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HomeMy WebLinkAboutMiscellaneous - 58 OLD VILLAGE LANE 4/30/2018 58 OLD VILLAGE LANE 2101059.0-0063-0000.0 09714 Date • y�.�f'TLTxD lily,.,. � • TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . � . has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of.S:�$ . . . .. .. . at . . . -,5b- -Od i4 a�.. , North Andover, Mass. Fee.�0;d 0. . Lic. No. PLUMBING INS�CTOR Check# / ys i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE 3 PERMIT# Q JOBSITE ADDRESS l I OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL D RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:© PLANS SUBMITTED: YES D NOD FIXTURES 7 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 I _-_I _► __ ,._.__( —1 ___ _ DEDICATED GREASE SYSTEM _J DEDICATED GRAY WATER SYSTEM i _. I ( ( -----.... I ! -_- - -- [ -_ [ �..__t I I DEDICATED WATER RECYCLE SYSTEM DISHWASHER ._-..__._.I _ l DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) J KITCHEN SINK [F—7 ..___J ___ i _.._..__.J i I _.._ 1 { ...._____f LAVATORY _ RO F DRAIN SHOWER STALL ..___-_J _._..._._1=_._i _____I _._.____[ __ _ ___.J _.____I _[ SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _1 .--------- ---.._._i ___.J [ -------I _--._f _._.._ .__.._ I _._ ----a INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES _I NO IF YOU CHECKED YES,PLEASE INDICAT7TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY i BOND OWNER'S INSUM�ORAGENT ware that the licensee does not have the insurance coverage required by Chapter 142 of the II✓lass is my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER D AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tr nd accurate tot best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mplia a with all Pe e�t ovi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME�raLICENSE# I SIGNATUR IMP r JP Q CORPORATION RII# PARTNERSHIPDI# !ILLC COMPANY NAME At )� F ADDRESS CITY - — —. - ._._.._..._...__{STATE ZIP TEL '� d ?._. . 1 \ FAX — _. CELL��EMAIL _...... ......_.. ....... ... .. . ._d ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �� FEE: $ PERMIT# LD PLAN REVIEW NOTES r r 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 Le ibl Name (Business/Organization/Individual): � Address: City/State/Zip: 0 Phone#: �_ '/Z J 1D3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ lam a employer with 4. ❑ I am a general contractor and I mployees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling 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.❑Electrical repairs or additions 3.E] 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.❑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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: lob 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 the pains and penalties of perjury that the information provided above is true and correct. mature: Date hone#: i 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#: 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' 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 Date •.,syl.ttirps,46• � • TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation ..� . . . in the buildings o . `S . . . . �. fl �✓1-i at • • • • V.111 L� � � . .1. . . . . . . . . . . , North/;Andover, Mass. Feea�' 0c) . Lic. No/ � � ,�/' , *.A ' ' * * _ GASINSPECTO Check# 8495 i r AMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK * CITYL.&(DIlrc�Jn rnOf _ _ MA DATE II PERMIT#BSc GlGI�� ��� JOBSITE ADDRESSt� OWNER'S NAME_V11 0 V OWNER ADDRESS TE _ TYPE OR OCCUPANCY TYPE COMMERCIAL E ATIONAL ® RESIDENTIAL PRINT CLEARLY NEWT] RENOVATION:E] REPLACEMENT: ED PLANS SUBMITTED: YES F-11 NO D APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER -- COOK STOVE E-A---J __ _ 1 :-. _ Jj DIRECT VENT HEATER DRYER FIREPLACE - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER WIF—I LABORATORY COCKSMAKEUP AIR UNITOVEN POOL HEATER .. ( _.-_. [ . .I - _ 1 l ROOM/SPACE HEATER ROOF TOP UNIT TEST l Ia _.!I_ .-1 UNIT HEATER `INVENTED ROOM HEATER ! L____1 WATER HEATER OTHER I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY © 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. CHECK ONE ONLY: OWNER [::I] 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 an curate to th e t of m knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ' nce w h all Pert' n roVl ' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME �-- LICENSE#ISS- - - GNATURE MPI MGF C JP n JGF LPGI E] CORPORATION 0# _ i PARTNERSHIP .�].f#=LLC Ly# COMPANY NAME: yrc j)�_____� ADDRESS CITY �la STATE ZIP __-]TEL FAXCELL --EMAIL �L- L ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# /-S A p PLAN REVIEW NOTES b D. The Commonwealth of Massachusetts Department of Industrial Accidents 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:_# �, �� (��; Z) Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. F-1I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [JNew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10-ElElectrical 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.❑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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cert#yunder the pains and penalties of perjury that the information provided above is true and correct. lnature: 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#: .tet 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' 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 Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dna Date.111qk.. ....... . pORTk Of o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLAfiION SA US h r This certifies that . . /. .i5?�!. . . 1`. . . !.'/. . . has permission for gas installation . S. . !?P! *!!. Its in the buildings of . . �?!? . .61'I!'1... . . . . . . . . . . . . . . . . . . . . . . at . ,��.4���%�S . . . . . . . . . . . . . . ., North Ando v r, ass. Fee.- Q:-P. Lic. No.. . . . . . . . . . eK,,�r q . . . . . . . . . . GAS INSPECTOR Check# 7879 w FwOvMASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CityITown: A16A N D , MA. Date: Permit# Building Location:_ � j �� Owners Name: Vhf r �Gf Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential New: J Alteration:❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES Cd W W T�(.-) a ~ CO1-- = co m W F- 2 i w rn H O = w Z F g Z O w _ W W 0 woe rn W W fe 0 w �, o a w o = Q W Z 9 W = W F- U C7 Z > W W Z 'J F- F- O Z J (9 LL rA = W W � O Ix j Q �Q IQ m > O Z O t~n F > Z I... _ v o o LL c7 6 x x 0 a 9 Ow IW— > > > 0 SUB BSMT. BASEMENT Ole- 1-5'FLOOR 2 FLOOR 3 FLOOR 4 FLOOR S FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# ' El Corporation Address:_ I L �� AI 1l kh C4/Town: State: ❑Partnership Business Tel: Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes�;(o ❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent El By checking this box❑;I 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 14 of the General Laws. Type of License: [APPROVED ❑Plumber e V // ❑has Fitter ature of Li ed Plumb r/Gas Fitter Master y/Town ❑Journeyman r OFFICE USE ONLY 0 LP Installer License Number: V-?-2009 03:47P FROM:PHANEUF INSURANCE AG 9783720431 TO:19786889542 P.1 ACC>RV CERTIFICATE OF LIABILITY INSURANCE /(M02W/O2D0I„YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcylles)must be endorsed. If SUBROGATION 19 WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Peter J.Phaneuf Phaneuf ins.Agency,lnc. PNON . 978 372-3636 P C No); 975 372.0431 P.O.Box 1298 13 L Haverhill, Ma. 01831 INSURERM)AFFORDINOCOVERAGE NAICA INSURER A: National Grange Mutual INSURED INSURERS: Safety Ins.CO. Paul Michel INSURER a: Granite State Ina.Co. 17 Windmill Rd. INSURE o: Haverhill,Ma. 01030 INSURER E: IkW RP: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIR L'm TYPE OF WSURANCE AWL S POLICY N MSER Y f IMMIDDIVYM O P LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000, nCOM MERCIAL GENERAL LIABIUTY 3 500,000. CLAIMS-MADE �OCCUR MED EXP Ono arson 3 10,000. A MP024045 09/0612011 09/05/2012 PERSONAL&ADV INJURY $ 1,000,000. GENERAL AGGREGATE $ 2,000,000. GEMLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGG S 2,000,000. X POLICY PRO- LOG s AUTOMOBILE UABIUTY aSINeD ret IN LIMIT 110001000. ANY AUTO BODILY INJURY(Per person) i B ALL OWNEDDULED AUTOS X AUTOS 8 50000174 04/19/2011 04/19/2012 BODILY INJURY(Per scriae1N) 3 HIRED AUTOS NON-OWNED RO R $ AUTOS (PNerpodderlt, S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESSLIAO CLAIMS-MADE AGGREGATE S D I I R TENTION4 S WORKERS COMPENSATION WC STATU- DTH• AND EMPLOYERS'LIABILITY TORY LIMiJA ANY PROPRIErORIPARTNERIEXECUTNE YIN N E.L.EACH ACCIDENT 8 1,000,0a0. C OFFICERMIEMBER EXCLUDED? F-1NIA2360073 07/19/2011 07119/2012 1,000,000. (Mands"ry In NM) E.L.DISEASE-FA EMPLOYE 3 Dy8Se,daul4lro under 1,000,000. DESCRIPTIO OF OP RAT N.� Ir1w E.L D18EA3 -POLICY LIMIT DE3CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks ScAadule,N mon apes Is mqutmd) Plumbing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Atte:Rick ACCORDANCE WITH THE POLI PROVISIONS. AUTHORRE REP ENTATIVE ACORD 25(2010/05) 6 1 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered ma of ACORD . I Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS • • • ••• • IMPORTANT NOTICE BOARD PL LICENSED AS A MASTER PLUMBER:: PERMITS FOR PLUMBING AND GAS FITTING 9 INSTALLATIONS ON STATE OWNED OR USED ISSUES THIS LICENSE TO FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE PAUL -GMICHEL ' —M 17 WINDMILL RD : -HAVE.RHILL MA 01830-4368., 753947 15549 05/01/12 753947. Fold,Then Detach Along All Perforations 1 I f ' I • I Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD I ! IMPORTANT NOTICE PL LICENSED AS A JOURNEYMAN:PLUM.BER;":. PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED ISSUES THIS LICENSE TO` FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE .PAU:L..G MICHEL —J 17 WINDMILL ROAD HAVERHILL MA 01830-4368' : ._ 753948 265.26 05/01/12 753948. 1 Fold,Then Detach Along All Perforations i I I i I 1 I i I � I � Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS`; BOARD : SHEET METAL WORKERS SM AS A:MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO jj TYPE PAUL G MICHEL d M1 17 WINDMILL RD - I HAVERHILL MA 01830-'4368 959315 5225 03/28/12 959315. Fold,Then Detach Along All Perforations i Ad �� 1 0397 Date..... NOR7M TOWN OF NORTH ANDOVER OL p PERMIT FOR WIRING ACMUS� IV This certifies that ............ .��.......... .....(1i��/.�..�.�..�..�...a�..�..... has permission to perform ....... ! ............................. wiring in the building of.......... 4��� �................................................. at-69...a&.. A� ael� North Andover Mass. V-!�..eolic. Fee.... No..d.7O<...........1.12.z.4. 1- l /�.... CAL IrtsPE Z Check # ' Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /0 0202_// City or Town of: NORTH ANDOVER To the Inspector of Wires: gives notice of his or her intention to perform the electrical work described below. By this application the undersignedg Location(Street&Number) -S% ®Il V Aq e- (Lo Owner or Tenant {Z A pi /C, l 1 Telephone No. Owner's Address ;5 A M Is this permit in conjunction with a building permit? Yes ❑ No !F!r (Check Appropriate Box) Purpose of Building �W� � n cJy Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters i New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: /,Vs 1, /� 41/44-0/e 110m5e Completion of thefollowin table may be waived by the Inspector of Wires. No.of Total No,of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency ig g No.of Luminaires Swimming Pool nd. ❑ rnd. ❑ Batter Units -- No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of?pones No..of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices Heat Pump N,!mber .Tons KW.......... No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices } ace/Area Heating KW Local ElMunicipal El Other No.of Dishwashers Sp g Connection Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of Water KW No.of Bal of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent / OTHER: W hQ SUS go &_0yZ- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC.NO.: 7 Licensee: (Z E'S T ca f_J i P�i Signature LIC.NO.: (If applicable,enter"exempt" he nse number line.) a Bus.Tel.No.: in Address: f 2 -� lice ',e Alt.Tel.No.: "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 Signature Telephone No. [PERMIT FEE:$ The Commonwealth of Massachusetts i I Department of Industrial Accidents Office of Investigations 600 Washington Street ,ak Boston, MA 02111 www..iWss.gov/dia . Workers' Compensation Inshrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -- Please Print Leoibly Hanle (Business/Organization/Individual): Address: City/State/Zip: Phone#: . Are you an employer?Cheek.the appropriate box: I.❑ I'am a e FE] ject(require m to d) employer with 4 P Y ❑ I am a general contractor and dI employees(full and/or part-time).* have hired the sub-contractors construction 2.❑ I am.a.sole proprietor.or partner- Iisted on.the attached sheet$ deling ship and.have no employees These sub-contractors have 8. ❑Demolition working for me.in any capacity, workers' comp.insurance. [No workers'com .insurance 5. 9• [1 Building addition p ❑ 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 have per MGL 11.❑Plumbing repairs or additions myself.[No•workers'comp. c. 1.52, §1(4),'and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' comp. insurance required-]uired_ 13.❑.Other, "Any applicant that checks bob#l must also fill out the section below showing their workers'bompensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. $contractors that check this box mustattached an additional shcct showing.the name of the sub-contractors and their workers'comp.pc?icy irfamtadon. lam an employer that is providing:workers'comPersa non 1psurancefor � employees, Belowteinfarmafox policy and job site Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: M 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 under the pains andpenaldes ofperiury that the information provided above is true and correct Sienature: Date Phone#: Official use only. Do not write in this area,to he corVleted by city or fawn official City or Town; Permit/License# Issuing Authority(circle ooe): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6.Other Contact Person: Phone#: � 4 Office Use Only _- 01 4t Tammnnu>r# If Mnsar4usrfts Permit No. �5 i9partment of Public $afetg Occupancy A Fee Checked <' S 527 CMR 12:00 3/90 (leave blank) (j\� 'a BOARD OF FIRE PREVENTION REGULATION APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date '42—f>_�. (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work dcr'bed below. �D" t C tr cel Location (Street & Numbers � zs b't-� �S� �"Cv r� Owner or Tenant f2�11 NI(- C-/GvL Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _ I Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets Y� No. of Hot Tubs I No. of Transformers Total KVA No. of Lighting FixturesK� I Swimming Pool AboveIn- r & grnd. L_. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets (c) No. of Oil Burners Battery Units No. of Switch Outlets ( No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Air Cond. No. of Ranges tons Initiating Devices No. of Disposals Dis No.of Heat Total Total p Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municioal Othar No. of Dryers Heating Devices KW Local ❑ Connection ' No. of No. of Low Voltage No. of Water Heaters KW Signs Bailasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including COMD13iad Operations Coverage or its substantial equivalent. YES have submitted valid proof of same to the Office. YES NO :: If you have checked YES. please indicate the type of coverage by checking the app ro ate box. INSURANCE 2 BOND — OTHER = (Please Specify) OZ) (Expiration Date) Estimated Value of E!ectrical Work S I cno. Q Work to Start _6""f� -5< Inspection Date Requested: Rough (q -kFinal Signed under the Penalties of perjury: ^� FIRM NAME t �� -�+'�-✓CL LIC. NO.,c�/� r27?fD Licensee LIC. NO. t� � Bus. Tel. No. 2 2- ZU$y� Address �/w I t N Alt. Tel. No. OWNER'S INSUR NCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) � � Telephone No. PERMIT FEE S // / (Signature of Owner or Agent) x•5505 r .. ..�' Date.......... .. ..,..J... ...�. NORTH TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING SSAcmUSft This certifies that ...�el ......... has permission to perform ........, w1'.r./r.!/.�..L-...................................... rt.ftl.l.. ........... .:.......................... wiring in the building of.........� . ........ . P, t- .1.1. k .................. ,North Andover,Mass. at............................. ............... .... .. . Fee.-r. ... Lic.No. ............................................................ ELECTRICAL INSPECTOR .2 05/19/95 11:05 t / u ) 55.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File 01 4E Clam wnI talth of -101i�L�lISlett Permit Oma u,. . ar mtntnt of Public $afctlg Occupancy d Fie Checktw� BOARD OF FIRE PREVENTION REGULATIONS 521 CMA 12:000 ""'blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) pate4/—/ . 0! 1 q& or Town of—NORTH ANDOVER To the inspector of Wlres: The udersigned applies for a permit to perform the electrical work described below. Id I n //' location (Street & Number) ___ Sq //ln Z&Ni_- Owner or Tenant �F�^/Y -1191) T=eAr k �t le R,t Owner's Address 00 y► L( to L A/t✓' Is this permit in conjunction with a !building permit: Yes No E (Check Appropriate Box) Purpose of Building �T I !r�I P. Utility Authorization No. Existing Service Amps —J Volts Overhead Undgrnd a No. of Meters V = New Service Amps _J Volts Overnead Unogrno E No. of Meters Number of Feeders ana Ampacity Location and Nature of Proposed Electrical Work .3 F ♦ fY 1. No. of Lighting OutletsI No. of Hat acs I No. of?ransformars T tel VA No. of Lighting Fixtures I Swimming P^oi At)ove♦— in- w' grna. _ grna. _ I Generators KVA ,`: No. of Emergency Lighting• No. of geceotacie Outlets I No. of Oil Eurners I Battery Units No. at Switch Outlets I No. of Gas Eurr.ers FIRE ALARMS No. of Zonas Toiai No. of Detection and No. of gauges No. at Air Circ. :cns Initiating Devices No. of Disoosais I No.of Heat Total dial ` Pumcs :ons KW No. of Sounding Devices •• No. of Sed Contained No. of Dishwashers I SoaceiArea Heating KIN OstactionrSounaing Devices No. of Dryers ( Heating ^ — Municioat yl ry g .evices KW Local _ Other Connection ♦ u No. of No. of Low Voltage ! No. of Water Heaters KW I Signs ?a fasts Wiring i No. Hyaro Massage Tubs I No. of Motors Total HP OTHER: /NS7jt// C INSURANCE COVERAGE. Pursuant to the reouirements of %Iassacni secs general Laws I have a current Liamlity Insurance Policy incluaing Comc:eiec Ocerations Coverage or its substantialaquivaient YES NO — 1 have suornined valid proof at same to the Office. YES = NO = It you nave checxed YES. plsase indicate th pe of coverage lay cn approonats cox. %E,' URANCE = BONO = OTHER = (Please Scec:y) (Exotration Oates .: also Value of E!ectn al Work Work to Stan , InsoecaWon Date Racues:ec: Rough M <r 6 (t Final Signed under Me Penalties of partu :. FIRM NAME '2 UC. NO. Q // Licensee to 5 / / S�gra:ure / LIC. NO. f; Address ,O?S��1 a /�l�t��'�i Bus. Tal. N0. . �7.a� `/�ZS��. OWNER'S INSURANCE WAIVER: 1 am aware that the L:censee cues not nave the insurance coverage or its suostanual equivalent as re• auirea by Massacnusetts General Laws. ana that my signature an :ries cermit application waives this requirement. Owner Agent (Please check onel- r/'G Tateonone No. PERMIT FEE SIZ0 (Signature of Owner or Agents s i, Date.. /...... .. T2 EE NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUS� O This certifies that w has permission to perform .. t ... ... ...........-�::a $ wiringin the building of................................................................................... at A. .R................��.......eh.. r............................. ,North Andover,Mass. Fed .....A..... Lic.No—,11' 144:9 ............... ELE.......... ..INSPECTOR........................ CTRICAL WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Location D No. �-� Date �5 TOWN OF NORTH ANDOVE pttt�eo ;•,gyp • e p A Certificate of Occupancy $ d Building/Frame Permit Fee $ b� r►'`�j MuSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ uilding Inspector 8631 Div. Public Works r Locatiln S-b (OCZ Y\(((L CE No. Date Q NORTH TOWN OF NORTH ANDOVEW F p Certificate of Occupancy $ � r > _ Building/Frame Permit Fee $ Qy tee'►+no �,�'h ,S-TA USEt Foundation Permit Fee $ Other Permit Feel' tW $ - Sewer Connection Fee $ CU Water Connection Fee $ TOTAL $ (� (� Building Inspector 7 Tp 8340 Div. Public Works PER31IT NO.� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK PAGE — ZONE SUB DIV. LOT NO. I LOCATI t� �� / kbfl6� (Pyr sE of s �/Jfae, rt. OWNER'S A VV `N-O. OF STORIES(( /[ SIZE 'E•WNER'S ADDRES / n ® BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME r SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE S BUILDING CONNECTED TO TOWN WATER , BOARD OF APPEALS ACTION. IF ANY WBUILDING CONNECTED TO TOWN SEWE BUILDING CONNECTED TO NATURAL GAS ZINE INSTRUCTIONS 3 PROPERTY INFORMATION � LAND COST SEE BOTH SIDES EST. BLDG. COST -,o PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Q. 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 INSPEgTOR ATE FILED �/ry, ✓ c SUILDINO INSPECTOR SIGNATURE OF O,Wf4tR OR AUTHORI D AGENT F E E OWNER TEL.# PERMIT GRANT CONTR.TEL.# 19 -1 U CONTR.LIC.# —uy l ` TINL H.I.C.# -is ?j3lz t�-1 ��6 31 S s BUILDING RECORD 1 OCCUPANCY 12 ' SINGLE FAMILYS DRIES 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 $ INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ lh 1/2 FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMI,AC:N VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEOUATE NONE 5 ROOF 10 PLUMBING GABLE _ HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES TILE FLOOR TILE DADO s 6 FRAMING 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 GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING " ORT Town of � � , 4Andover y ' .rt " dover, Mass., Ute- 19 ` T O 't- LAK:E COCMICKWICK 7�ADRATED PPS` �y E BOARD OF HEALTH Food/Kitchen Septic System PERMIT T Di BUILDING INSPECTOR THISCERTIFIES THAT .KVO...C.MQA............................................................................................................... I Foundation I has permission to erect.&T 2.................. buildings an .51�......0.4b�...... .(,�A,t-�4 6F,..... .................. Rough /0�f� 13 �W 1�+. Chimney to be occupied as lS -../ .................... ............ ....... R.. ..........................................I........................ 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 EXP 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS U Rough .................... ............. Service BUILDING ECTOR Final I Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final 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. �,.�.► Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT • I TOWN of NORTH ANDOVER AFFIDAVIT Hne mit Gmtractcr law anlmrt tc) Int t%liraticn ML c. 142 A mWires that the 'bmms rw-ti i, alteraticn, m at:im, repEir, ®diradm, oaiasim, inprvAmmt, ramml, dmblitim, or caztnrdm of an additzm to any pre` adstarg aaiw-ooapied build- irg cmtainkg at least a-e but nut ne thm far dwelliig uri ts...or to strazs which are adjaomt to arh res li ri re or huldirg"be dme by registered a ntracbars, nth certain aceptiais, alug with abet its. G Type of Work: ��/ D`r� C.t //D�/ Est. Cost 0110 Address of Work a �c Owner Name:- Date of Permit Application: t- � I hereby certify that: Registration is not required for the following reason(s): Far office Use QAy Work excluded by law R3idtND. Job under $1,000 Date Building not owner-occupied er pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONIIItACMRS_ FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGI. c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above note,e,,L I hereby apply for a permit as the owner of the above property: Date Owner Name-�-�s I - ^ff _ COMMONWEALTH i : .DEPARTMENT OF PUBLIC SAFETY " ' OF _ __ GORTON PLACE Falld»topoa�asacarrant « t__-. MASSACHUSETTS ItSSTON,MA 02108 -mas=�skettrStatae?j aft -� ,. -_-�C�d�tsaaa�losrLpn„•.�R..1� . .._ L i C E y S F •" arhtsuas• EXPIRATION DATE � 'r'" a 1° J ►�$T�?;• S U P L<U I, Q'R CAUTION RC 07/02/1995 . C71VE DATE UC-N0 i t PROTECTION AGAINST y s' RESTRICTIONS �. � `" EFT,.PU.T-_RIGHT-THUMB - NONE 9-$/3U_/1 993 035146 ' PRINT INAPPROPRIATE - ,KBOX ON LICENSE t v _._._ SS 111020-42-6976 >tIAV RHXLL,MA 0,1830 BLA�IGGOPER3 ` : "'''Ai3`/!INCLUDE-PHOTO. - PHOTo(BLASnNG OPR ONLY) F E. ,wraien t1t1160NMe,fAlp OFF1CNlLY .HEIGHT: stljp an Tl/iE OF THE DOB: ..._ JUL 2 2 tJ G` 07/02/1. 959 t' : THIS DOCUMENT MUST BE. :k^ - jf'''�.'�� • `;` CARRIEDONTHEPERSONOF -s'ti OFucErsEE i « 9�a ++r"LL AMP.)JINA THE HOLDER WHEN EN i oTWERs-RIGHT THUMB PRINT GAGED wn+IsocalPAnorr - ease.-�.•.s„,,:ti�;�-°�4.::.o.r..:+...s�::3w=a.=- __.�....__,.,.�..._.._-.�._,..r»_....._.,.._.,�.,�..• ' r �I I _ ti J ��� S I Noo,✓ � �l jT CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 254 Date AUGUST 4, 1995 THIS CERTIFIES THAT THE BUILDING LOCATED ON 58 OLD VIMAGE LANE MAY BE OCCUPIED AS ADD BEDROOM AND BATH IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. MORTN O',..•� ..�tio CERTIFICATE ISSUED TO Frank Cieri os '`` ' 58 Old Village Lane ADDRESS North Andover, MA �s�cNusf Building Inspector r NORTH Town Of LAndover I No. 254 rt dover, Mass., L�� '� 191C T O LAKE COCHICHEWICK ORATED PPS\ �C9 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THATTOKKV�...C. .M.Zi............................................................................................................... Foundation has permission to erect.I�4T --.................. buildings on .. ...... ....IC( ,1, t 6 ,..........(A.................. -I�." A�� (�` Chimney to be occupied as- 1.714.14 ../ ..-..... R.. ................................................................... provided that the person accepting this permit shall In every respect conform to the terms of the application on file in finalthis 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 EXP 6 MONTHS ELEC RICAL I SPEC O UNLESS CONS U Rough G ��/ ' � � .................... Service BUILDING �j ECTOR �s Fina / Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL et No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT a ye_s � 6�8 95 qS (EP MASSACHUSETTS U*NIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or ype) 0 '> ��'� Mass. Date Z 19 P_rmit # 3216 Building Location O/j AAA eIt,Owner's me I✓Uy Type of Occupancy AeS Newer Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES z Z Z to Q Y H y to (,) Z Z W (A F- to to g` _ Z O 96 O W) to y = to < W Y 'A U 09W Z � Z X_ V W Q = W in < W y o 4 . Z o d o o 09 K. ( Z to H N' C6Q to Z Z W = too < QZOO ocrgoC < Oocth` 3 3mHccS3x 69ca3mQ SUB•BSMT. BASEMENT 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 3th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name �'�`'eS Check one: Certificate Address IP//D• fSo� /D� ❑ Corporation [�f0�/GlLafit�f 144,4 OVE3el partnership Business Telephone 3 ❑ Name of Licensed Plumber 1,6 "e Get Ur�c�d INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes/J No 0 If you have checked yes, please indicate the type coverage by checking the appropriate box. a A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner 0 Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted 1 entered)in thea applica are a and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application be in compliance wit all pe t p vis.orx of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. gY Signatu f Licensed Plumbef Title Type of License:Masters journeyman C City/town License Number APPROVED(OFFICE USE ONLY) r" FINAL INSPECTION SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE RoY Y NO. APPLICATION FOR PERMIT TO DO PLUMBING _z • f NAME & TYPE OF BUILDING w% r 'a LOCATION OF BUILDING -- PLUMBER — R PERMIT GRANTED Date 19 U.G. Insp. Rough Insp. Final Insp. Plu'mhing Inspector "Ci...'5:+..+� i rye f�.Y-�^ir.-^ --`�..::c: ��:..ti+.d•...�� . ��. � , l ' Date.. /. ?.?0'2 I J2 3710 TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING ,SSACMus� r7V l O This certifies that . .�V/3 !,I:C . . . G. . .S . . . . . . ^' •m has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ./.c 13.1... . . . . . . . . . . . . . . . . . . . . . . .E at. . .o. .< <f. L'! .�!� . . . .``. . . . . .. North Andover, Mass. Fee. ,?.,.- . .Lic. No./.Q.y� .`l. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR N. WHITE: Applicant CANARY: Building Dept. PINK:Treasurer