Loading...
HomeMy WebLinkAboutMiscellaneous - 58 SUTTON PLACE 4/30/2018 58 SUTTON PLACE 210/060.0-0111-0000.0 - - --�- - - - ----- l PO Box 55098 Boston,MA 02205-5098 617-959-0600TASK- .r r Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: CHESTER M PAWLIK Jr. and CARMEN PAWLIK Property Address: 58 SUTTON PLACE,NORTH ANDOVER, MA Policy Number: HMA 0397446 Claim Number: BOS00060386 Date of Loss: 2/26/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed,$1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass.Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Lisa Monette Claim Examiner 5/4/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (857) 233-8618 Fax: (617) 535-5833 Emaif:"Ii-samonette@safetyinsurance.com MASSACHUSETTS UNII't:111 APPLICATION FOR nCRM1T TO QO GASFITTIN - ,- ---- (Print or Type) }: _ _ ,2. _ _ N n r t h A n d..p�e r �. Mass. Date 6 J an . 2 5 lg 9 4 Permit # Building Location 5 8 Sutton Place Owner's Name Mike P a w l'i k �S'"7✓ Type of Occupancy R e s . � New ❑ Renovation U Replacement ❑ Plans Submitted: Yes❑. No ❑ N i OC N w In Y 2 2 cn N N P U W Y LK N a N tr O '=) 0 = �. w N W O v in r y n x a W ~ 4 � Z ; o ~ W H I H4ir W O O .d. C a w d F- v1 > 1 w W N Z a = Er a W a W � w v z H a �1 O �- z , H x F. to w O > U. H W J w I i. X 4 w0 a z. Q a c o 0 W °� O P ` I t a 'x o ca x W a3: o 0 j o cr > o o. o SUB—RSMT. _ BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5THFLOOR ' 6TH FLOOR 7TH FLOOR 8THFLOOR Installing Company Name Andover P 1 g & H t g . C o . Inc . 12heck one: Certificate # Address 573 ' So Union St 1051''' - 2 Corporation _ a w r e n c e , Ma . ❑ Partnership Business Telephone 685-8383, 0 Firm/Co. Name of Licensed Plumber or Gas Fitter _ [INSURANCE COVERAGE: I have a Curren ability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.,142. . Yes No ❑ If You have checked G Y ,Yes, please ndlcate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity 0 gond O 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's on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signalure of Owner or Owner's Agent I hereby certify that all of the details and information I have suhrnifted(or entered)in above application are true a d accurate to the best of my knowledge and that all plumbing ^r4 and l^F:aiiarinns nArtormnd endo.the parm't Issued for this application a In pile with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142.ofZeq,, al,!gy T e cf t cense: I lumbi r Signature of LicensedPlumber or.Gas Titter ,, �wl y 11,x Title Gasfitter Mas terUcense Number 3762 City/Town -_. Journeyman �. Al*li,[ -f)FOiFI-CE-I Si ONLYT__` p , ' t ' Date... . F NpaTM TOWN OF NORTH ANDOVER 0 + pp PERMIT FOR GAS INSTALLATION s i • o�+ a SSACNUSE This certifies that . . . . . . . . . . i has permission for gas installation . . .! . . . :%C . .. ... . . . . . . . . in the buildings of . . ... . .�.(. .I t,. . . . ... ...L4Z. . . . . . . . . at . . . .`. �. . :..��� !:'.►... . ., ., North Andover, Mass. �Fee. . . . : . ' Lic. No.�'�. . . . . . . . . . . . . . . . . . . . . . . . . . . . Oj/E4rSf�p' ;t' � I -A5.00 +QjR GAS INSPECTOR WHITE:Applicant CANARY: Build ng Dept. PINK:Treasurer GOLD:File Date A� ... . ... . . ,,ORTIM 3� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SS C" This certifies that . . . . . . . . . . . . . . . . . . . has permission for gas installation ,�i. C GE? rte., . in the buildings of . . �! . � ' at . . . . .. . . . . . . . .. North Andover, Mass. Fee. .��. ... . . Lic. No.. . :. .! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check#J u 3777 MASSACHUSETTS UNIFORM APPUCA IO DO GAS �..� AaA.1.e Tuna) T N FOR PERMIT TO FCITING Date lo i 'AcinPef mt# ?7 Building Location S Owners Name ' Type of Occupancy � ;&40L:: New Renovation ❑ Repla 4nent ❑ Puts Submitted: Yes❑ No❑ EMS kffa Z Am < m W4L a 92 4C z ZccO W X t us = < ¢ h r � � O > fi E- v J � W < 4l i « W .7 Z. < < —X O O = 6 F O 1 1 SUB—BSUT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 4TH FLOOR OTH FLOOR TTM FLOOR STH FLOOR Msta M Company Name XANKEE GAS Check ofw. Certiricde Address t 40 SOUTH MAIN STREET W Corporation 103C MIDDLETON, MA 01949 ❑ Partnership 8tm6uss Telephone 978-774-2760 ❑ Firm/Co. Mame Of Ucensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I trove a current IidAlly Durance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes xx No Q If you have checked AS. please Indicate the type coverage by checking the appropdde, box. A llabifty insurance policy RX Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General taws. and that my signature on this permit applicatlon waWn Vft requirement. Check one: Signature of owner at Owners Agent Ont WO Agent❑ 1 hereby cw*that all of the details and iMomnation I have submitted for entered)fn above tbn are true arta accurde to the best Of my k1woledge and that all phmOV wont artd lh90AWons Performed under fhe psn►trlt kr thla wN bs hr encs with M Pew Provislaw Of the WAssadwsaft State Gas Code and Chapter 142 of the Laws. By S of Ucense: Per ture u r or Gat e ,at I 1 0.Al.n..i... 3785 arv..av..w.wR. /TO�RRn � ❑Jo��� Location No. Date NORTq TOWN OF NORTH ANDOVER ? �, • O Aidlilik 9 * ; : Certificate of Occupancy $ s�CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check #�!/ 17711 Building Inspector i s„ M TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPhCATION TO C'!ONSTRUCr REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1 ab*0000bt Ow *0 BUILDING PERMIT NUMBER: DATE ISSUED: Z�f ZL'a'16:7 Lrn C � SIGNATURE: z Building Commissioner/IA for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: sACt; O r Map Number Parcel Number 0 1.3 Zoning Information: 1.4 Property Dimensions: �I Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required - Provide Required Provided Required Provided 1.7 Water Supply Iv1:G.L.C.40. 34) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J /AUTHORIZED AGENT I {; i r!Ct. , .. n SECTION 2-PROPERTY OWNERSHIP _� , 17 rn 2.1 Owner of Record r/) tC1.4AZ ?,,)�l ,k �a s,�-rCa:� r�i►��� Name(Print) Address for Service Signature Telephone e 2.2 Owner of Record: a 0 Name Print Address for Service: y M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1.Licensed Construction Supervisor: Not Applicable ❑ O tv ; 1(�. `c c )-0",,�z v Licensed Construction Supervisor: C C' License Number 333 sV oN 5� MWtu Expir tion ate Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �4. �,, C fl6Z CoCo p y Name 1 `f c) Registration Number P 7znn 0,i j z) 60G Expir tion ate ff2lre Tele hone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No....... SECTION 5 Description of Proposed Work chec appHcable New Construction ❑ Existing Building Repair(s) 0 Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: I '`�/�T�l O�Q�Y`^ ��t"�CI�LI..� F' NO �IfZUCfiU2YaL e.►�L N"�S �— SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building Oho o (a) Building Permit Fee Multiplier 2 Electrical o G Q (b) Estimated Total Cost of C'S Construction m J 3 Plumbing ( 5 0© Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L as Owner/Authorized Agent of subject property Hereb 1 o ' to act on 1 r e elative to work authorized by this building permit application. //I '( iature of ier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate;^to the best of my knowledge and belief 5'Z ii 3 Si ature J O er/A ent D to NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIyIBERS1' 2' 3KU SPAN - DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUII.DING CONNECTED TO NATURAL GAS LINE ti R & M Carpentry, LLC 11mimarmwnt coRtroct THIS CONTRACTis entered into an this day of, 4 , by and between _.!,M kv, ?Aw'i. k (hereinafter "Owner") li,aving an address of and R.& IM Carpentry, LLC (hercinafter. "Contractor"), having an address of 3:13 Sutton Street, North Andover, Mas,sachusetts, MassaelluqetisRegi5tt,,itir)t1 Ntimbet Whereas the Owner desires to engage the Contractor to perform certain work on the premises located at jP ("pretnises"), whereas the Owner model and/or improve the aforesaid premises in accordance with local and state building codes, and whereas the Owner agrees to compensate Contractor for or services performed and materials provided, Now, therefore, the parties to this (7 ontract intaually Hgree as follows; .1. Sgoge gL&2rk The Contractor shall perform the proposed irnprovements specified in the plans and/or specifications developed for this project, including materials to be utilized, attached hereto as Exhibit A. The Contractor acknowled.ges, that the proposed improvements have been reviewed and that said improvements are ticcurate and consisi-cm as to soope of work and the coat for said improvement. The Contractor agrees that it shall use materials consistent with industry standards in the performance of-said contract. 2. Time for PerforManeg The Contractor shall cornmence the w(.,)rk, to be performed under, this Contract by oc-T -aomor os; v'urn tberenfler as a building permit is received. 'Fhc Cont actor acknowfc-4es—dh�—ttime is of ll-W essence in the performance of the Contract. The work shall be substanlially completed by iw "StihF,unifril completion" is defined aq 'being the point al.which the project is suitable for its intended use, or the issuance of to final building department approval, whichever occurs first. The parties agree that tinic shall be reasonably extended for substantial completion and final completion if it is detertnitied that there was an excusable delay, including, but not limited to strikes, Hds of god, Owner's failure to comply with the terms A � +A May. 20 2004 01:45PM [ NEW I NO, NAME TELEPHONE NUMBER TIME OF CALL ANSWER 01 NO NAME RCVD OUT OF AREA May. 20 02:46PM 02 CAPITAL ONE C-S 1-972-819-6005 May. 20 11:57AM 03 CAPITAL ONE C-S 1-972-819-6005 May. 20 08:47AM 04 TEXAS 1-281-560-1788 May. 20 08:38AM 05 SAWYER MICHAEL 1-978-828-4919 Ma.y. 19 08:28PM EXT 06 DUANE DENOI 1-978-258-0972 May. 19 07:18PM 07 DUANE DENOI 1-978-258-0972 May. 19 06:46PM EXT 08 DUANE DENOI 1-978-258-0972 May. 19 06:26PM 09 WIRELESS CALLER 1-603-930-8590 May. 19 05:52PM EXT 10 UNAVAILABLE 1-888-465-3153 May. 19 05:47PM 11 EIDAM,LOIS H 1-978-682--7489 May. 19 05:18PM 12 NO NAME RCQD OUT OF AREA May. 19 03:31PM 13 WE,MEA 1-978-373-7554 May. 19 03:27PM FAX 14 WE,MEA 1-978-37.3-7554 May. 19 02:22PM FAX 15 TUFTS-NEW,ENGLA 1-617-6.36-5000 May. 19 02:00PM 16 WE,MEA 1-978-373-7554 May. 19 01:52PM FAX 17 MARSHALL,MARIE 1-978-459-665.3 May. 19 10:11AM 18 HEALTH BENEFIT 1-815-787-7814 May. 19 09: 13AM 19 NO NAME RCVD OUT OF AREA May. 19 09:07AM 20 CAPITAL ONE C-S 1-972-819-6005 May. 19 09:26AM 21 TEXAS 1-281-560-1759 May. 18 08:57PM 22 LIPORTO,J &J 1-603-778-7764 May. 18 08:28PM EXT 23 CHIASSON, DAVID 1-978-691-5498 May. 18 08:07PM EXT 24 NO NAME RCUD 1-978-866-0822 May. 18 06:46PM EXT 25 CAPITAL ONE C-S 1-972-819-6005 May. 18 05:43PM 26 BOLDUC NANCI 1-508-633-7336 May. 18 05:39PM EXT 27 THOMAS � 1-978-258-7476 .SHEILA May. 18 05:02PM 28 NO NAME RCVD 1-508-397-2040 May. 18 04:59PM EXT 29 BANKFIRST 1-480-776-2466 May. 18 03:57PM 30 ALTER,DEBRA 1-978-689-0655 May. 18 03:30PM [ OLD ] NO. NAME TELEPHONE NUMBER TIME OF CALL ANSWER TO TURN OFF THE AUTO-CALLER LIST, PRESS MENU #26. THEN SELECT OFF BY USING '+' OR '-'. FOR FAX ADVANTAGE ASSISTANCE, PLEASE CALL 1-800-HELP-FAX C435-73291. THIS CONTRACT is entered.into on this day of -Atack 200_. ._ , by and between M%'X u P Aw k,k A—ereinafter Owner") having an address of.. At� and R & M Carpentry, LLC (hereinafter "Contractor"), having an address of 333 Sutton Street, North Andover,,- Massachusetts, Massachusetts Registration Number Whereas the Owner desires t(, eligage the Contractor to perform certain work on the premises located at i A "Prctnises"), whereas the Owner desirbs to iv.habilita(c, t-cnovatc, remodel and/or improve the aforesaid pterrilses in accordance with local and state building codes, and whereas the Owner agrees to compensate Contractor flot set-vices performed and materials provided, Now, therefore, the parties to this, Contract 13lutually agree as follows: 1. SC222 Of A26 The Contractor shall perform the proposed improvements specified in the plans and/or specifications developed for this project, including materials to be utilized, attached hereto as Exhibit A. Tile Contractor acknowledges tbnt the proposed improvements have been reviewed and that said improvements arc accurate and consistent as to scope of work and the cost for said improvement, The 'Contractor agrees that it: shall use materials C01114istent with industry standards in the petforinance of said contract. 2. jjtgLhr PeEE2Lmaace The Contractor shall commence the work to be perf'ornied tinder. this Contract by _�5!47, -40&1 or as soon flieres-fteras a building permit is received. t/The Cont actor acknowledges that time is of the essence in the performance of tile Contract, The work shall be substantially completed by "Substantial completion" is def reed as being the point at which the project is suitable for its intended use, or the isstiance of a. final buildhig depni-tivent approvni, whichever occurs first. The parties agree that time shall be reasonably extended for substantial completion and final completion if it is deterp,-iincd that there was all excusable delay, including but not limited to strikes, acts, ofgod, Owner's failure to comply with the terms v This Contract, together with ttic exiiihits attached, represent the entire understanding of the parties, and ncither party is relying on any representation not contained herein. i 12. vczability In the event that,any provision oCthis Contract shall be deemed invalid, unreasonable or unenforceable by arty court of conipeWnt jurisdiction, such provision shall be stricken from the Contract or modified so as to render it reasonable, and the remaining provisions of this Contract or the modifled provision as provided above shall continue in full force and effect and be binding upon the parties so long as such remaining or modil.ieri provisions re.tlec,t. oir inteial of'the p.arlie" as of the date of this Contract. No work shall begin on the premises until this contract h executed by both Owner and Contractor. DO NOT SIGN THIS FORM IC '!'UPAIi, ARE ANY .BLANK SPACES C er Ronald F,. Finoccli' ro, Jr., Member l�atrd for K cot. M Carpe try, LLC 333 Sutton Street,N, Andover, MA Federal Tax 11)No. 43-2056899 Dated; 8 a The Commonwealth of Massachusetts d Department of Industrial Accidents Mice of Investigations Boston, Mass. 02111 . y' r ' Workers'Compensation Insurance Affidavit Name Please Print Name: «R +�+ L�+ rs•, , Location: IsIr City tl,)Q-441-44S.1-111— Phone # am a homeowner performing all work myself. H/I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: - r i Address City: Phone# Insurance Co. Policv# Company name: Address City: Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a fine up to$1,500.00 and/or one years'imprisonment_as_ _dv.il..penatties inlhefnrmd-a_STOP WORK_ORDER..and..a.fine af.($100.011)-a JJay against-me. I understan hat is statrpnndpen abe forwarded to the Office of Investigations of the DIA for coverage verification. I do here y ce ai h of perjury that the information provided above is true and correct. Signatu'e I� Date ! `� Print name P4 N �, �V ec���a:�� Phone# Official use only do not write in this area to be completed by city or town official' City or Town PermiVU ensin 0 Building Dept []Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person. Phone#: Health Department Other i 1k 1 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: s9t, S.rA o tion of Fac' y Signature of Permit Applicant t Ch 6 Date .1 ' 7 NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH t Town of Andover No. z/ _ i _ odower Mass. & O COC MIC MEWICK ' o ' RATED G BOARD OF HEALTH Food/Kitchen PERMIT T 0 Septic System A BUILDING INSPECTOR THIS CERTIFIES THAT..... ..I.........................................��� A..w. L t �C ..........� .......V ............PiA�....... Foundation has permission to erect ,�ON►�►i&/buildings on ... ................ ............�................. Rough Bto be occupied as ........... N P V31 �V� 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-La s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. & ®7 /f/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI N AR S ELECTRICAL INSPECTOR Rough 00 .......00 ................{Y Service '.00BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 11 SEE REVERSE SIDE Smoke Det. r Date. .R 7. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . . .. . . . ... . . Z P ��- has permission to perform . . �J1gc. ��"�' ��. `. . . .AJe.. plumbing in the buildings of . . /. .A:w -. . . . . . . . . . . . . . . . . . . . . . . at . . . . . . ... . . . .5 . ... . . . ���. . . . . . . . ., North Andover, Mass. Fee. . aZS . . .Lic. No.2' 1°/ �.• i71oa? �i1�t U (✓`- J PLUMBING INSPECTOR Check # S� l 5686 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS (� v Date Building Location St Ar e4k. Owners Name "i� Awl /` Permit# Amount Type of Occupancy s -��/Q New Renovation Replacement ® Plans Submitted Yes No FIXTURES Eliz HrA W F d ; Gn Cn aa � ,� W p� w A a � �" E• d � w M FIS M Hmt 3MFUM 41H FLOOR 5IH FIDQ2 61H FUM '11II Fimt gm FIDQ2 (Print,or e) Check one: Certificate type) Company N�^ame`Dcc - L- tt'f2 ( + ���A'`�" y Corp. Address I /.I(/t Partner. A �'VJ�.f-t /,e u11 ,M A- I rgq Business Telephone CY FV Ir j//IV Firm/Co. 7 n n Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ��� Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massacbms9tts S to Pl in Cod andrChapt r 142 of the General Laws. By: i a e or Licenseaer Type of Plumbing License Title a.�2--1 e City/Town lcen' NUMper Master ® Journeyman APPROVED(OFFICE USE ONLY 1.�8 1 Date. °'M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACHUSE� This certifies that� , has permission to perform . . . -t � r r plumbing in the buildings of�-r-;.,.-�-���- '. . . . . . . . . . . . . . . . . . + at .t,�7(1. , North Andover, Mass. 3 Fee 7c?. . '. .Lic. No.. . . . . . . . . �: ..t. .� . PL�9N�INSPECTOR Check # 6213 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date -Zz y� d City,Town ftl Permit# / � Building ¢ Owner's AT: Location_ r, S(.M70 n Pl ace. N e L 4 r/n Ak, Twe f Occupancy: New ❑ Renovation ❑ Replace ent FIXTURES Plans Submitted Yes ❑ No lJ z Z N z be Q f. N N N O Z F' > O W J N V Q N z O W Q N _Z N 6 OC _ ~ _Z O z N d O J N W y ~ W y 1r V Y Q N W z d Z Vl x ICW H •�, x O Z O O Z y W3i F- q D Q N O oQC 4 cc O us Q W tJl W J z W W S F F. 3 O a -1 !• Q �C C a t; cc V Z x CL Z Zt F, Y d 0 z Z Q W Y W 1- O O N a a a x N a a O s -�+ Q s s m a 0 3 Y m N D a J x N F Y. O � 3 O a 3 Q m O SUB—BSMT. BASEMENT 1ST FLOOR ' 2ND FLOOR * 3RD FLOOR 4TH FLOOR 5TH FLOOR BTHFLOOR 7TH FLOOR —ST H FLOOR fttffgffffffff (Print or Type) Check One: Certificate Installing Company Name Ltir Cv k 101 `t) 4 n} ❑ Corp. Address ❑ Partnership ❑ Firm/Company Business Telephone Name of Licensed Plumber or Gasfitter �rreiV J?Zg 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 Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations covers By Title igna ure of Licensed Plumber City/Town //r7 Type of Plumbing License i APPROVED (OFFICE USE ONLY) License Num ber ❑ Master 7 Journe man FORM 1240 r HbW W—o .WA ....i TM BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE PLUMBING INSPECTOR r , Date.................................. f ,40RT#1, r `°:° "� TOWN OF NORTH ANDOVER end O T p. = A PERMIT FOR WIRING t 4 SSACMuSE� This certifies that ...... `-g' f....................................................... has permission to perform �- : !�s G� ��-�..................... . . wiring in the building of ,., �,-roc-y .................................................... at..`'�f�....... ................... ............. .......... North Andover Mass. Fee...�-d�..... Lic. .,�. ................ !f 4�---ELECTRICAL INSPECTOR Check # 5523 THECOWONWEUTHOF SACHUSEM Office Use only DEPAR M&� TOFPUBIIQS9FE7Y Permit No, BOARDOFFIREPREVEMONRUTATTONSR7CMR12M fOccupancy&Fees Checked APPLICA77ONFOR PERMIT TO l'EIZFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE H THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /o - 14• a4 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical OrJdescribed below. Location(Street&Number) Owner or Tenant Owner's Address $�*ih C Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building $„;/�� �,�.�..t i`� Utility Authorization No. _ Existing Service Amps �Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 71W le fr.-iod,��s No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 0 ground No.of Receptacle Outlets Z No.of Oil Burners No.of Emergency Lighting Battery Units .No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained •�— Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal � Other N(Y of Water Heaters KW No.of No.of Connections Si s Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER 2 �)c1liGvSri9�/S hmuanoeCor�a�.Pt�anttotheraquit�nadsafM�Is�C3enaall.aws Ihawaamaxliabkyh►an=R)hcymchxkgCoI CowaageorilswbsUrialegtrivalat YES NO Ihar WmliWdvabdpmofOfsametotheOffiM YES g haw YFS l please' thetypeofwvby dled�gthe box ��,,,AJ INSURANCE BOND OIIER (P1ea9eSpecdy) X10 -O� Eqkafion Dale WodcroSta<t /�' /�i'04� Estirr>amdValueofF chmlWodc$ Si 0da0stmt iePenaltiesof D* Rotlgtt /O ”�'e� Final FIRMNAM�E / O c £Gr �L IicalseNo. 9 3o 2,S S1— se/t I _ 0$W Sig>almLkr.NTOE 3d ZS � Tel No. &'d3 6 f _f t`� � 3 9-8TA1 A7 /� — Alt,Tel No. G 01 P'S.f 3 d OWNER'S INSURANCEWAIVER,1amaW&ethatthefkmsedm nothawtheil>sutanoecova�oritssubstarMegttivalentaslagEWbyMmxhusMsGenedLam and that my signature on this peunt appkation waives this legtliterwl (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Signature of Uwner or Agent