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HomeMy WebLinkAboutMiscellaneous - 56 JETWOOD STREET 4/30/2018 / 56 JETWOOD STREET U-1 210/011-0-003D-0001.0 Date.I.A ..... �........ GF NOprH,,yO TOWN OF NORTH ANDOVER s PERMIT FOR WIRING sSgCHUe�� This certifies that .............1"'1N �Q(? _i... ................................................................ has permission to perform �.. VP�6Ce,..,} , c �,o U r....... .....15 wiring in the building of .. .................................................... at ............` ... .. .......................................North Andover,Mass. Fee ..............Lic.No. .. h 2. t.................................................................................... ELECTRICAL INSPECTOR Check# Commonwealth of Massachusetts Official Use Only - r Department of Fire Services Permit No. I 0 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT INMK OR TYPE ALL.INFORMATION) Date: t�— -T- %,9- 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) j(o JJ� S�-_ Owner or Tenant SJ! Telephone No. ko 0- V63- 1 11,4 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of BuildingUtility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 2S, LIS t-.1k Comp�f the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: — "."...".." " Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW SecNo.u to be i 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 Telecommunications Wiring: No.of Devices or Equivalent " OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 4jo. (When required by municipal policy.) Work to Start: I I-S-Is Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: _ i .; LIC.NO.: 1415415 Licensee: �� � "J� L_ Signature LIC.NO.: pI S 42-9 (Ifapplicabk,enter. "exempt"irtthe license number lin Bus.Tel.No.: Address: _] . -k.�VI S�_ ,a-l ,.. , /J I+ 6744 Alt.Tel.No.: 1-01- 2-31- Sldj- *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. $ L� Signature Telephone No. ❑ 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 concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed IM Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: f Y Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed ❑' Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass 0 V Failed 0 Re-Inspection Required($.) ❑ ) /' Inspectors Comments: Inspectors Signature: Date: 11 - L DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com a � The Commonwealth of Massa.chusetts Department oflndustrialAccidents Y ---- I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization4ndividual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑Tama employer with employees(full and/or part-time).* 7. ❑New construction �2gI am'a sole proprietor or partnership and have no employees working for me in 8. Remodeling ancapacity. 'No workerscomp.insurance required.] Y P h' � P q ] t 9. ❑Demolition 3. I am a homeowner doing all work myself o workers'comp.insurance required.]❑ g Y (N P q ] 4.F1I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 F]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,'they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: v� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer unde a pains and penalties ofperjury that the information provided bov is true and correct. Signature. Date: le Phone#: 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-'contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatioii'policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 9 a COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS.-A REG :JOURNEYMAN ELECTRICIAN -RICHARD F DELVECCH 10y t { `w 1 7 DEERF.IELD ST ��ui SALEM NH 03079-1373 26659 E 07/31/16 36134 Chi 1 COMMONWEALTH OF MASSACHUSETTS Milivi BOARD OF ELl,CTR ICIAN.S I ISSUES THE FOLLOWING LICENSE AS A j REGISTERED MASTER, ELECTRICIAN , Z ALPINE ELECTRICAL SERVICE11 C RICHARD F DELVECCHIO 7 DEERE I EGD ST r; SALEM. NH 03079-1373 15929 A 07/31/i6 36133 i i Date. 9420 NORTH ?�.,� •�,;..'�,o� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING 'SSAOMUSE� �� This certifies that . . . . . . . . . . . . has permission to perform plumbing in the buildings . . ,-? e "7. . . . . . . . . . . . . . at . --��. . �'el`4 . . . . . .S . . . . . . . . ., Niorth An//dove , Mass. Fee..-*!61�'.Lic. No. 3/05'. . A 4r � . . . . . . . PLUMBING INSPECTOR Check # �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _._.. CITY d _ A, Wle MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAMEI1� P OWNER ADDRESS TEL ('T&9-JS�- MFAX TYPE OR OCCUPANCY TYPE COMMERCIAL F-1 EDUCATIONAL F-1 RESIDENTIALK PRINT CLEARLY NEW:E-1 RENOVATION: REPLACEMENT:54 PLANS SUBMITTED: YES N0[] 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/AREA DRAIN INTERCEPTOR INTERIOR x KITCHEN SINK LAVATORY ROOF DRAIN E SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL - WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER],.,----.,-- - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E] NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY E] BOND [] OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and rate to t best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia all P rovision e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ISTEVEN J.ADDARIO JR. LICENSE# 13106 IGNATURE MP EJ JP® CORPORATION[E]#3102 PARTNERSHIP[]#�� LLC Q#L__- COMPANY NAME I ADDARIO INC. ADDRESS 120 COOPER ST. CITY LYNN � I STATE MA ZIP 101905 1 TEL 339-440-8100 —� FAX 339-883-3059 CELL 781-760-5367 EMAIL DISPATCH ADDARIOS.COM ROUGH PLUMBING INSPECTION NOTES 'PHIS PAGE FOR INSPEC'rOR USE ONLY FINAL INSPECTION NOTES Yes No Never Contacted for Inspection THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date..,f-kk .... . .. . NORTH 3= 0 TOWN OF NORTH ANDOVER O � A • PERMIT FOR GAS INSTALLATION CH This certifies that . . / !1,4' 9!77 b. . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . in the buildings qf . ...5 U . . . . . . . . . . . . . . . . . . . . . 'c ' ti . . . . Nyrthndove ass. at ,� Feed:9? . Lic. No./.. qf, e ,0/1�4 . M67 '7 . . . GAS INSPECTOR Check# 8 '1 57 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS L �_ -- OWNER'S NAME GOWNER ADDRESS I TELcj$1,5. fr FAX TYPE OR OCCUPANCY TYPE COMMERCIAL L] EDUCATIONAL © RESIDENTIAL,® PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERS=x----, , y b i BOOSTER --� _ �__ CONVERSION BURNER COOK STOVE - .i. �-� (� _ �_ DIRECT VENT HEATER DRYERtl_ p( - FIREPLACE FRYOLATOR _. a _.._._.i.'-- ���? F ® 1 FURNACE I` ��_ _.._.-_� -- _ 3'--; GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNITt�'(_�._._ . [ : _ - - ,i_ I � - - OVEN ...... , POOL HEATER -_ p - Ir---- L A ROOM/SPACE HEATER ; a ' � ROOF TOP UNIT TEST — - UNIT HEATER t .j� �? — UNVENTED ROOM HEATER � "_ '` 4 WATER HEATER FF; _ :3_ '177) L_—..i OTHERI.._-�� -- — — 3 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [6 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [�j OTHER TYPE INDEMNITY E] BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurst o the be of my knowI d e and that all plumbing work and installations performed under the permit issued for this application will be in compliance with rtine on of th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Steven J.Addario Jr. I LICENSE#5131 SI TURE RF MP Q MGF© JP❑ JGF© LPGI❑ CORPORATION Q# 3102 PARTNERSHIPQ# LLC❑#� COMPANY NAME: Addario's Inc. ADDRESS 20 Cooper Street CITY I Lynn STATE MA ZIP 01905 - TEL 1339.440.8100 FAX 1339.883.3059 CELLI 781.760.5367 EMAIL dispatch@addarios.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Never Contacted For(Inspection FEE: $ PERMIT# PLAN REVIEW NOTES 9 0 U u Date. TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING . s SSA US This certifies that . . . . .�. '. .�. . . . . . . . r. . . . . . . . . .�: . . . . . . . . . . . has permission to perform plumbing in the buildings of at.-5& .214: ".U-' ?4. . TT- . . . ., North And r, Mass. Fe?c9:S:� .Lic. No..i�i � . . . . . ..(.•.A. . . PLUMBING INSPECTOR Check # MA'SSACHUSETTS UNIFORMiM. APPLICATICN FOR PE MIT TO b0 PLUMLING U Tint or Ty-pe) l r , /Y ��o�e--1r`-' Mass. Date �y�T� ���L Ferr•,it EuildinC 2Wq Mien 549 e 1 ' 04�pr�� �vner's t(anx .SEmfivyOylE Type c.Cri.cu,:zncy New C Sencvation C Rer{acement Flans SubrrP„e-:i: Yes[r_ No � I N .L < t'•' N � L'1 Q Y L•1 V 1 e St1--3SMT, =ASEMEN - I I I I ! I I ! I l l i l l l l I I I f1I Ill I I { ST FLOOR zyo FLOOR I l l l l l l l l l l l f l l l ( l l l l ! I f ! =RO FLOOR '7X L C C F 6711 FLOOR P. FLOOR sT? FLOOR Ins'ailiny- Ccr.z^y t:ar-P C`----1c e.�: Cer:'icte w l4907" C Farv�ershi� Evsiness Te!ephene 97�-gam- �y�8 ,p G Flan/C. Name of (censer Plum;---r or Gas Fr,-,e., INSURANCE' CCVEF AGE: i have a c_: ent ti- Insu•�nce pciicy er as sc=sartia! eq:rivote^.i wi is t nee:s t`e ret;uirerr�erts cf MGE_C z. lc2- Yes 2 No C It you have cneckc-:l ves• p:e_se indic_te .the type ecverz-ce by checking U'e a::roerate bex. A Habil y inrurznce pofiey ZII/Other type of indernnty 01 Eend OWNER'S INSUR=.NC- WANER: I an avrare that the lice-n,see does n& have the Insurance caverace re_uireC by C.`acter 142 of the Mass. General Laws, and that my signature on this perm ac;aictien waives this requirement. :z_:: cAgent C et"a data:!:21! L.1. (f2v!3:.•.n.:v�(cr entvvtl i.• 'e 2.:2:2 t:. k; r.it_C° 2n 'u.2:LGl C:' '- •^,�Mm vv! : u,-,ca:v.2'2'-:L'St:afrwr `2^ptl ''` it De L.C�T•p 2.^.�1�ltLt 2111 y_rinert previsions cf L1e State Gas C:ce anc Cac:er 142 cf Me C_ngri r e: L Pu: r cc .:a-S Flue. G;yrrarey,—a- fin COAfIMONWEALTH OF MASSACHUSt TS 4 Coto RO' # ttAPOR?ANT o dt�n�St_� REGISTERED AS A PLUMBING CORP destroyed, notify Y°ur 6 is lost or i�ensure, 1000 mash 9 ISSUES THE ABOVE LICENSE TO: license if this of ProfessMA 02118• I Division ed,notify your board i PAUL J R A F F I Boston, is ch en9rnaillnq of next P J R A F F I P L B & H T G INC M 9 ,� 7th Eloor, shownnumber. If your name°re ordraddress to Ins Proper our license Laws i 8 BRIDGE LN R 1 Always refer t°y of the General of correct namication• the provisions on your ' t�enewal App ect to and must not be I°aped W I L M I N G T O N I subj al rivmge: M A 018 8 7—2 6 72 � This license It- a person p Keep this license 44 as amended• other Pefso Y n 1 ` 1552 05/01/12 780838 or assign p d to nuIted la steda req b w. person -= • • , p 3T CONTROL# G 013 0 3 3 f COMMONWEALTH OF'MASSACHUSETT$ IMPORTANT NI ER��T r IQ TRS If this license is lost or destroyed, notify your Board at ti,a LICENSED.AS A MASTER PLUMBER t Division of Professional Licensure, 1000 Washington St.,. 7th Floor,Boston,MA 02118. ISSUES THE ABOVE-LICENSE TO: PAUL J RAFF1 If your name or address shown is changed, notify your board 1, of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license rnurnber 8 BRIDGE LN ' This license is subject to the provisions of the General L iws as amended.It is a personal privilege,and must not be loarr;d. WILMINGTON M A 01887-2672 ''� or assigned to any other person. Keep this license )n y_ur person or posted as required by law. 9898 05/01/12 780839 I } G, i �Qe 10170 Date..... .pf NO 8711 Ati TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 SA US -," This certifies that ......... .................................... ........................... has permission to perform .........z................ ........ ----------- _57e wiring in the building of.... ..... ....... ..... ........................ at..3..�.... .....::v.................... .North Andover,,M Fee.—K)........... Lic.No?�Zf,�.............. ......... ..... B CTRICAL INSPECTOR Check Commonwealth of Massachusetts •.. Official Use Only Department of Fire services Permit No. 10170 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(M C)527 00 WORK (PLEASE PRINTM1AW OR TYPE ALL.WORMATIO City or Town of: leIORTII ANDOVER TO the Paqtor Date: // re By this application the undersigned gives notice of his or her intention to perform the electrical wordtescribed below. Location(Street&Number) Owner or Tenant Owner's Address � ,t Telephone No. Is this permit in conjunctio with a building permit? Yes �� Purpose of Building y,, NO 1-� (Check Appropriate Box) Utility Authorization No. Existing Service '' Oct Amps l0 / Volts Overhead ❑ Undgrd� No.of Meters / New Service Amps / __Volts Overhead❑ Undgrd El No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: " Com letion of the followin table may be waived by the Inspector orWires. No.of Reeessed.Lumanah-es No.of Cell:Sus No.of p.(Paddle)Fans Transformers TORI No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming Pool Above ❑ I_ o, o mergency Ig g --, No.of Receptacle Outlets d, nd, ❑ Batte Units No.of Oil ARMS Burgers ��pt No.of Switches `�lY S No.'of Zones No.of Gas Burners No.of Detection and No,of Ranges Initiatin Devices . No.of Air Cond. °tam Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW - No.of Self Contained Totals: No.of Dishwashers Space/Area Heating KW Deteetion/Alertin Devices Local❑ Municipal No.of Dryers Connection 0 Other m3' Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or E uivalent Heaters KW No,of Data Wirin Signs Ballasts. evices or E nivalent No.of D No.Hydromassage Bathtubs No.of Motors TlWiring; Total HP Telecommunication OTHER: No.of Devices or E uivalent j Estimated Value of Electrical Work: Anach additional detail if desired, or as required by the Inspector of Wires. Y/ Work to Start: (When required by municipal policy.) 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 lieensee,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 th FIRM NAME: e information on this application is true and complete. Licensee: p S S, r LIC.NO.: t, de � Signature (If applicable,enter empt"in the li� number 1i ) LIC.NO.: { Address: Gi 'e„ ti T4 6 Bus.Tel.No. *Per M.G.L c. 147,s.57-61,security work requires Departmm ' t of public Safety S License: Alt.Tel.N . OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have' Lic. Owner/Agent the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) Elowner ❑owner's agent. Signature Telephone No. PERMIT FEE: C .S3 1-- 4- ELECTRICAL PERART NO. .� ELECTRICAL INSPECTOR-DO G SCMALL TION PORT: p 1.ROUMwspECT1Passed Failed—[ ] nrequired($50.00)-[ ]Inspect (Inspectors'Signature-no initials) Date 2.FINALr,INSPECTION; Passed—[ ] Failed—f ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) , Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00) Inspectors' comments: (Inspectors'Signature-.no initials) ' Date 4.INSPECTION—SERVICE: - DATE CALLED NATIONAL GRIL: NAlV E: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed— [ ] Failed-.f ] Re-inspection required($50.00) Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE PIGLET) OUT AND LEFT ON SITE IF TRE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TORE CHARGED. The Commonwealth of Massachusetts Department ofrndustyial Accidents Office ofInvestigations 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): J69 pt-d Address: ��- City/State/Zip: C/(/o Gtr z f Phone#: /" f S73- Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4, [7. pe of project(required): ❑ I am a general contractor and I oyees(full and/orpart-time).* have hired the sub-contractors ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. �[]Remodeling ship and have no employees These subcontractors have working for me in any capacity. workers' comp.insurance. . Demolition [No workers'comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.[]Plumbing repairs or additions Myself [No workers'comp. C. 152, §1(4),and we have no insurance required.] t employees. [No iiiorkers' 12.❑Reof repairs comp.insurance required.] 13.❑ Other "A=Y applicant that checks Sex#1 must also rn out the section besot•,sheep i -:. comporn policy o_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ontras must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workerscompensa information. tion insurance for my employees. Below is the policy and job site 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der JAepains nd enalties of per jury that the information provided above is true and correct: Si ature: Date: l/ Phone#: 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6. Other Contact Person: Phone#• n ' STr S 9:f � k� sCECTRIOANS , As A °U ^ YaN � ccr� s �`- L NSE TO. IF # 1 PSI P, P GRAM' D.L IiJI' JR' ' 1'• T7 1 S KMER, WAKEFIELD t +; R02 ?"U a ttaa WashingtonJ,e ard 't •k3oston Of to or address sho•vn is chan tiRe'le rE r)arhe Or add�Ug3t0 ir,S�Fe �dn0,yia. YYQ,6E bThis ifQef e s�+G,.V, tAly, iei r to Y�reiicen a nLmoamends^! tt s p � a r'a �:ryns of the G erad Lr. assign,d(c �t nJ pnuiiege andtza sf tPerson PDsted e r F�emo n, Keep th4censn'oru;red by iatu. Location r '' 1 _ NO. Date ,.ORTFTOWN OF NORTH ANDOVER Icate-of.:Occupancy $ �. /FM � tTn$ Permit Fee $ * . ._�__. AN ""° � Foundation Permit Fee $ s�CHust ,Y ., Other.Permit Fee $ A1 11C tion Fee $ L Wate,Connestion Fee $ TOTAL $ Building Inspector y Div. Public Works -11 PF,R]%tIT,TTO. _ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP IIAT�/- 'BOOK PAGE _ O 1306 3 i /7S_ ZONE SUB DIV. LOT NO. DMCI PURPOSE OF BUILDING ��e G�auw OWNER'S NAM -�I� v�wood NO. OF STORIES SIZE OWNER'S ADDR SS 1 I�_74-5 v C•"/J alaad 5 i+v�O4w�fV BASEMENT OR SLAB ARCHITECT'S NAME C! SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME + Aryl SPAN DISTANCE TO NEAREST BUILDING %14At DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT 1.,4-x ;Z7 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 3(!VV PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH IGNA JARE OF OWNER OR AUTHORIZED AGENT F E E 0 y PERMIT GRANTED OWNER TEL.#1a9.S'9-;2k,/ PLANNING BOARD CONTR.TEL.# 19 CONTR.LIC.# BOARD OF SELECTMEN �UILDINI INSPECTOR 4 I BUILDING RECORD 1 \ QCCUPANCY 12 SINGLE 'L STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANC OM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCH S. GA - APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION $ INTERIOR FINISH f,-`;�cl0 CONCRETE J i V aJ CONCRETE BL K. PINE B l 2 I, _ •— f.�—__.._t �_ ^T f, BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT I I � AREA FULL FIN. B MJ AREA a' 'L `/t '/ FIN. ATTIC AREA NO B M FIRE PLACES HEAD ROOM _ MODERN KITCHEN _ 10 -7777 4 WALLS 19 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ 1 WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE 1 STUCCO ON MASONRY STUCCO ON FRAME t } BRICK N MASONRY - ATTIC STIRS. & FLOOR _ BRICK ON FRAME I CONC. OR CINDER BILK. l STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ A­UAT NONE {. 5 ROOF 10 PLUMBING t GABLE I MIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) / + FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY r WOOD SHINGES KITCHEN SINK ` �. `C•��� SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR 1 V TILE DAD O, 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. l,\\ TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING \� RADIANT H'T'G UNIT HEATERS O. O ROO l GAS OIL B'M' 2ndI E L Edgit Ist d XV gbov fX V � L 4- o 0 N ews-r I m i JTop �T �r .{/E.rEeY CE.fT/,ffY 727 T-E' Iml. Q/ Rz 4AI 7b T//6 C.O.Ve XWT CgC, 7TCO O.t/ rile Lor qS-ilA ww wwo Tiwr/r o4ws "Word e"W M'/TiV T•t�E- -, ;cJ r Q ANgo✓E,2 20.v/, a ,CE6v[-4rA:ws. �ACbI.CO/.115 SfT6IC.t' a 1 COTU.vES. I f!/.lTif�C.0 GE.PT/fY T .f!' ✓.rlr /S�1/OT �'"/�'7 toc.�►rcO /.✓ rA'E fE O A.PEA.� O,�/�/rj(/ fO.P/ 12 • JiZ//S PC.�N F+7,� .Ma�7if4GE Avt/'t7SES-.t�oT FO.� /� � V���y' oOvvoty�r��.rN,✓.+ria✓. so�.vo.ory�ivF,or,�- A/E.P.�/�G/Gt'E.V�.cvEE.P�.v6 JE.P/�/C'crS .ITiO•v rA.t'E.y f.�.y EX/.tr/.�/C .�EL'7�tOS. G6 /�-4•P,(� .ST.rEET /j%I-f jQ"� ANOOYE�, �1AS.Swl.��/SETTS O/B/O NORTH Town of dover o �o�H dover, Mass., "Je 0 19 f� ADRATED P"' \ �� BOARD.OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT) ... l l!Ii. .l11 ....��+ '+�/r i� Foundation DING INSPECTOR ��� BUILDING x has permission to erect...Aws.I............... buildings on Cog�.��....�r�►!f!�.r.e.�..., ..�...••• Rough to be occupied as.�j.*..V..L....C�0.o-wog...... �.... ....elf AS...Me�� ......... 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough 'A.d1k .... -1, Y AFM /? Service BUILDING INSP CTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL3�a y CONSERVATION FINAL street No. Smoke Det. QMAIPP /IAiATFR FINAI <--9Y DRIVEWAY ENTRY PERMIT