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HomeMy WebLinkAboutMiscellaneous - 62 CARLTON LANE 4/30/2018 (2) 62 CARLTON LANE 210/706_ =U 000.0 ® t O Date ... . +`7.. TOWN OF NORTH ANDOVER ° slim 9 PERMIT FOR PLUMBING �s�CMUs� This certifies that has permission to perform...Hn..4n!?.......6......... plumbing in,the buildings of........, ............ at.24....("Ag: .....,North Andover,Mass. FeOV."....Lic. No.�'0,7.4...... .......................................................... t ,t' PLUMBING INSPECTOR Check# ` `t� X012 r+ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY1 MA DATE ^. 6 PERMIT# H I JOBSITE ADDRESS �� y- ( W OWNER'S NAME r. �F OWNER ADDRESS i TEL="--, JFAX( _ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:E] RENOVATION:V— .REPLACEMENT:L] PLANS SUBMITTED: YES N0[ FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 P 8 9 10 11 12 13 14 BATHTUB 1; li CROSS CONNECTION DEVICE i_.:. . ... ,. DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOWSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ._ t. y i�..:_ 3, ,'€ I,_._, :f V DEDICATED WATER RECYCLE SYSTEM r r DISHWASHER DRINKING FOUNTAIN - __. FOOD DISPOSER } ...,_,. , FLOOR/AREADRAIN -- —.::.. =':- ._.., .... INTERCEPTOR(INTERIOR) „_ _ 3_ KITCHEN SINK ___. _t _-_ LAVATORY I I t ROOF DRAIN _ SHOWER STALL s` f SERVICE I MOP SINK - J E 'I _ TOILET URINAL WASHING MACHINE CONNECTION .- - - WATER HEATER ALL TYPES WATER PIPING `. OTHERr ; - rv� E Y € -... .......�.. _._._... _- -...ems-.�..... _ —._. ._... ..:_ _. JIL -. .. INSURANCE COVERAGE: libave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 7kNO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BONDE] 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 El AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application ar 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 bei mplianc inent provisio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7-1 PLUMBER'S NAME mA n5 �,C . i uCENSE# Q Z L 3 SIGNATURE MPx JPD CORPORATION #' PARTNERSHIP #L LLC[ # _ COMPANY NAME ADDRESS3On.._5r: ti._T STATE LQ _. 1 ,... .7'.,7-a---.. ► Ft E__._:p ZIP TEL 7-rolz-4 �__ CITY FAX5126EMAIL .y�,1 UGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION X4ES t� S Yee No c = THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �I i� s. me Comm"w�h of)(Awad - w0 WaungAm Soled Basma MA 02111 wWj*W gav/db ' admrs'Comte Onli mwanre AMUYit-B� AvvlicIn6onma#�oa _ Ple�e Pn..t r �_ Name cJ �R Piuc �[n H EAT�nc��1�1C Address: - - - _ 23u-,Aman Emig qjl FIEL-DAA 01860 : 7 1215-X770 Are you an iumpmy !Cbe&ftipprop ym T�P1.( I amae:nployerwi6►_ 4. ❑Ism agmaai aomsew and I' � (K4aireak- uplgyan(5iIl mdIarparr4ma p- huchircddiemoors 6. ❑Nei►c !.0 I anasole,dap uipaw. -listedoo6e s shit. 7. 0 Rimmodeliag ship andhavano e*oyees Theo subcouhwkn have � 0 Demo) k. wad&g far me in mmy j. eanplwm aadham we&=- ' (No mss'c®g.bmum CMIA kounum, . 9.-Q Baufttitian Wil- 3. We are a oaapoaaliva and its 14❑ t.Q I-am ahameowar doing all wa k ofeas chave axm=ed dW 11.0 additions . MYRZ Did wakiw kTdm ar inmime n�irea l t - � l( we hmc no 12.0 employe.[No wort M, 13.0 odw _ myapplirad�dLiasl�sca�fiuotfkas�tdowsha�ggelra Py �omeonnas'wLosa6�e5��a.;ear.��aIIwaAcamII�m�ootstaaoumo�mrsma� ane�s � �ff saaddoaiatcl�tsi�nwiagiammeaf�emb oo�do,amtsaud�se�rhaheraanot �x� mea aodu�• P�Ynomixr_ _ _ - - Fna> atleA. qpmfi*W01*0e �far� O'r+tt memaydirdjob site imrmce caopayx -ti RuAms ffmu t. insumnice licy#or Self-im I:ie_ DM- i�/Z4lZo Site Aft,-; �i^ �>>; L aeh a ropy of the Waliere aompemmum policy declaration page(showing the policy umber and lure to swm coverage as inquired under Section?SAdf MGL c.152 c lead to dte. �' t date). np to 1:1,iU0Ao and/or cno yew as well as avT peaaitim m the foam of Wip es of a V to S"d-60 a day againd 4mviolatvr. Be advised tlmt a of fids statement w and a fine m6gadam of&a MA for ms cov � �Y�forwarded to the Off ce� erage vxas5eation. ham ' of �1FrE istrareend Convc Date: le #: OWcfal me ej* Do not rvdtelu gkb area m-be MVIdsd by cip or town amt Ety or Town: Permft/I,ioeam# wing Authority(circle one): __ - Board of Health Z.Banding Dgmronent 3 CityjTawu Qerec d.Itledriwt Inspector 5. Other- - . �L� etor ' intact Perm, - Phone M. i v COMMONW 'NLTH OF Ma CHUSE'iT5 a .. BOAR>t? Of PLUMBlRS GAS ITTERS ISSUES THE FOL LOWI<1VG L -CENSE:, L I EEhSE3S A JOURNEYMAN,PLUMB!` W FRt p RICK A MANSF I'ELD ' IZ -• 4 y 36 BART.IEY STREET �l Z J 1 SCI �1 ELD MA 01880-3* "` 230 65/0Z 199477 OMMONW LTH OF M S .OHl3 • • - • • 8.0AOP PLUMBEEtS AND DASF ITTE1.5 ISSUES THE FOLLOWING,:LFLE{�ISE REGESTER D AS A PLUMBING.CORP Q FRE4 RICK A MANSFIELD �' a MANSF I EL q, 8€BB 1 NS PLUMB I:NG ,s; H 36 BARTLEY ST `�`I Z W VA" MA 01880 3i`3 2& 3 o /oiL:.t6 199475 • Alijd GOMMONW TH OF MA RCHUSETT& , BQAfI Of PLUMBER: ;AN€D" GASf:JT::T:,Bf S ;: ISSUES THE FOLLOWIN' 1 (CENSE;_,_, L I Cf1SETi AS A MASTER PLUMBER _ ,FR 4p I CK A MAN'S 36 BARTLI=X St "I", f Z fifEF I:ELD h4A 01880-3130' :.,... J tt94 `05/01/:i6 199476 . Date..:�OAT............ NORTIy TOWN OF,NORTH ANDOVER 0 PERMIT FOR WIRING U This certifies that" ...4-k.��.... .........I........................................ has permission to ........M... ........ ...... .. ....... . i V'0Jp wiring in the building of...... ................................................................... ............ ... ... at (P 2- Andover,M. ........................................................................... Fee..... 'N .........Lic.No.2 ........... .... ..... ..... . .........k......:.�.w.................... . ........... k I--I z 39- EdECTRICAL INSPECT'o 6heck# �O 13137 plp Commonwealth of Massachusetts Official Use Ord y - Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev.9105j eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts El:ica4Inct6r C) 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL FORMATION) Dnte: City or Town of: �P,r To the of Wires: By this application the undersigned L�jotice of his or her intention to perform the electrical work described below. Location(Street&Number) . p Owner or Tenant d Telephone No. Owner's Address snwc Is this permit in conjunction with a buil`dinippermit? Yes No ❑ (Check Appropriate Box) Purpose of Building 1�ti Utility Authorization No. Existing Service�j Am !Zt olts Overhead❑ Undgrd 0 No.of Meters New Service Amps ! Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and N re of Proposed Elec 1 Work: ,._ 4.11 lel) t4 it A Completion of thefollow table m be waived by the Ins ctor of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans NO.or Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n. ❑ o.o Emergency ng ffnd- d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ' No.of Switches No.of Gas Burners o.of JIMectlon an Initiatins Devices No.of Ranges No.of Air Cond. Tom No.of Alerting Devices HedNo.of Waste Disposers mp ....am. ,r ons a o Self-Contained Totals: ..................... ................. Detection/Alerting Devices No.of Dishwashers Space/Ares Heating KW Local❑ unnen c pction a ❑ Other Co No.of Dryers Heating Appliances KW u Yo ystemces: Na of Devis or I,qnivalent No.of Water KW o.o o.o Data Wiring: Heaters signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications gg No.of Devices or uivalent OTHER: ht Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El Work: _ �S (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and uponcompletion. 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:) 1 certify,under the pains and penalties of perjury,that the information on this appikadon h hue and complete FIRM NAME: LIC.NO.: 172'i8A Licensee: Richard J. Arel Signature LIC.NO.: 27514E ffappliaable,enter'exempt"in the license member line.) Bus.Tel.No.;978-372-1601 Address: StreetAlt.Tel.No.:Q7A-'107-7 1 R7 *Security System Contracror License required for this work;if applicable,enter the license number here: 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,l hereby waive this requirement. I am the(check one owner ❑owner's agent Owner/Agent PERMIT FEE:$ Signature Telephone No. -h � 1 r - " 1� s A — - - ----- — -- - j11y �� -7 ) ` 1 {� .Ir � li/(5..••, i `Nl"r'_ 1' .. r +.. r �� �J � �I r _ .. .,1 .��+t,r. _� 1 - f. , 1 (. 'I _ ..',�I• r-= t .. ....`i' � 1 .t r S . ��. �]'. .. ,S+'1 tilt. ;,i. ,�.{ .i4 t.`.y ,.0 - _ •°� a: ?°li. r. � 1 1"t 1 t� _._ r t '1'�• l+ 1 s .'�' _�� - __.._._. Y + _G{�ti .. ! -1' a - [, s,a - F '" _ I The Commonwealth ofHassachusetts 411 al Department of lndustriglAceitlenfs Office ofInves9gations 600 Washington Street .Boston,MA 02111 -www.mass govIdia Workers,Compensation Insurance Affidavit:BuildersfContractors/EIectricians/Pliiinbers Applicant�nforination Please Print Legibly Name(Business/Organization&dtvidual): Address: T73 &41 City/State/Zip:��/�/�� � ` #I Phone#:. 7p . Are ypu an employer?Check the appropriatebox: Type of project(requirecl): 1. I am a employer with 4. ❑I am a general contractor and I 6. [l New construction employees(full audlor part-time).* have Medthe sub-contractors 7. 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 8. emodeling ship and'haveno.employe as. These sub-contractors have 8. Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition. [No worbxa'comp.insurance 5. ❑We are a corporal on and its 10.❑Electrical repairs or additions required.] officers have exercised.their 3.[l X am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and have no 12.0 Rcofrepairs insurancere ed. employees.[No workers' �� 13.❑Other comp,insurance required.] *Any applicantthat checks box#1 nmwtalso fill outths section below showingtheirworkers'compensationpolicyinfornation. t'Homeowners who submit this affidavit indicatingthey ale doing allworlt and then hire outside contractors must subh*a new affidavit indicating such. tContractors that check this bDz3nust attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workerscornpensadon insurance formy employees Bellow is the policy and job site infomation. Insurance Company Name;- �IZ5*bYO)ICL AIG�s .rl 1a Policy#or Self.in.Bic.A we A.ro 3 2 61 C'6 Expiration Date: (n 15 rob Site Address, /2Z 49 AA /�/VI d-' Pity/State/Zip: Attach a copy of ee workers,compensation-policy tleclaraticon page(showing the policy number and expiration date). failure to secure coverage as reguiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a lime 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 Iniestigations of the AIA for iiLsurance coverage verification. do hereby cert u/[I�Y1171 S a en Iti2sOf peYfldYytlZattr12iI2f0Y3111dI072 IYOV'd i d ab0Y0 S true andcorrect./,�j" ��2 Date: vp Si ature• � Phone#- ��� 34 7,. 01,F7 Oficial use only. Do not wMe in this area,to be completed by city or'town official. City or Town: Permit/License# Issuing Auth ority(circle one): 1.Board of Health.2.Building Department 3.C41T- own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Jerson: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an eWloyee is defined as"•..every person in the service of another under any contract of hire, express orimplied,oral or written.,' An employer'is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore Of the foregoing engaged iu a j oint enterprise,and including the legal representatives of a-deceased employer,or the xedeiver or trustee of an individual,partnership,askeiation.or other legal entity,employing employees. Tloweverthe owner of a dwelling house having notmore 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 constxuet 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 snbdivrlsions shall enter into any contract fbr the performance.ofpublic work until acceptable evidence of compliance with the iusurance requirements of this chapter have beenpresented to the contracting authority." Applicants Please fill•out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cergeate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. If au LLC or LLP does have employees,apolicyisxeq*ed. Be advised that this affidavit maybe submitted to the Department ofludustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Department of ladustrial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain a*orkers' comp ensationpolicy,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 Tovm 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 lilt inthe pemlit/license number which will be used as a reference number. In addition,an applicant thatmust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Sob 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-lion file for future perniits or licenses. A now affidavit must be filled out each year,Where ahome owner or citizen is obtaining a license orpermitnot related to anybusiness ox commercial venture (i,e•a dog license orpermit to burn leaves etc.)said person is NOT required to complete this aisdavlt. The Office of Inves0gations would like to thank you in advance for your cooperation and should you have any c estions, " please do not hesitate to give us a call. The Department's address,telephone and fax number: The Goxouwea�t�Z o£ rssaol?usatEs Deparbo tQfladu*ld,A.ccidents OfFl oe off' wattgatt 690 WaSW4-01.ftoet Boston.,MA.021 It TO. 617-7-27-4900 eA 446 or 1-877,�iVA�8 AM Revised 5-26-05 Fax 617-727-7749 ' v�ww.zX,IOS�.��•v�c�`.a - 7 { ( . ''OMMONWEALT HOF MASSIkCHUSETTS �d � n og Ito] o 0 B©ARDCJS a E:C: CTR I I QNS S S U E S THE, FOLLOW NO I_7 CENSE AS .' REGTEEtEQ MASTER 'E LE �TRICI;A Q ,i1RL ELECTR I C I NC R1 CHARQ .� AR£L! ' Z ' 773 WASITY'NG�ON ST �. HAIERHIIL MA 01832-4 i 2 . . , 3117 /3. j _ ... . . :. .�.�;. `rGOMMONWE, LtH OF MAS�1�CFiUSETT BOASQ E L1�TR I'C IANS I SSUE$ THE FOLLOWIJ1; L I'CEN$E AS A R£G .:JOURNEYMAN_ ELEG,TR=IGG1 3 Rt;C�IARD J AREL l 4 t 773 WASFfi I NGTON ,a~ qZz Lu HAVERHILL MA 01832-4 i .. 2751 +;; E o6 56830 - :. Date..--�. ".X2.".P...... pORT1, °���``°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING AcmUS This certifies that .�--......... ........ ......................� � - ,.�..:..�. has permission to perform ..... ':.:Y. �....rte.................. __. wiring in the building of.... ........................................................ at ..f "i;6�North Andover Mass. Fee.. ... Lic.No�/ S�U!Yfi •......... '-- /' ELEC Check # 9242 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. &-�� Occupancy and Fee Checked L7,6 v BOARD OF FIRE PREVENTION REGULATIONS ' [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordancewith the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER �-/,?By this application the undersigned gives notice of his or her intention to perform the ele electrical wor idescribed below. Location(Street&Number) fin n P. Owner or Tenant o s a Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building s �¢e �(,f` Utility Authorization No. Existing Service Amps / Volts Overea ❑ Und d ----- hd >�' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No,of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: / G 4-% u Com letion of the ollowin table m be waived b the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Ni.of Total No.of Luminaire Outlets No.of Hot Tubs Transformers KVA Generators KVA No.of Luminaires Swimming Pool A ove In o.o mergency rg g d• 13d. � Batte Units --, No.of Receptacle Outlets No,of On Burners FIRE AL-ARie>IS No.of dunes No.of Switches No.of Gas Burners No.of Detection and 1: No.of Ranges Initiatin Devices g e `s 1/1, No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: '-'� Detection/Ale Devices No.of Dishwashers Space/Area Heating KW I'm[IMunicipal Connection ❑ Other No.of Dryers Heating AppliancesKW Security Systems:* No.of Water KW No.of No.of Devices or E uivalent Heaters No.of Data Wiring: Si s Ballasts. No.of Devices or E uivaient No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: �,pip (When required by municipal policy.) Work to Start:,2:IZ-/0 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 ❑ (S eci I certify,under the pains and penalties ofP 1 ►er uy,that the inform non this application is true and complete FIRMNAME:1.S.7 L=��>(i.`<*�l �� LLL Licensee: LIC.NO.e L/�� 5��^ c o�KS�-► Signature (If applicable, enter"exemp(,"in the license number line.) //I /t�I/ LIC. Address: e/ 3/�.'.s)e e �- (70/'fs`,t..H /(�/� 0 3 o c/J Bus.Tel.Na: �v3-3!T-6 7>> *Per M.G.L c 147,s.57 61,security work requires Department of pu lic Safety"S"License: ��L ci No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the IiabiIity insurance coverage no rmally 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.$A4— w R i� r t. } Dat . . . . . . . . . . . NORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAUS� ,y This certifies that .��1 �. . . !':� . . �, . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .r:4.,. . a . . . . . . . . . . . . plumbing in the buildings of . . �?''��'L�. . ... . . . . . . . . . . . at.�a . �'ll!1 G n �Sf ... . . . . . . . . . . .. North Andover, Mass. Fee 1��,.w. .Lic. No..� >�2. . . . . . . . . . .�. . . PLUMBING INSPECTOR Check # 8494 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or per) NORTH ANDOVER,MASSACHUSETTS _ Building Location t? C04- 4or Date Permit 4 �d Owner (� a�� �OY'�-i✓� i Amount New Renovation Replacement Plans Submitted Yes No FIXTURES rf SIBERa— MHOCR 3MFKM 4MRfm 6MROCR �{ Lf /Mam�.7ryryM 9M ELOOR ' (Print or type) Check one: Certificate Installing Company Name LM fLL 1� ❑ Corp Address a My -Drl Vy, Partner. Lon d Q" -ey-12 r N JA Mo<-1 Business Telephone (0 03 -LGLI—Y7a 00 Fim{Co, Name of Licensed Phumber: Pet-r- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond El ' Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code pter 142 of the General Laws. By: Signature of L EMseciYigpmer Type of Plumbing License Title US (O _ l 3 D S 2�_ APPROV City/Town icense um Master Journeyman ❑ ED FFICE E ONLY The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston, MA 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):— ���� J�� L -C Address: d�0 `�va�vl �yi l/2 City/State/Zip:_ I-011d0nd.eLO_.j IV 03COPhone#: 603 — 1-13LI --77-1 CLQ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 2.gemployees(full and/orpart-time).* have hired the sub-contractors 6. ❑New construction i am a sole proprietor or partner- listed on the attached sheet 1 2• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5• ❑ We are a corporation and its 9' Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 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.E]Other :Any applicant that checks box r1 must also,fill out the section be lo••,sho:"i^g their wari em'comps cation policy inform uon. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, lContractors 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 employee& 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: o? ll U Phone#: [Contact only. Do not write in this area,to be completed by city or town official Town: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical In::U::I:: son: Phone# M11 �r t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 inanrance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to for city or town that the application for the pernait 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 bum leaves etc.)said person is NOT required to complete this affidavit. .I 'Me 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#617-72.7-7749 www.mass_gov/dia Location ` "^ t No. .11 Date H°RTM TOWN OF NORTH ANDOVER % Certificate of Occupancy $ xz-+i ; • Building/Frame Permit Fee $ Foundation Permit Fee $ �cHuSt > � r=f1r ir!!/J IJ/ '� I er Permit Fee $ oQp` �4"--*Sewer Connection Fee $ tater Connection Fee $ Building Inspector Div. Public Works T A ' PERMIT NO,V �J APPLICATION FOR PERMIT TO BUILD- NORTH ANDOVER, MASS. V/PAGE 1 ,MAP 4qO. LOT NO. 2 RECORD OF OWNERSHIP IDATE ZONE I SUB DIV. LOT NO. BOOK PAGE�I I LOCATION 7 r��j 1„a / PURPOSE OF BUILDING �c ��j�/J� OWNER'S NAME c/' ]l 1 TZ7 p ` — NO. OF STORIES 2 •A SIZE � ' � �// !'ip*,2 5�k OWNER'S ADDRESS /Z / BASEMENT OR SLAB �f• (Aylf/ Fes/ ARCHITECT'S NAME [[ G SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME T/teleses✓ �� �� 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 IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IF IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Q. FT. V PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG.COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY 7 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR - DATE FILED I� - BOARD OF HEALTH SIGNAT>SREF OWNER O`N AUTHORIZED GENT FEE orzgso 6j'' PLANNING BOARD PERMIT GRANTED OWNER TEL# S pp Z� CONTR.TEL. 19 CONTR.LIC.#mss S�Z�k BOARD OF SELECTMEN - BUILDI 6 INSPECTOR Sy A . BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY �FF OPIES THIS SECTION MUSTSHOW EXACT DIMENSIONSOF LOT AND DISTANCE FROM MULTI. FAMILY ICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 I3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJALI UNFIN. 3 BASEMENT AREA FULL FIN, B'M'T' AREA _ 1/1 '/2 3/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING ASBESTOS SIDING _ COMMON VERT_ SIDING ASPH.TILE 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 SUPERI ADEOUOATE I� NONE $ ROOF 11 10 PLUMBING l GABLE I HIP BATH (3 FIX.1 GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE ._.._ FORCED HOT AIR FURN. TIMBER BMS. &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'I'T 2nd _ ELECTRIC Ist 1-3rd I NO HEATING a-r�— d COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY �2x VOF 1010 COMMONWEALTH AVE. 9) 'j MASSACHUSETTS BOSTON,MA 02215 L.I E 1\1 S E CAUTION EXPIRATION DATE (.-)7/31/ 1.99F'; 0DINIS31-R. ::-:;li P E R V I-S f'-i IR EFFECTIVE DATE LIC-NOFOR PROTECTION AGAINST . RESTRICTIONS THEFT, PUT RIGHT THUMB I/1 92 PRINT IN APPROPRIATE 0 BOX ON LICENSE. 0 C41 ENKI Ill 13ARY 0 BLASTING OPERATORS 44: (-'):-12-54-5(--)::-:.'l MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEE: I AWRIE'Ni"'.E. MA 1::..:41 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: o9/1.`_1/1.96. THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGEDIN THISOCCUPATION. A PF,R(J V 01-11-1-4. ................ ij. zp-"7^11 d 1' ADMINISTRATOR GI EN"N A F V ' r`_NER L C 0 RAC 7'0RS 1070 I 38 KENDALL ST. 4,` LAWRENCE, MA 01841 ; (508)682-6445 6PR3",AL SUBMITTED TO J' FCS. PHONE DATE 4 V Z ~J DAU 7/Z �S 9 Z L) STRE T JOB NAE OZ CITY,STATE A/fN'11D ZIP CODE JOB LOCATION // ARCHITECT DATE OF PLANS JOB PHONE py G x•/`72 /k/, / ruQOOel We hereby submit specifications and estimates for: �-: r^'1 v J`' _ �x�J 1•'�..� _. .G�r ��� -, L�� ..j`=r a`1 Cy_.. ��_. _ _ .---__ ---. _ t , .... _.......... 1C _ f 1 C \ _ . :&C X ! C hj 'e( C :i V, p...._/�o t: ._ _i' .,f._.C.�f`c e 1 / J _ �3ir pro orir hereby tofurn ish material and labor—complete in accordance with above specifications,for the sum of: t4,t7177 +7 71T � C — dollarsC $ ^ ( 4 ., ). Payment tobemade as follows: f t` All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Anyalterationordeviationfrom above specifications Authorized /J involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our Note:This proposal may be ) --- workers are fully covered by Workmen's Compensation Insurance. withdrawn by us it not accepted within days. Condo, r �ereptzmre of Proposal —The above prices,specifications and SIGNATURE itions are satisfactory and are hereby accepted.You are authorized to do the k as specified.Payment will be made as outlined above. DATE OF ACCEPTANCE: SIGNATURE FORM 65103,RAPIDFORMS,INC..THOROFARE,NJ 08086-9499 1289 Town of � =ort 5ORTtq Andover NO. 37 5 °/ �� �r���� �F�o �,. 7 EArt N over, Mass.,, '_.PERMIT T LD 19�� t BOARD OF HEALTH db THIS CERTIFIES THAT... .. .... ... ......................... �y I BUILDING INSPECTOR has permission toagowtON �,. ..iaiiliill�n .............. .. .. ..................... ....... Rough to be occupied as....&A . .. rd.JOU..A..A.&C....................... Chimney 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 this Permit. PERMIT EXPIRES IN 6 (MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTIO STARTS � Service .. .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burne FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector Date...,Z 4. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 8 CHUS This certifies that ..-.(4— ...... ...... .............................. has permission to perform .-..- r�-<r.... -,;p. ............ wiring in the building of.... ............................................. ...... ......... ......................North Andover,Mass. Feel. ............. Lic.Not*,.,1,19:?�? �': z.... ..... ....... CAL.INSPECTOR. ................. Check # 5493 Commonwealth of Massachusetts Official Use only Department of Pre Servi s Permit No. BOARD OF FIRE PREVENTION RE ULATIONS Map&Parcel C APPLICATION FOR P RMIT TO PERFORM ELECTRICAL WORK All work to be performed in acco cc wi the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IN RN1ATI0h) Date: /2— 20-off City or Town a€: , d/Z , pvF2 To the Inspector of Fres: By this application the undersigned gives notice of 1W or her intention to perform the electrical work described below. Location(Street&Number) '7 61z�1 _ Owner or Tenant 4 f,*T Telephone No Owner's Address S/41t'l6 Is this permit in conjunction with a building permit? Yes 19 No ❑Building Permit# Purpose of Building S/,N4i.E 4, 11-y /-/p,qUtility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fFwla,a Completion of the followin table mg be waived by the Inspector o Wires. No.of Recessed Fixtureso.o of No.of Ceil.�usp.(Paddle)Fans e Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool ove ❑ n- ❑ o.o Emergency Lighting L rnd. rnd. Bette Unita No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of DeEiHoin an InitiatInLr Devices No.of Rankes No.of Air Coad. Tuna tal No.of Alerting Devices No.of Waste Disposers ea mP ,_�um er ons �_._ o.o e ont n Totals: ` Detection/Alertino Devices. No.of Dishwashers Space/Area Heating KW Local ❑ c Connection ❑ Other No.of Dryers Heating Appliances r Security ystems: Na of Devices or E uivalent No.o Water )F KW o.o o.o Data Whing: Heaters 678 Signs Ballasb Na of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommu ca ons No.of Devices or E uivaieut OTHER: ,s`j"��,t,•( h / Attach additional detail if desired,or as required by the Inspector of Wires. 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 [I (Specify:) 9 17 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I eon*,cinder the pains acrd penalties of perjury,that the lnformatlon on this applicadon Is tate and complete FIRM NAME' 19— LIC.NO.:Al 1983 Licensees LOUIS CONTINO Signature LIC-NO.:E28788 AfWlieable,enter"exempt"in the license number line.) 6Bus.Tel.No.9 7 8-3 6 3-5 4 2 0 Address:_ 1 nnNr)NrA l r)R Le7F4T NP.WRTIRV 114a 019AS Alt.Tel.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:Lab