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Miscellaneous - 507 SALEM STREET 4/30/2018
507 SALEM STREET 210/030000.0 _� - -- ---- Date....1... .... S..- ..�:.f..�..� -. r p►ORTH TOWN OF NORTH ANDOVER °?e` `` •• O°311 .. PERMIT FOR WIRING ,s`SACHUS�� Thiscertifies that ................ . ..................................................................................................... has permission to perform P2 ���. ?' .........................................`'_'a C P,r� ........... wiring in the building of..... P '.. .......................................................................... at ... V ......... .......... . ......................North Andover,Mass. 21 e)13 Fee..��`-�.....""..........Lic. No. ................ .................................................................................... ELECTRICAL INSPECTOR Check# : A0 O Commonwealth of Massachusetts fficial Use Only " Department of Fire Services Permit No. 9 Occupancy and Fee Checked ,� • BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: j2-//L5 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) 50-7 S,,d e s Owner or Tenant ('()ar r pe ry j Telephone No. Owner's Address 0 `' cz.,j e*.n I St, Is this permit in conjunction/nwith a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building gt,S jep e e Utility Authorization No. - Existing Service 2.r,,b Amps 176 /2t16 Volts Overhead d Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires 7 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimmin Pool Above ❑ In- Elo.o mergency Lighting I g rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burgers No.of Detection and Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Num.....................................er Tons KW No.of Self-Contained No.of Waste Disposers Totals: '' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection �. No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: �� d (When required by municipal policy.) Work to Start: 12 2 115 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless t the licensee provides proof of liabiliV insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, cinder the pains and ennalties q fperpury,that the information on this application is true and complete. FIRM NAME- ickcr2 C.� n's C d16� C ?, C LIC.NO.:R 101 " 14_ Licensee: WiCYCI.-Tel C��Sz Signature C. C. • LIC.NO.: JZ 6 u (If applicable,enter "exempt"in the license number line) Bus.Tel.No.. -131 Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. lam the(check one)[]owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the r notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending'through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: . V Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INCTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature:-, Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com � The Commonwealth of Massachusetts , Department of IndustrialAccidents d 1 Congress Street,Suite 100 Wi Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information A / Please Print Legibly Name(Business/Organization/Individual) Address: '714 C ting ,dP,. R%j e City/State/Zip: M' ye_r I ( 8I S Phone#: 2 6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑ ew construction 2.NfI am'a sole proprietor or partnership and have no employees working for me in 8. RRemodelirig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t w 4.F1 am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 ilding addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.E]We are a corporation and its office have exercised their right of exemption per MGL c. 14.E]Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subniif 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: P 19*" Policy#or Self-ins.Lie.#: Expiration Date:f� Job Site Address: .3 7 CJr City/State/Zip: CJ/ � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do herebycertif under the pains and penalties of peijury that the information provided above is true and correct. Si nature: 1-7dDate: 12-17— Phone ZPhone#: O� 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute an employee i e s 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 1 � ff COMM ;> �4� LTF1yr ° `® OF MAH eo SE ELECR�O ISSUES . TR1C►A S NS _ THE FO Aq :REG JOU SLOWING RICHgRD CHASE JR RICIgN a- 74 LqG A VE A .;: RH 1 LL 1,26o A p 18 n1 t 3 J e 07/31 5 771 `' -- 56874 . 0 o MMONW&A OF MA USE eOA S . LECTRICI ISSUES EANS rHE' 6LLOWI REGNG ISTERED STPLICENSE j R ELEGTRLC' R1`=CyARD CHASE +x 1qN 74 LAMO'I LLE qVE I ` i � :HAV ERH I LL 21093:.q C7 A 01835-7113 31/16 56875 • . 10900 Date... ........ ,&OR'r#g 9 D TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING This certifies thatN.� .................. has permission to ...................... He,eplumbing in the buildings of.................. L5 -sp at.............�q....90 1 .......................................................................... North Andover, Mass. Fee 5.b ........Lic. No. .....Mf�............... PLUMBING INSPECTOR Check 42-S 35' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK :. ' b CITY NORTH ANDOVER MA DATE 121212014 ' PERMIT# ��UD JOBSITE ADDRESS507 SALEM ST OWNER'S NAME PERRY P — i OWNER ADDRESS _.. TEL 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E] RESIDENTIAL F] PRINT CLEARLY NEW:[] RENOVATION:El REPLACEMENT:l PLANS SUBMITTED: YES® NO FIXTURES Z FLOOR- BSM 1 2 3 4 1 5 1 6 7 8 9 10 11 12 13 14 BATHTUB _; — CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ W DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN �-- FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) tj i . KITCHEN SINK ! - LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK LLJ TOILET URINAL WASHING MACHINE CONNECTION 1 ^ WATER HEATER ALL TYPES ` �1J WATER PIPING OTHER BACKFLOW FOR BOILER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E] NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY E] BOND E] 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 Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian eAwith allfiertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f �� PLUMBER'S NAMEJEFF HUTNICK LICENSE# 15212 SIGN' URE MQ JPD CORPORATION # 3532 ._� 'PARTNERSHIP# LLC[]# COMPANY NAME CALLAHAN AC AND HTG ADDRESS 191 BELMONT ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978 689 9233 FAX CELL EMAILPLUMBING@CALLAHANAC.COM A -�+ � . `� F < < 1 i y i M I f I �� �S� � i Date.2-.17--�.1-.1........................ ..... ..... .... OF NOi1TH, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU 'This certifies thalZ .................... ................................................................... has permission for gas installation ................. ............................. inthe buildings ofA/.in................................................................................ at....... ......... North Andover, Mass. FeeZ.©.7..... Lic. NoY`32 �'S ..... ...... ...........-.......... ........I!g........................................................ GASINSPECTOR Check# 2-%'3 9715 f.N- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE 121212014 PERMIT# JOBSITE ADDRESS507 SALEM ST OWNER'S NAME PERRY GOWNER ADDRESS TE FAX ✓ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALE] PRINT CLEARLY NEW: RENOVATION:El REPLACEMENT:01 PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _._ FIREPLACE COOK STOVE _ _ _ . a p DIRECT VENT HEATER DRYER rte:: � 3. r 9 FRYOLATOR €=-:3=I= FURNACE -- -.� � -- � .. .G - I.�I, GENERATOR I F � u... w _...,._„e _- —w.... �.r GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _.. _. ROOM 1 SPACE HEATER —_ ROOF TOP UNIT -. TEST �.... ,. ?.. ,...,, . UNIT HEATER i UNVENTED ROOM HEATERED?=' WATER HEATER i � -- ED OTHER INSURANCE COVERAGE I have a current liability-insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY BOND fj 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. r CHECK ONE ONLY: OWNER 0 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 cgurate t the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia c €hall Pertinent provision'of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JEFF HUT NICK LICENSE# 15212 'C / SIGNhXURE MP 0 MGF JP JGF LPGI CORPORATION # 3532 PARTNERSHIPCj#=LLC # COMPANY NAME: CALLAHAN AC AND HTG ADDRESS 91 BELMONT ST CITY NORTH ANDOVER STATE MA ZIP 01845TEL 978-689 9233 FAXE CELL EMAIL PLUMBING@CALLAHANAC.COM i I r ��a �y I I[l ,�l �� �/ /s!� The Commonwealth of Massachusetts f Department o DeP IndustrialAceidents m Once of Investigations N I Congress Street, Suite 100 w� Boston, MA 02114-2017 , www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Iudividual): Callahan A/C and Heating Services, Inc Address: 91 Belmont Street City/State/Zip: North Andover MA 01845 Phone #: 978-689-9233 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me m any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. 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 ' right of exemption per MGL Y �o workerscomp. 12.F-1 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#1 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. tContractors 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: Guard Insurance Policy#or Self-ins. Lic. #: CAWC586931 Expiration Date:09/25/2015 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 statementt may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 7Z el- d ,2_,� 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#: COMIMO.NWEAL--TR OF MASSr 14US . r PLUMBERS ANS} GA5F 1TxTfU..- y }SSUE S THE F ols- w-1,14G L}CE#NSE ftEG}STI_IZ1:0A5API-UNIB1l�i ', ;gJEF1�R Y NU 'I CV, _ w ALLAHAN A C A 1l3 HEAT 1 NG S RV��, f£. 60 PLYME7UTti ST fe } s aaytA.. �n}�A 1„O�s 426.,�': �i Z k<353 0501 2040 4 - -< COMMONW r Ea _TH OF MM"C PLIBElS AI[ A5F}T x b" IS�St1ES T.C1E FfJ€CLOW► ' TEAS ,g a ET�51;1T ASIA MASTER P-L=1P. # °•1EFFEY P HUTNCK .�� � b0 P L:Y1{TU`I ff S T y}¢ 3 OOMtMONV1lEATH'OF NIASSO1 LlSIETTS til • t PLUMB-ERS qND GASF1T;f 1_SSUES THE f- LLOW A� �1 NG L 1 CENSE 4I� L}CENm5E0 AS 'A�,JOURNYMI'�P.'LUE�B� z MR o�844 4256 } j( i ! Location .�--to No. qlq Date Z /0 u,j MORTh TOWN OF NORTH ANDOVER ►' 9 Certificate of Occupancy $ 1'�s''•° E<�' Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # a h� 1651 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING m r; BUILDING PERMIT NUMBER. ` o/ DATE ISSUED: X SIGNATURE: Building Commissioner/19s for of Buildings Date SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT F M 2.1 Owner of Record Name(Print) Address for Service: �-' Zi- Signature V Telephone O UV 2.2 Owner of Record: tvAV, O Name Print Address for Service: Z r M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor:r Not Applicable ❑ L k a/aj cY .1 Licensed CAstruction Supervisor: ?p� & O 11`` License Number Mn Add ss �/m (� a&q Qfj"u/ 7k Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 s® Company ame Sy— Registration yRegistration Number Addresl���v// 7,VW—(o 73 Z Expiration Date /1 Signature Telephone YI m. 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.......❑ SECTION 5 Descri tion 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFI�GUL USE ONLY Completed by permit applicant - ........... 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction < 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 4,C 'S'.� ,as Owner/Authorized Agent of subject property Hereby authorize U` �� �, to act on My behalf,in all matter elative to work authorized by this building pennit application. Signature of Owner Date SECTION 71h OWNER/AUTHORIZED AGENT DECLARATION 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 N e Si ature of Owner/A e t Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1ST 2ND 3RD SPAN DIMENSIONS OF SILLS DEMENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X i MATERIAL OF CHIIANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W The Commonwealth of Massachusetts t , d Department of Industrial Accidents Office of Investigations Boston, Mass. 02 919 Workers'Compensation Insurance Affidavit Name Please Print Name: /� ' l/e U t lel Me yG/u/� b Location: d 7 ` S% City Ivo 1 /-N1) 6W ie /v-7 Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for rry employees working on this job. Company name: so Address City lvo A/V d�zle e Phone#r 97"JIY--6 73-7 Insurance:Co. ec /1t�h�` Policy# Company name: Address. City: Phone#r Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can oto the imposftn of airrinal penalties af:a fine U1110$11500.00 and/or one years'irrprtsonrnmt_as vkelLas_civil oenalttesin-thelam d-aB DPYAKM-OR)ERAid-afiae.-cf_(,$iMiq-a understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification.� o� 1 /do hereby cenWYpnp1hr the pains and Wallies ofperjury ffm 04Qe infonnatkrr provided above is bue and correct. Signature Print name–Aer ffgA -''J7 40V;- PbDne-# 7 73 Official use only do not write in this area to be completed by city or town official' City or Town PerrnWUcensir2 Building: Dept []Check flmmediate response is required © ,Licensing Board p Selectman's Ofte Contact person: Phone# E] Health Department Ei Other 4 A .J. Walsh & Sons Inc. 55 Hcasunl Slrccl North Andover, MA 01845 Klass. LICENSI d 022690 1\lass. RlIdS'I•RATION N 10.3.358 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting,unless specifically exempt from registration by provisions of Chapter 142a of the general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should Id be made to the Director Home Improvement p ment Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: This agreement is made on "C ._3 between :. � �� ..•-'`i �-a'�•�.,.-°" (DA (CONTRACTOR) of _ 4) (ADDRLSS 1(PliONP.NUMBER) hereinafter called"Contractor'and � -•, �� of / d a? (ADDRES ) (PHONE NUMBER) hereinafter called"Owner". i DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contract���r to rfoTyn in a gD(x�i d workman'kc m nner all work detailed tx low. Such work 90milstsof the follow hg _ ?A G ¢ , DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials��pp be used in performing the above described work consist of1.% a fol}owing:L:C:ii �1a�a .Fm��c•� -fL�i,l'<Z,tk '.l �'�' .�.�1. 1� c.c c•Z�2 l U. PRICE : s . X,0 Contractor agrees to do all work described in Section I for the total price of S e ill. PAYMENT Payment will be made as follows: [33 llzl 4'0(S � ''� �(1. )upon signing C7of 1°0(S U"Q��� )upon completi(S —.... )upon completio �;J � Lis and the remaining�1�'��%(s L/( s )upon verification of the work by Owner iAORTF ikndover Tdwn 6 . ` ` VO t� • / 3 LAK * dower, Mass., �y COCHICMEWICK S RATED i U BOARD OF HEALTH Food/Kitchen PERM_ IT T D Septic System C BUILDING INSPECTOR THIS CERTIFIES THAT........JeW /.1 AP........... I..............,� N.. ..�. .................................................. Foundation I�ISAO40) SSAIR � .� � has permission to erect......... t........................... buildings on ...... ................. ............... Rough to be occupied as......at. �~', ........�.. ......�r fr l.r!..... .........................:........................... chimney provided that the person accepting this permd shall in every respect confor.A the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Ins ection, Alteration and Construction of Buildings in the Town of North Andover. 3 9 /xr 0 / 910 0000' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough 00 .. ................................. Service BUILDING INSPECTOR Final Occupancy Pemit 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. SEE REVERSE SIDE Smoke Det. i CS # 022680 ® i Page# of pages 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted Jo me Job It Address ` Job Location Date Date of Plans Phone# Fax# Architect =herebybmit specifications aV estimates for: ...... . .......... ................. .......... .......... _. _...._. ._...... ............ _._..... ......... __ ..... ..._._......... .. .......... ... _... ........... We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: a $ Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdr n by us if not accepted within days. i 01cceptance of A9ropn al The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature NC3819 MADE IN USA Location &012 5l9 1,F No. c Date 16 -10 -03 ,.ORTq TOWN OF NORTH ANDOVER Oi�t� e ,ti0 0 ♦. 09 i s + ; . Certificate of Occupancy $ �o Building/Frame Permit Fee $ HUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ $Check # 160 Building Inspector r^ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. 02 6, DATE ISSUED: © a , X A( CC4-,,,� SIGNATURE: Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Properly Dimensions: v V" Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name rint) Address for Service: N" a Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ i Licen;� onstruction.Supervisor: 2,2411)2,2411) O License Number Addres0�- 0 P/N `� XP �a�o(� �6 -� Expiration Date 7 Signature Telephone r 3.2 Regist4red Home Improvement Contractor Not Applicable ❑ Company am e &03 M at- z/f„/` Registration Number r ! r Expiration Date G)A Si nature Telephone 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.......❑ 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ,OMCIA L USt ONLY -y feted by permit applicant 1. Building (a) Building Permit Fee ( l w Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b)4 Mechanical HVAC /VO 5 Fire Protection 6 Total 1+2+3+4+5 Check Number b 61-(v SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT her/Authorized Agent of subject property Hereby authorize to act on My al&i all e r 1 tiv to authorized by this building permit application. 10 - � ��� Signature of Own Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ��'&&&6 b ,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 Pri me M 0, 1 /,o -� Si ature of Owner/Agent Date goo NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1ST2ND 3PM SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS t. SITE OF FOOTING X t MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted Jo me Job# Address Job Location Adz Date Date of Plans 'I Phone# Fax# Architect We hereby submit s�hpje��if estimates for: _ _.. . . _..... ''.. .... . ....... ............:. .. .._......_ ................... . -- _.. ......_. : . .._._.... ....._ ._....................... ............. ....................._.... ....... . ........ _ . _........... ___ ..........._ . . ... ............... _..._.... ..__..................................... ............----..... ...................... ............ . . _.. _ .................._..__................................ ....._. .. .. . ...............:.......................... .. _ .... . .._ .. .... . _ ....... .. :... .. ... ................... ............_...._ - -._.... ... . .... ........... ................ . _ ._........ .... ....... . ............................._ ........ . ............ ................. . .......... ...... _ ......._. .. ............................. ..........._....... .......................... ......... ....... ...... .......... ...... ..._ .. ................ .._..._........................................................................ ....... ..... .__. _... . ... ... ..: __.. .......... ........... ................................... ...... ._......... _ r$We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control Note—this proposal may be withdr n by us if not accepted within _days. 2cceptance of Prop al The above prices,specifications and conditions are satisfactory and are Signature ��— `�"�'' ` hereby accepted.You are authorized to do the work as specified. .Payments will be made as outlined above. Date of Acceptance Signature NC3819 MADE IN USA . ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 W 'ers'Compensation Insurance A>�davit Elm Please Print Bill" I'll I Name: c 41YgL Location: City /V6 IVA t'J //Lf Z -/ Phone �-- Am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity i am an employer providiingl workers'compensation for my employees working on this job. Company name: IS0&S Address Cifti Af6 UdC "/iT Phone, . .?7k . I stt Par .. # �2 Omeaanv name: Address i i city: Phone# Insurance Go P icw — Failure to secure coverage as required under edion 25A or MGL 152 can lead to the iittposition of criminal penaifiea.of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WOPX OftD It and a:fine of($100:00)a day against me. I understand that a copy of this statement may be forwarded to the OMW of Investigations of the DIA for coverage veritkation. I do herby certify under the pains and penalties of perjury Drat the information provided above is true anis correct Signature Date ,OV 't G G Print name r/VL' "9/ I✓l/A- '/,i Phone# Official use only do not write in this area to be completed by city or town official' 0 Building Dept ElCheck if immediate response is requxed Building Dept 0 Licensing Board EJ Selectman's office Contact person: Phone#: Ej Health Department 0 Other VORKMAN'S COMPENSATION I i JL %J VV JL k WA. ............ A. A6JL A61bolL 1%otw V '%ww JL it Nc ` � 0 dover, Mass., q 0"?ATED C:) H 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR rn b C.0 A.0 ,41 THISCERTIFIES THAT.... .................... ............................................................................................................. Foundation *P10twl S. I it Rough has permission to erect...Rf............................... uildings an ............................................................................I................. 00 Chimney ......W......C sp&0Q# to be occupied as....................... ................................V.714!!..................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough *#41 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. SEE REVERSE SIDE t Smoke Det.