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Miscellaneous - 54 BRIGHTWOOD AVENUE 4/30/2018
�eR�cHr 21pjD66.0_ W OOD AVENUE -0000.0 ti `t TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1S�ACMUS� ^ This certifies that . ._.)./.). . . . . . . . . ii. has permission to perform plumbing in the buildings of . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .. . . . ..a... . . . . ., North Andover, Mass. i Fee Lic. N6�vz!. . y.;t���c. .�1. ... . . . . . . . . . . . -7;' :S%lJ PLUMBINGIINSPECTOR Check # Ao-q _ v G8u7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location i Or wners Namefflqatv ReA rPermit# Amount �7 Type of Occupancy p S New Renovation �� Replacement 0 Plans Submitted Yes ❑ No ❑ FIXTURES H z a v Fz w w w z a PQ C) a {� W z a z a 3 sLRasvn: RAAESir FT Isr H-" Z%nFLOCIt t 3M 1-001 4MFLOCR 5MH—OOt sMHAOCR 7MMOOR 8MFW t (Print or type) Check one: Certificate ` Installing Company Name �� ❑ Corp. Address Partner. .v Business Telepo—ne aFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate t e of insura e over ge by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa efts Slate Plumbing Cod and Chapter 142 of the General Laws. By: nature-of ,iens er Title Type of Plumbing LfcLfnse City/Town ices er master ElJourneymanr�]/ APPROVED�oFFice usa ONLYL_I Date. .../.. '��.......... r �aORTM 4, TOWN OF NORTH ANDOVER j ` p PERMIT FOR WIRING ;,S'SACMUS� 1 . This certifies that .. .................................. ................................ has permission to perform ...... ........ wiring in the building of ".7�1 .................................................................................. at......y ......_........ ............. ,......... ,North Andover,-,Mass. U Fee' ..�.......... Lic.Nok.lf'j..Vl.`. �, CLECr ' ............................. RICALINSPECTOR t ^ b Check #�V 64 '19 011-1cial 1!�,e 011IN Commonwealth of Massachusetts Department of Fire Services q., �I Occupancy and Fee CheckedBOARD OF FIRE PREVENTION REGULATIONS i[Rev. 9,051' deave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All �. ork to be performed in accordance\Nith the klassachLlSettS FIC011C,11 Code(\lFC). 527 C1011 12.00 (PLL ISE PRL\-TI,V[AW OR TYPEALL IXFoRILITIoA) Date:--;�7eb Z, )-Oa6 City or Town of: Iva lWovw- To die Inypeclor of Wires: By this 3ppliC,-16011 the undersigned-i Oor, to petves notice of his or her intention -forni the electrical work described below. .� Location(Street& Number) 44-e- Owner or Tenant 0,hn` J*hl- — Telephone No. Owner's Address 5 tq/Y)e. Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building sl,02 . Utility Authorization No. Existing Service_ Amps —Volts OverheadEl Undgrd 0 No.of Meters New Service Amps Volts Overhead F1 Undgrd R No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: complelion a/the fi)llolc ing tablemav be waived by the No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA No.of Luminaire Outlets 3No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above r-� In- No.ofEmergency Lighting vrnd. — pand. ❑ -Ba ttery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 'iNo.of Detection and Initiating Devices Total No. of Ranges No.of Air Cond. Tons jNo. of Alerting Devices No.of Waste Disposers Heat Pump lNumber F.09S.- KW No. of Self-Contained Totals: .......... A IDetection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of'Devices or Equivalent Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: IMICh 1111CU11011(d tIL'1a1i 11'(h,siretl, oray rcq,m-cd h., the lmspt,tor tjWin,, Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 1 ,06 Inspections to be requested in accordance with VIEC Rule 10, and Upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue L1111CSS the licensee provides proof of liabilitV i11SL11-a11CC inClUdinly"completed operation-coverage or its substantial equivalent. HIC Lin&r.si-ned certifies that such coverage is in force,and has exhibited proof of same to the permit office. Cl-lECK ONE: INS(JRANCE E] BOND [] ()HIER [:] (Spccily:) I cerfilj,, wider the pains that the h!Iiii-11106011 on this applicadmi A ii-tie eiiid coinl)lefe. FIRM NAME: 5�ea,6 - - — LIC. NO.: IAM6 Licensee: j)6yAcjja' Signature— LIC. N 0.: 140, -c /it i7l P01 I-Ht,. Bus.Tel. No.: Address: d%44 cy ej 2 AIt. Tel. *Security System Contractor License-N(JUircd for this work; if applicable.enter the license number here: OWNER'S INSURANCE \NAIVER: lani aware that tile Liccnseed0(!S;701/h1l,e the liability illSffancccovcra�-�e nornlally required bylaw. By my signature below, I hereby waive this requirement. lai-nthe(check one)oowner 1:1 - 's agent. Owner/Agent owner .signature Tcicphonc No. I 7PF-R,,WT,F-FE.- S 3L5 mlci,tl C unk Commonwealth of Massachusetts Permit No. Department of Fire Services I Occupancy and Fee Checked—;L BOARD OF FIRE PREVENTION REGULATIONS I[Rev. 9 05] heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ,\[I \m-k to he pert1(,q-jjjcL1 in accordance\\i1ll the Ma""ilchu',cits Hcctl-ical Code(%IFC'). 517(AIR 12.00 (I'LEASE PRL\TI,N- 1AK OR TYPEALL [N-FORHITION) Date: City or Town of: IYJ. fin4civel, To the h7SI)eClol' By 1111S ,IPPIIC,16011 the Undersigned 'gives notice of Ills or 11cr int ciltioll to Perl'orn' tile electrical \%ork described below'. Location (Street& Number) Owner or Tenant Telephone No. Owner'sAddress Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Buildingf4m4... Utility Authorization No. Existing Service_ Amps Volts Overhead ❑ Undgrc! ❑ No.of Meters New Service Amps Volts OverheadEl Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4?,-1hA1vat7 11Wfi)11()111z fahle mciv be itan,l 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 L!iminaires Swimming Pool Above f❑1 In- N❑ o. of Emergency Lighting grnd. mi-nd. Battery Units No.of Receptacle Outlets No.of Oil Burners IFIRE ALARMS No. ofZones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons 1�No of Alerting Devices Re_a_tPump_7,Nu miller rolls L No.of Waste Disposers 1 of Self-Contained Totals: t. /%I t.rig Devices 'Municipal No.of Dishwashers Space/Area Heating KW Local 0 ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Devices or Eguivalent No.of No.6f Heaters KW — Data Wiring: Signs Ballasts No.of Devices orvalqnt _E� No. Hydromassage Bathtubs No. of Motors Total illP Telecommunications Wiring: OTHER: No.oi'Devices or EauiNalent IMI /1 I ld(1l1lG'Nfl/1 Jilin/lf,l't'sired. dic h1q,( E,-tirnated Value of lectrical W rk: ("hen required by municipal policy.) 1k ork to Start: 06 - In:,pcctions to be requestedin accordance with %lEC RUIC 10, and Upon completion.INSURANCE COV ERACE: L,lilcss waived by the owner, no permit for the performance of clecti-icli work inay isSLIC unlcs (lie licensee provides prooforliabilit,, 1lS,L -MlCC.inCjttilu"CornpiCtCL ("PC_ltiollC)\tru J C Or its substantial equivalent. I Ih:[ ldc-sk-jied certifies that SLCI i4 in I0,cc, MId has C%hihitcd proof or!;allc to the permit i:.:uill'-,ol ricc. 0117CKONF: INS1,1RANCE" Q nwi) ❑ ()rmR I Wider the Pains 'hiif the h�fi)rnyutioij e)jj ifij.v flyl)licillit1j,is true eiiid complete. F1 RM NA:"E: LIC. 1,!0.: Ueellsee: /V :i;onat re Lic'- No .: A t Sq1_4 ;;11i, 1,olib l''NIC Address: Sus. Tel. No.: 12 7 ' � � h '(1e" ' IVII '`Security SystemContractor JJcCrhC required tiw this vvc,rk; if,ipplicable.altertht: license llunib'er here: OWNER'S INSURANCE NNAIVER: I ;irn avv:jrc that the Licen,,2ee dot,.% ;70t huvr the li:tbility inAll-,111CC icqUired by law. By ljlv!,1"_'nature bC10\'V, I IICI-ChY V\Ai\lC tlli;;1-CCILlil-Cilklit. 1 :1111 the(check 0110❑ ok\,ncr ❑ 0 Owner/Agent MIC1, 'JI-12cilt. T1:rp,%,.,).kk ",�J. PF_RMJT.11�'VE- S I 3j, `4 l L Date,-� ....... NORTH ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... .......... ................................ has permission to perform .............................................. wiring in the building of.......... .......................................... ... at./-/R....i;!�. .......................................... .......... . . North Andover,Mass. Fed?,,IF... .... Lic.NoNx!rF9�,— -�!.......... ELECTRICAL INSpECTO pQ Check # 6425 Commonwealth of Massachusetts 0i,ficial I se 011IN - Department of Fire Services Peinlit No. UCCLlpancy and Fee Checked/J; BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9,05] 1 eav e b I an k) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .111 %k o rk to he performed in accordance%%i t h the X In ssac h u se its Electrical Code I1'(). 5?7(AI R 12.1)0 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 4jl0� City or Town of: - /10HA 191h6&1_(r To die lnspecf(ff(#Jr�i/Ie,V.' By this application the undersigned gives notice of his or her intcnti 11 to perform electrical work described below. t' the electi Location (Street& Number) 4- . Owner or Tenant • -tcr K6 C) Kell Telephone No. Owner's Address :S�ke-w_ Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Sloe L vc-mv/ DLVC\UAUtility Authorization No. "i Existing Service Amps Volts Overhead El Undgrd R No.of Meters New Service Amps Volts Overhead n UndgrdEJ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: meskir- /2-CW/wim Completion the fidlom,niz table mov be waived by the 1JlSJWL't01'(?1 I'Vire No.of Recessed Luminaires jC) No.of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n In- No. of Emergency Lighting rilid .. — grod. Battery Units g No.of Receptacle Outlets PL.S No. of Oil Burners FIRE ALARMS I No.of Zones No. of Switches a0 No. of Gas Burners No.of Detection and Initiating Devices No. of Ranges No.of Air Cond. Tons Co.of Alerting Devices No.of Waste Disposers 1, "eat Pump I Number Tons KW :No. of Self-Contained Totals: * ' -1 1.-.1 L I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[:] Municipal ❑ Other Connection _S_y stems:* FT No.of Dryers Heating Appliances KW Security.g ems: No.of Water No. —1vo.of No vices or Equivalent If Heaters KW Signs Ballasts Data Wiring: No.of Devices or No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or EquiNalent OTHER: 1fdUS11_Ud, (Wt1S)'C.-J1111'Vdht. rhe'1MS/A'L/1J/'()/ If 11-c., 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 wvvner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including7'"completed operation"coverage or its Substantial equivalent. _111C Undcrsi,,,ned certifies that Such coverage is in 1,61-cc,and has exhibited proof of same to the permit issuin office. ("BECKONE: INSURANCE [:1 BOND E] 01-111'R J__J (Specily:) I cerl4j,, wider the pains and1witalfies ql'perjuty, ,hat floe htfi)rntadon on 1hi.v,,11Y)1ica1ion A it-tie and con1lVefe. FIRM NAME: LIC. N 0.: Licensee: R;r_x_ P\, ccra LIC. NO.:1 :-v2i 301V_f32�_ kd�lrcs' • Bus.Tel. No.:Aft.Tel. No.: -16 '-'Security System Contractor License NqUirud for this worr; if applicable,enter the license number here: OWNER'S INSURANCE VNAIVER: lainaware that the Licensee e10(!,V17011711l1e the liability insurance covcrau�e normally required by law. By mysignature below, I hercby waive this req uircincrit. I am the(check one)❑0 o-wrier E] owncr'i3 ;ioent. Owner/Agent "),ignature TclLphonc PF_R.,VfJT,FF_E: S Location '05 r No. 40rel Date �� O NORTH TOWN OF NORTH ANDOVER F � 9 a Certificate of Occupancy $ �'�s'•°•Eta' Building/Frame Permit Fee $ a2 s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ D Check # 18932 / / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 5. DATE ISSUED: / r M ic SIGNATURE: Building Commissioner/1r of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 AssessorsMap and Parcel Number: O !,v _� .6 — - 5G Map Number Parcel Number N ' 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regiured Provided RegLured Provided v 1.7 Water Supply L.c.ao. saI age 1.5. Flood Zone Information: 1.8 SewerDisposal System M.c. Pubes ❑ Pete ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes No rn 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Li sed Construction Supervisor: Not Applicable ❑ a� L jin o42a � 3 Licensed Construction Supervisor: O `l _A n /�( n J n License Number Mn A dres/s/� � — 7 — d Expiration Date Sign re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Cot L, L (!!a6L, ,j c lll � ? 9 Com y Name rn C Q 1.1,-j e� �r�� r� (s � e� J� Registration Number r 3�Address � f/� v . f (J r2 /f( � 61 L'— s `�// ' �'! �} Expiration nate f. Signature,, Telephone G) .. /'I- Y 6'2f— SECTION 4-WORKERS COMPENSATION(M G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: / ? d C e �, 0 ')(/ 1(l L r[ '7"krO o A-1 Y, t a/ic( csi,-) (4- -ri (--IUO r -- r`)--I"- cd N`, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be s ,,.QFFICIAI USE(3NLY Completed by permit applicant - 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee t$)X(b) p 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 o 0 U Check Number 136 SECTION 7a OWNER AUTHORIZATION O BE COMPLETED WHEN �� Z OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 7E I, ,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, 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 belie L 01 1o �-fc Y� I Print Nam /� � ' � � O CJ /� , Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS iST 2 ND 3 RD SPAN DRv1ENSIONS OF SILLS DRAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of _� 4 over 0% No. 99 dover, Mass., —// o A �. COCMICMEWICK V 7 ADRATED OPS` �y �`s E BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System 16 A BUILDING INSPECTOR THIS CERTIFIES THAT.................... ..... ►.. .... ..0�..... . .....................0 .. ...... Foundation has permission to ere;fo ............:.......... ..... buildings on ...... .�edf ��*.e..al.*4040. Rough to be occupied as........ � /..... Chimney ... .. .. .................................................................................... provided that the person accepting this permit sha eve r ect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES INN6i MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU !�[�TS v j 10 Rough ........... .......... .... .............. Service DING ECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the. Building Inspector. Burner Street No. IF SEE REVERSE SIDE Smoke Det. Licerise CONSTRUCTION SU'FERVLS'OR W6 S,;. 042063. J 7 Tr: no 9267 0 Iffly - gp_ � E 36 ABTINIORE`S�T AL 1 HAUERHIIL; MA 01`�Q F -- -- =.Commissioner _ ed space 0(),351000:cf enclos M �L C.112 S.60L) -Masonry only j 4 G-1&2 Family Homes Failure to possess a current edition- ode f the MassachusettsState.Buildh$.license. is cause for revocation of t is 1 88 - DIG-SAFE CALL CENTER: 8)344-723& ` I � �/ze �arrvrnaruuec�!/ o�./�-aaa¢c�uaelta , Board of Building Regulations and Standards HOME IMQOVEMENT CONTRACTOR t Registraitio i 111079 ExppiFfa—ffon ,A 12 /2006 UJJJVidual PAUL M SOUCY PAUL SOUCY 36A BALTIMORE HAVERHILL,MA 01830 Administrator • i i i I I G1ORW_LERSTON1F__1, KITC_r_;HEV15S- 1' 36-A Baltimore St. Haverhill Ma 01830 978-374-3035 Submitted To: Job Description: r` Megan Moore Remodel upstairs 54 Brightwood St. .bathroom. N. Andover MA Cost$12,000. 508-816-6329 Electrical: -Install recess lights over entryway. -Install a new exhaust fan. -Install lighting over the sinks. (Purchased by Megan) Demolition: -Remove existing shower unit, walls around the shower, closet, vanity, top and sinks, portions of the floor. Carpentry: -Install new cabinets and counter top,(Purchased by Megan) -Repair drywall on the ceiling, walls and install new drywall where needed. -Repair floor and install floor tile. (Purchased by Megan) Painting: -Paint bathroom walls and ceiling and trim. Plumbinz: -Install a new neo-angle shower unit in white. -Install 2 sinks and 2 faucets (Purchased by homeowner) -Install a new shower valve. -Relocate toilet. -Relocate heat. i Payment Schedule: -$1000 At signing -$5000 At the start of the project. -$3000 After the demolition, rough plumbing and electrical and inspections are done. -$3000 At completion of the project. / -Cornerstone Kitchens will be responsible for all permits and insurance. All work is warranted for I full from start date 1/23/.06 Acceptance of Contract: Date: 1116106 Client: Contractor: ` ,. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: a,hu e is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: (Location of Facility) V'�A Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date 01/17/2006 13:46 978-521-5127 COSTELLO INS. PAGE 01/01 GAVE(MMMONVYV I Arco". CERTIFICATE OF LIABILITY INSURANCE O11/17i2U06 PaopucER 978}3746352 FAX (978)SZ1-5127 Tll HIS CERTIFICATE iS ISSUED AS A NIATTER OF INFORMATION ( ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE D OR COSTELLO INSURANCE AGENCY ALTER HOLDER,THTHI IS ERAGE AFFORDED BY THE FS NOT OATE DO! LICxTEBELOW. 2 South Kimball St. po Box 5248 INSURERS AFFORDING COVERAGE NAIC# Bradford. IMA 01835 INSURERA: National Grange Mutual Ins. Co - 14788 INSURED Corner Stone KitC ens/ Pae1 SOu[eY INSURER B, 36-A Bal tilll0re Street INSURERC: Haverhill, MA 01830 INSURER D: INSURER E TWITHSTANC E5 t THE THE POLICIES Of INSURANCE LISTEDCONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT O wHICHLTHIS RTIFICATE MAY IOD INDICATED,BE SUED OR DING ANY REQUIREMENT,'TERW►OR CO MAY PERTAIN.THE,TERNANCE AFFORDED BY THE pOLIC1ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF S UCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C ulCY EFPECTI Pa.IGY TIMI LIMITS INS TYPE OF INSURANCE POLICY NUMBER EACH OCCURRENCE E 30(),00 GENERALUABILRY MPS2998S 08/12/Z00S 09/12/2006 D MAGE ToRENTF0 S 500. COMMERC-IAL GENERAL LIABILITY MED EXP(Anyone person) 5 10. CLAIMS WDEX1 OCCUR PERSONALS AOV INJURY $ 300.000 A X GENERAL AGGiIIEGATE S 600.00 PRODUCTS-COMPIOP AGG 5 600.0 GENT.AGGREGATE LIMIT APPLIES PER: - POLICY )ERCT LOC AUTOMOBILE I.IABILIY COMBINED SINGLE LIMIT. 5 (Eq iCCldenl) ANY AUTO BODILY INJURY 5 ALL OWNFDAUTOS (Pergown) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY 5 (Per awdenq NoN.OWIIED I,LrrOS PROPERTY DAMAGE 5 (Per acdclent) AUTO ONLY.EA ACCIDENT f GARAGE 1IABILI" OTHER EA ACC S THAN ANY AUTO AUTO ONLY: AGG f EACH OCCURRENCE S axCESSIUMBRELLAUABI AGGI GATE S OCCUR CLAIMS MADE 5 S DEDUCTIBLE i RETENTION f WC DTH' WORKERS COMPENSAT'ON AND E.L.EACH ACCIDENT f EMPLOYFJW UABIUTV ANY pROPR1ETOFWARTHERrEXECUTAIE EA,DMEASE-EA EMPLOVE E OFRCEWMEMBER-VAUDED? Vyes E.L.DISEASE•POLICY LM/IT f dr.oibe undc• SPECIAL PROVISIO?I bNoa OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 E,CLUVOXSAOOED BY ENDORSEMENT I SPECIAL PROVWMa . EL TION RT1Fw'ATE NO SHOULD ANY OF TME ABOVE DESCRIBED POLICIES at CANCELLED BEFORE THE EVIRATION DAM THEREOF•THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FWLURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIASIUSY Town of North Andover OF ANY IOND UpON THE INSURER•ITS AGENTS OR REPRESENTATIVES- Att: Gerry Brown ^U-HOMZEpREPRESEWATIVE N. Andover. MA William Costello 0AcORD CORPORATION 198 ACORD 25(20(1/08) FAX; (978)688-9542 Date . . . . . . . . . . . V'OR TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING S4CHUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . plumbing inAbe buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Fee?4. . Lic. No.. . . . . . . . . . . . . . . . . PLUMB G INSPECTOR Check # 6743 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU 1. MBING (Print or Type) . --/ ��UE/ Mass. Date /A �P > Permit# j �`l f Bu1. ilding Location j�j�f�7'/�QD!) y�Qwnet's Name �d% , hype of Occupancy ; /I L�1! New ❑ Renovation ❑ Replacement � Pians Submitted: 1�1 I.Y"es❑ No I 11B.P r S%EWER F[XTUP,�S SEPTIC i 1 Z — V) X Y G F- to „P ��. N 1.a `z a }. > s 1. i Sa Y .1 tom U .� O �. z 0 c rc i _z ? z n O N W vs y F- u- 6 X a y u. ." a _ Q7 ?G . X O ;d W ;:� : 4 Q "< cn ,z X. a ,¢ O Lu �- a x U; Sa < :tom > H O # ;� z o Q. ',.y 'z ;z w � p I 11V, SU81:'BS MT.: BASEMENTI. %% '� 1ST FLOOR.. 1. 1. . 2N0 FLOOR: .9 9 . :3 1) FLOOR' 4TH,FLOOR` 5TH FLOOR fiTH FLOOR: T7H'FLOOR 87H FLOOR` 77�7% 99 �. Installing Coriipanjr Name f-1uT/�'1 G�T I�rr , ! Check ane: Certfica d± -:1d to n�� �/fj���j/ ❑ Catpora#ion ❑ Partnershi rL'p f. 3usI r Telephones / ❑ Firm/Co. Name of licensed Plumber', rr / � 7`- dNSURANCE'COVERAGE: I have a current iiabifity insurance policy or its substanfiat equivatenfi which meets the requirernents of ti, Ch. 142. Yes Nap , L. If you have checked yes, please indicate.:the type coverage by checking the appropriate box ... A['ability insurance policy !❑ � Other type L r.of indemnify ❑ ` Bontf Q OWNER'S INrr '9SURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chaptef 142 of the Mass. General Laws, and that my.signature on this permit application waives this r..equirement Check one ;'" _SignatuE�of Owner or Owner's: Owner ..❑ Agent Agent 1 hereby certify that all of the details and information t have'submitted for entered)�n above application are true and accurate to the best of m I r. rL. . LL rr. knowledge and that all plumbing work and'installations pe rm unde the permit issued for this application wilt be in compliance with all Y pertinent provisions of the`Massachusetts State Plumbin and ter I42 of the General Laws. �' Sign Licensed lumber Title , �J Type of License. Master Joume �jL Crty/Town �j/ ,. APPRQYED OFFICE t1SE iONLY) License Number c�� / a��_ . 1 � NORTH 1ti0 3? '` TOWN OF NORTH ANDOVER ` PERMIT FOR GAS INSTALLATION � a 9 'ts,SSACH S MUS _1 L ` � This certifies that . . .` . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . in the buildings of . . . �_}..... . . . . . . . . . . . . . . . . . . . . . . . . . at AR . `. . • North Andover, Mass. Fee 4a. . . Lic.No—',` U. . . . . . . . . . . . . . . . GASP SECTOR Check !/ 5387 'IMASSACHUSETTS 1.U�31F©RM,APPL.iCATiON AOR PERtvfiT T`Q fl0'GASFITTiNG 1. _ (Print or Type) 11. � �du�-i _ ._Mass. Da1.te' 1.-:� 4t� Permit # �> ` Building Location f l �(� =owner s Name J� Type of Occupancy —- ' New"p Reno1.vation 'p Frepiacement. Plans'Submitte1.d Yes ❑ ' Na.p N:o (iC;: W N: N /A= U 1!1 -.1 % /n,,, cC; O j:' to 2 �: W W xr ci I . t ; U F- S 7f 4 ''m N F- t:. o. O f,, W ul- Q a. ti w r J .z s W x. , a Ll.. y-. f, c o W' % o. �a r $UB—a5"M T. BASEMENT1. �• . �. : .� � � � I. - - � " I�L T yS:T FLOQfl 2NDFL0OR A. F O;' D OR : l #TH FLOOR .- � ,", . - _�� a 51 I{ FLO>OR atH FLOOR TTHFtOpR I 11 - 87t: FLOOR � .1 , L . =1 �11 - �.., .. ± I. - _I - I �,-11 - k, �' , _1 Inst Company Naive. G/ 1 L - v 1. Check"one: Certificate . Address ( v r� orporatlon" > CI `Partnership 8usines Telephone • � (. ,' - i Fir /Co, ,, Name of Licensed Plumber of Gas Ftti,er_ c4z/i ` INSURANCE COVER4GE: have e`current IlabUfly insurance policy+ or i1.t%s substantial equfvatent'whtch meets,the requirements of MGL'i.Ch. 142; Yes .- , No 0 if you`have checked yes, please lridlcale the type coverage by checking the appropriate;box ...: 11 A ltablltt y Insurance"poticy �� Otherf a of Indemn!! ❑ o ► Yp Y S nd .0 , O!N,.. I . .INSURANCE W -IVEn- Ii arn.aware that.the 1lcensee does not have 1 e Insurance coverage requ red by; Chapter td2 of the Mass. Oe- neral laws, ,and:fhatr my sionature or!1h.is per nit'appitcatton`waives ttils requirement. Check tine: Signature of Owner of Owner's Agent Owner❑ Agent I hereby certify that all o1 the delaits and Ihlormation 1 have submitted for entered)in above application are true and accurate to the tient ol,my I I .I. + I F knowiedk and that all plumbing work and Installations ppeiiflrmed tinder iiia permlt`lssusd for thls:appli.ation;wlil be'In compliance with alt Qerilnent provisions of the Massachusetts State Gas`Code"and Chapter !42 of{he,Gene of laws. r. -' �' Ir T' e of license. . Plumber Thje " Sg _tu e o c nse um er or Gas !tier as(ittel aster . /l Cit !Townrrr. Ucense Number, �`7 ,kpIIfY"A DEQ TC Journeyman• o 11 �� a' Date. . ? No G. 5 � TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �,SSACHUS� - This certifies that ��. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform r. 7. . . . . . . . . . . . . . . . . . . plumbing in the buildings of . /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at.k`VV. /`t'!- . . . . ., North Andover, Mass. Feg---7. . .Lic. Flo.. . . . . . . . . . _ PLUM�NSP CTOR cr` v Check # %? WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR P RMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS r / Date Ea Building Location OR tg N �0 Q Owners Name Permit# Amount Type of Occupancy 5/Il 6 L 1� New Renovation Replacement Plans Submitted Yes 0 No FIXTURES z H > w H a >0 O z G 5 3 x a A A a 3 x H w a 3 a ca o SME RVE >4SE" vr M Haat M Haat 3MHDM 4]HHJOM sMWM 61R haat 71HRDM 8M'IBM (Print or type) D Check one: Certificate ran 'I InstallingCom Name S / Corp. Company Address 3 C(0 N i fQ / 71 U 4 Partner. Business Telephone "j 3 Firm/Co. Name of Licensed Plumber: F A S C y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy Er Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Pe it Issued for this application will be in compliance with all pertinent provisions of the Massachusett:Elumbingeode an hapter 142 of the General Laws. By: Signature or. riumner Type of Plumbing License Title I Ay 3 City/Town IcenseFlumBer Master E✓ Journeyman APPROVED(OFFICE USE ONLY Location �Z y No. U Date MORTM TOWN OF NORTH ANDOVER + Certificate of Occupancy $ C Building/Frame Permit Fee $ /y 9 d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Z=i 9 -- Check # Fj:� i 5 ? 1 - /� Building In. ctor 4 r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING PEW BUILDING PERMIT NUMBER: / DATE ISSQ SIGNATURE: za,10,440m- BuildingCommissioner/12iof Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Informati 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS B Front Yard Side Yard Rear Yard R red Provide Regifired Provided R red Provided 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSE"/AUTHORIZED AGENT rn 2.1 Owner of Record ce Name(Print) Address for Service: \, Signature Telephone 2.2 OWner of Record: Name Print Address for Service: O Z m Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number mn Address to Expiration Date � 'Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name 2 UK ��' �C Registration Number r Address! �� /�"I r �jry may/ /moi s o2G Expiration Date ^ Si nature Telephone V SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be -OFFICIAI-USE ONLY Completed by permit applicant 1. Building 0�0 Multiplier ding Permit Fee 2 Electrical (b) Estimated Total Cost of Q©l? Construction 3 Plumbing Building Permit fee(a)X (b) 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 I, 94 y 9:"(1-;>""c;"-3 ,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 SECTION7bOWNER/AUU�THORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �i1 6 ✓7 Print Name e�— �� Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1ST 2ND 3PD SPAN DIN ENSIGNS OF SILLS DIN ENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH ANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i :-� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location' City AX Phone —,2 71 am a homeowner performing all work myself. �1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance Co. Policy# Company name: Address tits Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 Sndlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do herb cert' under the and penaltie perjury t 4he information provided above is true and correct Y �Y Signature i' Date '-�F-�O Print name G � �G/�o�IG�s� Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Town of North AndoverttORTH Building Department o 27 Charles Street * _ North Andover Massachusetts 01845 i .^ (978 688-9545 Fax 978 688-9542 l �f94°R4reo Pp�AC5 SSACHUS� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# Oma/,92—?,C the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl50a. The debris will be disposed of in/at: ac Facility location Y Signature o Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 14 RTH � t Town of _ dover <, L No. 410 * =_ .. N A E - dover, Mass., COC MICME WICK ADRATED pPa\ '9S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System 990. BUILDING INSPECTOR THIS CERTIFIES THAT....................................... Foundation ................ .... ..................... .. .................... .......................... JLe has permission to ere ............. .... buil ings o ....a-4-4Rough to be occupied as. ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST*JELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 1V° r 5 3 0 Date........� .°�,� „ORTIi r°�<;��".;•'"o°� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �sSAcMUSE� This certifies that ......... . 4...�..0 �- ....tc..... ..G h C t. } ............ ....... has permission to perform ......' ��� ......... ' i. ...................... wiring in the building of i .. l �S ..... .. . .. /G ............................................ ......�CT'-'c' N6rth Andover,Miss. Fee. . .. ......... f......� ��- �NSPECTOR Check # ' WHITE:Applicant CANARY: Building Dept. PINK:Treasurer =09AM0AW TH0FAf4M—CgUS S Office Use only DEPARTALEATOFPUBLIC&4FETY Permit No. BOARD OF FM PREVEAWONRW M TIOA S S27 0IR 12.00 Occupancy&Fees Checked UAPPLICATION FOR PIRAff TO MFORM ELECTRICAL WORK . ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date D o Town of North Andover To the I pector of Wires: The undersigned applies for a permit to perform the el�ttl�I o-H T woa prical work described below. )� Location(Street&Number) _ �',� /,4- Gy Owner or Tenant / ,-$ Owner's Address :7 42L/--: Is this permit in conjunction with a building permit: Yes FM No ® (Check Appropriate Box) Purpose of Building D (,c, L L /)V,- Utility Authorization No. Existing Service //,,0 Amps / ,7�,Volts Overhead M Underground ® No.of Meters ®.v New Service Amps Volts Overhead ® Underground ED No.of Meters N.Wmber of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and round No.of Receptacle Outlets /! No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets r No.of Gas Burners No.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals f No.of Heat Total Total No.of Detection and ` Pumps Tons KW Initiating Devices No.of Dishwashers / Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal ® Other 1 Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• `L/T' d�f/Y UtsttarceCo Ruai3taothem4manatsdMwmdxEeisGataalLaws Iha,�ea=utLiabi*h>st d=POILymdLidirEC #et Coc�crtss lagriWat YES ® NO Ihaw s hnitlsdvalidpoo fsamelDffieOffia- YES F NO ® Ifycuha%echo3wdYES,plemm e1ethetAxofwmagpbydrdcgthe INSURANCE � BOND ® OTHER ® (PleaeeSpecify) EViatim D& Eshm&d VaetedEkftical Wak$ WtrkiDStmt � hgxrdcnD&Raied Ratgh Final p Sigtedtrn r tie;ofP W.. FIRM NAME Licasee/f/�i�� �G L� U Sig..(L��/`®� licatseNo Address— ?�Iel OWNER'S INSURANCE WAIVER,Iama%NwethattheLica damnot theirstm=co►e�orissubsww asteg8adbyMmdxsttsCair", `� andirtn y mcntspen*Wpfico6mw 'Vies smw*wttat. ,}�J (Please check one) Owner ® Agent ! t((//"" Telephone No. PERMIT FEE$ k N l 0 COMMONWEAL H_OP MASSACHUSETTS DIVISION OF FlEiGisTkATION; Nei ' a."t ( SUES TH(5 LIC NSEi k I rY3 � y er ` A` , f 1itf COMMONEAL"�H OF ASSACH"USETTS 4-;'• k �## I ISSUIi 'THIS-UtENSE To E_ �