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HomeMy WebLinkAboutMiscellaneous - 58 PADDOCK LANE 4/30/2018 58 PADDOCK LANE / 210/107.D-0099-0000.0 90 y S Datey..41`h/. . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i •iID�A``'a' SACHUSE� M a This certifies that ./'t , , , , ,14 has permission to perform . . �. . .,BGc�ft !`�'``. . . . . . . . . . . . . . . plumbing in the buildings of . .l.�✓. 44-ri . . . . . . . . . . . . . . . . . . . . . . . . at. . . . .S l�. Y�q W0 A . . . .�<.�. h Andover, Mass. Fee.�s.g�" .Lic. No.. ./. ./.r7 9�. . . . r Check # �2�� PLUMBIN INSP R 11r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING CITY/TOWN:[M:VZ-4APPLICATION DATE: s iC.n/ - _ e V/ -- _ JOB ADDRESS: ..__(,,- V} PLANS SUBMITTED: YES❑ NOD — P OCCUPANCY TYPE: COMMERCIAL❑ RESIDENTIAL©--- NEW❑ ALTERATION❑ REPLACEMENT❑ REMOVAUDEMOLITION� n I' PLUMBING: PIPING-FIXTURES-FIXED APPLIANCES-APPURTENANCES 7 ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS ALTERNATIVE TECHNOLOGY DISPOSER SINK: MOP SERVICE -ASPIRATOR DRINKING FOUNTAIN STERILIZER DRAIN: AREA FLOORM EJECTOR ❑ j STORAGE TANK BACKWATER VALVE 0 EMBALMING Ll AUTOPSY URINAL BAPTISM:FONTLJ SACRARIUM FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK [-�II GLASS WASHER WATER CLOSET BATHTUB WHIRLPOOL ICE MAKER WATER HEATER:ALL TYPES BIDET INTERCEPTOR:ALL INTERIOR WATER PIPING: �] CROSS CONNECTION DEVICE KITCHEN SINK r OTHER NOT LISTED -1 DEDICATED: ACID WASTE SYSTEM LAUNDRY CONNECTION DEDICATED: GASIOILISAND SYSTEM LAVATORY DEDICATED: GREASE SYSTEM PIPE RELINING WORK ONLY DEDICATED:RECLAIMED WATER j ROOF DRAIN DENTAL FIXTURE/EQUIPMENT SINK: 1-2-3 BAYFJ PREP. if DISHWASHER SINK:CLINIC D FLUSH RIM PLUMBING INSTALLER-FIRi4'I-COMPANY LNFOR1VIATION CHECK ONE ONLY i - - corporation Business NAME: "-t.. ,.-1�-.�.I .U1 : �.k:_. ADDRESS: CITY: LW !ft�. l �._ ❑Partnership Business!<�� .�• t- - �1�- ❑LLC Business# TEOW-I ?. Q FAX::.- - EMAIL a Eb eZ' ❑DBA I Unincorporated_ NAME OF LICENSED PLUMBER: INSURANCE COVERAGE I have a current liability insurance policy or,its substantial equivalent,which meets the requirements of MGL.Ch.142 YES❑v'NO❑d 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 OwnerOwNERa AGENT s Agent _�-. OWNER'S NAME:!'. -- TEL:'_._,,.__:....z..::-:- ___..,__,..• .3 FAX: I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapt 42 of the a ws (OFFICE USE ONLY) TYPE OF LICENSE• Permit# ❑Plumber Signature of-LicensedIllumber Inspector [[Master - i---- --- -- --- -- -__.___f Fee: Journeyman License Number: ,-J, ❑ - 01 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE; $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - _ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - x tvww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): {P1,&R PLUMBIl G AND MEETING INC. AURUN ti I Kt::t WAKEFIELD,MA 01880 Address: City/State/Zip: Phone#: Are:you an employer?Check the appropriate box: Type of project(required): 1.0-1 am a employer with /U 4. ❑ I am a general contractor and I b. ❑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. 7. Q�modeliug ship and have no employees . These sub-contractors have g, ❑Demolition working for mein any-capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance. �? required] 5. F1We are a corporation and its 10-0Electrical repairs or additions y` 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.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees:[No workers' �3-�Other camp.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 nacre of the sub-wntractbrs and state whether or not those entities have employees. If the sub-contractors have employees,they mustprovide their workers'comp.policy number. I am air employer that is providing workers'compensation insurance for.my employees Below is the policy and job site information. Insurance Company Name:��nG� Policy#or Self-ins.Lic_#: �I/ `t � -� Expiration Date: j_- Job Site Address: 5q, 1/ !ice dl lAld�1- a A f' City/State/Zip: ` I 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 OfI•ioe of Investigations of the DIA for insurance coveraee verification. I do hereby cer under th `tea penaltie f pe ury fat the information provided above is true and correc& Simafore: t y ! Date: / / _ Phone#: Off cial 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 " b.Other Contact Person: Phone#: r Date/.. .��C ........... f NpR7M 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS US 11 This certifies that .... ....ih S►n e�-r �c 7y6................................. ............................................. has permission to perform ... ttxw� .............................. wiring in the building of... ��........ ... .. ....��'� . ..................................................... {�'���� .. . . .North Andover,Mass. at............ ....................................... Fee . -.. Lic.No.. .��F. � ..... . . .. r ELECTRICAL INSPEVR Check # 8551 Commonwealth of Massachusetts Official Use Only Permit No. l Department of Fire Services Occupancy and Fee Checked BOARD'OF FIRE PREVENTI I'F2EGt1LATI'ONS [Rev. vo -1W leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(I EG),527 CMR 12.00 (PLEASE PRINT IN INK OR-TyPEALL INFORMATION) Date. / {©9 . City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned ives notice of his or her intention to perform the electrical work described below. Location(Street&Number) AQ ,0 Owner or Tenant Telephone No. Owner's Address 'SM245 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building- SI—ARE RA&V Utility Authorization No. Existing Service Amps I Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampiacity Location and Nature of Proposed Electrical Work: M&-,,Gf 4,10 RX-Crela4-06166Er Completion o the ollowin table may be waived by the Inspector o :Wires. otal No.of Recessed Luminaires No.of CeilK-VA :Susp.(Paddle)Fans No.of VA i Transformers K r No.of Luminaire Outlets No.of Hot Tubs Generators KVA _ No.of Luminaires Swimming Pool rnd.Above Elnrn-d. El o.o Batte Units cy ig ung w No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Num,er Tons KW No.of Self-Contained Totals: " ` Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [I Other Connection No.of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No.of Water lKW No.of No.of Data Wiring: Heaters Signs Ballasts I No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications el NomfDevict�o r nival No.of Devices or E uivalent .• OTHER: Attach additional detail if desired or as required by the Inspector of Wires. f Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: X.S-;A,P Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2"'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.: j;e Licensee: , z fzl , ;Xf E QZA✓ SLC Signature t `,` LIC.NO.: 8 C7 (Ifapplicable�Jj� zempt"in the license number line. p� Bus.Tel.No-M2 2,7/ Address: la / / ' e. , P/ Alt.TelNo.• y *Per MG.L c. 147,s. 57-61,security work requires Department of Publi 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 a ent Owner/Agent PERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents x _ Office of Investigations ^�v 600 WashinVon Street Boston, MA 02111 www-Mass.gov/dia Workers' Compensation Insurance A Fidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiy Name (Business/Organization/individual): ���� Address: City/State/Zip: L �J , C S Phone #: Are you an employer?Cheek the appropriate box: l Type of project(required): .❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. o workers comp. insurance 5. 9• Building addition �`1 p. ❑ 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 insurance required.] t employees. [No workers' 12.❑Roof repairs comp. insurance required.] 13.7 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 diel'are doij-ir::;:;:r.;at,�u en Hire outside conuaciors must submit a new am`davit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workerscompensation insurance for OF employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .Failure to secure coverage as 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 cern er the pains and p aloes ofperjury that the information provided above true and correct Signature: �, Date: Phone#: 37 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions r 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 o r 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 compl-etely,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 anddate 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. Shouldyou have any questions regrurding 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 Invesfibations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-2645 Fax 4 617-727-7749 Vvww.mass.bov/dia 1 v Ln Howell Custom Building Group The Rivemalk Complex 360 Merrimack Street,#5 O Lawrence,Massachusetts 01843 T 978.989.9440 F 978.989.9441 —' 8 5. 0 0 Nv�xw howellcustombuild.eom a� U LQ � Q cj� W •.--I ,� Ln N Ord \\ Oo z � ci d w `ted U ,� ()0 x vLn LLJ Z \ I LI \ z O Q REVISIONS ,l Z� LO Z1 04/18/2011 . 7 off„\\ U O Q Qs, \ 0 0 03/28/2011 PZ • W = Construction Drawing Set O U r-I Deck Renovation z1 A0. 0 97y5 t t NOR71�, 3r°.';�`"-;•.:"�,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� This certifies that (}n.�... �-..l...E.. has permission to perform ... ......... .A I�JJ I .��o. . ............. wiring in``the building of.;:IQIY K...44-1r,..�.S.YI-N.......................................... at... Q........�.I �G........(.!.h„_................ North Andover,Mass. f Fee.... .`. ..)...... Lic.No.1.'IrT s....7 ......E.... . .. . ...... �ecratcw�. �. Check # � �� Commonwealth of Massachusetts Official Use Only 1, Department of Fire Services Permit No. Z�N l BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked[Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(. C),527 CMR 12.00 (PLEASE PRINTIN)NK OR TYPEALL INFO R OTION) Date:/ p-- I-Mi o City or Town of- To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) S'� /1LJ Owner or Tenant ,7dk,v Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Q- No ❑ BLDG PERMIT# 3a)- Roil Purpose of Building � �(� Utility Authorization No. Existing Service 900 AmpsDior /oZYo Volts Overhead ❑ Undgrd J�]-- No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 7-9 ri t e_ �t To 1 w,ti', /� JZcC4 iV Completion of the followin table may be waived by the Ins ector of Wires. No.of Recessed Luminaires l PNo. Ceil:Susp.(Paddle)Fans No.of Total, 1 Transformers KVA No.of Luminaire Outlets , � Hot Tubs Generators KVA No.of Luminaires ming Pool Above ❑ In- ❑ 0.0 mergency rnd. rnd. Batteg 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 Tons No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No. of Water No.of No.of No.of Devices or E uivalent Heaters ' Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: &47316201,6 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 E] OTHER ❑ (Specify:) I cert,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: ON r ec ori C— LIC.NO.: t 75 S Licensee: p r..i p (-� Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.. 17 Address: `moi !�-JT 7 3;(-- Alt.Tel.No.:r 0-aS -65ts *Per M.G.L. c.147,s.57-61,security work requires Dep artmen of Public Safety"S"Licen 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. $ �y,��— ELECTRICAL PERMIT NO. INSPECTION REPORT: I ELECTRICAL INSPECTOR-DOUG SMALL 1. GH INS ON: ' Passed—[ Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed—ItFailed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature A0 initials) Date 3.UNDER GROUND INSPECTION: i Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: t (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. h, The Commonwealth of Massachusetts 1 Department of Industrial,Accidents Office of Investigations 600 Washington Street Boston,HA 02111 www.mass.gov1dia Workers' Compensation Insurance davit: Builders/Contracfors/JElectriciansfplumbers Applicant Information ]Please Print Legibly c Name(B.usiness/Organization/lndividual): Address: (J/U t -C City/State/Zip: ���(p p Phone#: 9 ;E 6—() Are you an employer?Check the appropriate box: Type of project(required): 1.D 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.1 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition f workingfor me in an capacity. workers'comp.insurance. Y p tY 9. EJ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL If.E]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.] 1311 Other !Any applicant that checks box#t 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#G PO—Wo Expiration Date: /�� l --Q C) ( U Job Site Address: �p �� (_1�J N� 7ov City/Sta tate/Zip: (�1�SL/5 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 thepains andpenaldes of_perjury that the information provided above is true and correct. Signature: Date: I,Z/a 3/aO/G Phone#: Official use only. Do not write in this area,to he 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 2 Silver Ledge Road, Newbury, MA 01951 Office: 978-462-4331 • Cell: 978-973-2366 • Fax: 978-462-5528 • email: jfix@comcast.net December 14, 2010 Inspector of Buildings—Town of North Andover 1600 Osgood Street I North Andover, MA 01845 Re: Residential construction at 58 Paddock Lane,North Andover, MA Dear Building Inspector: I have visited the residence at 58 Paddock Lane in North Andover and made observations of the new construction. I observed that the structural framing, which was substantially complete, had been constructed in general accordance with—or met the intent of—the drawings which I had stamped. If you have any questions, please feel free to contact me. Sincerely, Of bA C JOSEPH P. �A - FIX STRUCTURAL No.34051 ®� 4.0, �IST[ oseph P. Fix, P.E. ��4� o� �BMAI EK 1 i 2 Silver Ledge Road, Newbury, MA 01951 Office: 978-462-4331 • Cell: 978-973-2366 • Fax: 978-462-5528 • email: jfixQa comcast.net December 14, 2010 Inspector of Buildings—Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Residential construction at 58 Paddock Lane, North Andover, MA Dear Building Inspector: I have visited the residence at 58 Paddock Lane in North Andover and made observations of the new construction. I observed that the structural framing, which was substantially complete, had been constructed in general accordance with—or met the intent of—the drawings which I had stamped. If you have any questions, please feel free to contact me. Sincerely, �►,A (f!OF iij JOS FPH P. <A d* fFIX a 7`JCTI;r1,AL Nz).34G51 oseph P. Fix, P.E. �� C'Stt��U��`Q a r3NA1.Ea 2 Silver Ledge Road, Newbury, MA 01951 Office: 978-462-4331 • Cell: 978-973-2366 • Fax: 978-462-5528 • email: jfix@comcast.net December 14, 2010 Inspector of Buildings—Town of North Andover 1600 Osgood Street North Andover,MA 01845 Re: Residential construction at 58 Paddock Lane, North Andover,MA Dear Building Inspector: I have visited the residence at 58 Paddock Lane in North Andover and made observations of the new construction. I observed that the structural framing, which was substantially complete,had been constructed in general accordance with—or met the intent of—the drawings which I had stamped. If you have any questions,please feel free to contact me. Sincerely, b tM Of b4 ��• pyo d� EH P. A �r FIX d' Q hto.34051 oseph P. Fix, P.E. stct+ 4� Location No. �� Date '1'°RT" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ SSAtMUSES Foundation Permit Fee $ Othee Permit Fee $ � 0 1 IZI4, Sewer Connection Fee $ 'r-. :Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works PERJtIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP� O� �1 LOT NO. ��� 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE — MA .i — .. ZONE SUB DIV. LOT NO. +y �� L ✓ __ LOCATION \ �� Y �1 �` PURPOSE OF BUILDING rL N / OWNER'S N E •\_*� `\� NO. OF STORIES 4 SIZE OWNER'S DRESS ,��,, C.C\\ i_ BASEMENT OR SLAB ARCHIT T'S NAME ;� SIZE OF FLOOR TIMBERS ISL 2ND 3RD BUIL R'S NAME -�'G\ ' \ O �� �• SPAN —LAY—�-- D14rTANCE TO NEAREST BUILDING } DIMENSIONS OF SILLS DISTANCE FROM STREET !-, POSTS DISTANCE FROM LOT LINES—SIDES ``'U+ }- REAR 4(y) t " GIRDERS AREA OF LOT "� FRONTAGE ��� •� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW 'n ..J SIZE OF FOOTING X IS BUILDING ADDITION I MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO R QUIREMENTS OF CODE (h IS BUILDING CONNECTED TO TOWN WATER YUC) BOARD OF APPEALS ACTION. IF ANY . IS BUILDING CONNECTED TO TOWN SEWER yK� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION y � LAND COST SEE BOTH BIDES ( 1 S5 EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Si). FT. I� 1e91 ;: PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM G 1J I SEPTIC PERMIT NO. V ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SMAT RE OF O ORA THORIZED AGENT C \` i✓��. -�—= ,� OWNER TEL.# 9 til F 1 , c CONTR.TEL. I I h CONTR.LIC.# Oc'M d5 PLANNING BOARD PERMIT GRAN. 19 BOARD OF SELECTMEN suILD d IN OR BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY I SroRIES 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 If 2 FOUNDATION _I 8 INTERIOR FINISH CONCRETE 3 I 2 13 - CONCRETE BL K. _ PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT i AREA FULL FIN. B'M'T AREA _ '/ 1h 1/ FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD\tJ D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE ---{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I IP BATH (3 FIX.) GAMBRELMANSARD 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 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 GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING vvr�ardj..ro vrs r r*.#r®�__ PLA��I�G FINAL SEWERMATER FINAL. xAORTH Town . of OL Andover NO- 417 --- C H EWICK er, Mas 1 A �V oR pR SS PER T LD BOARD OF HEALTH �,T THIS CERTIFIES THAT. has pe i /�� BUILDING INSPECTOR • ........ ...�� � .. Rough- Chimney oughChimney j/rhe occupied as.... ........................................................... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids thVn� it. PERMIT EXPIRES IONTHS ELECTRICAL INSPECTOR UNLESS CON RUC T ARS RoughService -- Final ... ... ..... ............. . .. ................ BU1LD1 R GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by TREETN".,I Smoke Det. Building Inspector 8756 Date. .� 1111 "O°T.�tio TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING ,SS3,4 E� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform f+.�.�. .'. -. . . . . . . . . . . . . . . plumbinginthe buildings of . . . . . . . . . . . . . . . . . . at . . . . . .�'f3.C,t.c,l .G,� ,(. . C.. , , , , , , . . . , North Andover, Mass. Fee. S. - Lic. No.. ./!.�1.r. `! . . . . . . . . . . . .z.0—. . . . . . . . . . . PL MBING INSPECTOR Check # `� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING _ (Print or Type) --` — Atoy l W d elyeV 11/ 20 Permit# ,Mass. Date a' �' I° d doCvV� is�. Building Location �, �-. n' Owner's Name Owner Tel# Type of Occupancy New ❑ Renovation 1!3/ Replacement ❑ PlanSubmitted: Yes ❑ No ❑ FIXTURES z Z z w ai O F z o z x C/) w H w F. x „ "' w z z 3 U Z h a' t=i> a Q F A ha O F. 3 = a z 3 .a a o z < H w 3 tix a ca o A a 3 x F- h w t� x A 3 x m 0 SUB-BSMT BASEMENT 1'T FLOOR 2"D FLOOR P 3RD FLOOR '4T"FLOOR * 5T"FLOOR 6T"FLOOR 7T"FLOOR TN M&R PLUMBING AND HEATING INC. Check one: Certificate 234 Installing Company Name ,,rySTREET WAKEFIELD,MA 01880 n Address PH(-)NF-(78j)945-1770 leorporation d ❑Partnership Business Telephone# ❑Firm/Co. Name of Licensed Plumber �/ P ✓�pL(� (�t{,CFS INSURANCE COVERAGE: I have a current lia ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Les,please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abov pplication are true and accurate to.4he best of my knowledge and that all plumbing work and installations performed under permit iss f thi pl' o will be in plianc ith pertinent provisions of the Massachusetts State PlumbingCode and Chapter 142 of General s. By Signature of Licensed Plumber Title Type of License:Master Journeyman ❑ City/Town APPROVED(OFFICE USE ONLY) License Number l(� FOM U TOWN OF NORTH ANDOVER • i LOT RELEASE FO1k1 SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANE TADDRESS (ASSIGNED BY D.P.W. STREET �F4 ,C? APPLICANT �(J\ti�,� ,�� ���;'� PHONE DATE OF APPLICATION — TOWN USE BELOW THIS LINE PLANNING BOARD DA'T'E APPROVED TOWN PLANNER DATE REJECTED �CONSER ATION . CO IS ION NZA DATE APPROVED CONS ION ADMIN, DATE REJECTED JBOARD OF HEALTH DATE APPROVED H •AL` H ANITARIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTIO DATE This form shall be signed by the agents of the Planning and Health Boards , the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. ';�- '. ",';"y:r✓s.r^£`7 ��'c. 'c `'rF•.�}= +,..„�"-;w J, � �J�-, ' n` tA y T s% -'`' '• !''C-•Q" :^'""'�"v'`"'.:. COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY 1010 COMMONWEALTH AVE.OF s' MASSACHUSETTS BOSTON,MASS.02215 ENCLOSE CHECK OR MONEY ORDER ' CENSE EXPIRATION DATE CONSTRLISUPERVISOR FOR REQUIRED FEE, 06/30/1993 MADE PAYABLE TO RESTRICTIONS 6 EFFECTIVE DATE LIC-NO. 6 NONE o 05/30/1491 026975 F "COMMISSIONER OF PUBLIC SAFETY" m J OH N DUZ I8 R I N (DO NOT SEND CASH). 17 LAKE STREET SS tl 001-56-0090 SALEM PSH 03079 PL'EASE KOTE FEE INCREASE PHOt911fl_LW_ WCT OPR ONLY, FEE: ! •' 100.00 E FECTIUE FEB. 1 , 1989 , � �'% � "t,-• HEIGHT' NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY _ =E: NER SIGNATURE OF THE COMMISSID MAYS 0199� `!;,i r DOB: 07/02/1958 1 '. - D NOT DETA IC,ENSE STUB v�\ f THIS i DOCUMENT MUST BE SIGN NAME IN LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE 4d • THE HOLDER WHEN ENGAG '<'f :OEH RS's gIGH_T iUMB PRINT ED IN THIS OCCUPATION. COMMISSIONER 20UMzY--87-81429 _ I 777 .� .�. i y• 1st r y\ • .00 t• t 4'� r.f s s F� P , + 1 r. '. 1 adl _ - r - .. I - 978-352-8441 I== Cell 978-375-4126 Fax 978-352-4643 PAUL A. SPADAFORE MA Home Improvement Reg.#110137 MA Carpenters License#035106 10 Parsonage St.-Georgetown, MA 01833 Email:spada4co@aol.com