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Miscellaneous - 5 VILLAGE WAY 4/30/2018 (3)
cc Y- 11143 Date .511' 1 ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... .. .. .. 1,... ................................................. `has permission to perform ....... ti...-......... . Ip..A......... :(n ........ . plumbing in the buildings of.... �`+�+� o ,,r 1 at ................. ...,��.�.i..! `.tet.. fig.1,.............................. North Andover, Mass. Fee'12.0. ........ Lic. NOA1. � ..................................................................................... PLUMBING INSPECTOR Check # 716 1 iNOUKAnt;t GUV1:KA0E: 1 have a current liabilityinsurance 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 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 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 he best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i c pliance II inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAMERichard B es Jr. LICENSE # 15435 (N TURE MP� JP� CORPORATION Q# 3498 PARTNERSHIP®# LLC®# COMPANY NAME Nurotoco 1 of NIA d.b.a Roto -Rooter ADDRESS 175 Ma le Street CITY Stoughton_ `STATE MA ZIP 02072 TEL 781-297-7049 FAX 781-341-8817 CELL 617-212-4589 EMAIL Richard.6 rg s@rrsc.com t► 61jkllf� ou ' d. 6 1 V -Y)94- 0 The Commonwealth of Massachusetts ..... Department of IndustrialAccidents z v Office of Investigations ° w 1 Congress Street, Suite 100 v` Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders_/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Business/Organization/Individual): Nurotoco of MA d.b.a. Roto -Rooter Address: 175 Maple Street City/State/Zip: Stoughton, MA 02072 Phone #: 1-781-297-7049 Are you an employer? Check the appropriate box: 4. 1. XI am a employer with 66 ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees o These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance coin P. insurance.$ required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑■ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, § 1(4) and we have no employees. [No workers' 13.0 Other comp. insurance required. *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Co Policy # or Self -ins. Lic. #: MWC 11826400 Expiration Date: 4/1/2016 Job Site Address: 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 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. 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 EI t ' I I 6. Other • ec . i a nspector S. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or. other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel # 617-727-4900 ext 7406 or 1-877-MASSAFE. Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia a st tZ anivnol��n orf t� tihLU ag 3 1W es o W Zi fY{J� h W W rn w Q to it1 = w a. •r= 3 t/► p Cil Z u_ wi co . . LL" w O a n. V) w� I Z =1 W 'JOS. m O , a. a. 4 N -- J co u31. y t7, D tai'.' sora h r a st tZ es o rn w Q to it1 = w p ul h� t✓x Z wi co . . . Z Q tw a n. V) w� =-1 co AG: t7, D cn a st tZ Aft TOWN OF NORTH ANDOVER p • PERMIT FOR GAS INSTALLATION This certifies that / .................. has permission for gas installation - ................ . in the buildings of ^ �`>........................ . at ^ ► .... , North Andover, Mass. Fee '. . .. Lic. -No d /GAS INSP�t G R Check # / G�,.� 6556 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Logations i I Owner's Name New Er Renovation D Replacement D Date Permit # ----- Amount $ Plans Submitted (Print or type) Name_. f'1,,,.k.. , Address --! 1-14 <J ,.,cL Name of Licensed Plumber�or Gas Fitter Check one: Certificate Installing Company Corp. Partner. Firm/Co. ,INSURANCE COVERAGE Check one: I have a current liability Insurance' policy or it's substantial equivalent. Yes 13— If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy � Other type of indemnity Bond 13 Owner's Insurance Waiver: Ilam aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mas . eneral Lavas, an t my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner there1:3 Agent 1:3 by 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 Massachus� is State Gas C9de andS�Oter 142 of the General Laws. Title City/Town, (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0'115lumber V I ::> I L/O L( �as Fitter icense um er 0 Master 1 urneyman 6 I a I 6elina5 Structural �ngineerinq LLC Phone 978.465.6436 Daniel L. Gelinas, P.E. Fax Line: 978.465.5160 579A North End Blvd. Salisbury, MA 01952-1738 email dant elinaskeomcast.net July 22, 2008 Joe Levis, Levis Companies, Inc. fax 978.687.3042 160 Pleasant Street phone 2783 North Andover, MA 01845 SUBJECT: levisco@verizon.net i Subject: 5 Village Way, North Andover, MA Enclosures Dear Mr. Levis: You have requested Gelinas Structural Engineering LLC (GSE) to review and comment regarding three additional LVL beams at the above address. On 7-14-09 GSE met you on site, made structural observations, etc. The results of our observations are as follows: All three LVL beams satisfy the code requirements of the Massachusetts Sate', Building Code 61h Edition Chapter 36 One and Two Family Dwellings as well as the Massachusetts State Building Code 7th Edition One and Two Family Dwellings Please call all with any questions. Vel tr ly yours; 1/* Daniel L. Gelina , F Letter 3 add_L beams 7-22-08 08088 5 Village Way.doc OF S ��� DANIEL L. GELINAS 0 STRUCTURAL No. 33994 y ®ft F bay window front 3 Pcs of 1 314" x 117/8" 1.9E Microllam@ LVL TJ-Beam06.30 Serial Number: 7005121073 User:2 7/21/2008 11:45:50 PM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pagel Engine Version: 6.30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED i LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 7'6" Primary Load Group - Residential - Living Areas (psf): 40.0 Live at 100 % duration, 10.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 0.0 80.0 0 To 11'9" Adds To wall Uniform(psf) Floor(1.00) 10.0 10.0 0 To 11'9" Adds To attic Uniform(plf) Snow(1.15) 585.0 150.0 0 To 11' 9" Adds To roof 50 Pg SUPPORTS: Passed (44%) Rt. end Span 1 under Snow loading Input Bearing Vertical Reactions (Ibs) Width Length Live/Dead/Uplift/Total 1 Stud wall 5.50" 3.57" 5640 / 2334 / 0 / 7974 2 Stud wall 5.50" 3.57" 5640 / 2334 / 0 / 7974 -See iLevel@ Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design, Control Result Product Diagram is Conceptual. Detail Other L1: Blocking 1 Ply 1 3/4" x 11 7/8" 1.9E Microllam® LVL L1: Blocking 1 Ply 1 3/4" x 11 7/8" 1.9E Microllam® LVL Location Shear (lbs) 7521 -6009 13622 Passed (44%) Rt. end Span 1 under Snow loading Moment (Ft -Lbs) 20840 20840 30788 Passed (68%) MID Span 1 under Snow loading Live Load Defl (in) 0.263 0.369 Passed (U506) MID Span 1 under Snow loading Total Load Defl (in) 0.372 0.554 Passed (L/358) MID Span 1 under Snow loading -Deflection Criteria: STAN DARD(LL: L/360,TL: L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 11' 9" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel®. iLevel® warrants the sizing of its products by this software will be accomplished in accordance with iLevel® product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel® Associate. -Not all products are readily available. Check with your supplier or iLevel® technical representative for product availability. -THIS ANALYSIS FOR iLevel® PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the iLevel@ Distribution product listed above. -Note: See iLevel@ Specifier's/Builder's Guide for multiple ply connection. PROJECT INFORMATION: site: 5 Village Way, North Andover, MA client: Joe Levis, Levis Companies, Inc. fax 160 Pleasant Street 2783 North Andover, MA 01845 (r%qDANIEL OF MAj,sOPERATOR INFORMATION: Dan L. Gelinas, P.E. L. Gelinas Structural Engineering LLGELINAS 978.687.3042 579A North End Blvd RUCTURAL phone Salisbury, MA 01952=1738No. 33994 Copyright ® 2007 by iLevel®, Federal Way, WA. Microllam® is a registered trademark of iLevel®. C:\Documents and Settings\Dan Gelinas\My Documents\08_LLC\08088 Phone: (978)465-6436 Fax :(978)465-5160 danlgelinas@comcast.net i I Joe Levis for 5 Village Way N Andover\F_frdnt window 7-22-08.sms F center beam 3 Pcs of 13/4" x 14" 1.9E Microllam@ LVL TJ -Beam® 6.30 Serial Number: 7005121073 User:2 7/22/2008 12:16:04 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page Engine Version: 6.30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED i, pal 6 '14! V. Product'Diagram is CloncelAtial. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 15' Primary Load Group - Residential - Living Areas (psf): 40.0 Live at 100 % duration, 10.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 0.0 80.0 0 To 14'9" Adds To wall Uniform(psf) Floor(1.00) 20.0 10.0 0 To 14'9" Adds To attic SUPPORTS: Blocking DESIGN CONTROLS: Input Bearing Vertical Reactions (lbs) Width Length Live/Dead/Uplift/Total 1 Stud wall 5.50" 4.30" 6638 / 2952 / 0 / 9590 2 Stud wall 5.50" 4.30" 6638 / 2952 / 0 / 9590 Detail L1: Blocking L1: Blocking -See iLevel@ Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Shear (lbs) 9156 -7477 13965 Passed (54%) Moment (Ft -Lbs) 32238 32238 36387 Passed (89%) Live Load Defl (in) 0.386 0.469 Passed (U438) Total Load Defl (in) 0.558 0.704 Passed (L/303) Other 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL Location Rt. end Span 1 under Floor loading MID Span 1 under Floor loading MID Span 1 under Floor loading MID Span 1 under Floor loading -Deflection Criteria: STAN DARD(LL:U360,TL:U240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 7' 2" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel@. iLevel® warrants the sizing of its products by this software will be accomplished in accordance with iLevel@ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel® Associate. -Not all products are readily available. Check with your supplier or iLevel® technical representative for product availability. -THIS ANALYSIS FOR iLevel@ PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the iLevel@ Distribution product listed above. -Note: See iLevel@ Specifier's/Builder's Guide for multiple ply connection. I i PROJECT INFORMATION: OPERATOR INFORMATION:N OF site: 5 Village Way, North Andover, MA Dan L. Gelinas, P.E. � O client: Gelinas Structural Engineering tiG Joe Levis, Levis Companies, Inc. fax 978.687.3042 579A North End Blvd': DANIEL L. t1'� 160 Pleasant Street phone Salisbury, MA 01952-1738 O GELINAS 2783. U STRUCTURAL Phone : (978)465-6436 No. 33994 North Andover, MA 01845 Fax : (978)465-5160 danlgelinas@comcast.net Copyright © 2007 by iLevel®, Federal Way, WA. ! Microllam® is a registered trademark of iLevel®. C:\Documents and Settings\Dan Gelinas\My Documents\08_LLC\08088 Joe Levis for 5 Village Way N Andover\F_Ce Iter Beam 7-22-08.sms I ` F rear beam by deck byVge,wha,,.$ 3 Pcs of 13/4" x 14" 1.9E Microllam@ LVL TJ -Beam® 6.30 Serial Number: 7005121073 User:2 7/22/2008 12:24:03 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pagel Engine Version: 6.30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED i i '147 9" a Product Diagrani is Conceptual. LOADS: Analysis is for a Drop Beam Member Tributary Load Widths 7' 6" I Primary Load Group - Residential - Living Areas (psf): 40.0 Live at 100 % duration, 10.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 75.0 75.0 0 To 14'9" Adds To attic Uniform(plf) Snow(1.15) 585.0 150.0 0 To 14'9" Adds To 50 Pg snow j SUPPORTS: DESIGN CONTROLS: Input Bearing Vertical Reactions (Ibs) Width Length Live/Dead/Uplift/Total 1 Stud wall 5.50" 4.23" 7080 / 2362 / 0 / 9442 2 Stud wall 5.50" 4.23" 7080 / 2362 / 0 / 9442 Detail Other L1: Blocking 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL L1: Blocking 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL i i Location Rt. end Span 1 under Snow loading MID Span 1 under Snow loading MID Span 1 under Snow loading MID Span 1 under Snow loading -See iLevel@ Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Shear (lbs) 9015 -7362 16060 Passed (46%) Moment (Ft -Lbs) 31742 31742 41846 Passed (76%) Live Load Def! (in) 0.412 0.469 Passed (U410) Total Load Defl (in) 0.549 0.704 Passed (U308) -Deflection Criteria: STAN DAR D(LL: L/360,TL: U240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 9' 7" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel®. iLevel® warrants the sizing of its products by this software will be accomplished in accordance with iLevel® product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel® Associate. -Not all products are readily available. Check with your supplier or iLevel® technical representative for product availability. -THIS ANALYSIS FOR iLevel® PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the iLevel® Distribution product listed above. -Note: See iLevel@ Specifier's/Builder's Guide for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: OF site: 5 Village Way, North Andover, MA Dan L. Gelinas, P.E. client: Gelinas Structural Engineering LL Joe Levis, Levis Companies, Inc. fax 978.687.3042 579A North End Blvd �0 DANIEL L. 160 Pleasant Street phone Salisbury, MA 01952;1738 0 GELINAS 2783 Phone: (978)465-6436 U STRUCTURAL North Andover, MA 01845 Fax : (978)465-5160 No. 33994 danlgelinas@comcast.net SSIt, JA' �s? Copyright © 2007 by iLevel®, Federal Way, WA. Microllam® is a registered trademark of iLevel®. C:\Documents and Settings\Dan Gelinas\My Documents\08_LLC\08088 Joe Levis for 5 Village Way N Andover\F_Rear Beam by deck 7-22-08.sms i Date. �.0. i <:�•� :�ti TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING- SSACHUSi� ,� This certifies that fo'�:qf ....5� ! �<:....�............... has permission to perform ... pg �' P. ................. plumbing in the buildings of . Dr. p .4 .c: .................. l lc frJ at ... S ..1.�t. t.. f� . � z /........ ,North Andover, Mass. Fee / � Lic. No. 7... 3 b ...... �,,:-1.... . . Check # Sr 3 j ' / PLUMBING INSPEET01i 7782 f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location � V 1 111 Gar— 1") o New M me hgUi d be110 v0 of Renovation 1.5 Replacement "ID Ti MTT TD LMc Date 7-Z 2 —0 16 7 L Amount 1 O 7 Plans Submitted Yes ❑ No ❑ (rnnt or type) _ Installing Company Name p (�l [ J D �� Check one: Certificate ElCorp. Address 5 fz �V-V te- �Lt,- Y /V'H (p73_ 2.37_Ps-7 7 8/Fi:Co. Business elephone Name of Licensed Plumber. o a C'L Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy u Other type of indemnity F1 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 F 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 Masa husetts State P g Code and Ch By: Title City/Town APPROVED (OFFICE USE ONLY �� �pter 142 of the General Laws. T e of Plumbing License '3 (�-7 1� icense um er Master ❑ Journeyman Date. 7A 1�G ) ......... NORTIy °F ao ,°,1, ` TOWN OF NORTH ANDD/ER D • PERMIT FOR GAS INSTALLATION 4 This certifies that ... � ......... has permission for gas installation lj....... in the buildings of ..... .�. R v ........................ at Y ...... North Andover, Mass. Fee. 37.-�-'". Lic. No.. .....) �''```�� -�� GASIINSPECTOR '' Check # 6464 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS nT nNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Loqations Owner's Name New D Renovation Replacement D Date Permit # Amount $ 3 7 Plans Submitted (Print or typo Ire n't Address 03oE K Business I a eo one 1.4 h x Name of Licensed Plumber'or Gas Fitter Po a- t Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes If you have checked Les, please in ' ate the type coverage by checking the appropriate box. Liability insurance policyED' Other type of indemnity D Bond No 1:1 Owner's Insurance Waiver: I,am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the M� Gene w n d that my signature this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner13 Agent I hereby certify that all of the details and information !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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town; APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 3107% Gas Fitter License Number Master ff Journeyman x w U a w Z! O Cq H W 9 C a F W w 4 C a z w o> C O O W Z w> z W a= F F w s O x 3 0 m z U o z z o SUB -BASEMENT 4 > BASEMENT 1ST. FLOOR 2ND. FLOOR s 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR Jill r= 8TH. FLOOR I (Print or typo Ire n't Address 03oE K Business I a eo one 1.4 h x Name of Licensed Plumber'or Gas Fitter Po a- t Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes If you have checked Les, please in ' ate the type coverage by checking the appropriate box. Liability insurance policyED' Other type of indemnity D Bond No 1:1 Owner's Insurance Waiver: I,am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the M� Gene w n d that my signature this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner13 Agent I hereby certify that all of the details and information !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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town; APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 3107% Gas Fitter License Number Master ff Journeyman Date ./l..:....................... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING 49 `.i r J �/ Thiscertifies that . .:............... .:.......................................... ................................. v r has permission to perform ... '- '"' . ............... G r `r' ........... wiring in the building of ...... e . e .................................................... at ..... r°.r'1......:..PECTR�IcAL North Andover, Mass. ..... Lic. No"...f.... Fee .........:...... � ................. ....... ............. ..... . EINSPECTO Check # Jx 6,s-- 7764 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Use Only Permit No. 12�%4�7 Occupancy and Fee Checked :ev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Co E , 57 CMR 12.00,, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:_�� City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of i or her intention to perform the electrical work described below. Location (Street & Number) l� f (1/Q -&FF ,I f ) �4 Owner or Tenant Owner's Address Is this permit in conjunction with a building per it? v Yes ❑ Purpose of Building Existing ServiceZZO Amps JM / Volts Overhead New Service Amps I / olts Overhead Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I ),O re,3 /� Telephone No. No,,J!!!I— (Check Appropriate Box) Utility Authorization No. -252,.2 ❑ Undgrd.�' No. of Meters _L ❑ Undgrd.;?"' No. of Meters e C/^ I Vompletion of the following table may be waived by the lnsnector 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 ❑ n- ❑ rnd. grnd. o. of Lmergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No..of Zones No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump I Number I Tons -----J-KW No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Mun'cipa ElOther Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. o No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom m u n ications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the inspector of Wires. Estimated Valu trical Work: ®0 (When required by municipal policy.) Work to Start• Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCt 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 cover e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE VBOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties of perjury, t at the inf mation on this application is true and complete. FIRM NAME: / e � LIC. NO.: Licensee: /G5,1---L/� /�/ C Signature LIC. NO.: (lfapplicable, enter "efempt" in the license number line) Bus. Tel. No.: C Address: Alt. Tel. *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. o. 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 E] owner's agent. Owner/Agent PERMIT FEE. $ 77 ---G- - Signature Telephone No. I t _ a,T_ 6-T (2y,� r I 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnlicant information Please Print Legibl' Name (Business/Organization/Individual): Address: 10i% City/State/Zip: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I L ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Expiration Date: 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 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 certify under the pains and penalties of jury that the information provided above is true and correct Signature: Date: 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 #: Date ... z_-., ... ..... TOWN OF NORTH ANDOVER 100 PERMIT FOR WIRING . J I ' This certifies that Ze- ....... / ........................... ...................................................... has permission to perform -1 .................. ..................................... wiring in the building of .. ...... ........................................................................... at .�� ........ ............... .......................... ,North Andover, Mass. Fee. ....... Li Nd ................ .. Check # //A, 7873 f Commonwealth of Massachusetts Official Use Only lug Department of Fire Services Permit No. �O BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked-- [Rev. 1/071 (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: f) 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) 1r1 I 11 y5. IaJ 0, Owner or Tenant � � � '� to V0 Telephone N Owner's Address Is this permit in conjunct' n with building p rmit? Yes No ❑ (Check Appropriate Box) Purpose of Building N' tj lity Authorization No. Q 6— Existing Service'1�400 Ampsolts Overhead ❑ Undgrcy�� No. of Metersap New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ 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 'D�& &-7Inspections 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 cover ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under thesdd��acrd penalties ofRerjury, that the in orma,(ion on this application is true and complete. FIRM NAME: TZ. . [J'n,// e 14, k5eiw_/s- /, /� Licensee: LIC. NO.: LIC. NO.: (/fapplicable, enter "exe �''n the lies numb line Bus. Tel. NO.. Address: ® , Alt. Tel. N arc *Per M.G.L c. 147, s. 57-61, se urity work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware t the Licensee does not have the liability insurance coverage normally required by law. By my signature belo , I her waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. 977,f�o4'707 PERMIT FEE. $ mu uuuwuz euute rria oe waivea oy the tns ector o "hires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. ° Total Transformers KVA No. of Luminaire Outlets 32 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- E] No. of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets,00 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches Lp 0 No. of Gas Burners o. of Detection and Initiatine Devices No. of Ranges 1 ©U Z No. of Air Cond. Z_ Tons tal _ )' No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number I. Tonso. o e - ontame Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ unicipa ❑Other Connection No. of Dryers�AjQ Heating Appliances KW Security Systems: No. 0 of Water of Devices or Equivalent Heaters KW o. o o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Ia ecommunicationswiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start 'D�& &-7Inspections 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 cover ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under thesdd��acrd penalties ofRerjury, that the in orma,(ion on this application is true and complete. FIRM NAME: TZ. . [J'n,// e 14, k5eiw_/s- /, /� Licensee: LIC. NO.: LIC. NO.: (/fapplicable, enter "exe �''n the lies numb line Bus. Tel. NO.. Address: ® , Alt. Tel. N arc *Per M.G.L c. 147, s. 57-61, se urity work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware t the Licensee does not have the liability insurance coverage normally required by law. By my signature belo , I her waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. 977,f�o4'707 PERMIT FEE. $ 5E ,� 54 O�c_ v-o7�� -�--3 o- ma y -/, I It The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): City/State/Zip ",Ok J4 MO Phone #:%z� 6 9 -22, Z9_3 Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. I These sub -contractors have orkers' comp. insurance. e are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. FIRemodeling 8. Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also till out the section below showing their workers' compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy infonnation. I am 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. Lic. #: Expiration Date: Job Site Address: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties ofiry that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License /�- -P7 - G 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 4 Date. -�/ . '�!,(.�e� ..... TOWN OF NORTH AN PERMIT FOR GAS INSTA TI This certifies that wo.1,4 r has permission for gas installation . . "1. C4.1-7 /Ac in the buildings of ..'Ps v . .......................... at .. �. u. ! �. ! S..........:!......... , North Andover, Mass. Fee... . Lic. No. / l'/ / 3...r � ...... . GS INSPECTOR Check # 6435 01 MASSACHUSETTS UNEFORM APPUCATON FOR PERMIT TO DO GAS FrrnNG (Type or print) Date ,,�, � �► �� NORTH ANDOVER, MASSACHUSETTS Building Locutions Permit # J ) -- --owner's Name Amount $ 0 7 New Renovation Replacement El Plans Submitted (Print or type) I/I Name A_raoe p-5 z, c F a z o x 0 z � o z o a Z > dd w w • W d ai i W Nz x a a w z� w 'o a F F 3 0 SU B-BASEM ENT U BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) I/I Name A_raoe p-5 Name of Licensed Plumber'or Gas Fitter ,6ne: Certificate Installing Company Corp. ElPartner. 11 Firm/Co. INSURANCE COVERAGE Check I have a current liability Insurance, policy or it's substantial equivalent. Yes [ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1 Other type of indemnity 0 C Nap Bond 13 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. Signature of Owner or Owner's Agent Check one:Owner 13 Agent 13 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 Massachusetts,Snte Gas C?dfjand Chapter 142 of the General Laws. By: Title City/T_..._. APP; OVED (OFFICE USE ONLY) Si nat a of Licensed Plumber Or Gas Fitter Wniber L14 / Gas Fitter_cense Number P Master Journeyman !\ a z o x 0 z � o z o a Z > F z > U w w • -`��. Name of Licensed Plumber'or Gas Fitter ,6ne: Certificate Installing Company Corp. ElPartner. 11 Firm/Co. INSURANCE COVERAGE Check I have a current liability Insurance, policy or it's substantial equivalent. Yes [ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1 Other type of indemnity 0 C Nap Bond 13 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. Signature of Owner or Owner's Agent Check one:Owner 13 Agent 13 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 Massachusetts,Snte Gas C?dfjand Chapter 142 of the General Laws. By: Title City/T_..._. APP; OVED (OFFICE USE ONLY) Si nat a of Licensed Plumber Or Gas Fitter Wniber L14 / Gas Fitter_cense Number P Master Journeyman !\ Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............. .................... has permission to perform .... PCA .0, ..................... plumbing in the buildings of ..................... at. f. Lo -Q. ........... — North Andover, Mass. Fee!/?. Lic. No./( -!.1/ � . ........ 11.1\... ;—a...... . PLUMBING INSPI ' 101R Check# /L2 I -4e' 7312 a 4 rJ LV MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUIVIBIN (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location \/i Io Date V 6 )wners Name Permit of OccupancyAmount_ �/hL�� ,�,,,_ ...�� New Renovation b Replacement Plans Submitted Yes No MTTTVPC ❑ M (Print or type) Installing Company Name Address Check on d,. Certificate 0 Partner. 0 Firm/Co. Name of Licensed Plumber: k4 I fly Insurance Coverage: Indicate the t of insurance covefage 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 D Agent D 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 Mass chuset s ate TbiXCode and Chapter 142 of the General Laws. By' Signature or Eicenss—ewmmoer own ZOVED (OFFICE USE ONLY Type of Plumbing Licenset 04;W (� cense NumDer- Master Journeyrn , ❑ 1 Location No. D Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ ... 9.._..: . s'•^° Building/Frame Permit Fee $ 4CMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U Check # �7,n 7() ` Building Inspector' J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT.5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING 51 BUILDING PERMIT NUMBER: DATE ISSUED: Q ! dZ6 !/fi SIGNATURE: ✓I Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 14y a / 1.2 Assessors Map and Parcel Number: 00,%LZ, Map Number Parcel Number A) 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Vater Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Pubtic 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENTr—m8foric is ric : Yes O 2.10 1 wner of Record 979—& S� 7.6-4/ 7 l n 0 /^ '� 6— r ef + Name nt) (Jr -K J Address for Service: —r - Si nature / b el phoi!5 !J� 's�a 5&<=)C) 2.2 Owner of Record: Name Print Address for Service: Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address t Signature Telephone Not Applicable p License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T rn X Z v rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) + Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ........❑ No ....... 0 SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: % )"f-r�< 0 I SECTION 6 - F.STIMATF.n rnNSTRiTf T1nN rncTc I �C i Item Estimated Cost (Dollar) to be Completed by permit applicant pFFICIATSE,pNLS( 1. mg j-�m �- • �- goo (a) Building Permit Fee Multi tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number Jr.a.iivl. /a V VVIR( AV 1nVMLA11Vf4 1V ISE UUMPLEIEJ) WHEf4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> ��- e / V �- '� as Owner/Authorizedd gent of subject property Hereby au ornze to act on My beh ' f, all matters relative to wor • uthorized by this building permit application. 11 / ! A Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE • loe Customers Full Name Street Address Seacoast Tent Rentals, Inc. 5 Chadwick lave o Plaistow, NH 03865 �Q�i G �� � 0 Vo TEL: 603-382-3600,o FAX: 603-382-1571 A.b ('- - ) A-44 www.seacoasttents.com RENTAL CONTRACT (1,3 0 v c Telephone& i!a — 25 City A {`+cloy IE -.t" State i Zip Code DATE OF OUTDOOR FUNCTION- 3005 TIMI." 0 _ISET - UP DATE t t Tent Sizes & Descriptions Notations, Comments Special Orders Cost . Rental Terms & Conditions I. Renter agrees not to allow any cooking under Seacoast Tent Rental Canopies and agrees to take full responsibility for any and all damages on their premises. 2. Renter assumes all risks arising from the use of equipment and understands that equipment can cause serious injury or death to customer or others if not properly used. 3. Seacoast Tent Rentals guarantees equipment to do the job for which it was designed. Customer will not hold Seacoast Tent Rentals liable for down time, materials, or other consequential damages resulting from the use of equipment. 4. Customer promises to hold harmless Seacoast Tent Rentals from claims by customer or customer's family, or by third parties arising out of the use of the equipment. 5. Customer promises to pay for any loss of or damage to the equip- ment while on their property. 6. Seacoast Tent Rental may terminate this contract and enter custo- mer's property to recover equipment at any time. 7. ALL DEPOSITS ARE NON-REFUNDABLE 50% deposit is due with contract, balance is due prior to event date. TOTAL FROM ABOVE $, 3 ") & .— � rge �$ 7J TOTAL CHARGES $ Deposit on Placement of Order �j� "w S Balance Payable Prior a S to Installation 8. All accounts with credit are subjec to 1-1/2% per month service charge, for balances over 30 days. I have read and agreed to all the above prices, terms and conditions: 11n I X / ' — TABLES: 8' BANQUET 6' BANQUET 72" ROUND 60" ROUND # 48" ROUND 36" ROUND C) -- CHAIRS TYPEDANCE FLOOR: NO. SECTION . - , xa SIZE: '76?0 ---- LINEN TABLECLOTHS LINEN NAPKINS LIGHTING r =' `" `' �' l� � I I t t� 0 i STAGING N SECTIONS SKIRTING OTHER: r� rid Ls . Rental Terms & Conditions I. Renter agrees not to allow any cooking under Seacoast Tent Rental Canopies and agrees to take full responsibility for any and all damages on their premises. 2. Renter assumes all risks arising from the use of equipment and understands that equipment can cause serious injury or death to customer or others if not properly used. 3. Seacoast Tent Rentals guarantees equipment to do the job for which it was designed. Customer will not hold Seacoast Tent Rentals liable for down time, materials, or other consequential damages resulting from the use of equipment. 4. Customer promises to hold harmless Seacoast Tent Rentals from claims by customer or customer's family, or by third parties arising out of the use of the equipment. 5. Customer promises to pay for any loss of or damage to the equip- ment while on their property. 6. Seacoast Tent Rental may terminate this contract and enter custo- mer's property to recover equipment at any time. 7. ALL DEPOSITS ARE NON-REFUNDABLE 50% deposit is due with contract, balance is due prior to event date. TOTAL FROM ABOVE $, 3 ") & .— � rge �$ 7J TOTAL CHARGES $ Deposit on Placement of Order �j� "w S Balance Payable Prior a S to Installation 8. All accounts with credit are subjec to 1-1/2% per month service charge, for balances over 30 days. I have read and agreed to all the above prices, terms and conditions: I 0 n SO .t" E Me 0 N C O CD e CP c m 0 cm C C N m Z r 0 Z O 5 0 :a R, W ,D Y/ W N 19 W C9 W U) 0 a c �a a 0 ` a C h O C V C.3 CL C Cc cv m C b w° U) U a G w° a�G U -� x W a x� 4 w w atkD w � I w Ea � —co w w rR CO cn .t" E Me 0 N C O CD e CP c m 0 cm C C N m Z r 0 Z O 5 0 :a R, W ,D Y/ W N 19 W C9 W U) 0 c �a 0 ` C h O C V C.3 CL C Cc cv m C :Z O O Ea CF 0 0 ' z to :r o a N E� C r CO2 CA 0 CCr N W o Z' 3 N Cm zo O �0 .m W N W �E Io ac3 N 0 -moo r � c 0Q C 0 W o Z c � o CL m N C = O C H w dr N 4D 4. 'N OrC LO r. N dZ C •N J rui o cp m CL ms y mZ I 1 a=m .t" E Me 0 N C O CD e CP c m 0 cm C C N m Z r 0 Z O 5 0 :a R, W ,D Y/ W N 19 W C9 W U) 0 0 Date . /.. L11 `. ' ..... . 3"% y TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SACMU5Etth 4 This certifies that ....................... . has permission for gas installation ...d? :A!.1 I ... . in the buildings of ... ...... ......................... at .... .............. North Andover, Mass. r' Fee. Lic. No. ........ �....... ....... GAS INSPECTOR Check # 3 G 6272 MASSACHUSETTS UNIFORM APPLICATON FOR PERN Ur TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations r�S— 1// '/ L �� 40 U 6'1 Owner's Name New Renovation Replacement ❑ Date Permit # Amount $ �G Plans Submitted 0 (Print or type) Check one: Certificate Installing Company Name �/ /,� 0 Corp. Address IP �d Q i a �� 1' % - 0��i�'y 11 Partner. Business I a ep one --Firm/Co. _ Name of Licensed Plumber'or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 13 No� If you have checked Les, please indi to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond 13 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 13 Agent 13 I hereby certify that all of the details and information I have submitted (or entered) !*p above application are true and accurate to the best of my knowledge and that all plumbing work and installations perf�grmed u e Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse a Cod hapter 1 e General Laws. By: . Title City/Towm.. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber c2 3 Gas Fitter License Number Irl Master 0--lourneyman SUB-BASEM ENT w z a� z x w C x v, w o � z .. x �' v � a �" w x �. d m x F` 3 �, a 0 z w v� x o� m .Qa w w � a w Z ° � O E, O O x ca Z > E✓ > F W o w w a 0 F w c �1 BASEM ENT i 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Check one: Certificate Installing Company Name �/ /,� 0 Corp. Address IP �d Q i a �� 1' % - 0��i�'y 11 Partner. Business I a ep one --Firm/Co. _ Name of Licensed Plumber'or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 13 No� If you have checked Les, please indi to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond 13 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 13 Agent 13 I hereby certify that all of the details and information I have submitted (or entered) !*p above application are true and accurate to the best of my knowledge and that all plumbing work and installations perf�grmed u e Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse a Cod hapter 1 e General Laws. By: . Title City/Towm.. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber c2 3 Gas Fitter License Number Irl Master 0--lourneyman ti y Date/ .�. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .............-.. . has permission to perform ..... flf7 - ......... plumbing in the buildings of . -P+'. at ....... 4.! 1.1..� f .� ..tri .�� rY......� . , North Andover, Mass. Fee?.'cP Lic. No.R.3 f). ......V ....... '2 PLUMBING INSPECtOR Check N > � � � 7606 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location � G✓G Owners Name V ( Date Vo Permit # ? �� Type of Occupancy , ,C 1 —� New Renovation r Replacement Plans Submitted Yes No FIXTIIR F.c (Print or type) ��� Installing Company Name Check one: Certificate ❑ Corp. ❑ Partner. Firm/Co,. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E Other type of indemnity rl Bond uuu 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 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installation .,perforn compliance with all pertinent provisions of the Massactiisetfs:St�fC Plumb IBy. (APPROVED (OFFICE USE ONLY Agent ❑ in above application are true and accurate to the - Permit Issued for this application will be in hapter 142 of the General Laws. Typef�� Plumbing License / icense Numoer Master ❑ Journeyman MIMMEMEMIMMI MM M IME ME . MUMEMI lIMOMMIM MMMMMMM ME .... 4.7 M IENIMME MIMMI IMME SIM MKII-16110MMMIMMEMEMIMM MEMI M FT MMMMMMMMIW.P-1,1217--tMEMIMEEMIMEMIM ��e������������ MIME (Print or type) ��� Installing Company Name Check one: Certificate ❑ Corp. ❑ Partner. Firm/Co,. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E Other type of indemnity rl Bond uuu 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 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installation .,perforn compliance with all pertinent provisions of the Massactiisetfs:St�fC Plumb IBy. (APPROVED (OFFICE USE ONLY Agent ❑ in above application are true and accurate to the - Permit Issued for this application will be in hapter 142 of the General Laws. Typef�� Plumbing License / icense Numoer Master ❑ Journeyman