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Home My WebLink AboutMiscellaneous - 53 SUTTON PLACE 4/30/2018 53 SUTTON PLACE 210/060.0 0108-0000.0 BUILDING FILE i Location �`� ��'- � ! �"C-A--._ No. Date . - TOWN OF NORTH ANDOVER • ` Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ '- TOTAL $ l r- Check# F7 .-- 624 /Auilding Inspector NORTF� 1 O��t LED 6'q ADR'�TED SSACHus�� Town of North Andover BUILDING DEPARTMENT CONTRACTOR AFTER HOURS REQUEST FORM N CONTRACTORS NAME: �-�' — I ADDRESS: '3 i 5 G+`\,- I�? CITY/TOWN: TeAV,-U N\— STATE: ZIP: G3c,76 BUS. PHONE: ? 6917 CELL: MA. LIC #: MASTERS: 8 3 JOURNEYMANS: , `b u PERMIT# —I N-GRID SR# ` REQUESTED DATE: �` b3lJ 7 TIME: f/C I JOB LOCATION: OWNER: Oat\ PHONE: 7 $) ^ 769 WORKERS CELL: REASON FOR REQUESTED INSPECTION AND JOB DETAILS: )10 K� .e-c, VC4 GGA CCAV1 CONTRACTOR SIGNATURE: NORTII ANDOVER SUPERVISOR SIGNATURE: Contractors requesting INSPECTIONAL SERVICES due to weekend or after hour operations such as service related planned updates or special situations, will be required to provide a four hour minimum charge of$150.00 paid to the Town of North Andover at that time. Community Development Division,1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9545 Fax 918.688.9542 Web www.townofnorthandover.com r t NORTI{, 3r etr``�-•" 4,oma TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING �SS,�CMUS� s�Vim -. Thiscertifies that ................................. ............... .. .................................... has permission to perform ..... 5..... !!Cs'L .............................. wiring in the building of Q.. ..I � =?U ............CTT .. ..... ...................................... ...... 3 Sv d�-r A?Wl�.7at ..,' ............. .�............ ..................... .,North Andover,Mass. Fee..4 .......... Lic.No.64,Jv4.............. .. ....... ... ... ....... LECTRICAL INSPECTOR' Check # 77 68 Date. . .... .. .. N°RTM 14, of TOWN OF NORTH ANDOVER 0-4 PERMIT FOR GAS INSTALLATION •�•Sy SACH �. This certifies that . . .5.T Pr.fl has permission for gas installation . Ze.(�.cNe/.�. .( v. :'. . . . . . . . ... in the buildings of . . .N.l A.P4. . . . . . . . . . . .. ... . at . . , . 5��..� �� t . tic . . . . . ., North Andover, Mass. Fie 3 0-�- ?. . Lic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 1 -7 1 g' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING p CITYITOWN . _ . �!�rw ? _, STATE:MA APPLICATION DATE. JOB ADDRESS:',_ 3. �np('�. Cow OCCUPANCY TYPE: COMMERCIAL a RESIDE TIAL PLANS SUBMITTED: YES❑ NO NEW[] ALTERATION[] REPLACEMENT REMOVALIDEMOLITION❑ l NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT-APPLIANCES-SYSTEMS Z ENTER TOTAL AMOUNT FOR EACH SELECTION LIMITED TO FIVE(5)NUMERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER:ALL TYPES GAS PIPING THERMAL OXIDIZER BOOSTER GENERATOR STATIONARY ENGINE TURBINE BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES CO-GENERATION UNIT 11 INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12,500MBH COFFEE ROASTERINFRA RED HEATER POTHER NOT LISTEDZ COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE 1 CRUCIBLE COOK APPLIANCE COMMERCIAL LABORATORY COCKS DECORATIVE APPLIANCE MAKEUP AIR UNIT I DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT DRYER: ALL TYPES OVEN: ALL TYPES FIREPLACE:VENTED 1 UNVENTED POOL HEATER FRYOLATOR' ROOF TOP UNIT FUEL CELL ROOM HEATER-VENTEDNENTLESS PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY Stark bm Inc R ❑✓ Corporation Business# 24asc� NAME &Cronk Plum9,., K ADDRESS 308 Main Street - - ❑Partnership Business# -�-- � CITY Groveland STATE i MA ZIP 01834 Business# TEL: 978-372 6981 ._. FAX . EMAIL:374 0837 reg@starkcronk.com ...... LL C — I. . _ __ _ .,.. 9. g@ , ❑DBA I Unincorporated /� NAME OF LICENSED PLUMBER I GAS FITTER: / V�I('b INSURANCE COVERAGE I I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 AGENT Signature of Owner or Owner's Agent OWNER❑ OWNER'S NAME: TEL FAX i I hereby certify that all of the details and information I have submitted(or entered)regarding this permit applic Ion is t ue and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issu , ill be' compliance with all pertinentrovisions of the Massachusetts efts Uniform State Plumbing Code,and Chapter 142 of the Gen I a (OF E USE ONLY) Type of License: Permit# l ❑Plumber ❑Gasfitter o l l ❑✓ Master Journeyman gnature of Licensed Plumber 1 Gas Fitter Inspector �' ❑ :• ..._... ___.. __.......v_ Undiluted LP Installer License Number: Fee: ` 11027 [:]Undiluted ❑Limited LP Installer ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES C,ommonwea& of/YlaiaacLelta Official Use Onlv ' la Z��1 2cc�� 'c 77 nn Permit No. eparfinent of }ire >ervicei Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK h All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 N (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ' �� ell City or Town of: �b �o VO4' 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 Owner or Tenant 910-v� Q� ��, � Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Buildinga&o�/r e//L&4 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity p Location and Nature of Proposed Electrical Work: F 019ey ,4/� &/4, le-G Completion of the following table mal,be waived by the Iris pector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA II, No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveElln- ❑ o. o Emergency Lighting No.of Luminaires Swimming Pool rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners / No. In Detection and Initiating Devices No, of Ranges No. of Air Cond. Total No. of Alerting Devices Tons No.of Waste Disposers ::::]Heat Pump Number Tons KW o.of Self-Contained Totals: J .............. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent t 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 Wires. Estimated Value of Electrical Work: --O // (When required by municipal policy.) Work to Start: 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 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2"BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: a LIC. NO.: �" Licensee: Signature LIC. NO.:/?Fa2194 (If applicable, enter "ex mpt/"a}the license number line.) Bus. Tel. No.: 978 370?9121 Address: oZ 3 u/c.Gj ��Y� , (r-pn1Wd.- ` Al) 0/19Sy 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. I am the(check one) [) owner ❑ owner's agent. Owner/Agent cam. Signature Telephone No. PEPWIT FEE. 5 ;I,d s �y 4 r r% c M '!lie Coutnioniveultlt u/tllats'sctc/xct �ftts Departtatent oJIndustrialAceitlent Offlc:e of Investi atirttas 600 Waslzrn,qtotz Street Boston, AIA 02111 rpwtp,mays.gov/dia Workers' C®cttpertsatioll 111suratice Affidavit: Builders/Coati-actor-s/Electricialls/pitrrllbers � Applicant Lnforttta.titart Please Print Legiblv. � Nan).; (Buslr7c-,s/ort;anizatiori/ittdivictUaIii:_ Address: City/Skate//_ip63o_\ E_/414 4th Q!�.��_.__._.. Phone k- �J�✓i- X70'1 %�a l Are you an employer'?Check the appropriate box: -._ .. ._.a am T - general contractor and 1 Type of project(required): 1.❑ l am employer with 4. Q g ( employees(6111 anchor part.-time).* have faired the sub-contractors b. �� New col7struetiorl r 1 117 a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. 0 Derrlotition j working for rete in any capacity. employees and have workers' [No workers' coup. insn,ranc,e comp. insurance.+' � [:1 BuilEiing additiort. required.1 5. EJ We are a corporation and its 10.LA, repairs or addttions ;3.G 1 am a homeowner doing all work. officers have exercised their 11.0 Plumbing repairs or additionsmyself. [No workers' comp. right of exernptior7 per MGL t c. 152, §1(4),and we have no t 2 ❑ Roof repairs insurance required.] f cu7ployees.(No workers' 13.❑ Other 1 comp. IFI$tlFancB required,) "Any applicant that checks box t#1 must also fill out the section below showing their workers'compensation policy information. � T r homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employeesIf 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 sand job.cite irafarrnatian. Insurance Company Nacre. Policy#or Self-ins- Lic,# l tptrauon Taate, __ _ Job Site Addre6s. Attach a copy of the workers' compensation policy declaration page(showing the policy number-and expiration date). 1~ailure to secure coverage as required lander Section 25A of MGL c. 152 call lead to the imposition of criminal penalties of it tine up to.`!;1,500.00 and/or one-yeas imprisonment, as well as civil penalties in the form of a STOP WORK ORDER.RUQ 1.and a flue 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 f'or insurance Coverage verification I do hereby certify tender the pains and penalties of perjury that flie information provided above is true and correct. Date: Phone 1 jj chit se`only. 150 nal write intiffiii a la,to be completed by t_y or lawn offariaL : . city ia4ri;fin: #f lssuing:Authority (circir one): 1.Board of Health 2. Building De'partrnent 3. City/Town Clerk 4.Electrical Inspector- 5. Plumbing Inspector 6.Other t Contact t'c:rsort: Phone#; �'t Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . .,,,,/,. �, .�,..�� ...�� •. has permission to perform . C �� - • •�• •U �� • • • • • . . . . . . . /f� wiring in the building of . . . �y�- !./1.- A. . . . . . • • • . . . . . . . . . at . .�v. . .P / rth Andover, Ma F;eGi`r�. . . v ELE"TR* Check# 11050 Commonwealth ®f Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank 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 PRINTWINK OR TYPE ALL INFORMATION) Date: R- 0- 1 City or Town of: NORTH ANDOVER To the Inspector of Wires: i By this application the undersigned gives notice of his or her intention to perform the electrical work described below. G® /0 f Location(Street&Number) �r p�� `Owner or Tenant Telephone No. `3 ` Owner's Address a Aug - Is this permit in conjun tion with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of BuildingUtility Authorization No. /f A . - Existing Service POO Amps /Z Volts Overhead EV 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 the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Sus .(Paddle) Transans r Total / p sformers KVA No.of Luminaire Outlets / No.of Hot Tubs Generators KVA No.of Luminaires / Swimming Pool Above ❑ In- El Batter o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons I.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers / Heating Appliances KW Security Systems:* Y 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 E uivalent OTHER — if 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: F 1_ �30— 12 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 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covera e is in force,and has exhibited proof of same tothe p rmit issuing office. i p CY� r CHECK ONE: INSURANCE W'_BOND El OTHER F1 (Spec(Specify:) v�� I certify,under thepains andpenalties ofpe 'ury,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: /e Licensee: Signature LIC.NO.: (If applicable,e r "exempt"in the l ense nt mber lin Bus.Tel.No.: — ' 413 Address: 10 , Alt.Tel.No.• G *Per M.G.L c. 147,s.57- 1,security wor re fres 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. I am the(check one)❑owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. J 1 • Y.1UJuCl.iu.'UALJ(�t�fOJ'7(.'��.`Re.►`(J�JQ'.{A•Q'.MoyQ•fw• P^�QQ{;�,Q�j• a/�o .'-+.11.7PEUJt.�.��J.`6.au�®�Ro . 0117PC� O1< P�sse�•-�j �i'a�e�•�� exnspeetZonx'egivxet�(��O.OU)�( � �ns,�ect. s'ca efts: (Xttspeeax zgnataxe- kntiaTs plate 3�'asse�--[ •�+`a�Se[�--Z �' � �e-�ns�ectzon.xe�uixe�(��0.00)w[ �` . • a'+ �rt�ieotaxs'commtextfs: �jJ (JCns�i ectoxs'b`zguatuze�bio txtxtzaTs) o� �•1 � .• � � date - Z>%/L- ' assed--� � �+`azle�--j � ate-�sPeetio�.�•ec�uixet�(��4.00)�[ ] , twectoxs'coJnm.ents: �lnspectoxs��zgnatuxe��.ois�.i�axs) ]ate • �, ' �'Xq CAI LOUD WATITOWM�C-90"DI . IwAr al : rse --[ ) afle�--je-xnspecon xequiYe ( �O.�D} j ' oeetoxs9 eoynkxr.e�tfs: . ( sectoxs's�zgnatuze��ojnials) Data ;��-� � ;0'ailer��-•� }. '?�e�nspect�onxequ�xed(��0.00)�[ � :Rtoxs'cO�T1Xl��l1tS: _ . . • S ' •asp ectoxa� zgnatuxe xto xnitia�s} Plate ' r�`a►m A A7�Tr �F*ft R !�7i x'73 tlli7 T' r l'� i Fi T`�Y�7,�xrir+ fit"�`€ +.AP ;dam`. 0 Z"1+ ORCQED YN NOW i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 S� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): , Address: , City/State/Zip: 0 R3 Phone#: 97 �`-E(51 46 13 Are you an employer?Check the appropriate box: Type of project(required): 1.R l am a employer with �. 4. ❑ I am a general contractor and I 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.FJI a:!i a sole proprietor or partner- listed on the attached sheet.t 7 Remodeling ship and have no employees These sub-contractors have 8. E]Demolition w.,ving for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]T employees. [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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. 'am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. nsurance Company Name: Za"aj, 'olicy#or Self-ins.Lic.#: Expiration Date: p JZ ob Site Address: ,� �t� City/State/Zip: i �X IL kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 'i nature: Date: hone#: — 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#: e, Informati®n 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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 600 Washington Street Boston,MA 02111 Tel.#617-7274900 ext 406 or 1-877-MASSAFE Fax#617-7277749 Revised 5-26-05 www.mass,govldia Date.Q/q * /`-12 - 9558 TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SSACMUS� a1016r } This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !�Ja7"h r r has permission to perform . 1 n. . . . . .! . . j. , . . . . . . . . . . . . plumbing in ffK buil ui ings of at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Andover, Mass. Fee . . . . . . . . . . . . . PLU BING INSPECTOR t Check K �J d3a r i. I 11 EE• • 1 1- `ti t TRI, TYP.EOR OCCUPANCY TYPE COMMERCIALO EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEM.[-, •,y a •/Z•I 3 31 DRINKING FOUNTAIN • • t • _- �• WATER PIPING OTHER 1 k COVERAGE: ' I have a cunentkbW dykisurancepolqorftssub_:•r.i rW eqL&dmt Vdft _eti&e -r r > tof UM k' NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE Erf CHECMG THE APMMTE BOX MLOW POLICYM OWNEIrS INSURANCE WAfVEk I am avmre MA the kensee does imt have the hmmce coverage requhm!by Chapter 142 of the Massachusetts _ 1 1my signaftneon this pemft R r It•ja f` aim this ./ i e( e CHECK ONE • OWNER M AGENT OSIGNATURE F a• ORAGENT' a :.� •:. i t r. �� t r r.i;:. 1 '�. ..ft - Ir: rly:.a or t:- �yregandbw oft.ppril r .i 1 :. � .;.tl .ti• tD i e..� .:. :-. - and - ll 'r tal 1 J e and .I I'!`. 1 R 4' underthe 1'J 1t ism a4 ! I I+ pp:h:'4d' i 1" t ►� ! -,..f. .'�•: :� !miki ! l Manachuseft rt: '1 bmg Code and Chapter 142 of the / MPM JP po - if a F-7,,Ci It I j ri M{: / . -.+:111 i ` e 1• f 41� .1 C Cam a,f 60 -41-1gallftea <: MA OM - orl '�Ca®npB am Any moban e _-_ -_ - Ad&m&- 1 Kinson Court - ems _ L lama w 46 0lana "dl 2.0 Iamasob ruftdontibeadachadsbuL7 E]Remodeft s�p�d �e�p�gees - !Jl ODemuffiaffwaaft fumero.owand�►ew+a = 9 o[No wags'cam. e � t requhe -I 5 0 Woaeogxis�amd� i��l sor3.01mma sHmak acesed 1L�I g�epc.M '1 aardwe =Do � -T - � 1 _ i�Hg $fBw= ii� �aaastSTs8�6ot�eeLCio�r �rtt tf�bo��ts-- a Issamome a I a - neaG��e ae�l�alC hflYG -- - � pprooppodow- camow _ - - - - - - 04101113__ Faei�se�neeaasmeda �SAcIQcaa _ utapa�a fiasup��l, lO. a�Va� t aav�Est'.iv exit fiu�mii �'WMKOK l ciafiee - oft��$�HUadagaffiev Bead�ad�a�r�� _ ste��u8� i�f Dole i�e� a��iBA�rcee - Id®beroebyao�ra efffir��s 7 haa'a� 7/,�" Pte#: -- C erTsum 1Bmd4i€H,ed& 2. &GWftmCftk 4LA SJ Y r CLO&W --- CP # c J Date.................................. f MORTIS 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,3'SACHUSE'� This certifies thatJ ...../ ....................... ............................................................ has permission to perform wiring in the building of....... 4--hof p?7---) / 5 at.......5... 5k�Dn.... ......11:mac=............. North Andover,Mass. Fee..40 4-^..... Lic.No.�1111............... ... .......... ............. ...f/,wl`? ... QCTRICALINSPECTOR /y Check # 9397 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. j BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave bank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 YY (PLEASE PRINTININK OR TYPE ALL INFORM14TION} Date: S12 - 10 City or Town of: NORTH ANDOVER To the By this application the undersigned gives notice of X10her intention to perform the ele electrical wIpector ork dies nbed below. Location(Street&Number) /{ Owner or Tenant Owner's Address • Telephone No.9�0-?18 Is this permit in conjunction with a building permit? yes NO ❑ (Check Appropriate Box) Purpose of Building Z Utility Authorization No. Existing Service ZOO Amps 1 ' 0 / 2-q0 Volts V Overhead ❑ Undgrd No.of Meters New Service. Amps / olts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work. Completion o the ollowin table may be waived b the Inspector o Wires. i No.of Recessed Luminaires No.of Ceil.-Sus No.of Total /,,Z p.(Paddle)Fans Transformers �A No.of Luminaire Outlets 8 No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ❑ In- d• B d. atte Units Bo. o mergency ig g ❑ —, No.of Receptacle Outlets JI No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No..of Detection and N g o.of Air Cond. No.of Ranges ota! initiatingDevices i Tons No.of Alerting Devices No,of Waste Disposers eat Pump Number ons KW o.of elf-Contained Totals: _" _.._ Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW SecuritySystems-* No.of Water No.of Devices or E uivalent Heaters KW No•of o.of Si s Ballasts. Data Wiring: ' No.Hydromassage Bath No.of Devices or E uivalent g tubs No.of Motors elecomm Total HP unications Wirin : OTHER: No.of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Stark (When required by municipal policy.) �Q 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 the licensee provides proof of liability insurance including "completed operation"coverage or its substantial e may ale issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to ermit issuing office. nt The CHECK ONE: INSURANCE 2 BOND ❑ OTHER I certify,under the pains andpenaldes ofpe jury, that the information on this application is true and complete. FIRM NAME: a � Licensee: LIC.NO.: f`/� 1 a 1 LIC.NO.: Address: Signatureyyj ��' ly (f pp icable, r "exempt"in th icense number 1' e.) a 3 Bus.Tel.No.-.9i s-FlFr%-G6(3 *Per M.G. c. 147,s.57- 1 securityw Alt.Tel.No.: ' - d -0 rk - quires Departrnent of Public Safety"S"License: Lic.No, OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability required by law. B m signature y q ty insurance coverage normally By y gnature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ { �� f��d� r "` r w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Ut 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: �} / 6 City/State/Zi P' MA (?/7?3 Phone#: 27L U-716 13 Are you an employer?Check the appropriate boa: ,�/ Type of project(required): 1•l.� I am a employer with j 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet T 2• remodeling ship and have no employees These sub=contractors have 8. ❑Demolition R working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' E]Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees_ [No workers' comp.insurance13.[1 Other required.] "Any applicant that checks box#1 must 4150 fill out the section below,showing their workers'compensation policy info Wation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outsidecontractors must submit a new affidavit indicating such. $Contractors that check.this box must attached an additional sheet showingthe of name 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:-AM &Xllt!A Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: o 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 co Investigations of the DIA for insurance coverage verification. Py of statement maybe forwarded to the Office of I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: _ Z Date.: Phone#: d'�'%EG [Contact l use only. Do not write in this area, to be completed by city or town official Town: Permit/License# Authority(circle one): rd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector r Person: Phone#: 1 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 P 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 s. 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 certificates)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 tocontact 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 c (i.e.a dog license or permit to bum 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 600 Washington Street Boston,MA. 02111 Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 vmw.mass._gov/dia Date. r f NORTH 1 p 3: < '°„•.,"oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSA�MUS� This certifies that . . . ?�. . �%�'. \ has permission to perform . . . .14{�.... . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . .- 3 at . . ? .3 . .S �.f.{c - / , North Andover, Mass. Fee.,>.0.?. .. .Lic. No.. . . .�. .�. . . . . . . . . ✓ . . . PLUMBING INSP CTOR Check # ,`'r ' C 8668 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING C-N A City/Town:, MA. D —Yermit# 3 Date Building Location: 4-Q Owners Name: ,.,, Institutional Type of Occupancy: Commercial I EducationalIndustrial Residential New: . Alteration: Renovation:,,/ Replacement: Plans Submitted: Yes No _j FIXTURES 2E z rn 0 Lu z Lu Na U) q W 0 z -j 4 z z z Z 1.- 4(4 3: .W W W 0 W - P W 0 0 9 OMMIX ILLUU) n (1) LU a I-- Z z 0 d -LA. XLL 93 U) W 9 Lu to Lu -j U. 1.- 0 0 0 1-- X LL CL -J 4 X W W W Lu Lu 0 1.- 0 0 z W X X IL 0 U) 9 -J < O != 0 z '0 SUB BSMT. BASEMENT . 15T FLOOR 2 N LFLOOR 3Ru FLOOR 4VH FLOOR 5'"FLOOR' FLOOR 7 THFLOOR 8'"FLOOR Check One Only Certificate# Installing Company Name:'i Stark&Cronk Plumbing, Inc ------ Corporation Address: 308 Main Street _jCityffowni Groveland State: Partnership '-'-- ----'"--- 978-372-6981 Business Tel: 34- 3xFirm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 ✓Yei,,V]No�� If you have chocked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 I Agent Signature of Owner or Owner's Agent i-) n is I hereby certify that all of the details and Information I have submitted(or entered)regardi application are true and accurate to the best of my "as Knowledge and that all plumbing work and Installations performed under the permit Issued r this application will be In compliance with all 'a :- ws Pertinent provision of the Massachusetts State Plumbing Code and Chap of the Gen ter� By— Type of License: Title �-Slglhature of Licens-ed-Mmber -1 KJ Plumber Master City/Town JLicense Number: ' 11027 Journeyman APPROVED(OFFICE USE ONLY) FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) ~ FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED DATE: PLUMBING INSPECTIOR �' z Date. . .S� • ��/. .... . Of "ORT1y 32 '` TOWN OF NORTH ANDOVER O D PERMIT FOR GAS INSTALLATI N O� �9SSACHUSE� _ This certifies that . . S�/,eA./-,. . . :. l>. . ! . . . . . . . . . . . . . . . has permission for,gas installation . !? .Y.r!'. . . . in the buildings of . T'�.< r.ty.q. . . . . . . . . . . . . . . . . . . . . . at . 3. . .Y.C. . .L. . . . . . . . . . . . . .. Orth Andover, Mass. Fee._3.?. Lic. No.. 1(.Z 7 . . hAS INSPECTOR r Check# 7241 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING SA b City/TownG Date: / .,o Permit#i �z Buildingu. 6/1 jO/rf! -. .a Owners Name: �(�1,_ //, /?GC7!�%lG? Type of Occupancy: Commercial w I Educational, Industrial ..b..5 Institutionali I Residential; G'i New _. t Alteration:- i Renovation:2 Replacement. (Plans Submitted: Yes No m' FIXTURES vi LU Z W Y _ m 2 . O0 O W V Q. ~ N 0 W 0 z Z O �I FW- W 0 Q W W W W m O Q d F- W W W X > Z y W U) O Q = LL W Q W W W Z (/� . = W ~ W Z W OW > V W Z O J H H O J O W H = W 1--,,-W W z >- a N =� Q Q m w O z 0 > zQ 2 c°� c c R s = g o no �a ow � > > > 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 . FLOOR 4 FLOOR STR FLOOR WH FLOOR 7 TRIFLOOR 8 FLOOR Check One Only Certificate# Installing Company Name Stark&Cronk Plumbing, Inc " Corporation i2486C Address 308 Main Street °City/Town: - - - j Groveland (State: MA I � Partnership Business Tel: 978 372 6981 Fax '978-374-0837 -' _ !Firm/Company,.,,w„ Name of Licensed Plumber/Gas Fitter. INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes, JN0,,, _j If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy;V/—�, 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 i Agent Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have sub i d(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and install ns perfo a under the permit issued for this application will be in' compliance with all Pertinent provision of the Massachusetts State Plumb g Cod and Ch the General Laws. Type of License: By Plumber lzzl� Gas Fitter -- Title „ .w _ Master t!.` "Si ure of Licensed Plumber/Gas Fitter .n _ w,_.... Cit /Townw., _ Journeyman ;„ $ City/Tow F f License Number: 11027 i APPROVED OFFICE USE ONL µ LP Installer i., » FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER_GASFITTER,LP INSTALLER LICENSE NUMBER: PERMIT GRANTED r-j DATE: GAS FITTING INSPECTIOR 9 0 U 6 Date. RT:'4, TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING ,SSACHUSE� y This certifies that . . . . . . . . y.^.�'�. . . ��A` -: . . . . . . . . (]� has permission to perform plumbing in the buildings of . . 4. .�. . . .F� �.r �� . . . . . . at. . ...-!�. 3 . . ��v C'Cc L' -- North Andover,,Mass. Fee Sc . .Lic. No.. .1.(w? . . . . . .�? PLUMBING INSPECTOR Check # i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING CITYITOWN . .._. . . ... _ _ _.___._. .. _ APPLICATION DATE .- _-_ .:,.� . ..,.... .. ._,. . s y JOB ADDRESS1 �ILzYL /G _ PLANS SUBMITTED: YES❑ NOF] POCCUPANCY TYPE: COMMERCIAL❑ RESIDENTIAL )0/0,l _D1'b,, ,d 1, NEW❑ ALTERATION❑ REPLACEMENT REMOVAUDEMOLITION❑ t PLUMBING: PIPING-FIXTURES-�FIXED APPLIANCES-APPURTENANCES -1 ENTER TOTAL AMOUNT FOR EACH SELECTION LIMITED TO FIVE 5 NUMERALS ALTERNATIVE TECHNOLOGY DISPOSER SINK: MOPLJ SERVICE ASPIRATOR DRINKING FOUNTAIN STERILIZER DRAIN: AREA El FLOOR EJECTOR ❑ STORAGE TANK BACKWATER VALVE EMBALMING AUTOPSY URINAL BAPTISM:FONT SACRARIUM FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK GLASS WASHER WATER CLOSET BATHTUB WHIRLPOOL ICE MAKER WATER HEATER:ALL TYPES BIDET INTERCEPTOR:ALL INTERIOR WATER PIPING: CROSS CONNECTION DEVICE I KITCHEN SINK r OTHER NOT LISTED 1 DEDICATED: ACID WASTE SYSTEM LAUNDRY CONNECTION DEDICATED: GASIOIUSAND SYSTEM LAVATORY_ DEDICATED: GREASE SYSTEM PIPE RELINING WORK ONLY DEDICATED:RECLAIMED WATER ROOF DRAIN . . ...... .. DENTAL FIXTURE I EQUIPMENT SINK: 1.2.3 BAY PREP. DISHWASHER SINK:CLINIC FLUSH RIM PLUMBING INSTALLER—FIRM-COMPANY INFORMATION CHECK ONE ONLY j Stark&Cronk Plumbing Inc 308 Main Street.,----. Corporation Business# __...._.__....� NAME: ADDRESS. ,Groveland ❑Partnership Business# CITY: (STATE. MA ZIP.;01834 . - i 978 372-6981 ;374 0837 re starkcronk.com __ LLC Business# TEL: - FAX . EMAIL..9 9@ � .. NAME OF LICENSED PLUMBER: DBA I Unincorporated INSURANCE COVERAGE I have a current liabili insurance policy or,its substantial equivalent,which meets the requirements of MGL.Ch.142 YES M NO If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 Signature of Owner or Owner's Agent OWNER[] AGENT OWNER'S NAME.3.... ... ..... ... . _.. TEL.,.. . .. w..., FAX �� m. I hereby certify that all of the details and information I have submitted(or entered)regarding this permit ation is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit�ru�l l be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 o e (OFFICE USE ONLY) TYPE OF LICENSE: Permit# E]Plumber Signature-;T11mdsed Plumber Inspector ❑✓ Master 11027 License Number. Fee: ❑Journeyman i I i ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES i 1 Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ 1 I FEE: $ PERMIT# i PLAN REVIEW NOTES I l 1 Three ry ,Suite ,pt01JMAARCHITECTS + PLANNERS Newburort, MA01950 [office] 978.465.2263 {facsimile] 978.465.0270 inquiry@jmaarchitects-nbpt.com June 11, 2010 I Mr. Brian Leathe Building Inspector Town of North Andover 1600 Osgood Street North Andover, MA 01845 Reference: 53 Sutton Place Dear Mr. Leathe, As per my framing inspection yesterday at 53 Sutton Place, I have observed that the dbl 1 W x 9 '/z" Versa LVL floor beam was properly installed by contractor, David Clarke, was done above & beyond the structural engineer's instructions. Should you have any questions, please feel free to call. Sincerely, Poll R�ti M 01 Jeanne Allen, AIA No.85.91 NEWSUUR PORT OF 14