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HomeMy WebLinkAboutMiscellaneous - 49 WINDSOR LANE 4/30/2018 (2)\XO 6/19/2017 Town of North Andover Mail -Permit #24245- Job Location 49 W indsor Lane in North Andover MA r NOR T#_0 R Massachusetts Maura Deems <mdeems@northandoverma.gov> Permit #24245 - Job Location 49 Windsor Lane in North Andover MA BRC Renovations LLC <info@brcboston.com> Fri, Jun 16, 2017 at 12:25 PM To: Maura Deems <mdeems@northandoverma.gov> To Whom it may concern: BRC Renovations, LLC will no longer follow through with permit number #24245. We would like to withdraw our application for 49 Windsor Lane, North Andover, MA. BRC RENOVATIONS, LLC would also like to close the permit #23826 for 458 Johnson Street North Andover, MA. We will no longer do any work at such property as the home owner has dismissed the need for our services. We do not want to be related with any work performed at such property so please access our request for dismissal of such previously issued permit. Thank you, Carlos Pereira BRC Renovations, LLC 800-272-0676 x700 [Quoted text hidden] [Quoted text hidden] All email messages and attached content sent from and to this email account are public records unless qualified as an exemption underthe Massachusetts Public Records Law. Visit us online at www.northandoverma.gov. ����Jf �4� Pl � �.6 23� Z+ https://mai I.google.com/mai I/ca/u/0/?ui=2&i k=aeO2b3b5c4&j sver=TW xnQsEVC20.en.&view=pt&msg=15cbl b9l8b7O9261 &search=i nbox&si m 1=15cbl b918b7O... 1/1 5 M. u X N = V ,e V • (D Zy (CD O o -a (D z 0 m m cr CD A[f X 3 CO co 0-4 -a =3 y Co g oo -� o W p� x =� < CDD� OHO CD 0 O Fn,X w W Qn ii _ 3 V cn 77 p 0 (<D :U N A p fD ;o 0 0 p o n m 3 0 IV > > m fD p (OD O p < 1 Q M CD I y I m vm rn_ cn D< (n to D3 0=) v = 3 N CD F J O E CD p Z C p � 0 0 Q s N (D O CD n (D O — m n v ? n. r r (D (n �. Z n cn r r j r j 3 s nC7 — N(D ° n (D r n v r O d 0 0 a O r — 3 C*) CL on m N o a o 0 0 (00 3 O dO n o N N j iUcn 7 (Q Q (D 0 �j m O O CD 0 O N 0 N O 0 3Cn a' (D O p Q 7 0 CD Q m 73 n - N v C) Z O f o c q < a=rCD O p N sv m pp G �� (D v N O 0 �,��3 mC P. = 0 (D 0Z O iv W . c C c- mZ N) Z3 O o goo,CD m D m o 4* 0)3 _ r n (D O (�3� N) W (D Q O 0 * w N)3. c (CD O c zr O N C mr Z3CD M y En p `° ° D 79 D Q_0 in� 3 '- 0 U Q Q cD c �v� CD N o Qz CD � 0 0 (D Zy (CD O o -a (D z 0 m m Location 41 No. -�� Date TOWN OF NORTH ANDOVER D o , Certificate of Occupancy $ A.I5 <� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6 A 4 G`Building Inspe • r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: y SIGNATURE:--Az�. Building Commissioner/IEEeEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Z-/ 1.2 Assessors Map and Parcel Number: ��-66 7 Map Number Parcel Number 1.3 Zoning Information: Zonin District Pr osed Use 1.4 Property Dimensions: Lot Areas Fronts e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required. Provide R red Provided R red Provided 1.7 Water Supply M.G.L.C.40. ml 1•S• Flood Zone Infomtation: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT —I Owner of r Name (Print) Address for Service: oti Signature 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ AU- U40tyt &t ( Licensed Construction Supervisor: 66 / l Z � Address 44 Sig/ re Telephone 3.2 Registered Home Improvement Contractor ALL 4 Company Name Address License Number L4? —L Expirati Date Not Applicable ❑ Registration Number I I Expiration Date M Z O rn O z rn 90 O r M r z ^ Q SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 $ 2506) 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 .......0 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: l L Al -4 2 S'7"✓2 j f/ z Q� /' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by 2ern-tit applicant UEFICIALITSE ONLY k=" I . Building (a) Building Permit Fee Multiplier Q 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (I+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZEDAGENT DECLARATION I, `- W� , } �T• Z%1J% " [' ,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 o' caner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS lsr 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I [EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X vIATERIAL OF CFUN NEY IS BLriLDING ON SOLD OR FILLED LAND , IS BUILDING CONNECTED TO NATURAL GAS LINE C= C d CO) C-) cm CD C�j Z y CD CD '0 = r n Cl �. _• y 0 n -3 CD C3 p CD Q o CL cr� CD CD Q CD 00 w P. C CD CO) CD CL O y CO CD � v CO2 o 'v Z CD a o 71 CD O C CD It C O �• N CCD C3' N ®� CD to CA n o. C -j O m m -o ca N• =r a- -. o. O -1 .. o m 0 O N �' O ? m � CD ca C.D -00 CIO CC) O ZC.n O N 2 : mom: � o,m CL ^' CD O y : O O CD m N O. CS c ®: m C CO) O N w N : O O to w '-► C! O O ®o 'NO O CD Wim: CD co, CD 0: o C mm: a�: ': C) c i CD c o � co y Cl) m ME CO2 =1 ccn ,�* O Gc � ^n w o C,) � � w c r y H O w x O :? w n 7y -m G 0 0' 5 D cn 10 � n, j 11 x tw OrA y Q r BOARD OF BUILDING REGULATIONS } License: CONSTRUCTION SUPERVISOR 1 Number. CS 069120 Q p Birthdate, 04103!1959 Expires: 04!03!2003 Tr. no: 8820 Restricted To: ' 00 I JOHN W LANZAFAME _ 30 TEMPLE DRQ METHUEN, MA 01844 Administrator i� fie Co=WMveafth of9Kas=h=e= ` s oepan=ent eFnduzTia[,q=ide= .'- _. Office ofInvate9ations 600 Washington Street Boston, 9KA 02111 Workers' Compensation Insurance Affidavit APPLICANT INFORMATION Please PRINT Legibly t Name:— Location: 7 CJ / ILO L- city' f . An 112 & Ui (,� Telephone #: ❑ I am a homeowner performing all work myself. ❑ I am sole proprietor and have no one working in my capacity I am an employer providing workers' compensation for my employees working on this job n Company Name: i L� Address: City: ice• -c.1 �l- J fiyi "La %�'3J Telephone Insurance Company: AM Policy #: ❑ I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed below who have the following 1_ workers' compensation policies: Company Name: Address: City: Insurance Company: Company Name Address: City: Telephone M Policy M Telephone #: Insurance Company: Policy #: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP 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 Investigations of the DIA for coverage verification. I do hereby cem ft under the pains and penalties of perjury that the information above is true and correct. Signature:Date: Phone #�1�' `l J" �T3/ Print Name:,--./ — Official Use ONLY - Do not write in this area City or Town: Permit/License #: M Check If Immediate response is required o Building Department o Licensing Board ❑ Selectmen's Office o Health Department o Other INFORMATION & INSi'RucnONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law" 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 section 25 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, 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 beenpresented to.the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the . Department of Industrial Accidents for.confamation 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. City or Towns 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/hcense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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 Pax # (617) 727-7749 Telephone # (617) 727-4900 ext. 406, 409, or 375 w« UNDER ONE ROOF Chimneys Residential & Commercial Roofing Siding CHIMNEYS POINTED-RE13UILT-CAPPED k Types Of Expert Masonry Work Mass Toll Free Roof Leaks Experts *1Licensed &Insured 1 -$00 -WAIT -4 -US Locally Owned & Operated.Since J976 �•••• License #034200 (924-8487) IKO® C2ee Vzoe d or 7O/,w $4 �a We Work Year Round 978-794-3883 70 Jefferson St., North Andover, MA 01845 &4eezAC&,V 57eveoz: 30 Temple Dr., methuen;�,MA:6194 Proposal Submitted To Phone _ q Date Street Job Name r) a City, State & Zip Code � } &A Job Location Job Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: Dollars ($ All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorizedli�� manner according to standard Any alteration deviation from practices. or specifications be- Signature:/ - low involving extra costs will be executed only upon written orders; and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents NOTE: This proposal may be or delays beyond 'our. control, Owner to carry fire, tornado and other necessary insurance. .� Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within• -1 r-� days. We hereby submit specifications and estimates for: S /Z !,2 , Install 3 feet of special "Eave Seal" ice and water barrier protection alongall bottom edges of roof g and top to bottom in each valley. If roof is stripped, we will apply conventional ice and water shield ft. high in the same locations previously described and tar paper will cover the remaining bare wood. Any rotted or damaged boards will be replaced at ( ) per linear,ft. or ( 6" ) per sheet of plywood. tIZlnstall heavy gauge aluminum drip edges along every edge surface of each roofline. ,Cover entire roof (s) with IKO 25 year all asphalt, non -fiberglass, premium grade shingles (Color of choice). 'OUA(- �S/x7cX Replace all pipe boots where possible. 2fSeal all flashings with clear Geo -Cel sealant. No black tar unless previously applied. LdRemove all work-related debris. Z'Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under .normal circumstances. "Local current references and proof of workman's compensation insurance gladly given. ,U Remarks: ; 1 Cup E r l /3 n?'v 1�77 i Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified: Payment Signature:will be made as outlined above. Date of Acceptance: /,L// L Signature: Location `�l �����'J�S�h' ) /,/ No. 112- Date i i TOWN OF NORTH ANDOVER ... , aL p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Ss....sE ?10.4ywer Other Permit Fee $ Connection Fee $ WConnection Fee $ 1, 1= � r NQ• q �, TOTAL �l(yO1/�rCp// 00 Building Inspect or / Div. Public Works PERMIT NO.' APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. ��� I LOT NO. eAPCIjF jS' 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZON SUB DIV. LOTANOC. �0 — LOCATION 9 WrN�S�IP �a/Ic% ^ L PURPOSE OF BUILDING 0� j S SAE Il�, c.k OWNER'S NAME :54-ID44 4- /1?/C'!�{,�EL 'T� �,Q,02 v' (` NO. OF STORIES / SIZE 1-1, x �� � � �- � X�6 OWNER'S ADDRESS 5TA1� BASEMENT OR SLAB MSN`G ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING©rte DIMENSIONS OF SILLS DISTANCE FROM STREET ! -3 "' POSTS X 6 !! X p DISTANCE FROM LOT LINES — SIDES REAR GIRDERS rJ lr X T�N� b AREA OF LOT fl ^i! '7/l/ S)[ FRONTAGE /,5b /I J HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING D sl X 31 ^1l!�16 19 IS BUILDING ADDITION yy$ 61.175� �1�• 1i MATERIAL OF CHIMNEY AZ�� IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ���' IS BUILDING CONNECTED TO TOWN WATER A� BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER Alt' IS BUILDING CONNECTED TO NATURAL GAS LINE /-'D INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANp APPCROVED BY BUILDING INSPECTOR DATE FILE J �� SIGNATURE OF OWNER OR AUTHORIZED AGENT OWNER TEL. #_ 6 FS' -3 (( O e6 illf, _ FEE jD U-�� CONTR. LIC. # PERMIT TED S19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST Ol a O UJ , Qu EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD -7 BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY:::::::::l OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 6 INTERIOR FINISH B 1 2 I3 PINE CONCRETE CONCRETE BL K. BRICK OR STONE HARDW D— PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA '/. 1/1 '/. FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 _ _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDNWD COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK N MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR I -i NONE 10 PLUMBING i�N 'ADEQUATE 5 ROOF GABLE GAMBRELMANSARD I A HIP BATH )3 FIX.) TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO v b 6 FRAMING i l HEATING WOOD JOIST vr PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS _ GAS OIL 4 B'M'T 2nd _ Tat 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. Z: 'a' y ° r., a O o o: gon rA fe �. o W e S A O• O S A s v A m V� < rn d � rrl C31 � T � r � s W c � o ivy b —y l<O r '^< V CZE % H A C fA Zc ? V7 •7 -0 A O Q) A p w A O ; H .q 3 c 1 s r O p cr .! 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DATE APPROVED DA'Z'E REJECTED DATE APPROVED DATE REJECTED DATE APPROVED < 6 Z DA'Z'E REJECTED RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planciing and Ilealtli Boards, the Conservation Commission prior to the issuance of any building hermits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. ♦. 70ISO i • ti "� 4P CD i PD p0,5Ej) to t6 r �.' ._ . ., .t•_� :�f;:�,�. �. T CON FOUND 41-46 5pj.0bRA `&A 22o N (R5-39�� Woerc (�l?�`f�55�/7�57 73 �i O s� C7 v W aT' aillM.e+ k)CO LJ rr-C, r -'17r — x 'K•+. � T u m _::a .;2�'?i P. . 7? -9- Ln La :a iii n X X x X X X � rn :< rri X X sic X F --i X M X r J 10 M rV .b+ n; -� to W J% w r •-i --4 'II x x Q v .eT_ : TZ iV =J Iii i ! _ .� .•moi 1 n C r� ,---r M -.M m a x M —1 i - — L7 t.t -• Ul C- ,.-3 J D - - O LQ Ln— Zl -. 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CD, , to N -00 co K 0 r) 0 > 0 V00 CO to 0 CL w *m -4vw CD —0) CD .N * M—a fn -4 (n - Cn 'CO 2� cr Z CO I m Z =Z 'm 0,70- 0 CL -4!D CD W CD 'n 000 0 C,2? • m 0 m m SQ, 0 Z C :E) m :1) m Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE JOB LOCATION_ umber Street A "HOMEOWNER" Name ress e Phone PRESENT MAILING ADDRESS sf} Ivy, L 0l. 4YT Iown State Section of town Work Phone Lip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use arid/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules acid regulations. The undersigned "homeowner" certifies that he/she understands the Town North Andover Building'Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUR of .APPROVAL OF BUILDING OFFICIAL. Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. Date . . NO 41.6, of ,•;.�tio TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING 'rY ' This certifies that .../-/.! -A. //-'7.; . ,c ...................... has permission to perform .... .. T ..................... plumbing in the buildings of 6''.` at .. V. �.'..1:4� J. .` ..... , North Andover, Mass. Fee. . `�. �.. Lic. No...t......'. ....... ........ t.,- -!....... . PLUMBING INSPECTOR CFS' C0 K 101 f WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DOPLU BING (Print or Type) r4d v—,e_ ✓-' Mass. Date W IQ 6 1 Permit # Building Location / �(/,��j�_ Tot-0�6.'tLg.-Owner's Name hu 1,��rar/tY) New L7 Renovation L7 Replacement LN FIXTURES Type of Occupancy Residential Plans Submitted: Yes ❑ No ❑ Installing Company Name Heritage Htg . &Plg. Co. Inc. Check one: Certificate Address 35 Pleasant Street / Stoneham, Ma 02180 B iness elephone-4, 781 -438-7776_ Name of Licensed Plumber Gordon Switzer a Corporation 714 ❑ Partnership F] Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R7 No ❑ It you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Z 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 ❑ Signature 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 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 provisions of the Massachusetts State Plumbing Code Codee(and Chaptor 142,of the General Laws. By rgnature o icensod umber Title Type of License: Master Journeyman ❑ City/Town 8322 APPROVED (olff LY) License Number____ N u� z o z Z r .. O� W t3 _ I- W N Y J J N `t U Q ~ Z N N N P W Z_ vi LL a rt N rr 1- z U w N_ Q (n o U. Z a _ U1 1 r v w rr m v~i x N w > t~ (") v' x aMW rid Z > o a r cn a x .( U ~ > H O S V1 4' N vt r Z O O N Z Z W H O U a (ll ri 3 �[ Q Q J m S N Q O Q J Q 3:LL O Q 1- -i V) J Q LL 0 2 D X a: a O Q 1. fu -F.+ rti iJ rq b b _ SUEZ—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg . &Plg. Co. Inc. Check one: Certificate Address 35 Pleasant Street / Stoneham, Ma 02180 B iness elephone-4, 781 -438-7776_ Name of Licensed Plumber Gordon Switzer a Corporation 714 ❑ Partnership F] Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R7 No ❑ It you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Z 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 ❑ Signature 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 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 provisions of the Massachusetts State Plumbing Code Codee(and Chaptor 142,of the General Laws. By rgnature o icensod umber Title Type of License: Master Journeyman ❑ City/Town 8322 APPROVED (olff LY) License Number____ u z 0 r U w CL a z u u u R C C a Q w w LL N W V Wui Y N O Z m J a O G O F- 0 � Q O = p W J a In O LL IL O m LL O Gu. O ~ C Q �tl W. u h- ID W CL a0 CL z J a