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HomeMy WebLinkAboutMiscellaneous - 57 HEWITT AVENUE 4/30/2018 57 HEWITT AVENUE 210/060-C-0049-0000-0 1 I i March 11, 2015 ANDOVER BUILDING COMMISSIONER ANDOVER CITY HALL ANDOVER, MA 01810 Claim Number: 033546734 Policy Number: 82759400003 Company Name: Arbella Mutual Insurance Company Date of Loss: 02/15/2015 Insured: NANCY CHASE Property Location: 57 HEWITT AVE NORTH ANDOVER, MA 01845 To whom it may concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Laura Barber CC: City/Town Fire Dept., City/Town Health Dept. •BrightClaim, LLC. PO Box 502048 Atlanta, GA 30350 • Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ..�► N G� . . . . . . . . . . . . This certifies that . . . . . . . has permission for gas installation . . . �„/.�,.,. . . . . . . . . . . . . . . . !► in the buildings of. . . .�/tr! . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . J5 A42 . , . . . , North Andover, Mass. Feej,�.''A . . . Lic. No.wl . . . . "! . . . . . kvt. . . . . GAS INSPECTOR Check#ml� 8451 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _Wof* .__, Rn�Ov�SL _ II MA DATE ll-a0-��-PERMIT# s� JOBSITEADDRESS7 {Ew1' �aL� _ .P..�_ OWNER'S NAME OWNER ADDRESS ? _ _ TEL� ��" FAX TYPE OR OCCUPANCY TYPE COM ERCIAL� EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:[Q RENOVATION: __J REPLACEMENT: .01 PLANS SUBMITTED: YES dNo Q APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ! I BOOSTER CONVERSION BURNER COOK STOVE �­J DIRECT VENT HEATER i __r f Ir_.�J _ - �( , ]----A _ I DRYER FIREPLACE FRYOLATOR FURNACE - - - GENERATOR f . _ J _ _I . I _ I _ - _I GRILLE �1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNITI OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER --_ I_ _.�1� J'�. ._�. �I • - .. .{ ___ 1.� ��._- �—( .-� L_ .. .. �= f OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES .._J 40 �I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND E] 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 Q AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w'th allpertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME L �&ww _ _� �LICENSE#L!-q7SIGNATURE MP ZMGF[� JP D JGF F-1LPGI _.._I CORPORATION 0# PARTNERSHIP 0#=LLC D# COMPANY NAME: NM_!�IN__P ADDRESS[a �>r _ CITY ►,P•+' � �INQ� STATE MA__ ZIPTEL FAX gc W __��7 CELL_ I EMAIL „ j1f1�"MQ ��dA�T' i 'f- f 3 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ AAd� FEE: $ PERMIT# PLAN REVIEW NOTES .'r t. .w a a � a ' S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg><bly Name (Business/Organization/Individual):_ �W j✓ `� � Address: Y. City/State/Zip:_ (nq Phone #: �i`y��D7� zw Are you an employer?Check the appropriate box: 1 El am of project(required): am a employer with- 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ew construction 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7• LVJRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10-ElElectricalrepairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] 1 employees. [No workers' comp.insurance required.] 13.0 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 reformation. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: -ob Site Address: City/State/Zip: kttach 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 ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Tup 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. do hereby certify und4fihqand penalties of perjury that the information provided above is true and correct. i nature: q Date: hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �1+ 7 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 andvwho 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 air,einp16yer." MGL chapter 152, §25C(6)also states thai"every siateor.local licensing agency shall'withhold thelssuan&' or, renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a 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 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 WWW.,mass.gov/dia � I I COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER aw; ISSUES THE,A$OVE LICENSE TO: SHAWN ` INMAN 2 BRADLEY RD . NORTH READING- MA 0187`►�--1Z•18� 1 07b4: 0�/01/14 164583- 1 • 1 N° 9673 Date.!1 ? 12 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . N, . . . . . . . . . . . . . . . has permission to perform .f w , �1 r.It_.�.P? F. . plumbing in the uildings of . . . . `'. . . . . . . . . . . . . . . . .. . . . . at. . . . �.`---�'. P,-1 �' . Q�. . , N rth Andover, Mass. Fee"7 15b . .Lic. No.f. 104 . . . . �.I.�. . . . PLUMBING INSPECTO Check # C7 2&_ -K WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (L MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Y CITY —I MA DATE i'a.A 11 PERMIT# /61 J08SITEADDRESS �7 r� { ViE OWNER'S NAME OWNER ADDRESS P TEL 1 _ FAX -- { TYPE OR OCCUPANCY TYPE COMM CIAL® EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: 0{ RENOVATION: 1 REPLACEMENT:Q PLANS SUBMITTED: YES JNO© FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ___._J CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM _..._-_._1 _..___.._1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM € DISHWASHER DRINKING FOUNTAIN .__.......J ..... .-_._.___( --_-.__J ___._i _...._- FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR) { KITCHEN SINKi _._.__l ._.______1 ____( _____[ _.__.__.� ___ ._6 ___.__._{ —J= LAVATORY --------_-( ROOF DRAIN _ .__€ 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 { NO 0 IF YOU CHECKED YES,PLEASE INDICATE T TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ! OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT _I g hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia a with I Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMENv I LICENSE# .JO SIGNATURE MP[ JP i CORPORATION n# j PARTNERSHIP 0# _ I LLC COMPANY NAME _ M�NNVQ' ; ADDRESS CITY !STATE ZIP L01 6 —� TEL FAX 07 pip CELL[V�EMAIL ` .6 Gpley -- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES �,lu !'� Pr) Yes No 7 J-tel i THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ i FEE: $ PERMIT# i PLAN REVIEW NOTES �� rs N, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): VV l Address: � j , City/State/Zip: t AINY Phone#: Z Are you an employer?Check the appropriate box: 1.ElI am a employer with 4. El am a general contractor and I Type of project(required): el maployees(full ad/or part-time).* have hired the sub-contractors 6' rn construction 2. sole proprietor or partner- listed on the attached sheet. 1 7. odeling 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. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#I 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. 1Contractors 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 thepolicy and job site Wformation. Insurance Company Name: ?olicy#or Self-ins.Lie.#: Expiration Date: ob Site Address: City/State/Zip: kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ,f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do Hereby certify under th p ins and penalties of perjury that the information f provided above is true and correct Date: hone ��[� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e 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 dwellinghouse having not more than three apartments-.and who resides therein or the occupant g p o pa t 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 beur s e 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia fJ : COMMONWEALTH OFM ASSACHUSETTS lip PLUMBERS AND GASFITTERS LICENSED ASA MASTER PLUMBER ` ISSUES THE,A86VE LICENSE TO: r SHAWN INMAN 2 BRADLEY RD h t l ..t It NORTH READING' MA 0187zi=-IZZs 10764: 05/01/14 164.583 . - . • I TOWN OF NORTH ANDOVER A PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . e.l--C. . . . . . . wiring in the building of . .A-k,,. =T. . .,y/�� . . . . . . . . . . . . . . . at .T�- —�- -L. .Ay,/., # . . . . . . . . . . . . . . . . . . North Andover, M s. Fee . Lic. No. . . 4wpf. . . . .�. . ELECTRICAL INSPECT 'R Check# //� 1 °1232 Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527C R 1 0 (PLEASE PRINT W INK OR TYPE ALL.INFORMATION) Date: /, City or Town of: NORTH ANDOVER To the lnsp ctor Wares: By this application the undersigned gives notice of his or her intention toperform the electrical work described below. Location(Street&Number 2,�7 Owner or Tenant rj Telephone No. Owner's Address q"7 7 69 7 1 u� Is this permit in conjunctio with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building O 0 C�/`' Utility Authorization No. - Existing Service/a I? Amps `�Q /;y� 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: Completion of 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 No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ..................................................... 14 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW 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 El ctric Work: (When required by municipal policy.) Work to S -tart: / /�, 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) X certify,under n r the a' s and enalties o er'u that the in or tali fy, on on this application is true and com fete. P P P L rJ' .f PP P FIRM NAME: Y J ✓ C ? / V /� 6 G' •� - Ti"i c��,IC.NO.: Licensee: Signatur LTC.NO.: (If applicable,�zte,�`ex�p��the license nzzmber 1'ne.) Bus.Tel.No.• � cam' s�7 *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: $ 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 G^` 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 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Y Date: FINAL INSPECTION: Pas ' Failed Re-Inspection Required($.) ElInspe ors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 40714 Tj41e � G/X-Z,Phone#: I Are ypu 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ? E]Remodeling 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. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' comp.insurance required.] 1311 Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site zformation. isurance Company Name: S,J, � olicy#or Self-ins.Lic.#: f foe ✓0,00 C) Expiration Date: ✓ �� 3b Site Address: 7 �/ �f �i"�t�G v/o City/State/Zip: !tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Y ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a I�Ie 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certify a the and pe s erjury that the information provided above is true and correct. i nature: Date: zone 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#• t� 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(LLQ 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 of 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 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1.877-MASSAFE .evised 5-26-05 Fax#617-727-7749 www,mass.gov/dia Date. /.? ./ NORTh °E 3� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACIIUSEtA This certifies that . . . �!tiL. . . . !. . . . . . . . . . . . . . . . . has permission for gas installation . . . . f7/ . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .5. 2. . Tr. . . North Andover, Mass. Fee. .)-. . . . Lic. No.. .5. SA ?. . . . . . . . . .t .. . . . . . . •GAS INSPECTOR Check# 5 2 Y A MASSACHUSEM LIP-IFORXIAPPUCATON FOR PERNMIrTODOGAS F1rDNG (Type or print) Date Q NORTH ANDOVER,MASSACHUSETTS '— Building Locations S�fT, ylTr Permit# Amount$ a0 Owner's Name well Q,f.41 New rl Renovation n Replacement Plans Submitted U o U H Oz H w o a a a o SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR . 4TH. FLOOR e 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR ( STH . FLOOR (Print or type) C&eck Certificate Installing Company Name iY�D :L /�GLf�/.�/t/�+6Jy it/�r Q>`�it',1 2? ? Corp.Lj rp. Address Partner.. 4=40"4 � 8 13usrness Te ep one Hrm/Co. Name of Licensed Plumber or Gas Fitter z9&Ay— a Ii iSURANCE COVERAGE Check one;-,' I have a current liability Insurance policy or it's substantial equivalent. Yes No o If you have checked Yes,please i Cate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the :Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 0 hereby certify that a]I of the details and information I have submitted(or entered)in above application are We and accurate to the, best of mN knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with.all pertinent provisions of the Massachusetts ,ate Gas Codc a Chaptu-,14*11 the General Laws. By: natu of Licensed Plumber Or Gas Fitter Title LUPlumber City,Town Gas Fittert>V c`nse Number Master .- PPROVED(OFFICE USE 0,NLY) Journeyman The Contnromveattli ofMassaclutsetts --- Department of IndustrialAecidents° `!I Office of Investigations 600 Washington Street . — � Boston,MA 02111 avtvsvraassgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibIy Name(Business/Organization/Individual}:. Jf/���/� Address: 0%06;60A/ City/State/Zip:g j ffio Phone M Are ypu an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with 4• ❑ 1 on a general contractor and I employees(fiiIl and/or part-time). have fired the sub-contractors 6. ❑New construction 2.[] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees -- These sub-contractors have g, (�Demolition working for me in any capacity. employees and have workers' � �. 19. E]Building addition [Na workers'.comp:insurance comp.insurance. required.] 5. [] We are a corporation and its 1 O. lectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself.No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 15Z§1(4),and we have no 13-El Other 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 wort:and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached art 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 aur an eurploJ►er t/rat is providing workers'compensation insrrrattce for my employees. Below is t/repolicy and job site information. Insurance Company Name:S 4fld E A� d�� �4 Policy#or Self-ins.Lie.M td@ 79irj� Expiration Date:�d Job Site Address: J~���f�—�l�i� 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 u er tlic pains acrd penal ies of perjury drat the information provided above is tare and correct. Sign lure: Dom- Dae: Phone#: — 3 Official use only. Do not write in this area,to be conipid'ted by ch),or teivn 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#• r Information' and Instructions Massachusetts General Laws chapter 153 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as".:.every person m the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,as 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. Howeverthe es theret n or the occupant of the td P owner of a dwelling house having not more than three apartments and who res i dwelling house of another who employs persons to do maintenance,constriction 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 tooperate 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." i 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 till 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 i.f 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 appro nate 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. re to fill in the ermittlicense number which will be used as a reference number. In addition,an applicant Please be sure p that must submit multiple permittlicense 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 le for future permitsor licenses.,.A new affidavit must be filled out each affidavit is on file p t o roof that a valid . applicant s p 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 oflnvestigations would like to thank you-in advance for your cooperation and should you have--any questions, please do not hesitate to give us a call: The Department's address,,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,'MA 02111 Tel..# 617-727-4900 ext 406 or 1-$77-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia $ 8U4 Date. � °f<"•0'R°T�1►p TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ; � _ • ; • p ,SSACsw This certifies that . . ((4 . . . .. . . . . . . . . . . . . . . . c' � � lL, . has permission to perform . . . . . .T. . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .1� ..J4 . . . . . . . . . . . . . . . . . . . . . 1 at . . . North Andover, Mass. Fee.3o. Lic. No. /.`:}:-3. . . . . . . . ... �.��11� . . . . . . . . PLUMBING INSPECTOR Check # S Z li b , MASSACHUSETTS UNjEFORM APPLICATION FOR PERMIT TO DO PLUN13ING (Type or print) NORTH ANDOVER,MASSACHUSETTS 0 Date Building Location :577 � Owners Name A&YU Permit It Amount. ' We of Occupancy ' TYP BC� New Renovation Replacement Plans Submitted Yes No � � FIXTURES rn HV rCr � a w W a H a Msec 9 M aaR 3M1~WR 447 1 - 4ISMOM 5MHDM 61HH0M 7MFLaR SI HUR (Printortype) Checkone: Certificate Installing Company Name Andover Plumbing & Heating Co. , Inc. Corp. 2122 Address 20 Aegean Dr. Unit 410 0 Partner. Methuen, Ma. 01844 Business Telephone (47A) AS 83R3 Firm/Co. Name oflicensedPlumber. George LaRose Insurance Coverage: Indicatgth type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity. El Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not hale any one of the above three insurance Signature _ , Owner Agent El 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 lmowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus State Plumbin ode 142 of the General Laws. By: bigna reomicensearlumoer Type ofPlumbingLicense 9983 Title cense er Master EEfJourneyman I.City]TO"M PPROVED(omcE USE ONLY _ _ - a The Commonwealth of Massachusetts Department of Industrial Accidents- Office ofinvestigations 600 Washington Street Boston,MA 02111 wwmmass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual}: Address: City/State/Zi : Phone#: -nr— Are ypu an employer?Check the appropriate box: Type of project(required): 1.91 am a employer with 4• ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• [�New construction 2.(] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp: insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ lectrical repairs or additions 3.1711 am a homeowner doing all work officers have exercised their l I.Viumbing repairsor additions , myself.[No workers right of exemption per MGL comp. g P P 12.[:]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[:1 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 a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contiactors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing tvorkers'compensation insurance for my employees. Beloly is the policy and job she information. Insurance Company Name:3"411 Policy#or Self-ins.tic.Mule- Expiration Date: /,� 076 Job Site Address: -wjc• City/State/Zip:_/yD��.r�//�-. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure covetage.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 forwardedto the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify and r dy pains an4 penaltieesss pfperjury that the information provided above is trite and correct. Sienature: Date: o?q /D Phone#: 6 — Official use only. Do not write in this area,to be completed by cihr or town official City or Town- J Permit/Lkense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: . A 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." partnership,association,corporation or other legal.ehtity,or any two or more An enepinyer•is defined as"an individual,p p, - of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employee,.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 on_employer:' MGL chapter 152,.§25C(6)also.states that"every state or local licensing agency shall withhold the issuance or renewal'ora 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 Pleasef ll out the workers' compensation affidavit completely,by checking the boxes that apply to your'sitdation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)witli 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 linea 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 permittlicense 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..:Anew 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 600 Washington Street Boston,MA 02111 Tel.:#617-727=4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 _._.. ..Revised 4-24-07 www.mass.gov/dia OMASSACHUSE77S UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING —1 (Flint a Typal NORTH ANDOVER, Masa. Data Budding o Perm* # 02 13-7 7 t.OGtIOn Ownervi 's ' Name DB ; — x/21 New 0 Renovation Q Replacement (r/ Plans Submitted: Yes Q No Q PIxTURE6 ......._ 9 d s111�- w es o = 31 o re M s = • F� U N M �_ < w16 = a s44 0 « s N 0 s N t N O IS siU 19t t ti 11-- o 46 K M V to W3• H O M �' s O p eeIs s N ~ p V r 1 w o o s j s w i a a < i a i 0 sua—tsMT, aAaaMaNT 1ST FLOOR 1NDFLOOR SAO FLOOR 4THFLOOR ITH FLOOR Iml FLOOR. PTHFLOOR 9TH FLOOR - r Check one: Certificate Installing Company Name/f/��� /•��/��i��.�/� �/G ?,tt" . 0/corp- Add r e s a dCorF,Address ❑Partnership �w ❑Firm/Co. Business Telephone(2z,?i Name of licensed Plumber INSURANCE COVERAGE: ecK���e' 1 have a current liability Insurance policy or Its substantW equ"enL Yes No ❑ It you have checked yam, please Indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity, ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the ilcensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Check one: SignOwner 0 Agent ❑ slurs o Owner a Owner s ent 1 hereby certify that all of the delaAs end Information I have submitted for entered)in above appikatbn are true and scoxate to the best of my knowledge and that all plumbing wak and installations performed under the pemN Issued Im We application m1 be In oompflancs with aA pertinent provisions of-(Massachusetts State Plumbing Code and Chapter 112 of the lswa. This urs ow cense Plumber t- Clty/Town APR License Number .� - - Type of Plumbing Lkense:Master 111--,Mf'f1C1VED (OFFICE USE ONLY) Journeyman ❑ WORTH Of a ,ti0 cr �• TOWN OF NORTH ANDOVER t - PERMIT FOR GAS INSTALLATION SACHUSEj This certifies that . . �f^. .` . .� . . . . . �� F. has permission for gas installation !.'. . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . .��. :/. P. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . .. ?. . . . . . . . . . . . . ., North Andover, Mass. Fee. . . . . . . Lic. No..7.s!. . . . . . . . ,. >GAS INSPECTOR• Check# C' 4475 MASSACHUSETTS UNHURM APPUCATON FOR PERMIT TO DO GAS FITHNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations 5-1 R L'u )i 4fA_ A Qe_• Permit"# 'Y Y Amount$ Owner's Name �"L New❑ Renovation ❑ Replacement Plans Submitted ❑ w 0 � � a c O w o a C p 1W Gw m � � � x � � � � w w � a v, a SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR IR D. FLOOR 4`r H. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) C one: Certificate Installing Company Name AnAooee V1,021. A Corp. 2122 Address L ❑ Partner. Business Telephone8313 ❑ Firm/Co. Name of Licensed Plumber or Gas FitterC�� o�S� INSURANCE COVERAGE Check Me- I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked es,please'Indicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement. Check one. Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 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 Massachusetts State Gas C and Chapter 142 of the General Laws. By. Signature officer9gPlumber Or Gas Fitter Title d Plumber q City/Town ❑ Gas Fitter License NumDer Master APPROVED(OFFICE USE ONLY) ❑ Journeyman 01 ".0 R':14, TOWN OF NORTH ANDOVER • PERMIT FOR PLUMBING 41 SA us This certifies that . . . . . . . . . . . . . . has permission to perform . . . ?f�.`�. T . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . �. '`1.�^. . . . . . . . . . . . . . . . . . . . at . . . . .? . . .&- u . . .T. . . . . . . . . . . . . . .. North Andover, Mass. r Fee. . .v. . . . .Lic. No. ` `? . ?. . . . . . .9w ; . . /,, -.�" . .�. . . . . . . . UMBING INSPECTOR Check # `?1 7 575 ) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date D3 Building Location 571 HeAA,,�t t Aye,, Owners Name N\= u Permit# Type of Occupancy Amount New ri Renovation M Replacement Plans Submitted Yes ❑ No ❑ FIXTURES w a w x x � SUMME &ASENfNr BE FUXR 210 HIM 3MHJOOR 4M Hi" 5M H" 6THHfM — MHOM $IH HIM (Print or type) , Chec one: Certificate Installing Company Name �,� Qr �� ,. . Corp. 2122. Address 20 %1eDP""\ Partner. ,/Yl P�-1n hma /Y1ya c'S 1 R1I t-1 Business Te ep one (A-1Al UkS- FZ383 Finr/Co. Name of Licensed Plumber: Cj�Ie_ L0...9k2Se Insurance Coveraee: Indicate&type o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity E 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 Massachusetts State umbing Cod d C pte 42 of the General Laws. - �� BY Signature oT License(Tyujiluer Title Type of Plumbing License City/Town lcense lNumoer Master Journeyman El(OFFICE USE ONLY Z Date. .4/ . /1.-G7 C . . . . . . . 2877 °'•NOT N'"° TOWN OF NORTH ANDOVER 3? ; e o� PERMIT FOR PLUMBING '•,AI. ,SSACMUS� This certifies that �. -.{'.'?. . . .��d. ` has permission to perform . . J/ L-4— 7— plumbing plumbing in the buildings of . . . at. . .S. .�. . E�-�- orth Andover, Mass. Fee J�.' . . .Lic. No. `? 3 . . . . . . PLUMBING INS ECTOR i 04/16/% 13:28 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File r _ Location J 'r No. r Date ,40RTh TOWN OF NORTH ANDOVER pf t"90 1, 3? � • pL - S Certificate of Occupancy $ + ` Building/Frame Permit Fee $ ,S?AC NUSEt 'Koundation Permit Fee Other Permit Fee $ Sewer Connection Fee $ Uo�R yr Water Connection Fee $ _TOTAL $ J Building Inspector Div. Public Works PER311T NO. J APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK PAGE ZONE I SUB DIV. LOT NO. 7 1-1 ► LOCATION PURPOSE OF BUILDING 790V IDE HANDICAP ACCESS OWNER'S NAME ANANCY +T, $GQT �RN NO. OF STORIES ' SIZE ] OWNER'S ADDRESS 'JI c 1 BASEMENT OR SLAB 5'1 HEu7lTT ME ARCHITECT'S NAME MICgAgL j11OR51 SIZE OF FLOOR TIMBERS 1ST ,7 yg 2ND 3RD BUILDER'S NAME �'I�T v SPAN J / a ;7�Ia DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET / �/Ci QS POSTS DISTANCE FROM LOT LINES—SIIDES .T/ REAR GIRDERS AREA OF LOT /�_`'QOO V+ FRONTAGEz/ HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING ?"' 'O 6 &eX / P e IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION Cd(Ajql4 L4 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y. IC 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 AND COST SEE BOTH SIDES EST. BLDG. CO8T PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS t 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 76--m= �, BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT � OWNER TEL.9SOS-681-10'1 ' FEE CONTR.TEL. CONTR.LIC.# _.-- PLANNING BOARD PERMIT GRANTED .ff 19 _ BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD • 1 OCCUPANCY 12 SINGLE FAMILY S'ORIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS C 'r RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTEREll , _ DRY VJALL 34- GN F-IN UNFIN 3 BASEMENT AREA FULL FIN. B'M'TAREA _ V. '/t '/ ` FIN. ATTIC AREA _ N_O B M \ FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I g FLOORS CLAPBOARDS �K B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ------111_ ASPHALT SIDING HARD%!d'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY \ ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME- SUPERIOR ADEQUATE I-i NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE ' FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAL TRIC Ist^T 13rd I NOCHEATING f Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE 11 (2• a2 JOB .LOCATION Number Street Address Section of town :'HOMEOWNER" Q Rq- � 42 Name Home Phone Work Phone PRESENT MAILING ADDRESS} 0 lRys City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use acid/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , . that he/she shall be responsible for all such work performed under the ..building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" •certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . -HOMEOWNER' S SIGNATURE . APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger, will be required to comply with State Building Code Section 127 .0, Construction Control . 22905A j PLAN OF LAND IN NORTH ANDOVER # Ralph B. Brasseur, C.E. Oetobor 23, 1950 I }0•cib Irgistry ki5trirt FGR REGI STRAT�IO m 10- 0 CLOCF. ---1---m —,.EKT;FiCA,TE N0._� 01 3�— IN RFGISTRA"CN BOC'KDle PAGE.J�— I I a � i i _ J t Ora Be/al7yer SVdneq 51n/lh � ° =160.01- -5 /60.0/ et a% d.A. N 63° 16• 30",C-+- dh •;20.00'i' 140.01 C Qs •- W C •, r O { rn N ek ti C C 2 � •. O I � , O 20.00 I 140.00 607.81 l.P. . 3 63° 00" 00" W I d.h.in SB. se =/60.00 ar :=0. P0 /CHEWIrT AVE.eet wia i • x,20.00.. .a_ �(a.00,.a 40.00 n►` 111 co� Z V I � i Copy ofpart of plan flkd in — LAND R£G/STRAT/ON OFF/CE APRIL ?/9,3/ i. Scale of this plan 40 feet to an inch W.T Fairclough,Engineer for Court✓ 1 ESSEX NORTH nGISTRY OF DEEDS l LAWRENCE, MASS. � k` A TRUE COPY: ATTE 'REGISTER OF DEEDS NaRT�y Town of 0 No. 534 tf � �--�- gyp` o�J C LA dover, Mass., /& AcoDRATED PPa\��� '9S H BOARD OF HEALTH s Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.&OW 1. 106.06000f-r �......�. �...�� �.................................. Fou ndation has permission to .................. buildings on ...� ...... Rough to be occupied as........ ramimne-je. 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 .. ......... Service BUILDING INSPECTOR f Final Occupancy Permit Required to-Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough l No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL ( CONSERVATION -FINAL street No. L Smoke Det. QCIAMP /IAIAT�R FINAI �a7 DRIVEWAY ENTRY PERMIT 2. yir," y.. "�'" - �'d �r ;i:'y..ij`. ;. ..'1�i.....k- .,i .r!';);, fi}'. ��tR <.-.. K .rt. 'I. ':;`.<..i g 24,r,. ;f,:�,Fot er ` _ :�; .< ✓ ->r' :'''ta— r�•7r �` 5�3�- "°' ei *=.a« r r s+`a •t .gt fi>'�J�-}�c� �K, ji: C4 +• t .. .wr /�7�\.• ^ :�. y-. '4' i T a,' l-> t:,: -k„ 1 t 1 r"I C ° _< IIki Titt ........ ...... .....O.A If 7 ItI2*.,�,Z. TIICL it.IIco-ENGINEERS I �✓'�YJti :s _ Y+,�1 +. 77 I-PIN OoY��'..�rs�€: �+�..��•_�-:_' .. . '. oCL r 1 / `r� �: 'I°��i S-;y e't`i ;;= j:AlIcc i �KtA! f�Qt! I �; oil pa u to L t" "Iu ° { '+ v- v l SAT{� .-�_. 4EIL Ar SS­ PAti ` a EaitpL�, Wt7H-.:t,C :.STkT� T4{05E^..� jRC -49 ANSlip Act F Ir '4'1'li'xa.£1�tSfiFw gy �q,A,pr � ^0Q. -LI ... (� r 6174 .e•+, i + 4 -+�;' '-:.Si�+,�..:t��• off.:�i�S'.^� At���T.:T�Si�'� tea: pt.a -_,`*44 �� �E. , :C'oDt C:T C StJb .� 1 .5 .: 'G.PYi��t•". 1°�S/Vr1�+ ,� 1 TIS: t t-r .�_ A _ -4 - �. 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Dv 1_4 N.�,.T4-i i 1 ������: 1 T'si't A1,.! �� .F�.�TC�� :, ./'..r,.�_�`---- -kms' T14' R'sC_+_4T -ro C jAr-�c'w�4 At\J V .l—r'1i-�•� (' ,(`l `4. 7E��A���'� ��le.r=�C��� 1r.` ...aw._....;...�- ,-,t, <z..- ..,.,_ ,+,..»v.�� w _ :�v�.. �,�:a.�q•...+.+.,• t " 'nc�sga _�_w. iyst•.wN �+ .�" -9y>.:-ie:w.4•i':sl. ,• ,` L�._��R.>,l^ - _ �+4•�-.•.e.n.�w:-e ..'"�� j � orf _iF `..... -•--.--' •_ t� � �' -_.'_� .( � i r ti�Y�ir•g... -.. -(�_` 4 if � (,,��+ - ' J '� -y • Vii$.. _^..r.-...._.•.� ' S �A Y /j R f..J(-[4. L'j i. .,, ` f • .drf. 'f a+fs3:a•>rr>,p-• r. �_ -�` - - ` 1 - fir e_7•' �:i f�lf�lt'[�-�-�-�.a(j.$tjg � i � ,rr�:1 i• � j i �. 1 1 `° f - ..'r^.•:"r'N` -. _ ` I• � :5.�..�...i..+.,,e+,rt.stw..4 ...x.:_...... by _ .�q,r.-• /,,irk � '-/;4,��^��- WiTK .1 FT t. Er_st �.; � . OLA V � 9^' r! .1i 1' i j} i -[fir �• •i. �{'�` n .,, la r >P". f<'•7'�`t: :.+ ,h �f.r"7 :I ` D - � �..Mp�„�,�• •s+-. l �1�>r:� 61 X .. - ., MU) ca (800) 752-0163 Fax: (508) 429-6974 c c M ® o �WqHI ESS CO WW TRK LZ V Accessibility Contractors _Z_ ■ g Stephen Maliniak 2 Kuniholm Drive oe W CL Regional Manager Holliston, MA 01746 Q . W LO t I fi` ;;'� , FTI➢. .� •� s t bk .w> i �L R�' '�Y Qyea,' �, .+ e ,a•.s, • PORCHELIFTO VERTICAL PLATFORM LIFT The Americans with Disabilities Act of 1990 has SETS forever changed the way we look at our buildings. Now, we see problems we may not have THE - TANDA considered before. American Stair-Glide has the solutions. IN VERTICAL No one has more experience in solving the access problems of disabled Americans than we RM do. In fact, we have been breaking the barriers PLATFO imposed by stairways in offices, churches, residences, schools, factories, and shopping areas for more than half a century. LIFTS We can open your building to all people, regardless of their mobility,so you can serve more people than ever.Our wide range of models gives us the flexibility to design access systems that fit your exact needs. No other system is adaptable to so many different building environments. WE STAND BEHIND OUR PRODUCTS In your building, Porch-Lift Systems are durable, easy to use and virtually You can choose any PORCH-LIFT maintenance-free. They do their work so quietly model with confidence. Each carnes a and efficiently you can forget they are there.There two-year limited warranty the drive is no more cost-effective and worry-free vertical train and aone-year limitedd warranty on transport system for disabled Americans. component parts. Our dealer's service p y department and our engineering department back up the warranty and are Let us help you surmount the architectural your after-installation support team. obstacles imposed by your building, so you can BUILT TO EXACTING STANDARDS offer your services to all people. All PORCH-LIFT Vertical Platform Lifts No matter what your disability access problem, are designed and built to conform with the American Stair-Glide has the solution. specifications established by the American National Standards Institute (ANSI, A17.1, Parts XX and XXI). They are fully approved, listed, and carry the (UL) label of Underwriter's Laboratories when properly equipped. I 1 i I 8 PORCHmLIF'108 VERTICAL PLATFORM LIFT PL-LD GROUP Our dependable light duty space-saver 1 �''•t Y PL-LD group is designed for use @ in those applications where a low-rise lift is needed to serve a limited number of people. 'f The "LD" (light duty) model t group consists of three models -- _ the PL-LD 48A, 48B and 72B with different drive and electrical W systems.The 48A utilizes an Acme w :' Screw Drive System and the 48B and 72B models incorporate a Ball Screw Drive -- two systems to match your drive system preference and budget. Both meet the requirements defined by ANSI A17.1 Section 2100. The LD models are space efficient and easy to install and maintain. REFER?Ng...P. l SPECIFICATIO 1 Y� ar NO CROWN — NIT BASE 3 e-16x3 2 < �t— 4- DIA. FRAME HOLES-SEE INSET 71' THUNDERSTUD WMGE ANCHOR 4 OR EQUIVALENT /MFD. BY UNIVERSAL) ` FASTENINGS CORP) 31 -tel �6 At • ASA d6 -- 4 MIN. I -- -- --—I FOUNDAOR OF 3500 olive REINFORCED CONCRETE INSTALLER PROVIDED --{3� ATE SWITCH BDIA.HOLE . i zI 2116 .V.L rti: 3I 2 DIMENSIONS SHOWN IN INCHES INSET'A" 1 7 WITH EQUIVALENT MILLIMETERS DENOTED SS19 'WGEARANG� S7 9 v 3 8 3316 368 14e 480 2•�� PROVIDEJ ADDITIONAL ,3 - 1 6 CLEARANCE WHEN 284 60 A.S.G. LANDING GATE Z°. 2`032 13 USED. �{6q e .� TOP LANDING Tr 11 . u 1 11 1 II �I __ 11 ____ _ �1 H L LOCAL CODE APPROVED 1 3 CONDUCTORS 14 GA.MIN. 4A IN CONDUIT. THESE ITEMS lam tl /P1RWIDED BY INSTALLER. .` B GA CONDUCTORS �•-- 1 FOR REMOTE STAT qN WIRING/ I � 1 POWER (ENTRANCE REM STA 1 ENTRANCE I � I 42 12676 I 296 +n v2 3 Z T IS 1 I3 180 L 13 33 I 46� 1e 1 31 CLEEVELD 591 GATE SWITCH C •+WEIGHT-H I LIFT-L I MODF WEIGHT-LBS SHIPPING SIZE 0k , —(� WIDE X Sx�o LoK�i 1�a.,,: 2a•>. .,. =ae:T nt T 7e r 89 1/e 69 7( 760 46 96 V2 74 z z v w ee 43 L 40791 113 v8 93 ( 660 46 1201/2 74 i 3 4 2 'a oea e�°6 —NOTES— CAPACITY: ALL MODELS-450 LBS. - 204 KGS. CONSTRUCTION:IB GA.OR HEAVIER (22 GA.IN SAFETY PAN) SPEED: 9.6 FEET PER MINUTE WELDED AND/OR BOLTED STEEL PANELS & FRAMES DRIVE SYSTEM: INTERNAL WIRING: ALL ELECTRICAL COMPONENTS ARE MOTOR-I,4H.P. 1750 RPM. 120 VAC. 60 HZ. IPM. 7A. U.L. LISTED - FILE NO. SA5388 INSTANT REVERSING DRIVE- BALL BEARING NUT 1 SCREW TOLERANCES: ± 1/32 V-BELTS t PULLEYS FAINT: COOK FLAT TAN BAKING ENAMEL 831-N-522 SAFETY DEVICES: I PRIMER:SHER. WMS. INDUSTRIAL WASH PRIMER P60G2 UPPER &LOWER LIMIT SWITCHES f FINAL LIMIT SWITCH ELECTRO-MECHANICAL BRAKE 24 VAC.CONTROLS GROUNDED SYSTEM 1 / BALL SCREW SAFETY DEVICE - AUTOMATIC RAMP GATE:MECHANICAL LOCK WITH ELECTRICAL CONTACT NONSLIP SURFACE ON PLATFORM & RAMP KEY LOCK ON CONTROLS DATE 8_24_82 391000 .ocation i i No. Date 3 —,2/ !'O/ w f NaRTN TOWN OF NORTH ANDOVER A Certificate of Occupancy $ i Building/Frame Permit Fee $ /5,c y • off ..:?::... +� • Foundation Permit Fee $ s�CHU E` Other Permit Fee $ rn a Sewer Connection Fee $ I Water Connection Fee $ f TOTAL $ Building Inspector 2/22/94 15:42 7078 Div. Public Works PER3fIT NO. d APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MA114'q'40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK iPAGE — ZONE I SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING Ew c- _ _WD VttFg- L OWNER'S NAME ! 1 � a NO. OF STORIES SIZE OWNER'S ADDRESS 6S ] �° �V BASEMENT OR SLAB —_ ARCHITECT'S NAME 7 V SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME / fr!� OSIAJ.f � rom! ioSPAN DISTANCE TO NEAREST BUILDING /"�1 C6� 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 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES EST. BLDG. COST JOY612 opo PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. QTY PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. L 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 3• `'-� � BOARD OF HEALTH SIGNATOR F OWNER OR U D AGENT FEE PLANNING BOARD PERMIT GRANTED 19 _ OWNER TEL.# (P 0 7 Io y BOARD OF SELECTMEN CONTR.TEL.#1�� CONTR. LIC. BUILDING INSPECTOR I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ 8 1 2 13 CONCRETE BL K. ---III PINE _ BRICK OR STONE HARDw D — PIERS — PLASTER — — DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. BM T AREA _ '/. 1/1 '/. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCFETE ��_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMIACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING t STONE ON FRAME SUPERIR ADEQUOATE I� ONE SJ 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBQEL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OAS IL BTRIC SM'T 13rd I NOHEATING f-- i �xORTH Town of And 0L No. 053 �. a r dover, Mass.,AlW eA z.1 1 o # 11111,WICK A COCHICMECli L0_ RATED Cl PPS\ BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... I .0...A. .......................................................... Foundation 4111P� .... has permission to erect.f4ALjVAff1.f buildings on ... ............ Rough to be occupied as...........tAAM...4..0... ./',�.0I.,AA.!!wr�S..f'.J`A..ee.f. .,t�!!.C� r,E/ 4 • 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 ELECTRICAL. INSPECTOR UNLESS CONSTRUCTION STARTS � - Rough .. .... .. .. .. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. cr:1Ai1:R /IAiATr:R FINAI DRIVEWAY FNTRY PERMIT MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t (Print or Type) NORTH ANDOVER Mass. Date building Location Permit # 21\ IG 7 Owners Name D • :Y New 77 Renovation Replacement E?( Plans Submitted D -� FIXTUP=� N W (n N C1 U cz F C � s (n L C u < G = O 0 p0 2 d LII O N ys U 4 tt W s w d -. F- in �. 4 N C U W to 4 Q O C W ,u ,`l m ' E a = a s a Q W o x - a- cc F- :0- cn m i o r W o (a to Z Crd W G � .-. _. .r d u } C W < G a d O O W a: O W F- Sub—$SMT. BASEDlIEN1T Z ST FLOOR 2NO FLOOR 3Rn FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TK FLOOR STH FLOOR (Print or Type) f Check one: Certificate Installing Company Namefit/ 4.1y �� �' 1.� /C• Q✓� Corp. Address -s�_j� - �/y%4/7# �ST� Partner. Firm/Co. Business Telephone: '�8) Name of Licensed Plumber or Gas Fitter 4ay Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EfOther type of indemnity Q 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 coverages. Signature of owner/agent of property Owner = Agent 1 hereby certify that all of the details and information I have submitted (or entered)in afore 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 Massachusetts State Gas trade and tlsaptes 1S:of the General Laws. •_. By YPE LICENSE: rGasf lumber Title ("' R L � itter Si nature of Licensed City/Town: aster Plt�m� or Gasfitter ourneyman APPROVED (OFFICE USE ONLY) License Number •w �� 216 7 Date.. ...... a NORT1y 't'O TOWN OF NORTH ANDOVER 0 6 PERMIT FOR GAS INSTALLATION SS'CHUSEt O This certifies that . .A *% r J� . . . .P.� . . . . . . . . . . . . . . . . . has permission for gas installation . ``' .T. . . . . . . . . . . . . . . . . . . in the buildings of . . .6p S!r`� . .�?tY �. . . . . . . . . . . . . . .m atS.7. f e u t'. A , North Andover, Maa. Fee. r.:. . Lic. No..9 C7 `� . ✓ '�!i-. . . . GAS INSPECTOR A WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:A