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HomeMy WebLinkAboutMiscellaneous - 5 GIBSON COURT 4/30/2018 Date NORTh TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING �8's'�cHug� This certifies that ................:AI , '✓ti--O S .................................................................. has permission to perform.......k&.G- r,-! ......`, ..... j....................... � plumbing in the buildings ofWav � ' .. .....................�...............v............................... ..... at....'"1 ........tr- ., �,.r� � ..�.............................. North Andover, Mass. Fee.,��,,.�.......Lic. No. ................................................................................. PLUMBING INSPECTOR Check# 31P MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY v/ MA DATE La PERMIT# JOBSITE ADDRESS G 1 I. .T Y)In OWNER'S NAME leaGof' vC POWNER ADDRESS Z1.2 c% a ���- TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I FOOD DISPOSER FLOOR t AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL ASHING MACHINE CONNECTION WATER HEATER ALL TYPES ATER PIPING THER INSURANCE COVERAGE: I have a current H& Insurance policy or its substantial equivatertt which meets the requirements of MGL CIL 142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY NSURANCE POLICY &/ OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:l 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 requ"nfenient . CHECK ONE ONLY: OWNER [:1 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 plumbitng work and iinstallations performed under the permit issued for this application mn7!be in Hance with aH nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Pte\C1. . I LICENSE# i �4 - SI TURE MP 20", JP CORPORATION❑# PARTNERSHIP❑# LLG❑# COMPANY NAME I J ADDRESS t e z CITY , .C 1 �, STATE AA A7r ZIP ( K TEL FAX CELML''-3(Q()-q04'1 EMAIL Date....p. .� ...�.. . ............. S F NORT►1 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION + sSACHUgE t ' � This certifies that d h..�� ................................ 1 Shas perrmssion for gas ,,ins`tallati(o��n)NL45 L... .... f in th uild* of...........l....... ........................................... at......... ............................ North Andover, Mass. Fee 0......... Lic. No. ...�.`� t i GASINSPECTOR Check# L7 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T PERFORM GAS FITTING WORK CITY -�� MA [SATE PERMIT# l JOBSITE ADDRESS L___ _ ._. OWNER'S NAME OWNER ADDRESS -� QQ :.' - — TE TYPE OR OCCUPANCY TYPE COMMERCIAL 13 EDUCATIONAL RESIDENTIAL CLEARLY�a 1INT NEW.� RENOVATION:� REPLACEMENT' '� PLANS SUBMITTED: YES O i�0 _. APPLIANCES Z _,FLOORS-- BSIr4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERS BOOSTER CONVERSION BURNER � I COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR _. �.f L�_--s --=J __! - GRILLE _ -- _ _ —_ INFRARED HEATER -- _ - EnlLABORATORY COCKS _1 � 1 , J � J i� f J MAKEUP AIR UNIT ------ l_.- -1 _ ,,. _ 1 __ ..�__� . -1 OVEN _, POOLHEATER. E-3 -- ROOM/SPACE HEATER �.. . __I _._ _ 2 _. ._I _I _ l _ _ r= J ROOFTOP UNIT I 1 I TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER THERT _..�- .__.._..I C _ i` _l ! I _ INSURANCE COVERAGE - - -- - - I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGI..Ch.142 YES C NO I IF YOU CHECKED YES„PLEASE INDICATE THE TYPE OF COVERAG Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BONDE] OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required lay Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application valves this requirement r f. CHECK ONf ONLY OWNER Ej AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application or ru n accurate to tho b to my Wedge and that all plumbing work and Installations performed under the permit issued for this application will be In milli with all Pertinent o a Massachusetts State Plumbing Cale and Chapter 942 of the General Laws. PLUMBER-GASFITTER NAMEL_ LICENSE# i 1u� SIGNATURE MIS� MGF(W' JP�JGF LPGI© CORPORATION Ej# PARTNERSHIP -0-1 LLG r- COMPANY NAME:_ --- JAl)13Ri;S8 CITY STATE UNZIP L FAX .. LL i :::COMMONAOH USETTS: WEALTH OF MASS BOARS d PLUMBERS 'AND CASE:ITTEFt5 .1 ISSUES THE FOLLOWING LICENSE L._I L,ENSED AS A :MASTER PLUMFBER Z7 1 } C HGLMES i > ADAM r ji y Z b RUTH °C'('R i z J 01832 RH I LL »->` 2424 4 65 �� COMMONWEALTH OF MASSACHUSETTS . e • • • • • i BOAR :OF PLUMBERS :Ai�O GAS1 �Tf.Ki LRS ISSU;E;S,-.T. FO'_L04JIh'C LICENSE: ; w L I EP�SEJ AS A JOURNEYMAN PL °` AJ:Ak`i C HOLMES a • r� i x oW>`> 6 RUTH"C'I'RCLE i; Y 4:... J x' P.IC Rl I LL::';:::>< ::; <:�:A 018 3 2-8 tU0 x` '011 �< `LL,'F, _ . Dat4t—1 -" Ob. . 'oRTM TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING ,SgACMUSE� i This certifies that . A)CVV4 . . . . . . . . . . . has permission to perform Ye- plumbing plumbing in the buildings of . ?�. . . . ` at.� . &i �'�1. .� ?k*trT . . . . . . . . ., North Andover, Mass. Feea'GL!52?. .Lic. No. !'�L:5.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i � PLUMBING INSPECTOR Check N t q _ 33' 50 0� 6go0 6977 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date l G4 Building Location .S— (;,` O Owners Name do g` /rvt Permit# 7 Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No FIXTURES N a U a o ww z z z z z o 3 a A a z a SUB-BM MSEAM i M MOOR �n l�voctt —3m FLOOR 41H RDM 51H MOOR KOOK H1H FLOOR 81H HA" (Print or type) Check one: Certificate Installing Company Name I -QS Corp. Address Partner. . o�-- usmess a ep one inn/Co. Name of Licensed Plumber-:- _ 4:2� 1/4/.�t9 C- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy e� t er type of indemnity n Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the liceLns_ee of this application does not have any one of the above three insurance ignature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered} 'n above lication are true an urate to the best of my knowledge and that all plumbing work and installations performed u r Pe t sued for thi pl l tion will be in compliance with all pertinent provisions of the Massachusetts State Plumbi od n e 12 th eneral Laws. By: igna ure of tf-censeu riumoer TyVe of Plumbing License Title City/Town icense TIMM Master ❑ Journeyman c� APPROVED(OFFICE USE ONLY LJ NOR71� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,Sg�ICMUSE� This certifies that ........f.:r........................................--�.. ................................ has permission to perform . ................................................... l _ wiring in the building of... .: ..:. '.;.:. ! .�... -- ......... -- d r at../.... :_.................... ................................. ,North Andover,Mass. Fee?d.............. Lic.No. y�;.. �...........1. ELECTRk&L INOECTOR Check # 6 A 5 6 tommonwealtit�of Massachusetts OfEcial Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 02/07/2006 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) 1 Gibson Court Owner or Tenant Wood Ridge Homes Telephone No. 978423-7867 Owner's Address 10 Wood Ridge Drive,No.Andover,MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts " Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity iLocation and Nature of Proposed Electrical Work: Re-feed street light,installed EMT to timeclock,installed lamp i Completion of the ollowin table Mg be waived by the Ins ector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers. KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool d.e ❑ -d. ❑ Ao.Bato Emergency t ng gg! Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.iN DRection an Initiating Devices Total No.of Ranges No.of.Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat mp ... um.__r ......---.._.......-.ons o.oSelf-Contained Totals: .. -... . Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ umc'p ❑ Other Connection No.of Dryers Heating Appliances KW ecunty sy tams: No,of s or Equivalent No.of Water KW o.of N&of Data Wiring: Heaters Signs Ballasts No.=vices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWining: No.of Devices or Equivalent k OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC.Rule 10,and upon completion: I certify,under the pains and penalties of perjury,that the information on this plication is true and complete: FIRM NAME: Landers Electrical Co.,Inc. LIC.NO.: A5912 Licensee: Terrence J.Landers,Vice-President Signature LIC.NO.: 9743 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No., _978-685-3828 Address 1000 Osgood Street,North Andover,MA 01845 Alt.Tel.No.: 978-686-3829 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)0 owner ❑owner's agent. �./1 5 � � f � . .,. , . � . � . - �� � , �. Date TOWN OF-N16RTH ANDOVER 4491 PERMIT FOR PLUMBING • s r SSACMUSE� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . has permission to perform .s:2. . . . . . . . . . . . . . . . . . . . . . plumbing i the buildings of . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . r. . . . . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Fee . Lic. ... . . . . . . . . . . . . . • � PLr81 G INSPECTOR Check.# ���/ /. 3 r 7137 MASSACHUSETTS UNIFORM 1 APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building LocationDate `d Q A-S'ITA. Owners Name/ 9 Permit# Amount— Type 3 2.of Occupancy New Renovation Replacement �Plans Submitted Yes ❑ No ❑ FIXTURES c� z , zw Or Griz GL > w o SLBBM Rk9NM M FL" M11" s1lHHjOOR 6M FL" 7MHDM 9M ELCK t 11 L (Print or type) Check one: Certificate Installing Company Name ❑ Corp. Address UJI Partner. 1 usmess lelephone IFY o Name of Licensed Plumber: / C Insurance Cover Re: Indicate the type msurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or ente Tin above applicatio true and accurate to the best of my knowledge and that all plumbing work and installations per der Permit Iss d ' rt app lication will be in compliance with all pertinent provisions of the Massachusetts State P g C to 14 the General Laws. By: Signature or Licensea– um er Title Type of Plumbing License City/Town APPROVED(OFFICE USE ONLY tense Num7er'�� Master Journeyman s ❑ �— Date. 1- 11A . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �STcMusE� This certifies that . . . . �! .�. f'. . .l. .L. S. . . . . . . . . . . . . . . . . . . has permission to perform . . . ./3 R . . . . . . . . . . . . . . . plumbing in the buildings of . . . .. . . . . . . . . . . . at . . . . I` . . . . . . . . North Andover, Mass. Fee. Lic. No..).? . . . . . . PLUMBING INSPECTOR INSPECTOR Check # 6778 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ff Date A (��p Building Location SA/l Owners Name`,1�� r Yla Permit# ?p Amount l`7 Type of Occupancy New Renovation Replacement Plans Submitted Yes a No FIXTURES H cn a � 3 l WIVA A 3 RiMME R4SaM BE E[DM MI ax 3M>j 4M EL" 5M HOM slHELaR 91H MOQt { (Print or type) Check one: Certificate A)A6 Installing Company Name Corp. V Addre s A N"��e Partner. BuMess Telephone Q ;zFirm/Co. Name of Licensed Plumber: lid/ Insurance Coverage: Indicat t e type of insura ce coverage by cher ' g the Eappropriate boxP: I/ Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 0 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 pe ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State n Chapter 142 of the General Laws. By' igna o icense mer Tide T pe of Plumbing License Q City/Town ice a um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY RECEIVED f. WOLF PLUMBMIff d HEATTLNG INVOICE NUMBER: pt 101 DEC 0 9 2004 INVOICE DATE: 8-DEC-04E P. 0. SOX.# 2229 ,�r SALEM, N.H. 03079 RAND64P�l A kYOL1" TEL: 603-$98-6505 MA. MAPLUMBER 12299 FAX:SAME CALL AHEAD CUSTOMER: WOODRIDOE HOMES(;o-OP TELEPHONE: ADDRESS. 10 WOODRIDEE DR. Fes:N. ` CITY,STATE,POSTAL CODE: NO.ANDOVER,MA. 01845 PO NUMBEW. 1 A 61USON CT ORDER DATE GARY PLUMBER . . . START END -D _ LADY 5:50 $80.00 `DEC 04 440.00 0.00 $0.00 TOTAL ACTIVITY COST: 40=00 � . 1) TO TIPPER WASTE 17 W RASS REMOVE/MSTALL TUU 1) 1/2 C 90 DRAIN/SHOWER VALVE 0.90 �) 1/2 CXM 2.00 ?) 1/2 C COUP REPAIR TUU DRAIN BEHIND 1.00 1) 1/2CXEE DROP 90 WALL 3.00 10`) 1/2 COP TUBE L 10.00 a) 1/k MIL HANGER 2;50 3) 1/2C CLIP 0.45 1) 1-1/2.PYG COUP 1.50. j 1) 1-1/2 PYC FA 2.00. TOTAL MATERIALS COST: YOU TOTAL, BILLING: �5 28.35 S TITANIC YO - VET. 10 DAY i AL Invoice Location ` 7 &,� No. -- a Date c ? ,,N°"T TOWN OF NORTH ANDOVER + ; , Certificate of Occupancy $ T.T. Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r� Check # "?9k 16760 BIding Insp t i The Commonwealth of Massachusetts State Board of Building Regulations and . TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number. . 6-1 Date Issued: _c�DD-3 Signature: Building Commissioner for o Buildin s Date SECTION I.SrrE INFORMATION 1.1 1.2 Assessors Map and Parcel Number. Map Number c;-3 Parcel Number 1.3 Zoning Information: 1.4 Property Dimmsiooa: Lot Area(sq) Frootage(R) Zemin District Use 1.6 Bufldhs Setback >t Frau Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 107 Wator Supply 9M.O.LC.40.4 34 I.S. Flood am Information: 1.8 Dicpoaal System: Pubes Q primo b Zone Q outside Flood Zone Q Muoioipmd13 on Site Disposal System Q1 2.1 Owner of Record Name(Print) Address: 1� (.Jt�or��`f'�d e Y2 4 Signature` Telephone ,7 (�g 2 704 3 QS 2.2 AuthorizedAged./ I0. (3 &r N (print To a Address 3 Lo0 j h4 r►IS 0 to od'A Signature Telephone p (D SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN A000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Number d (3 Addre �t I (1 Q Wls f2�Q Q,�ol ExpuatlonDate 3 15 ?—OOH Signature Telephone o 21 �2C7 3.2 �Ho ent Cor�aCtort Cts. Not Applicable Q Company Name Registration Number C Address Expiration O Ll Date �l J Dt.11 (-7-7 9- Z zp 50 (o ZZ Signature Telephone Co g Revised 1997 RMC SECTION 6-DESCRIPTION OF PROPOSED WORK check allapplicable) New Construction 13 1 Existing Building Repairs U Alterations Addition Accessory Bldg. Q 1 Demolition Other 0 Specify Brief Description of Proposed: vq S -t- S . T g I✓1 S. 9- SECTION 7-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check asapplicable) CONSTRUCTION TYPE A Assembly A-1 A-2 A-3 IA Q A-4 A-5 1B [J B Business 2A 13 E Educational C) 2B 1 F Facto E F-1 F-2 2C C) H 11igh Hazard O 3A 13 I Institutional C I-1 1-2 I-3 3B C3 M Mercantile 13 4 R Residential 13 R 1 R-2 R 3 SA Q S Storage S-1 S-2 5B U Utility Specify: M Mixed Use 10 Specify: S Special 10 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 SECTION 8-Building Height and Area BUILDING AREA Existing(ifapplicable) Proposed Number of Floors or stories include basement levels Floor Area per Floor Total Area Total Height ft SECTION 9-STRUCTURAL PEER REVIEW 780 CMR 110.11 Independent Structural Engineering Structural Peer Review Required Yes 13 No 1 SECTION 10a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMPT I, ,As Owner of subject property hereby authorize -F7 o ,i)CA P'r-, --tz-y-)C . to act on my behalf,in all matters relative to work authorized 6y this building permit application. Si ature of Owner Date revised bldg form/state JMC i SECTION 10b-OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to Official Use Only be completed b permit applicant 1. Building (a) Building Permit Fee Multiplier 2. Electrical (b) Estimated Total Cost of �0 Construction from 6 ©/ 3. Plumbing Building Permit Fee(a)x(b) / oO 4. Mechanical AC 6 5. Fire Protection 6. Total= 1+2+3+4+5 Check Number �� `��'Pamononwea�lfr���aao�rc�/ivaeG$ t g9AEtP QFRCiUI, TIONS I; r (i lcenss: CONSTRUCTION SUPERVISOR 1 Numo b033843 i i Rl 1955 1 ?• Tr.no: 19350 fit;i#� _, JOHN HAFFE :o 3 WILLIAMS RO — WAYLAND, MA 01 Administrator 1 II i x r AXe Board of Building Regulations and Standards x = One Ashburton Place - Room 1301 Boston_ Massachusetts 02108 Home Improvement Contractor Registration I Reqistration: 108945 Type: Private Corporation Expiration: 8/27/2004 J. T. HAFFEY BUILDERS John Haffey 3 Williams Rd ___. - -- ------ -. . ----- --- -- Wayland, MA 01778 — Update Address and return card.Mark reason for change. E r, Address F--1 Renewal r-; Emplovment i Lost Card i ✓/ie �o�sinro-rw�ea/,�/ o�ivaaaac%ccaeCla i " Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 108945 One Ashburton Place Rm 1301 Expiration: 8/27/2004 Boston,Ma.02108 Type: Private Corporation J.T. HAFFEY BUILDERS John Haffey 3 Williams Rd � Wayland, MA 01778 Administrator Not valid without sip_nature , usetts The Commonwealtfifof} at sah Department of Indudents lt. � ccl Office of InVesfl` atlo�s a 600 Washet Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name: rt e— S Location: City: N o rt to (� yjc[oye r rVA phone# ❑ i am a homeowner performing all work myself. ❑ I am sole proprietor and'have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: J' 1 H oc-Ea f3u l(de r-s Tr,r— Address: ' 3 U rr t u i�s City: �4 (a'Vj phone# SCS S co zD`1 l to 8 Insurance co. Q1t '` C'Y'^Q policy# W CLo� Li i 3 �o exp 12—,s'-o ❑ I am sole proprietor, general contractor,or homeowrier•(clrcla one)and have hired the contractors listed below who have the following workers'compensation policies: Company name: Address: City: phone# Insurance co. policy# Company name: Address: City: phone# Insurance co. policy# Failure to secure coverage a:'@gtiJr,@e.uNder Section:?,5A of Mc3L?142:'can'�,ea .'to thp'(mp Ilion of criminal penaltle$'of a fine up to$1,500.00 and/or one years imprisonment as well a:.clyll penalties in the form of a STOP.WORK;oRDE�;and.,a fide of$100.00 q day against me. I understand that at copy of this statement may be forwarded to the OM 4 of Investigation$of the DIA for:caverape 4erificatlon. I do hereby certify under the pains and penalties of pedury that the lnfomiagop,'pi v"above is true and correct. Signature' >: Date Print name PtiOne# —50 S-co Z_C� `� t l0 8 Official use only dp of write ti this area to be completed by al . City or town: J oertnitlticense# C]Building Department El Licensing Board pcheck If.immediate response is required ' ��t D Selectmen s Office. ❑Health Department po(ttact person hone#: ❑Other t�'! y ,.:• ,. h e i it �r(r : j E :4'Mr•t a '� i ,y:1 s I^• �k�tj1 ' �`'�p`•' T�.��jy'11" ��1 t7jiS A'y^'`�;� •��.� �� I t )' r 't '•`l.�t�j•BY{;I'W. .aJAj���l.'f`�,:'.a�:'{,hi.f .{+1t,Yt•rtf'n;.:'�:1::'•.K itkji7.'• Ut'�4`f. .. t • J«�. y fit/ h ° ri L ✓F�' � l,s t}(.,�titr/'7-�trYtt�ti .�':�YiY i` . �` µfl jrd-i... nal tY�, ,.��i•' • �et4�.�.(� � ;t��,1�5:.: C•f +,.i�+Tt�+r�" North Andover Building Department Tel: 978-688-9545 I DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: f Gt uV1, mot ss — (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I i SECTION 4 WORKERS'COMPENSATION INSURANCE AFFIDAVIT[M.G.L.c.152 25C(6)] Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No SECTION S- PROFFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDING AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 CONTAINING MORE THAN 3.%000 C.F.OF ENCLOSED SPA 5.1 Registered Architect: No Applicable Name(Registrant): Address Registration Number Expiration Date Si tore Telephone 5.2 Re istered Professional Engineer(s) Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name): Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number • Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone 5.3 General Contractor Not Applicable 13 Compal Name: Responsible in Charge of Construction Address Signature Tel hone X40RTFI Town ofover O .. 1. .zT�A No. a2&2 o� �„,A � 003 dower, Mass., Cf -a�► RATED PPG,`�� v H 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...WD.....R� !:.......�..M.L!.5.........00.O.. .`......................... ....... Foundation Ir has permission to erect..4R�.PJACOW..... buildings on ..)ft..') �..b..s�. ... Rough ... ......... ..... ' ........v.M+..... to be occupied as... . ..� m 1.... 1........' '�'....P...00. ..1!!� Chimney provided that the person accepting this permit shall in evel respect conform to the'ms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatinghe Inspection, Alteration and Construction of Buildings in the Town of North Andover. a a M to & o O .M. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det' SEE REVERSE SIDE