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Home My WebLink AboutMiscellaneous - 51 BREWSTER STREET 4/30/2018 51BREWSTERSTREET � 2101023.0 0068 000 0 Date . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . .l Z.0 <r . S q ✓t. m 4..�s.. has permission for gas installation . . . . n- . . . . . . . . . . . . . . . .. in the buildings of. . . . ► Ck 4 C.( . .. . .� C�,v . . . . . . . . . at . . . . : �.w r. -� ,North Andover, Mass. Fee ,.?Suo. . . Lic. No. . �? 3. . . . . . GASINSPECTOR Check#-\ 5 Z 8346 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY CUYi✓ —� MA DATE FY PERMIT# J JOBSITE ADDRESS 1^P.f,Vs Gtr OWNER'S NAME GOWNER ADDRESS ; ,'p,�,,� X ,� TE AX� TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT ❑ ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION;❑ REPLACEMENT:✓ PLANSSUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS- BSM i 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ? M, ROOM/SPACE HEATER ROOF TOP UNIT & TEST f UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER e INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES RNO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY [] BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru and accurate the best of my nowledge and that all plumbing work and installations performed under the permit issued for this application will be in co I' n with II inept provisi ollorin Massachusetts State Plumbing Co and Chapter 142 of the Gen ral Laws. PLUMBER-GASFITTER NAME i�LICENSE# 3 = MNATURE MP[�F❑ JP❑ JGF❑ LPGI❑ CORPORATION PARTNERSHIP[]# LLC❑# � COMPANY NAME: v �ADDRESQI (,�N CITY STATE ZIP (' TEL 5 06-1371 FAXCELL EMAILL Date.�d�/ �' ..... ... N°RTM °F 3� O TOWN OF NORTH ANDOVER � T • ''' PERMIT FOR GAS INSTALLATION 's,SSAC•MUSEt This certifies that /Q�iG�Olt�r `�, ,,y �Y�h . . . . has permission for gas installation . . .,f. . . . Q�?. . . . . . . .. . . . t in the buildings of . . . . . . . . .. . . . . . . . . . at . . �. -5 !� . . . . . , North ndover,,Mass. Fee. .?$.a? Lic. No..5 °P-1 . . . . GASINSPECTOR Check# 44, l`U 7837 vLASSACHUSE M UM ORV1 AMUCATON FORPE 'vff]PTO DO GAS FfFMG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ Owner's Name U New❑ Renovation ❑ Replacement Plans Sub fitted a 0 ih s1 U H Qj a U 0 0 0 o w o, °rij a H o o o ff SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR s (Print or type) � �� Name .�is/ `if�'.L /� �/�.__�l•+r ✓l�/6- ( mss, Ch ne: Certificate Installing Company Corp. Address d ,E✓ D 8 ❑ Partner.. t3us,ness Te ep one _ 3 ❑ Firm/Co. :Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please inAcate the type coverage by checking the appropriate-box. 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 :Mass.General Laws;and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 0 hereby certify that al I of the details and information I have submitted(or entered)in above application are true and accurate to the- best of mN 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 Stateas Coyle and Cha ter 142 't eneral Laws. By; a'40nature of Licensed Plumber Or Gas Fitter Title Plumber City/Town ❑ Gas Fitter Eicense Burnber aster .1PPROVED roFFteE use opt. R Journeyman � � � ' I { � � •\ r � I � \ ' �I � _ _ .. �� f F i .. � - � + � i � 3 _. _ - . � . ! . _ •- - - - � _ _ _ .. _ _ �. .. t- - �_ .. � _. 4_ _ 4 _, _ L .. �. � a�� .�� _ _ .� - . i �, . �., . The Comototrw.eah/t of1)!tussgcltrtsetts. � . Departtiietit ofli"dt 866 Aec eitis' - Y Qfflce ofl004ntlons - 600 Washington S&eet. . Boston,MA 02111 MR.P.»rass govIdla Workers'Compensation.Insurance A,ffidayrts;gullderslContractors/EleetrtdanslPtumIiers Applicant Information'.. Please l'rinf L 'bIv may_, Name EBusineWOrgpaizatrtmtlndviduaiA� i/ Address: A0AI :City/State/Zip: .Plione M. Are yfiu an emplayer?Cheek the appropriate b= 4: 1 am a '` Type of project required): I. I atn a employerwidr- ❑ . gawaal contractor end l.: employees(hill'arWor part time).* .6avehireed the sob-contractors;' 6:-[�New coisauetion 2❑ I am a sole proprietor or partner- I't. ....on the attached.t p 7._0-Remode[ing ship and have no 1 , _?'h eaub-contiactois}lave imp oy�.: - . 8. Detnolitton wonting for me in any capacity. employees and 6 workt3rs'- 9. Building addition (No workers'.comp.insmranee comp.�rauce3 ❑ required.] .5.0 We are a coi'poratioa•and its 10.0 legtrical iopairs or additions 3.❑ I am a bomeowaer doin a8 work nlEeeis have exereist:id tht 1-I' Plumbing g repaua or additiaas• . myself;[No workers'•camp. rigtitof piwM(3I:=_ 1�,0 Roofiepairs insurance required.]t 6.15%§l(4),za*wehaveno . employees.•(No worloets' =: -: .. 13.[]Other•. collo: ' - li�`f�Lt� �k�D GASFI`fTfRS REGISTERED AS A.PLUMBING CORrk,.� GEORGE R` LAROSE -.ANDOVER PLUMBING & HEATING C 20 AEGEAN DR _ . .::UNIT 10 '' METHUEN NA 018.44-1580.: . 2122 05/01./.12 `.. .. 784263; ; ANPUM IN�Et�aND'OA ITERSENDSURNYLICAS A J L STE LUM . LICENSED AS A MA R P BER GEORGE R LAROSE - GEORGE R LAROSE0` :_ 44 ODILE .ST 44 ODILE STREET ``- METHUEN MA: :01844-4233 METHUEN MA 01844-4233 18725 05/01/12 784282 9983 05/01/,12 78428 _......... I - Location 1, �7;7 No. Date 01tr" TOWN OF NORTH ANDOVER 0 Certificate of Occupancy ...... Building/Frame Permit Fee s Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check A 61 17 7 7 Inspector TON" OF NORTH ANDOVER BUILDING DEPAR'TMEN'T APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. ` 7 DATE ISSUED: (� / -/ SIGNATURE: Building Commissioner/M for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: z6)G7'__) � Map Number Parcel 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required 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 ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT NIST011C D ,slrlct, Yes ,NjO I,- '- M 2.1 Owner of Record (nJ N ave C' M zvc- p e.�p Name(Print)J Address for Service Signature Telephone 2.2 Owner of Record: Neme Print Address for Service: M Sin pure Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ G,*X"A�\.,3 L C CA"4,-,B'�( Licensed Construction Supervisor: �0 Q U, 3� � ( .I( O "/, p 3 ,0 License Number Address 1 d{ bt V V tf r/ G,3� Expirationon,�,� (�0 3 - 2 3 I- ��- 2� o� ate ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone S SECTION 4-WORKERS COMPENSATION(NLG.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 buildinE permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all a Reable New Construction ❑ Existing Building ❑ Repair(s) `f Alterations(s) G Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other G Specify ____ n f! Brief Description of Proposed Work: e-V' ` 3&' J 'Ju SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFFCIAL�[ISE ONtil' Completed by permit applicant 1. Building s Sn.Q a D O (a) Building Permit Fee / Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(n) 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` iCONTR�ACTOR APPLIES FOR BUILDING PERMIT 1, KOAe v7 \ V t' T 0 ,as Owner/Authorized Agent of subject property Hereby authorize ��r,\k-3 Gv�S vcZ1"� to act on M u natter r lativ work authorized by this building pennit applicati� _ a5 Q Si nature of Owner Date SECTION 7b OWNERIA�UTHORIZED AGENT DECLARATION I, I kk—V A e--J _ 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 Signature of Owner/Aent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIN BERS 15 2' 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOIINDAIION THICKNESS S1ZE OF FOOTING d X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND r 1S BUILDING CONNECTED TO NATIJRAL GAS LINE 0RTjj To," O ®ve r No. C� LAKE 0 over, Mass., I' CoCHICHEWICK W RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. ... Foundation ........................................................................................... .......... ..................... .......... .. . ... .. ... . . . . .40 has permission to erect........................................ buildings on..%r/r..T.;F. .................... Rough to be occupied as .. w ....*....*.....*....... Chimney provided that the person jaccing this permit shall in every respect conform to the terms of the application on file in Final *A I this office, and to the provls�ie ns 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 S Rough .............................. Service r.....41AOV........................................ 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. IF—sEE REVERSE SID I E Smoke Det. BOARD OF BUILDING REGULATIONS License: CONSTRUCTi6N SUPERVISOR ' Number CSS 077696 Birthdate11f2811970 expires; 1?/2812005 Tr.no: 7668.0 a Restricted04 MATTHEW J BURKE� s: 71 SUTTON HILL RD (•Es»��i NO ANDOVER, MA 01$45 Administrator BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR Number GS 077696 j Birthdate#fM28/,1970 expires 1 /28/2005 Tr.no: 7668.0 Restricted 00 � MATTHEW J BURKE _ 3 � i 71 SUTTON HILL NO ANDOVER, MA 01845 Administrator u a The Commonwealth of Massachusetts W Department of Industrial Accidents Office of Investigations oWR Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Name Please Print Name: c('-9 2 q `Ck vl OpyS L < Location: �W- 91it n ?0 AY-5 City Phone # 663-2 3 I am a homeowner performing all work myself. 0 . I am a sole proprietor and have no one working in any capacity 121-1--1 am an employer providing workers'compensation for my employees working on this job. Company name: ( Qn S Address To Go 3 7- City: Y Z i e C, S, -k)V- 03 l Phone#: Insurance Co. 8 r0., S T�nS• �o '"W�K�,Policv# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as_we➢_as_civ.il.,penakiesin She form-of-a_STOP WORK_ORDER.and.a fire-of.($1.00.00)_a-day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pai s and penalties of perjury that the information provided above is true and correct. Signature >/� Date ®UI Print name 1`�a-�1 �n t .,J Phone#Z,d 2 31' -qo 5 - Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board Selectman's Office Contact person: Phone#. Health Department r7 Other f North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Sign at re of Permit Applicant a 6 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Fi1.. Date. 3972 ORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,sSACHUs� 4 This certifies that . . , . . . . . , , has permission to perform . . TJ! . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . at. . . . . . . . . , North Andover, Mass. Fee. . v� �.Lic. No.. l z.z .g�. . . . . . PlUM81NG INSPECTOR pqqg � 3 WHITE: 1.4931 T 16. CANARY:6o,ilding C?6%P PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMB (Print or Type) ING Mass. Date — /C 19_21_ Permit # Z 8ulldln8 Location vu f a S�— Owner's Name_ Af<..ti e., Type of Occupancy New ❑ Renovation O Replacement lam- Plans Submitted: Yes ❑ No O FIXTURES Z N = N Z Y a h 0'1 N N O z WY J U1 } U < N = W w W z y < rr < F' z ° N rr rr O W h WCC x Q W — 0 z ry M x N h U W N Y < WF- Q X ¢ m 1A W a h y z e a o a — < 3 x ¢ W O m < Cr .� W — o a m z a a � 0 u h h W y O to C J — .+ h u < x 3 x 0° z x Y a G ►- < x m m a a < h < ( x y y O N h x O O N 2 X W F- O V X < 0Q J J < ¢ ¢ z < O Q h N O O J 3 x ►- (n lL V p < C m O sun—aSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR nTHFLOOn 1 Installing Company Name_ / l��v_�. Check one: Certificate Address k" .rt c ❑ Corporation AA�, ..PY o a •r �` 3 3 ❑ Partnership ----___ Business Telephone_ (2-2 '9 :Z-7 �_O f O--Frm/Co. Name of Licensed Plumber _ (' h t�� ► _ .. !� N INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes p-- No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box- A liability Insurance policy Lj-- Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this.requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 y knowledge and that all plumbing work and installations performed under the permit is.;aed for this application will be in compliance with allm Pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. BY Title Ngnature of Licensed Number - ------City/Town Type of License: Master Cg-- Journeyman ❑ MPfi011ED(OffIC USE ONLY) License Number. N21579 Date.................................. NORTH TOWN OF NORTH ANDOVER 0 minim. I PERMIT FOR WIRING SS�CHU This certifies that ...../I........... has permission to perform .... ................................. wiring in the building of ........ ....... ................................ at..... ° ..... .- ?1` .. `....................North Andover,Mass. Fee41... ........ Lic.Nov??.�� ... ................. . ...4...4ne",. ........ ELEcrmcAL INSPECMR 04/05/99 13:57 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 7 ,R-Z", The Commonwealth of Massachusetts �� ^ -ILI + P.•r mit So. Department of Public Sejery V`r,pa ncy S Fee Checwed BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 il.. bl, k) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Macuchusetts Electrical Code. 521 CMR 12:00 (PLEASE PRINT In INK OR TYPE ALL IYOF ILMON) Date :3-'.7— City or Town of �, �/Z c�a✓` To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 371 411 Owner or Tenant A Owner's Address Is this permit ir. conjanc 'on with a building reit: Yes No (❑ (Check Appropriate Box) Purpose of BuildingUtility Authorization NO. Existing Service Amps / volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I-Al 19--4 No. of Lighting Outlets No. of Not Tubs No. of Transformers Total KVA ,lo. of Lighting Fixtures Swimming Pool Above❑ In- ❑ grnd. grnd. Generators VIA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Iotal No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heat ts Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices f No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters kW No, of No. o Low Voltage Si of Ballasts Wiring No. Hydro Massage Tubs No. of Yators Iocal HP OTHER: INSURANCE /BCOND Pursuant to the requirements of Massachusetts General Laws I have a clity Insurance Policy including Completed Operations Coverage or iy�substantial equivalentO[] I have submitted valid proof of same to this office. ;ESE NO ❑ If you havS, please indicate the type of coverage by checking the appropriate box. INSURANCE OTHER❑ (Please Specify) Expiration ate Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under t pe altie of_perjury: FIRM NAME o� p�,�, j<Y(� _ LIC. NO.2137 Y4 Licensee ignat -e LIC. NO. Address us. Tel. No. Alt. Tel. No. / OWNER'S INSURANCE WAIVER: I am aware that the Licensee does n t have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S )TO y Signature of Owner or Agent