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Miscellaneous - 538 WINTER STREET 4/30/2018
CT W co Z m m m m m 'A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY MA DATE L %_ PERMIT #- 10+00 JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS S / /YL,40 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL EI] PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: Of PLANS SUBMITTED: YES NO© FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR (INTERIOR)f _--_J ..__.._._l I ___.J ____j KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL _l .__._1 _..._ _1 _ f __--_ ._._—I ..._ ..._J _-._I __ 1 __ I SERVICE / MOP SINK TOILET URINAL _._.._ E _._ i __._. ► _._..._;-_--___-) (! I _! .___.! -. _) _._..._._! ! WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING ( ! ( OTHER _ _ I 1 _E INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC i OTHER TYPE OF INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER: I am aware at 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are tr and accurate t e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pli nce with all P rti ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � A — - A PLUMBER'S NAME 11%P i�SC L► Kl ,�l�.0 I LICENSE # iJ I I ATU MS JPCORPORATION'#PARTNERSHIPP# LLC COMPANY thl NAME_G �YYZCni ADDRESS AL - CITY STATE ZIP L TEL FAXCELL EMAIL 3J N ❑ H W CL The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):� j{� ��SG ryyac Address:s 1—Jy1/S— City/State/Zip: �Z" ,LL�1�L f° 1� Phone #: ; �7 Jd d(- % %d Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors F1 Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5.e are a corporation and its 10.❑Electrical repairs or additions required.] 3. F1 am a homeowner doing all work officers have exercised their right of exemption per MGL 11. F1 Plumbing repairs or additions myself o workers' comp. insurance required.] t employees. [No workers' oof repahs 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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name; Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby 4ert1A under the of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local.licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply 1 to your situation and, if t necessary, supply sub -contractors) 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 ewers or puffiers, are not requYe-d tcarworkers'y 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. a 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Investigations 604 Washington Street Boston, MA 42111 Tel. # 617-727-4904 ext 446 or 1-877,7MASSAFB Revised 5-26-05 Faze # 617-727-7749 www mass,govfdia Date . 7 /P/7..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0.N- z--46r7'� A,12A Thiscertifies that......................................................................................................................... has permission to perform .... � t'` .) � wiring in the building of....... .-'............................................................................ LA) �,,,,,,,,, , N h Andover, Mass. at...................................................................................... Fee . .,..."....... Lic. —N 2— ......!.:... /(9 ......... ELECT ICALINVSPECTOR Y 2(x°1 Check # ' �- N all Commonwealth of Massachusetts Official UsOnly Department of Fire Services Permit No. a Occupancy and Fee Checked a s BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code WC), 527 CMR 12.00 (PLEASE PRINT WINK ORTYPEALLINFORM TION) Date: J'utj ion 201 - 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) S"38 W,1,u7-(5,Q S7'/2Ec Owner or Tenant Cy uT(4, A Telephone No. Owner's Address S-78 W/,VTt -< S7V 6(5 f Is this permit in conj unction with a building permit? Yes Pq No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: wi,rl,U 6 dlc 91T-T1,U6 i?OO J4 Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- Elo. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets £%j No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches Z No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons ""' .. "' "'"" KW "" "'..........Detection/Alerting No. of Self -Contained Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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: 1NSURA-NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. GEoa.G t J;I-�As /f rt a ►;i" D6A CTI &t 6c.TZ c. 4 LIC. NO.: 413 26 3 Licensee: 6Co2Gc S N9j;5,A eV t' Signature LTC. NO.: iSU33 2 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 -2 5S' -0 see Address: /3140 (, m6,3 woof A2tu6 SIAf Pow4) N ff 03873 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 . gent. Owner/Agent PERMIT FEE. $ Signature Telephone No. 4�. ❑ 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 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 conceming 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 ❑ r, ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comm Inspectors Signature: Date: FINAL INSPECT Pass Failed Re- Inspection Required ($.) ❑ Inspectors Commerits: Inspectors Signature: lel' Date: 9 2Z-� DEB WEINHOLD ... TOWN OF MERRIMAC, MA . .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccid&ts Office of Investigations UV. 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): �EO�Ga�� i'tl� SS/j✓iDJ Address: 13 /4v C,h cs c -,0v o Dw r v(� City/State/Zip: A A.) O o oi �U Mf 05� 7 3 Phone #: W3 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. [ I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. El Plumbing repairs or additions 1211 Roofrepairs 13. ❑ Other *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 ere 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. eo33_Z3�;---0 388 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, • express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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. t 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 Departmiat of Industrial .Accidents Office of Investigations 600 Wash ngtou Street Boston, MA, 02111 Tel # 617-727-4900 ext 406 or 1-877rMASSAk'B Revised 5-26-05 Fay, # 617-727.7749 wwwmass,govfdia i c i V ,v Date --/'-/±')/v ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that gedy ................................. ... ......................................................... ....... has permission to perform "YL. A- C' sevv-- J— .. ................. ...................................... I ...................... wiringin the building of,,,..,,. ......................... ................................... I .................................. Xvrth Andover, Mass. ........... ........................ : .......... Fee./,� ........... 1� ............................... ......... ...... Lic. No. ..... ......... ........ ELECTRICAL INSPECTOR Check., 12277 a, r Commonwealth of Massachusetts official Use Only Permit No. Z77 Department of Fire Services �2 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEA SE PRI NT IN INK OR TYPE -4LL )NFORMATION) Date: f}p2i t, i o0 Sol ¢ 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) -S38 u91 A,lTt= R STIZEE7- Owner or Tenant CYNTI11.4 Pi9A&,v l Telephone No. Owner's Address 5-38 w t N'tex S7 -,.E c5 7 - Is Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service /00 Amps 120 / Z40 Volts New Service Zoo Amps 120 /240 Volts Number of Feeders and Ampacity Overhead 0 Undgrd ❑ No. of Meters Overhead 51 Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: u FG,?A 0C- Y k v t ( FROA-r /0 04 Ay Z004 (PlKLU& &E F&SEAcAiT f?f-,a/macL Completion of the followinz table may be waived by the Inspector of Wires. No. of Recessed Luminaires Q No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of LuminairesSwimming Pool Above ❑ In- Elo. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets ! (o No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches / Q No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .................................................. Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security f Systems:* es 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 Te1ecommunicatNo. of Devicesoons or Equivalent PTHER: Attach additional detail if desired, or as required by the Inspector of Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRMNAME: �) LIC. NO.: 4 13 Z 3 .p-fck Licensee: 6eo►eGeT ASSaR4l Signature LIC. NO.: E 28932 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 403-23S`-0388 Address: 1314aLhe t oop Oez;v€ f,9,u0oLo.0 A.) If 0Zc373 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 PERMIT FEE: $ �3.2, Signature Telephone No. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint. enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a Iicense 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 -contractors) 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 maybe 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 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 Gom onweazthofMoSsaclhvsetts Department of lndustrial Accidents Office of Investigations 600 Washington Street Boston., MA 02111 Tel # 617-7274900 at 406 or 1-877rMASSAFB Revised 5-26-05 Fax ## 617-727-7749 www.raass,gov1dia I i Location 6-3 No. Date 7-,;2'Z-0,3 AOWTPI TOWN OF NORTH ANDOVER O�'`�•D :• 1•yC - _ L .. A Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ 3 CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / q / 6557 Building Inspector 10490 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .................................... Y .............................. has permission to perform :....... ....................................... plumbing in the b ildings of........ at �... F...` .� X77 S.. ............ Fee .d.... Lic. No./../�.�. �'.. Check # 14 ........................, orth Andover, Mass. ........... .. P`fEUa . ......... NS ...O..R .................... M G I �R TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / DATE ISSUED: �/ 0 SIGNATURE: Building Commissioner/Inspector ot'Buildings Date SECTION i- SITE INFORMATION LI Property Ad ess: G-;8 1.2 Assessors Map and Parcel Number: i o 4 A Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided TegtUred Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �1 &w�-t&lTlbk 57 Name (P nt) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: W 1)' Hrel& Licensed Construction Supervisor: (�' <S 14!4: lA'� Address V V K �9W-9- !q Signature 0 Telephone Not Applicable ❑ [� License Number C) 3�� Expiration 15ate 3.2 Registered Home Improvement Contractor i-►egsr u --M u Not Applicable 0 Com-wnyName PO + C "A'Registration Number 2- d Expirati Date Address `^ �( 26:3 Si natu a Telephone ou M Z O O Z M 90 O r M r Z 0 SECTION 4 - WORKERS COMPENSATION (XG.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 buildig permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Descri tion of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify BriefDescriptionof Proposed Work: IK�t1+ ?, S iCsilSCS�U I� X 6-n TR 14 k IG ?, slx<s u 16cv'ot tis m-( I ( X 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant „ OFFfCIAL U,SE UNLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical ©d ' UO (b) Estimated Total Cost of Construction I (9 a D 3 Plumbing 1 O Building Permit fee (a) x (b) '�L 4 Mechanical HVAC 5 Fire Protection 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, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, t as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name D to Si ature om%Eer/A eiYtME NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HE- IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE tv nU(0 FORM U - LOT RELEASE FORM `` P,, A ` le— INSTRUCTIONS: This form is used to verity that all necessary Boards and Departments having jurisdiction have been obtained. Thsvals/permits r om does not relie the applicant and/or landowner from compliance with any applicable or requirements. Ve *****************************APPLICANT FILLS OUT THIS SECTION ******** ----------------- APPLICANT PHONEq `7 26 9 LOCATION: Assessor's Map Number a PARCEL SUBDIVISION j LOT (S) �• STREET 63 tT �tirnTQr �� ST. NUMBER *OFFICIAL USE ONLY **y►****** RECO FNDATIONS N GENTS: f ' CONSERVATION ADMINISTRAT DATE APPROVED 6 DATE REJECTED COMMENTS s� TOWN PLANNER COMMENTS— FOO 3 OMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR-�HEALTH DATE APPROVED /% - DATE REJECTED — SEPTIC INSPECTOR -HEALTH iU DATE APPROVED DATE REJECTED 1I.1 PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT Revised 9\97 jm El TE f�I I am a nomeowner pertorming all worK myselr. I am a sole proprietor and have no one working in any capacity The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: QAC- A -WE - -1 I am an employer providing workers' compensation for n -y employees working on this job. Company name - Address City Phone # Insurance. Co. Policv # Company name: Address City. Phone #: Insurance Co. Policv # 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' irriprisonment_as_weelLas_civil4maltiesjn-thefnrrnafaETOPWDRK ORDERand a.fine_of._ l—OD 00)ajiMagaiasime. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under tl)e painq agd #hes of perjury that the Ydamation provided above is true and correct. Print Date TKI& IT01- 2009 Phone.# 93B 9 -2-6 2 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept FICheck if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone # E] Health Department ❑ Other Massachusetts ffopae Imp ovement Sample Contract n& fwm u = aD basic tag k meats of ft sW* Hom hnptoremmt O LiLW (MGL.cbaptC 1422), bat does not iatdade standard bmgaage to protect bow'"Mers. Sath legal advice Hnewsery- Any petsoet planning ice noptaventents do dd lost obtain ace" of •A OonsamwGuidc m 6te Home hnpovemW COot bn:to LttW before agiaittg to any wat on- yow , idmoe. You may older a free copy by catimgthe Office ofConstanerASahsand BosbaeaResdatimKConsonserI albamadonHoi =atW-727-7780. Homeowner Ldotlwliien Conhaeiorbdormaties Nam T6cur � �iQ� STIL�tKif SmxtAddttss(donot aPoOOMaeBoxaddnas) Conou�d a loweNmte 538 1fi t (ju w. Sr *,* Cr same ZIP Code . - k bt• 94A (3124S SasiaeaA&beas P 0 JEa) 4Qt6,+ DaytimeVhooe Eweabtgt'boae Some zips MdfmgAddtaa(ItdiitadRftatoa6ove, l'imme FederalEn*Jq clDor&&Nundw asa.araa�e.a. t.e�aaaaussta... � "'7612c, tot gide ° 2c, I t� maws �womm m.speat7ymgure gpe.m®d,amgtaaeor mato beu3t�,aseoal alteiss ifnearsa�.} i'7 IQl ckTk "t nw hw PC -k t S ft 6F ti t-. s� 1'armitt - The bw'3ding pts ate reed skirt and Cbmplatioa srd:�sie-The fad srlrednte wr�l wiD be soavred by the caatracoor as Bre bameowadi agent. be adhered toookss de�noes beyondt9te oosaractor<a aeanol a tenets who secure their own peru is wM be dulled from the GuBrnM; lend prat sioat of K,e= amacm will Depn coorrace d work.- dwpter 142&) Zo2 t.lbmt& S when connected wort: vn'U be mbstmttially completed. The Contractor agrees to perfoim the work, limti,,h the material ate labor spadfied above for the tont sam ad: 6 S(fo J[o • c3D (•) Payments will be made according to the following schedule: �ft5 —&ftsi r $ f l r A"=ton sigtrmg (cot tb eased l/3 of the tool} price a the cost of special order items, vdddwm n grenta) $ QEI Y —I or upon c mpwm► of ckt a Sy / I �uponarmpkdonof i�'4"11''H (L,EA�RLllliL R'�lrf �,��jCdi"!= $ ,2%- upon coMplc&n of the wntracL (f ar forbids damndmg hU papmW tool mitis completed to both party's satisfaction) tirefoAonriogkgeipaaaotmoat6espdad s m6tpaodicr,�1 adored brfare rix ooah'aeeed work begma is oder s tm be paid for 7 a>r�ZMe�h�� NOTES: (•) Including all finance charges.( ") Law mquhas that airy depositor down -payment mqubed by the contractor before work begins may not exceed the greater of (a) mx-third of the total connect price or (b) 9ro actual cost of arty special equipment or custom made material which must be special ordered to advance to meet the completion scbedute. Floret Warsartty is an ezorvxa wamtoN beingyR„rov�� by fhc corttraetort Flo Ya (all terms of the mmaft Must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work dpwbed regardless of the actions of any third patty/subcontractor utilized by the contractor. The contractor fhrther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise notal within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract • tont be,pr wand into signing the contra rt Take time to read and Rely anderawd It Adv questions if something is tmclear. • Make sane the eln kagar bo a valid Home 6nnraovmteet Com R The law rexI i — mast borne improvement contractors and gftM&8a=tDbcrc&wWvn&*tDvc=oflimmlmpmvazmCawacwReoaWm Yoomayinquireaboutcontractiar registration by writing to the Dneatas st One Ashburton Placa, Room 1301, Boston, MA 02108 or by cdit 617-727 3200. ctrl 25205. • Dow the contractor have insurance? Cheek to see thntyour contactor is properly instead. • Know your rights and militias. Read me hquo nt Imtamadon onthe nevem side ofthis form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may angel this agmemM if it has been signed at aplaee atIM tan the M9MC t)r's names 01M of btu provided you notify the contractor is writing at hislha main- ad{'ice or btranrb orifice by y stall portal; by ftk nm sent or by deGvoy, trot Imre than midnight of the third business day following dw signing of thissgreeMML See the attached notice of cancel{ation form for an awhmation of this nPhL iG 2cb3 aad dpelf. On COPY dam Ptotha hmamwo". 'Ate anter be leapt iry are e.mnetoc. ' LeA102 Contractor's Signature JM* i d'- HRH Construction Scope of Work 538 Winter St. N. Andover, overview Construct a 14'X 16' room addition with attached covered 14'X 10' deck at the rear of 538 Winter St. per the attached plans. Demolish the existing three season room and exterior stairs and remove the existing sliding glass door between existing dining room and new addition and case out opening. The new room will be built off sono -tube footing type foundations. Exterior of new addition will be sided to match the. existing house as closely as possible. New addition roof will be three tab, 25 year shingles, color to match existing as closely as possible. &W new Marvin Integrity IDH3660 windows and one ISD6068 OX door with removable grills and screens will be installed per the attach plans hio `t?o `�a am New floor and ceiling of room will be insulated with R25 insulation c!w vapor barrier and new walls will be insulated with R19 c/w vapor barrier. Interior walls and ceiling will be Sheetrocked ( blue board ) and plastered. New floor will be Oak hardwoods sanded and varnished to match existing hardwoods in dining room as closely as possible. All new interior trim to be standard 2 %i" colonial door and window trim and 3 %z" baseboard either pre primed or stain grade per homeowners choice. Exterior deck will be 2" x 6" pressure treated decking with a standard 2" x 2" picket railing with new pressiue treated stairs. Ceiling over deck area will be 1" x 6" Tongue and Groove Pine. Electrical: Outlets in new room to code. 1 exterior outlet on deck. 1 fan box in new addition and 1 in ceiling over exterior deck. 2 flood lights of rear of new addition. I able and 1 phone jack in new addition. 1 cable jack in existing kitchen. eatin Extend existing baseboard heat zone from dining room into new addition. Paintin . No painting or staining of any kind is included Allowasm: The following allowances are included in the total contract price of $351 b2o and may be combined, added, and Of subtracted per the homeowners wishes to a total of $7284. c23 Electrical: $1500.00 Heating. $1750.00 Door / windows $4041.60 Total: $7,950.00 Miscellaneous: HRH Construction will provided an on site dumpster for the duration of the project. All waste, scraps, cut offs etc. will be placed in the dumpster for removal upon completion of the project. 1 The site will be kept clean and swept daily, however, the homeowner understands that due to the scope and nature of the work some mess and some dust contamination of non work areas is inevitable. No changes to this scope of work or contract will be made without a signed change order. The total contract price includes regular permit fees, however., there is no allowance for any engineering, architec wal, or similar services that may be required by the building department, nor does it ire any allowance for meetings with any board such as the historic commission, wet land, or board of health, etc. CON T$U 'TIO . DA TE• �2MG, i� � 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE 1_\ CONSUMER INFORMATION FORM - "SUNROOMS" lug Massachusetts State Building Code (780 CMR, Appendix J, Section J1.1.2.3.1) The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructinglinstalling a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J 1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year-round comfort considerations involved in selecting and utilizing a "sunroom" addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of "sunrooms", included below is a non -required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a "sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/ seal durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans • Applied Shading Systems • Insulation level in floors, walls, and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency, Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual property owner (not the owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, a undersigned hereby acknowledges that she/he has read the information in this d ument concerning sunto, in comfort and ever o ervation. Signatu of Actual Building Owner Dat (f N11_h)k 'kklA_ 538 c1S. zl . Print Address of Permitted Project Owner Address (if different than project location) Owner's telephone number 682 780 CMR - Sixth Edition 11/27/98 140.00 LOT 6 1.061 ACRES to w w _ o 2 STY WD # /538 4.70 ' 145.30 ' WINTER STRE'E'T MORTGAGE INSPI�CTION PLAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY LAWRENCE, MA 01843-3522 TLL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR: LOCATION.• JOHN & CYNTHIA PARENT 538 WINTER ST DEED REF. .4431/55 CITY, STATE: NORTH ANDOVER, MA PLAN REF..4431 DATE: 6/19/02 SCALE. 1"=60' JOB #:202105859 140.00 LOT 6 1.061 ACRES to w w _ o 2 STY WD # /538 4.70 ' 145.30 ' WINTER STRE'E'T a C1-�LAIV OVT CovE From Nous SFPr=c. T'Awl� �� 36 "-to ven+ I/ From Nouse. citjinno CHAANC�r-?, I/ 0�0 � Frdw< LCA( -k (d +0 u-000(5 GLAAI,514C)wS,Z6-. LEXN FX- Z -D PPV �z�rQ= r� i3oX �ocA7zo.''u '-- 538 t, ZIV-rC IZ Sr.; A). AtVooyr- & , OR . - OH) PARE1yI' pY : aUNU . 6 199 _.__.3ATc-5oy -EvvT(fRPRrSfS TriC r- X R3 P 0 i d C� x I Z X a 0 E OC7 0 w° >- '� cin p U I w° a�4 x U co p w O W o a4 G u. a W U W o' c� ch C w" O H o G H W w Z b cn E cn 6 z C2 `m c c Q O L eoy 0 �cc N � �a� mC�o o av Ail, rj C o4 O Z o® CM �o ID c� O vJ N 3 �-' cm Cc • � �: H C H C r-1 � : E o ev 2 COL co.) Co o � c X: ow** ' %. �� � 'COLoh m V y O o OC T N C C W o I- O N m r ~ o U -MD 19 I.- •tNA O.Z o6 Z �. cc'ui E v •N o 4 m CL oma= g f _ co)a y'�CO C � a 1� z 0 a z 0 U v/ 0 U) W W w cn ,'�' A� _ I Oo x 77 �3 N 4677 n Date .... .......... NORT#j TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACHUS� This certifies that ............. � ...................I............................................... has permission to perform ... �.. ¢ ... �........................... wiring in the building of ...:....� .................................................................. at ................ . North Ando er, Mass. Fee. ............ Lic. No... / y`..:� .....,t0 .,...1.. ..... / `ELECTRICAL INSPECT; Check # 4677 THE COMMONWEALTH OF MASSACHUSETI S' DEPARTMENT0FPUX1CS4FEIY BOAROOFFIREPREVEVHONREGUTA7IONS527CA17t l2 00 Office Use only Permit No. v Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 � M // �- (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires - The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant _ Owner's Address Is this permit in conjunction with a building permit: Purpose of Building Existing Service Yes [a No M New Service Amps / Volts Number of Feeders and Ampacity (Check Appropriate Box) Utility Authorization No. _ Overhead Underground Overhead Underground Location and Nature of Proposed Electrical Workk J grs N Wit) No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ci ground No. of Receptacle Outlets M / No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices ANo. of Dishwashers Space Area Heating KW A No. of Self Contained Detection/Sounding Devices Local Municipal Other _ lo. of Dryers Heating Devices KW Connections � No. of Water Heaters KW No. of No. of Si ns Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• IrM=Coverage Rmanttothi,-m mmitsofNb%whus�Gen�laws IhaNeaaur iLmbilityhm m=Pbhcymchlding(DonVlete Covrageorilsst ialegrm)art YES ID NO E IbudubmitbdvandpmofofmrtotheOffioe. YESLJ � FyoubawdrekDdYES,pb%eindcatedetypeofcc)wrigeby dwkd gthe box INE",VANCE ND MIER F-1 (PleasSpeafy) q=OnDateRe4tsled Roto co 'Zhd signodunderTr, Of 4m . 7N i1 • • I•' I ' • M E' I 1 • .: c iia 1 1 armmc.: . 1sab, 1 1. qL smqui . sem.• :16 and that my signah ue on thss peunit applicationwaives tins mqukiennt (Please check one) Owner M Agent Telephone No. PERMIT' FEE $ Signare o caner or gen TOWN OF NORTH ANDOVER PUBLIC HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr Public Health Director July 9, 2003 William D. Hope P.O. Box 5164 Andover, MA 01810 Re: Application for replacement of 3 -season room and new deck Dear Mr. Hope: Telephone (978) 688-9540 FAX (978) 688-9542 Your application for a building permit at 538 Winter Street, North Andover has been reviewed by the Health Department. The application was denied on July 9, 2003 for the following reasons: , 1.. X Missing information. A scaled plot plan no smaller than 1"= 40' must be submitted showing the dwelling, the existing septic tank, the proposed addition/construction along with a floor plan sketch of the entrance to the new room, and the exact placement of sono -tubes relative to the septic tank. 2. Passing Title 5 inspection of septic system required 3. Location of structure not acceptable To address the problem(s): If #1 is checked, please supply: &oor!exlano dition istin and ro osed ad—all rooms b. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b.Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: 1iuilding Department File w .- 'ti,�..e. ••r s,, mss.,, _� _ _ _ ,. .. s'�...v�' -- �i:i Location No. Date I oL � 4 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee ;$ 'Ss�cMUSE` Foundation Permit Fee $ Dither Permit Fee $ �L CU Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �YJwilding Inspector Tin 1 --' - 71314 Div. Public Works PEW IIT NO. - APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4.40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE (BOOK iPAGE Z,PFVE SUB DIV. LOT NO. LOCATION 5 3 8 Winter Street PURPOSE BP�tb&I`NG 19tSIP �l fii�l.�' 106 'S� s �,q ��[[ OWN.ER'S NAME Parent, John and Cynthia NO. OF STORIES SIZE W NER'S ADDRESS 538 Winter Street BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD 8075 NAME �.t L lI � "�-- ` SPAN _--- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "" POSTS DISTANCE FROM LOT LINES - SIDES REAR "" "" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ✓D rE� ,0ctobe�21 1994 / qK I RE OF OWNER OR AUTHOifIZED AGENT FEE A " —r PERMIT GRANTE lUCp 19 cl$ 3 PROPERTY INFORMATION LAND COST -EBT. BLDG. COST $ 1000 (cost of EST. BLDG. COST PER SQ. FT. S t o v e EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN OCT 2 1 1994 WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer 'NV1d 101d S3OV1d3a S1H1 'a3SOdWl2l3df1S '013 'S39V21 -VE) 'S3H:M0d H11M 'SONia-IIf18 d0 SNOISN3WIa lOVX3 aNV S3N11 101 WOBA 30NV1SIa aNV 101 dOSNOISN3Wla 1OVX3 MOHSiSf1W N01103S SIHI Zl G110D311 ONIaiins ONIIV3H ON _I PEi jBI DIM313 SVOSWOON dO 'ON L ONINOUKINOJ alb' 8OdVA 80 a.1.M lOH WV31S 'Ndnj M lOH 03DdOj 3:)VNdnj SS3l3dld ONIMH it OOVO 3111 80013 3111 S3anlm Na300W 83MOHS 11VIS ONt9Wflld ON ANIS N3H:)11A ANOIVAV1 —I R 'Sa DOOM 'S10D ' '8 'SW9 1331S 'S105 '8 'SW9 a39W11 1SIOf BOOM ONIWVad 9 0NIj00a 1106 13AVSO 8 aVl _I I Xlj LI X Al131101 l Cl H1V9 I� 0a dIH F 1383 9VO ONI9WIlld Ol II loos 9 �I 3a011a3d 800d S ONINIM 3WVa3 NO 3NOlS A8NOSVW NO 3NO1S X19 830NI7 a0 'JNOD _I 80013 V 'SKS DI11V 3WVdl NO ADla9 ABNOSVW NO ADla9 —� EF:-- WValOSVW NO oxmiomnis ABNOSVW NO O��f11S 3111 'HdSV ONIOIS '1a3A NOYMOD ONIOIS SO1S39SV O,Pi\OaVH HldV3 ONIOIS 11VHdSV S310NIHS DOOM £ F Z I t FTI F— SOaV09dV1:) Sa001i 6 S11VM y N3H711A Na300W WOOa OV3H S3DVld 3813 1.W 9 ON V3aV D111V 'NIJ % t/, 1/1 V3aV .1.W.9 'NIA linj V38V 1N3W3SV9 £ NljNn 11VM Aa0 ,— a3lSVld Sa31d O.M08VH 3NO1S a0 ADIa9 3NId FFF--- A.19 313NDNOD 313dDN05 HSINIi NOIN31N1 NOUVONnoi Z NOI.LOn?JJ.SNOO S1N3WlaVdV S37N3o kiiwvT aim S31a0!S A11WVj 310NIS AONVdf1000 . l WOOD STOVE INSTALLAHON CHECKLIST Permit _ A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and -not to the stove construction. ` Stove A. New x Used B. Type/fadfant 0-r-\ Circulating C. Manufacturer Lab. No. Name/Model No. -r -tc L U- 4_SZ ' Collar size Dimensionsi Height 2U Length —2: _�j Width S Chimney A. New Existing u B. Size (flue area) _ C. Other appliances attached to flue (Number and flue size) . dey k_ D. Prefab (Manufacturer—name and type) Lt. rq , E. Masonry/Lined 51, Flue liner atm C Lc_-, c Unlined type & manulactuM F. Height (refer to diagrams) can !o"ERIc" 11 �Jt I'�• T9V a x �-- CHIMNEY HEIGHT Hearth (non-combu tible) A. Materials f2i cv- B. Sub -floor construction 6�kw PAA - C. Minimum dimensions (refer to diagram) Clearances and Wail Protection (see stove installation clearances chart) A. Type of wall protection provided j2ri c V, B. Clearances (refer to diagrams) FIREPLACE CORNER HEARTH WALL/CENTER 13 ssww �totua ��� � � ..een the chimney connector and either V VIP to r,ilint, i%inadequate in installations such *t,� lyre it Mill require a special protective �,� „ , ,.,,t•,,,uhh rnantcl or trim, check the stove Wr Icaranccs. Use the necessary n,.rnrcl, tnm, and connector heat shields to rrijUlfril � Irarallccs. �. ,, j , vir,; , for clearance from the ceiling. .,�. r ,, t• , ,I,,,ui� r nlu<t tx' closed and sealed to lvina; drawn up the flue, reducing It ,,,u,t tr possible to re -open the , Iran the chimney. r4,vurh i Fireplace ,t:wr.t 1',nnrrlum 11calcr may be installed through llrn•nt ways, depending on the safety lv h, vtxtr situation, the height of the _= I .111,1 N our own preference: either without or with standard legs attached. -.,u,.a„u,, the Chininey connector/positive ku }:,s hari, Irons the stove, enters the _<;'� • .,.,t%, -ind turns upward. It then passes through :-: I•La r ,L ilx-r oix-ring and smoke chamber and %@-%I I It'lillicr Adaptor Fits to simplify fireplace "-'�-'►�r+t -„ r. ailable from your local dealer. ate. at WCeatan(;e WIF1t1 sections respectively.. , Wow "14 n .i. Wall Pass-Throughs"� Y� Whenever possible, design Your installation� " y connector does not pass through a combustible weatl, you are considering a wall pass-through in your i if tion, b - check with your building inspector before yott;, Also check with the chimney connector manufacputr_«"' any specific requirements. Accessories are available for use as wall pass.throughs, using one of these, make sure it has been tested and listtx for use as a wall pass-through. In the United States, the National Fire Protection Assock tion (NFPA) has established guidelines for passing chimney connectors through combustible walls. Many building code inspectors follow the guidelines contained the publication NFPA 211 when approving installations. The illustration shows one NFPA-recommended methor All combustible material in the wall is cut away a suffi- cient distance from the single-wall connector to provide the required 12" clearance for the connector. Any maten used to close up the opening must be non-combustible. Chimney Connector -'- A 12" Radius of Non- combustible Material mus encircle the Connector This Is one recommended method of constructing a safe wu pass-through. Three other methods are also approved by the NFPA. These are: - Using a section of listed factory -built chimney with a nine -inch clearance to combustibles. - Placing a chimney connector pipe inside a ventilated thimble, which is then separated from combustibles by s, inches of fiberglass insulating material. - Placing a chimney connector pipe inside a section of listed solid -insulated, factory -built chimney, with an inside diameter 2 in. larger than the chimney connector and having 1 in. or more of insulation and maintaining a minimum 2 in. air space between the outer wall of the chimney and combustibles. Installation Damper ' It- I I, rc las flue Liner _ Plate Is Removed or 1%4-4 t hin,nr% Fastened in I He I.Incr - Open Position �. Iilut Minimum n If or !'•�rrwe Inttallrr{nm , Use Block - Off Plate or Seal with Sheetmetal and Sealant %@-%I I It'lillicr Adaptor Fits to simplify fireplace "-'�-'►�r+t -„ r. ailable from your local dealer. ate. at WCeatan(;e WIF1t1 sections respectively.. , Wow "14 n .i. Wall Pass-Throughs"� Y� Whenever possible, design Your installation� " y connector does not pass through a combustible weatl, you are considering a wall pass-through in your i if tion, b - check with your building inspector before yott;, Also check with the chimney connector manufacputr_«"' any specific requirements. Accessories are available for use as wall pass.throughs, using one of these, make sure it has been tested and listtx for use as a wall pass-through. In the United States, the National Fire Protection Assock tion (NFPA) has established guidelines for passing chimney connectors through combustible walls. Many building code inspectors follow the guidelines contained the publication NFPA 211 when approving installations. The illustration shows one NFPA-recommended methor All combustible material in the wall is cut away a suffi- cient distance from the single-wall connector to provide the required 12" clearance for the connector. Any maten used to close up the opening must be non-combustible. Chimney Connector -'- A 12" Radius of Non- combustible Material mus encircle the Connector This Is one recommended method of constructing a safe wu pass-through. Three other methods are also approved by the NFPA. These are: - Using a section of listed factory -built chimney with a nine -inch clearance to combustibles. - Placing a chimney connector pipe inside a ventilated thimble, which is then separated from combustibles by s, inches of fiberglass insulating material. - Placing a chimney connector pipe inside a section of listed solid -insulated, factory -built chimney, with an inside diameter 2 in. larger than the chimney connector and having 1 in. or more of insulation and maintaining a minimum 2 in. air space between the outer wall of the chimney and combustibles. Installation r Location " - 4 �� 7 No. S� Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL 03/05/ 2121 :13 .� 9578 110.50 PAID Building Inspector Div. 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V Oww •' �w wU< < V¢ p� vi �x V vi0 _ axo.oD a er Z Z Zero LLLLLLf 01 O¢ V ¢Ovr W x V ¢ r ¢ >p w< ¢p¢¢� mr3�x 0�0�= z�n �r--� a0 R 0°C¢ZQ��O .:RI ZZ00WZ Z I ITT I TTI — I i T I IIII 0 0 a O �- Z ore z y oc Y r m er v¢ Z O Z 0 O �t O YZ W < W 0Z Z �¢0�o0i G xivxw n IE �0 0 �v J J N 7 m 0 Q (� z U' O 0� LL Q ¢ Z¢ LL e< Z� w Z 1L tl U as W N e7 O N m �_ � Z Q o Z N N Z � o Z Z< 0 0 < LL ZO Z0 V F 0 0 0 x Z 1 LL 0 N O y m f LL g J 0U 0V J� 0 m h- Z¢ OC o. N V V Z OV OVmn Y N u W M W m s m y¢ J O O o O W m V V » Y Y t� u V W Z z 00 z N .Wi m m i ¢ r x ¢d W eE 0 a J O W m W Q 8 n ` - -i :E Q�zx V03QQ>�nammOUv�-iv~i ���Q3in�� 3 Fut-i5 m� 9 CIL ' HOME IMPROVEMENT CONTRACTOR Registration `101846 .". Type -,y_ INDIVIDUAL Expiration 06/29/96 Stephen M. Keisling 68 6lenncrest Dr. " Andover MA 01845 : - AgjA N TRATOR t FEB 2 9 1996 ; 10' . � ./fie �a»irnaruuealC� o / F tv E DEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nn�6er: Expires: Birthdate:' CS 027489 07/16/1997 07/16/1953 Restricted To: 00 STEPHEN N KEISLING 68 GLENCREST OR i N ANDOVER, NA 01845 Page No. 2. of STEPHEN M. KEISLING'7. 7 Building & :Remodeling r 68 Glencrest Drive - _ NORTH ANDOVER,. MASSACHUSETTS 01845 MA Lic. 027489 Home lmpy'-101846 _ - Phone 682-2072 _.. Pages P PROPOSAL SUBMITTED PHONE DATE .. STREET JOB NAVIEL/C%^%Z/�-�-.., CITY, STATE and ZIP CODE ! JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: c ; -T-. 1 4Q tf �,�t�t/' ' ! '�7k! •� /J�L/v"'f�J Crcra-G .i{.[.�.�-C/%t3Q _t�yl� LC.CCX� � �L`e �yPiyJs-�L•"Ti% /d/'^�J �`T�G,�C/ifCC-�".. cpTV (,�`(/� ".v`"% / �-r�s21G�-r�..,t-,✓J�4', � �n-�C.�T4�C, ,-r - � r .. , :.,_.:..-.s----,. -.- - . Wr proPUSC hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dolla*$ ). Payment to be made as follows: f - All material is guaranteed to be as specified. All work to be completed in a workmanlike ' 7 7 + f manner according to standard practices. Any alteration or deviation from above specifications Authorize j involving extra costs will be executed only upon written order, and will become an extra , , Signature LLLLLL /� C charge over and above the estimate. All agreements contingent upon strikes, accidents _ or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. PtP1�F1ItPP D�i'QIISc�l=The above prices,specifications c� ' _. -✓/ and conditions are satisfactory and are hereby accepted. You are authorized Signature , to do the work as specified. Payment will be made as outlined above. Date of Acceptance: 6 Signature , Page No. -3Of „3 Pages r:-fro-�osttl: STEPHEN M. -KEISLING FEB 2 9 1996 `Bus-t+>sing & ReFgodelin y i 68 Gfencrest bfwe f i ! NORTH ANDOVER 'MASSACHUSETTS -01845 MA Lic: 02789 HorrEe irrpv. 101$46 - Phone* 682-2072 PROPOSAL SUBMITTpoqo PHONE DA�E � Q STREET - JOB NAM�s'" __ CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: CIO *�i'✓���t/ L.C/Wc.� / ! y���i%��c��Ls•` t�CYw9•r.r.�� O2 �Ap P??, l We PrupOsr hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars ($ ). Payment to be made as follows: . k All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized/ manner according to standard practices. Any alteration or deviation from above specifications Signature involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. CDateof re of Proposal — --- _� The above prices, sp_ e~ c tions and are satisfactory and are hereby accepted. You are authorized Signature {- as specified. Payment will be made as outlined above. ce: ° �' ' s` Signature d 0 ti s tj r r t]! "10 ) �.j 0g jo -900 N_ a y a. 7 a -d e✓;� �P n'd ry Z vzll�� } m kp 1k-/ i ¢zzwa u'F-�: wz3Zw hawwm N°C2 2�,UZZ C) 0ZUQ oQ�az 10 U) O a- Q►-�c7iw azOFnLa wWawLL� ,.j (3, N w 1- U E <j► -Zr-UD a Fz�w cZ_7maOww o,w2Npcc wrn0=a:¢ 0 n u (L0 N Q 0 m<zz z ui Ow -C OLLON z ac0z oZ��o zO Dp W ~— <0 < N w U (DwN -jw:) 4c 0 (1) LL rn _ N. } m kp 1k-/ i ¢zzwa u'F-�: wz3Zw hawwm N°C2 2�,UZZ C) 0ZUQ oQ�az 10 U) O a- Q►-�c7iw azOFnLa wWawLL� ,.j (3, N w 1- U E <j► -Zr-UD a Fz�w cZ_7maOww o,w2Npcc wrn0=a:¢ 0 n u (L0 N Q 0 m<zz z ui Ow -C OLLON z ac0z oZ��o zO Dp W ~— <0 < N w U (DwN -jw:) 4c 0 (1) LL CD O .. 0 O O CD O CA 10 CD O O CA c O __ C/! M3 C') CD O r� CD co a . CD N O O CDD a 0 G CD Jim -. N O C N Q O m 10 W m n O. n cil m H CD . c �. ?-C N —1 •O-►c'O•CD N T =r CL m Cn CD C) .-► H o CD H a o• o � O N n moCD: N C) o CA - CD m N O m CD d N a d r O. �o O N N � c c m d N — m o CD o �^ �lJ N . ► . -0 O O CD m' U a3� CD O o m 0 CD c o moo: s= �m sem: Z C r -r eD r m cZVI - V z �• Ox' n v c N C N o a x O � � O O cn ~• z: 1 n: o N Jim -. N O C N Q O m 10 W m n O. n cil m H CD . c �. ?-C N —1 •O-►c'O•CD N T =r CL m Cn CD C) .-► H o CD H a o• o � O N n moCD: N C) o CA - CD m N O m CD d N a d r O. �o O N N � c c m d N — m o CD o �^ �lJ N . ► . -0 O O CD m' U a3� CD O o m 0 CD c o moo: s= �m sem: 4 lu Z C r -r eD cZVI - V z r a n v c N ? o N o a x 4 lu r! CMZ\ (Print at type) �- . c4i 5'0 7 NORTH ANDOVER, Masa. Date / _10� BulldingSs Permit ag5 4— Location . -) D LSC j A/ f1E- Owner's Name t/1�L/ �/ l 2" P.�1, New p Renovation p Replacement Pians Submitted: Yes ❑ No C1�IXTUAES ......... . Check one: Certificate n - Installing Company Name !�- p < J t� r� .-n '17"p� z�7 Corp. Address o )1- /_"o /LS % 0 Partnership `vl ,/y'✓1/cl eL.,-e %7r2-1 , 0 Business Telephone (0 Q. Zt7 Name of Licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equtvatenL Yes 03-, No p It you have checked y", please Indicate the type coverage by checking the appropriate box A liability Insurance -policy ErOther type of Indem dy 0 Bond Q OWNER'S INSURANCE WAIVER: I am aware that the licensee doe not have " the Insurance coversQe required by Chapter 142 of the Mass. General Laws, and that. my signature on thla permit. application walves--this. requirement. Check one:.. Owner. p Agent p_ -- S;gnstuis at Owner or Owner ent I hereby certify that all of the details and Informatlon I have submitted for entered) in Above knowledge and that a1 plumb) wak and Instahtlona aDD�atlon ars lcw and�ain ' toonce'v best -of my ,_ _. - 1 the � De+iamed under the Wa ap lion h � Rrana with all ped1nen provisions of a Massachusetts State Plumbtnq Code end Chapler 2 By '7' of Lkensed Plumber TN1eSige Gty/Town Ucense Numbw 3 ^ Type of Plumbing lkanse: Master Lg' AP111OVED (OFFICE USE ONLY) Journeyman ❑ r J N = O K s = M .9 • o- N< N Zz A s U r !` r y S e =~ I; s; `�+ 0016 30 Is a 1,�+..�;�a.� sua—SeNT. Y eAasYtNT 111T FLOOR f 21410 FLOOR 11110 FLOOR 4TH FLOOR iTH FLOOR STH FLOOR.I t- TTH FLOORI ftFT71 eTH FLOOR I iiiE d —1 Check one: Certificate n - Installing Company Name !�- p < J t� r� .-n '17"p� z�7 Corp. Address o )1- /_"o /LS % 0 Partnership `vl ,/y'✓1/cl eL.,-e %7r2-1 , 0 Business Telephone (0 Q. Zt7 Name of Licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equtvatenL Yes 03-, No p It you have checked y", please Indicate the type coverage by checking the appropriate box A liability Insurance -policy ErOther type of Indem dy 0 Bond Q OWNER'S INSURANCE WAIVER: I am aware that the licensee doe not have " the Insurance coversQe required by Chapter 142 of the Mass. General Laws, and that. my signature on thla permit. application walves--this. requirement. Check one:.. Owner. p Agent p_ -- S;gnstuis at Owner or Owner ent I hereby certify that all of the details and Informatlon I have submitted for entered) in Above knowledge and that a1 plumb) wak and Instahtlona aDD�atlon ars lcw and�ain ' toonce'v best -of my ,_ _. - 1 the � De+iamed under the Wa ap lion h � Rrana with all ped1nen provisions of a Massachusetts State Plumbtnq Code end Chapler 2 By '7' of Lkensed Plumber TN1eSige Gty/Town Ucense Numbw 3 ^ Type of Plumbing lkanse: Master Lg' AP111OVED (OFFICE USE ONLY) Journeyman ❑ 2854 Ot NORTh 1 3:. •� o0L O 9 "Low. ,SSAcHUSE� Date. 3/w 9A n . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform plumbing in the buildings of . C t !?) ..... , ... . at . 5. . W�Tt S-2� . ,North Andover, Mass. Fee . 1. ..... Lic. No.. /ea. _ PLUMBING INSPECTOR C %C" So 79 03122!96 15-42 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 15.00 PAID GOLD: File �'� t=ems �'?.�". ✓� wiln' The Commonwealth of Massachuset7s��•jj- Dcpartmcnl of Public Scfcry !occvra.+cy i Fsa-C+ecW_��� 80ARD OF FIRE PREVENTION REGULATIONS S27 CMR IZW 3/90 cta..a a.waj APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed 1n accordance With the Macaachurent EJectrkal Codt, S27 CMR 12:00 (PLEASE PRINT IN nM OR TYPE ALL ORH MN) Date City. or Town orh/. �y (✓G ✓( To the Inspector of Wires: The uncorsigned applies for a permit to perform the electrical work described below. Lo—cion (Street & Number)_ �L3 Z 0--ner or Tenant_ (14 11411 Owner's Address ' -e_ Is this permit in conjunction with a building permit`: Yes 0 --go (Check Appropriate Box) Purpose of Building_ e- k„r , �y Z /(�. Utility Authorization N0. Existing Service /4'0 Amps_ /arr 12 yd Volts Overt:cad Undgtd ❑; No. of :.et�ts1 New Service Amps / Volts Overbead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work r �, L No. of Lightistg Outlets *to - of Lighting Fixtures S too. of Receptacle Outlets 1 No. of Switch Outlets No. of Ranges Nr. of Disposals Ao. of Dishwashers No. of Dryers No. of Water Neaters KW No. Hydro Massage Tubs OTHER: No. of Hot Tubs Swinming Pool Above strnd. ❑ No. of Oil Burners No. of Gas Burners No. of Air Cond. Total tons No. of HP�rps Total Io ?ons Space/Area Heating Heating Devices Ei5 burns ballasts No. of Motors Total HP d No. of Transformers ❑ Generators KVA No. of Emergency Lighting BatteryUnits FIRE AL SM No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑Other Connection Low Voltage INSURANCE COVERAGE: Pursuant to the requl.rements of Massachusetts General lave w I have a current Liab Insurance Policy including Completed Operations Coverage or ibstantial equivalent. YES NO 0 ts I have submitted valid proof of same to this office. YES NO ❑ Ii you have checked YES; please indicate the type of coverage by checking the appropriate box. INSURANCE BOhD [3 OTHER ❑ (Please Specify) Estimated Value of Electrical Work S piration ate Work to Start _ // 1!� Inspection Date Requested: Rough /✓ Y{J �°/�iC�G,Final Signed under the penalties of perjury: FIRM NAME_ L° S`- r t �� 74' LIC.. N0. Licensee 4j,+ �,�� L, �., - Signature. LIC. N0. Address fey �G �s �`— sr� �vr �j� �+us. Tel. No. G —2le y It. Tel. No. �L7R'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its sub - application waives this requirement. stantial equivalent as required by Massachusetts General vsadth.t my signature on this permit Owner Agent (Please check one) Telephone No. PERMIT FEE S t% 0 Signature of Owner or Agent