 6 D S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT ........... a -. ......... BUILDING INSPECTOR ... ..„r............... has permission to erect .............. buildings on .... .Q� ,, Foundation Rough ylh ���# t !...C.2 11.. •.2. R....... to be occupied as .... 1.. .. . ....l....... . .. .... ......../II�'-.-.�..... Chimney provided that the person accepting this permit shall in every r ect conform to the terms of the application Final on file in 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. ��,, 02 C-le' 10 -- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final G� • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T S Rough Service .................... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.a7'-f" Total land area, sq. ft.: y3 fy (/?..o a J ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ✓ DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) vi S ,m � v►/L W p rt-�. A/o LP z)Li d v ❑ Notified for pickup - Date Doc.Building Permit Revised 2012 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-049386 ,. srti MARK D RAPE BOX 156 -- i� Seabrook NH 03874 f'll ' 1�\ 1 Expiration Commissioner 09/30/2014 i North Andover MIMAP April 1, 2013 : _•:--'Af:,.;...._�-..'._.-' �� lv3.o-oils •' :•--' 3. �. 002 ' __ � '• 103:0'01 4 35 BRIDLEPATH 63.0-0004 i Ob3.0-003fly .,x�.•�..•..:•�.._.., ._ r'r 0 3.Q-0005 /� ,((, 43'13RIDLE,PA' :Water1E�rotechon :�••..r:j / ' 063.0-003 � .:..-'•:.. 63-BRIDLE,PA it r '' Q4.E-0092 063.0-0016 Rail Line `W Wetlands Zoning Interstates Exempt Lands Busine 5 1 District Interstate Busine s 2 District Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83, —Major Roads D Busine s 3 District Meters Data Sources:The data for This map was produced by Merrimack Y Busine s 4 District 14ORT1{ Valley Planning Commission(MVPC)using data provided by the Town of Roads •Gene' Business District Of �u�° '�� North Andover.Additional data provided by the Executive Office of L t Easements O Plan Commercial Dev ? Z. '�^�OO Environmental Affairs/MassGIS.The information depicted on this map is L:Corrido Development Dist Z. for planning purposes only.It may not be adequate for legal boundary ❑MVPC Boundary f.]Comdo Development Dist O _-- to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER ❑Municipal Boundary O Corrido Development Dist p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industd I 1 District Zoning Oveday t Y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY $.Induslri 12 District G3 Adult Entertainment � i � i OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ©Downtown Oveday District 93Industri 13 District • o. _ ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Industd I S District °' "" Q Historic District Reside it 1 District .���'.(�7 THIS INFORMATION ®Water Protection Residei ce 2 District 1`TSSEt ❑Parcels o R—ide ce 3 District ACNU Hydrographic Features ll de ce 4 District Slreams 1" 62 n ^{).de ce 5 Dislricl TrTTT de ce 6 District ,��°ge esidenlist District u 7 t Date.... /��... N- JJJ r 40R'r" °ft•``° ;e,"o TOWN OF NORTH ANDOVER ° , p PERMIT FOR WIRING « • ,SSACMU`'E� This certifies that .................... ,.. ..................... ........................................... has permission to perform ..... ...... .................................................................. wiring in the building of...... ��'��s.!4n- �.... I�j ................ .................................... �.....(. Q.t..........................,/!. ,North Andover,Mass. Fee �.` C/.... Lic.No./ .4./" ... r..... .w �VY� -c:.;?..-..... �. ...t............. / ELECTRICAL INSPECTOR Check # 0 5� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts FOR OFFICE USE ONLY Department of Public Safety PermicNo. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Receipt No. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of /u, 4�J,✓'P r- To the Inspector of Wires: The undersigned applies for a permit to perform the yyelectrical work described below: .(._ Location(Street and Number) 1^ I d Q` tP ),J 5-}-r-p-eJ� Map: Lot: Owner or Tenant QYn 0' C t rA 'f �(^,� Zone: Owner's Address 150'-01 V—. Is this permit in conjunction with a building permit? Yes❑ No (Check Appropriate Box) Purpose of Building D W J?J 1 Utility Authorization No. y 0_3 Existing Service ZCJQ Amps /?-a / Z L/O + Volts Overhead ❑ Underground go'- No.of Meters New Service Amps / Volts Overhead ❑ Underground ❑ No.of Meters Number of Feeders and Ampacity - 9 Location and Nature of Proposed Electrical Work ?106L r 5 104 No.of L ghting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd. ❑ In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg. Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection and No.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons Kw No.of Dishwashers Space/Area Heating KW No.of Sounding Devices No.of Self-Contained No.of Dryers Heating Devices KW Detection/Sounding Devices No�of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncipal Connection ❑ Other No.of Hydro Massage Tubs No.of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts Gener aws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES lld'NO ElI have submitted valid proof of same to this O office.YES NO 0 0I�If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE['3'�OND❑ OTHER❑(Please Specify) (Expiration Date) Estimated Value of Electrical Worr``k$ Work to Start fT4el!lb/ Inspection Date Requested:Rough Final /d S C.� Signed under the penalties of perjury: FIRM NAME C _- LIC.NO. AKIK Licensee Si nature A722 LIC NO. Address /l1 a/� _) T�2 � / W065 , ,01f Qd23 Bus.Tel. No. Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner❑ Agent❑ (Please check one) Telephone No. PERMIT FEE$ 5 (Signature of Owner or Agent)