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HomeMy WebLinkAboutMiscellaneous - 671 JOHNSON STREET 4/30/2018 (2) l_ 671 JOHNSON STREET - 1. / 210/038.0-0076-0000.0 Date..... 1 ,aOR7p TOWN OF NORTH ANDOVER PERMIT FOR WIRING GMUSEt This certifies that ............... ... ./r ...... T '................................ -has permission to perform .......... ............................................................. wiring in the building of G7l J Ds�NS� .. ................. .North Andover,Mass. at..................... ............................. . �• Fee............ Lic.No. 4��� ..?. !.!�nll �!/ �� •S�© I✓LEMICAL INSPE R 7757 39) Commonwealth of Massachusetts Official Use Only r ` Department of Fire Services Permit No. `7 7.- 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked V [Rev. 1/071 eave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTW INK OR TYPE ALL WFORMATION) Date: /C> City or Town of: NORTH ANDOVER To the Inspector of !res: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) G 7 Z /L,-,-j-r Owner or Tenant ?/ � c�`2F-�i�} v,�p Telephone No.`ZY Owner's Address yy ��� �zt / Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boa) Purpose of Building Utility Authorization No. -3 L:> j Existing Service Amps <!evolts Overhead Undgrd❑ No.of Meters New Service —�C�Amps ��o / �/QVolts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion o the ollowin table may be waived b the Ins ector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans °.°f Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators I • VA No.of Luminaires Swimming Pool Above In- o. o mergency ig g L-rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No. of On Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners o.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. otal Tons No.of Alerting Devices No.of Waste Disposers Heat ump Number I TonsIKW No.of Self-Contained Totals: .............. Detection/Alertin cr Devices No,of Dishwashers Space/Area Heating KW Local❑ Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Signs Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Totat HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent r >y ,� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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 suchcoy rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Kr 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.: e,-"Op !C/,.T-/� Licensee: ��fY!(� CG T� Signature LIC.NO.:� �i'• �/� (If applicable, enter"exempt,,in the license number line) Address: /% G � �i, /�_ ��v Bus.Tel. y *Per M.G.L c. 147,s.57 Alt.Tel.No.: -61,security wo requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ 6, e' } The Commonwealth of Massachusetts k� Department of Industrial Accidents •. 0 Office of Investigations tigi� r 600 Washington Street ark Boston, MA 02111 www nxassgov/dia . Workers' Compensation Insiurance Affidavit: Builders/Contractors/Electricians/Plumbers Al Plicant Information Please Print Legibly Nanie(Business/OrganizatioMndividual): Address: City/State/Zip: -eZ Phone#: e Are you an employer?Check the appropriate box: Type of prefect(required): 1.❑ I am a Employer with 4. E3 am a general contractor and F employees{full and/or part-time).* have hired the sub-contractors 6• New construction 2.�/ I am.a sole proprietor.or partner- listed on the attached sheet.t. �• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for mei any capacity, workers' comp.insurance. g, ❑Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its mored.] officers have exercised their I Qlectrical repairs or additions 3.❑ i im a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself.[No•worke'rs'comp, c. 1.52, §1(4),'and we have no 12.❑Roof repairs insurance required.]"t employees. [No workers' e ' comp. insurance required..] 1.3:❑Other *Any applicant that checks bo)M must also fill out the section below showing their workers'borimpensatiori policy information ?Homeowners who submit this affidavit indicating they are doing all work and then hue outside e ;Contractors tontractors must submit a new affidavit indicating such that check this box mustattaehed an additional sheatshowing,the name of the sub-contractors and their worked'comp.policy information. I am an employer that es providing:workers'compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins. Lie.#: 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.requited.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 w Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and eorrea •. J Sitmature Date c� Phone 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 S. Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual',partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees.'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),addresses),and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with.no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit.may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not'the Department of ' Industrial Accidents. Should you have any questions regarding the law-or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted 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 ofthe 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 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 ofFndustriai.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 9 617-727-4900 ext 406 or 1-877-"SAFE Revised 5-26-05 Fax 4 617-727-7744 www.mass.gov/dia Date...r.Z '.(z -U 7 f HOR7M, TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;�SS�cMUSE� This certifies that ...........7kft.01".. ......r .................... has permission to perform ............I ........................................ wiring in the building of.............19"y ....................................... 4 7 f Q�,!F/LD�'Y S� North Andover,Mass. Fee...,,. A.""r..—.. Lic.No.I- 9EF............... � ... � :... .. ELECTRICAL INSPECTOR l Check # 7871 Dates.�l....�,1./��..�.%......... NORTF, TOWN OF NORTH ANDOVER . ° p PERMIT FOR WIRING s o�• iow* -. ;7S SACMUSE� This certifies . .. .. .. ... has permission to perform ........................ wiring in the building of.. LV v .. ...... t ............. at7G,d! 1� `f� . ,North Andover,Mass. ...... S.'� :'� �Q ILECTRICAL�.Q�./ .... . Fee..................... Lic.No.. , ✓ INSPECIO R 1 Check # 7827 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Z 1WIF BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. l/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C ,R 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: `l' e City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) J-o kN jr f� Owner or Tenant2,k Telephone No.9 ze Owner's Address p �y�`�Cv Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters r New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fanso.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Po1Above mergeny ig gond. Battery Unitsnd. No.of Receptacle Outlets No.of Oil Burners ;FI!RERALAMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Tons No,of Alerting Devices Totals: No.of Waste Disposers eat Pump Number Tons _ o,of Self-Contained -.... ....... . . --- Detection/Alerting Devices ' No.of Dishwashers Space/Area HeatingKW Municipal Local❑ Connection El Other No.of Dryers Heating Appliances KW Security Systems:* M o.of WaterNo.of No.of Devices or Equivalent No.of Heaters KW Signs Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ra a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties ofperjury,that the information on this application is true and complete. FIRM NAME: �=C/�c /l /�� d d"1 LIC.NO.: g% Licensee: Signature L o - - LIC.NO.: (If applicable, enter"exem t"in the lice. a number line Bus.Tel.No.: 7 — Address: *Per M.G.L c. 147,s.57-61,security work requires D artrnent of Public Safety"S"License: Alt.Licl.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/Agen , Signature 7/- . Telephone No. g PERMIT FEE:$ . ��7- �52 2,,y 9 7 9 The Commonwealth of Massachuseft Department of Industrial Accidents Ogee of Investigations . t° . 600 Washington Street ' ! Boston, MA 02111 www.nwss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legaibly Name (Business/Organization/individual): Address: City/State/Zip: Phone#: . 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 6. ❑New construction i 1 ptiployees(full and/or part-time).* have hired the sub-contractors 2.12rI am.asole proprietor or partner- Iisted on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition ' working for me in any capacity, workers' comp.insurance. g, ❑ Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself,[No•worke'rs'comp. c. 1.52, §1(4),'and we have no insurance re uired.]"t employees. [No workers' 12.❑ Roof repairs 1.3.M.Other comp. insurance required_] *Any applicant that checks bort#1 must also fill out the section below showing their workers'compensation policy information, t Homeowner¢who submit this affidavit indicating they are doing all wotik and then We outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional sheet showing the name of the sub-contractors and their worker;'comp.policy information. I am an employer that is providing:workerscompensation insurance for my M ployees: Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins. Lie.#: 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$4500.00 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 certif der the pains and penalties of perjury that t e information provided above is true and correct Signature: j �— Date: `z Phone_#: Official use only. Do not write in this area,to be completed by city or town.official C ity or Town: PermittLicense# 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 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 timsteee-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." r Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es).and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with.no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit-may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,notthe 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 ime. 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 pennitAicense 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 of permit to bum leaves etc.)said person is NOT required to,complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-26-05 . www.mass.govIdle Commonwealth of Massachusetts Official Use only - Department of Fire Services Permit No. 7 7/ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6 /— v2 g`Q 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 6- 7 ©9r1 e-6 Owner or Tenant i`��,� ,'J 5'�t,1 o Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [� No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 1 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters r New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed LuminairesNo.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.'of Luminaires Swimming Pool Above El In- ❑ o.of Emerge-n-c-y-Tighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection and No. of Switches No.of Gas Burners No. Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons r No.of Waste Disposers Heat Pum p Number Tons K No.of Self-Contained Total .......... "''"""" """""' Detection/Alerting Devices r No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection ` No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterK� No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE J BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,Oat the information n this application is true and complete. FIRM NAME: � LIC.,NO.c Licensee: wjl& Aelorj Signature 'x ' tr LIC.NO.:�j' (If applicable, enter "exem t"in the license number line.) iBus.Tel.No.t� 3•-� Address: 1 �� _ a" G , Alt.Tel.No.:&1-7 :VY3 *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. B signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature zR/' Telephone No. PERMIT FEE: $ �©0 Date' z TOWN OF NORTH ANDOVER � s PERMIT FOR PLUMBING' M SSACMUS� This certifies that . . .�` r.•:�, . . ��.�. .� . . . .. . . . . . . . . . . . . . has permission to perform . . f --.—D. . .. . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .. . .j. . . . . . . . . . . . . . . . . . . . . . . . . . . �.I.. . . . . . . . . . . . . North Andover, Mass. 1'v � Fee.7P. Lic. NojP. i' . . . . . . .�. . . . . . . . . . . . . PLUMBING 1NSPECTOR Check tt i-3 4 1 7591 ZStSf/Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) N'd, 4Ai9d v 61Z Mass. Date //-21 '0 7 19 Permit # M BuildingLocation 6' 17! �,/aHw!v ,vV 5% Owners Name i�N5© V©r' r a A Type of Occupancy �a 9 New ❑ Flenovation ElReplacement ElPlans Submitted: Yes ❑ No ❑ OqM 5� FIXTURES B.P. # SEWER # SEPTIC # z U Z rn J m mU) OU Q z w W Y OJ U W U 1 W U H U Q U Q U Z Z Z d W YX L cc W O � W Q W Q W C Q J Z 0 d Q O lL H U Q r '� 2 0 Z W Y d Q ~ Z Y Q Cl � y W ?i Y J m W O J =O Q JO OJ Q 0= a: Q O Q to u_ C3 p Q 3 ¢ m O SUB-BSMT. s p BASEMENT 1ST FLOOR 4 y 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR I , I I —. 9 1 1 1 1: 1 1 1 , 8TH FLOOR Installing Company Name A, s%, /P�4 » 76, Check one: Certificate # Address 83 r» A,9Rljg- ❑ Corporation J'-1,J=7-,Y VC- P "4 0/J-'Al4/ ❑ Partnership Business Telephone D�-Firm/Co. Name of Licensed Plumber W-,VAW J2, R/4-Tl��.rJ�Q.rrJi INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C� No ❑ If you have checked yes, 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: Signature of Owner or Owner's Agent Owner ❑ Agent 1:1 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 installation performed under the 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. By A9 . Title Signature of06nsed Plumber Type of License: Master CJ,-"" Journeyman [7 City/Town License Number *O 2 9- APPROVED(OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR Date. ?�, G�. . ..... f f HOR7M TOWN OF NORTH ANDOVER PERMIT FOR GASIll It!ISTALLATION 'b�SSAC HUSESS This certifies that . . .�... . . . . . 1� . . . . . . . . . . . . . . . . .: . . . . . . has permission for gas installation . . 191v� s*. -. K!.�.r'*. . . . x in the buildings of . .P/qw.56.4.k.'y. . . . . . . . . . . . . . . . . . . . . . . . . at .7./. . . .`� r.I .,. . . . .. . . . . ., North Andover, Mass. Fee. Lic. No.. � !'. . 9GA_,. ��--�r -�� ,R_. . . . . . S INSPECT Check# 6253 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _-� (Print or Type) 7 Mass. DateI/=Z? `�'1 �a Permit Bullding Locallon 66 -7 ) T;!H 'Se X1 S %, Owner's Name P11IVJo 1,16 Y Type of Occupancy_D W",,-t NCE. New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No p N N x X W � X W. N {AIAW cc V ¢ F- W W cc 0 0N0 :) 0 Z O J CC F- F C ?' _ .O F- ¢ X O V c: ¢ O M O w ¢ CL r- w a H rn N C7 W = 7' O � ul N W Z V N pj -< a D 'Ll ¢ s x x v x w w F' = N w v W Z < W J i C ~ t-' )w.- N W 2 O Y aO t; Y a W Y ¢ W 2. < ¢ d -KO O W O 1- ¢ = O J U O SUB—HSMT, BASEMENT IST FLOOR 214D FLOOR e 3RD FLOOR 4TH FLOOR ST11 FLOOR 6Ttl FLOOR 7TH FLOOR STH FLOOR Installing Company Name--.T A. .r ?/,& `4' J-/T�� �;: Check one: Certificate # Address . : J C%J/L-V II-1 X/9W1/- ❑ Corporation ❑ Partnership Business Telephone _f O ,{' `� 7,j~^ �.S bj Firm/Co. Name of Licensed Plumber or Gas Filter ,7-o&A/ P. /"IE'71(/)AJ%yA,1 INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 11- No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 1C-- 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 tills permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the 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. E3yT e of Ucense: Plumber alure o cense Plumber or Gas Ater Title - Gasfitlor c� Master cense Number Cily/Town Journeyman M'f�fxr�t n o c_ . o BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FINAL INSPEC-ION SKETCHES FEE N0. APPLICATION FOR PERMIT TO DO GASFIT71HO NAME A TYPE OF 1311ILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE GA3INSPECTOR EC COLLOPY ENGINEERING CONSULTANTS 65 AYER STREET METHUEN, MA 01844 RESIDENCE:(9 78)685-7969 FRANCIS H.COLLOPY OFFICE/FAX:(978)685-8069 REG.PROFFESIONAL ENGINEEER CIVIL STRUCTURAL DYNAMICS October 24, 2007 �I Mr. Gerry Brown Building Commissioner North Andover Building Department 1600 Osgood St North Andover, MA 01845 Dear Mr Brown: I am writing in regards to the renovation project at the Pansovoy Residence at 671 Johnson St in North Andover, MA. This project is being const atFac" No�dover. The basic project consists of renovating the basement area, and it included the removal of an interior lally column under a wood girder, removal of that girder, and the addition of a steel beam over a longer span in its place. I prepared a letter and design for Bob Allen on October 10, 2007, and he submitted that to your Office as part of his permit application. This letter is to ascertain that I visited the site today, and inspected the installation of the W8 x 58 steel beam spanning approximately 24'-8" on the left side of the basement, as shown on my design sheets. Mr Alien also installed a lally support column, bearing plates, a new footing to accommodate the increased load in the center of that room, and an end support column in the left side exterior wall. In my professional opinion, the construction as-built satisfies the requirements of my design, and the Building Code requirements. My plans showed a possible installation of a shorter steel beam on the right side of the basement, which the Owner decided not to implement at this time. The increased interior footing size would allow for this in the future. If there are any questions in this regard, please feel free to contact me at my Office. Sincerely, .11A OF/y� COLLOPY ENGINEERING ?� FRANCIS H COLLOPY H v 20172 Francis H. Collopy, PE °•��.�cis1'E Structural Engineer ;tt1NA�� 116cation '� f No. Date NORT" TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSACMUSES Foundation Permit Fee $ -• h.l Other Permit Fee` $ Sewer Connection Fee $ PAR) RY 22". .fieell tion Fee $ Ae TOTACL. $ ' Building Inspector Div. Public Works PER]HIT — j I3 •- � { APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. (`AGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP '.DATE BOOK '.PAGE ZONE SUB DIV. LOT NO. OCATION PURPOSE OF BUILDING J _ V-'. Lw ex15t;na mtfed Jeej, �WNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS �� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME '[��� ,� Q� , p / a 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 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST yyf/Z PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS • PLANS MUST BE FI D APPROVED/BY BUILDING INSPECTOR LED ! / BOARD OF HEALTH GN'I(1 URE OF OWNER OR AUTHORIZED AGENT FEE � O vQWNER TEL q --b�Tlg PLANNING BOARD PERMIT GRANTED rnNTR.TFL.#/ 19 � �/CONTR.LIC.#P,/3/..s—/, BOARD OF SELECTMEN j c INSPECTOR I r r BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE E 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE P PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M'TAREA _ 1/4 1/2 '/, 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\!J'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT 11 SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE ,...._.�....�..,�..,. —� •�•i ~� FORCED HOT AIR FURN. _ TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR _, .— _ --• jt'3 ' 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 f 4 i c G.�/ze�anrmzmuaea/U al'./l�aae�/ruullti � � COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY =� HOME IMPROVEMENT CONTRACTOR ( ® OF 1010 COMMONWEALTH AVE. Ur Registration 188298 ; MASSACHUSETTS BOSTON,MA 02215 Type - PRIVATE CORPORATION f LICENSE CAUTION IVExpiration 86/15/94 ; EXPIRATION DATE CONSTk. SUPERVISUR I FOR PROTECTION AGAINST 06/30/1994 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB Rullo Construction Co. Inc i RESTRICTIONS Frank Rul t o NONE ' f /i/ it/ 1 9 9? U v 31 5 6 PRINT IN APPROPRIATE j —� 14 Stonepost Rd , �'6` � 6 o BOX ON LICENSE. ADMINISTRATOR Salem NH 83079 P % F RI`a k ROLL.► z 21 GRAY STREET BLASTING OPERATORS SS All 02$-48-4690 zNp ANDOVER MA 0184 Z MUST INCLUDE PHOTO. m ^ PHOTO(BLASTING OPP ONLY) �100,0FEE: f�ry �. Il ilk jrU 1,y. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY 9 HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER I DOB: 1 •1- 4/18 /1957 THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF IGNATURE OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. COMMISSIONER , I I 7 PROPOSAL d Sheet No_ Proposal Submitted To: Work To Be Performed At: Name Street., City ''�2_ ...... --- City .--_---- State ----------- State ._ly --------- Date of Plans ................ Architect ----------- We hereby propose to furnish the materials and perform the labor necessary for the completion of ----------- 47 ------------ --------------- ------------ ----­­ ------------------ ----------- -------- ------------- All material is guaranteed to be as Spec*ified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars 1$ with payments to be made as follows: ------- ------ ---------- ---- -- ------------ —--------- ---------- ------------- ------ ------------- Any alteration or deviation from above specifications involving extra costs,will be executed only upon written orders,and will become anRespectfully submitted ------- extra charge over and above the estimate.All agreements contingent 47- upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance upon above work.Work- Per ,._._/__..__'.____.________-____.___-._.._..._______—___ men's Compensation and Public Liability Insurance an above work to be taken out by Note-This proposal may be withdrawn by us if not accepted within--- days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date Signature—r TOPS FORM 3850 LITHO IN U.SA ONSE-RVATI1 FINAL PLANNING FINAL S / A' ` FNMA t, own of 0 nalover No 379 PERMIT -�� --- � � � �_ :� � .� )RIVEWAY ENTRY t; n� over, Mass., 19 A �V�7 ORS ,P�00 . G �+ f BOARD OF HEALTH PERM T To 1 LD do THISCERTIFIES THAT............................... .. ... .. ................. .....V........ BUILDING INSPECTOR has permission toe=W rN�4f�Hdingson ... .. 4 .... . . ............... Rough 4 to be occupied as..... 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 CONSTRUJCTIOU START( Service Final . . . . . . .. .. UILDING SPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Z�/, r/ Building Inspector Date. .<!: .'' . . .5 4307 f NOR71y TOWN 0 .NORTH ANDOVER C _ CE�vEp PIS IT FOR PLUMBING SSACNus� This certifies that . . QR� jQR ),4. , . . , . . . . , , , has permission to per-- SO. IU ( f < < plumbing in the buildings of . . /�� A- 1'P. X'. :! MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT 77- PLUMBING (Print or Type) t!,--- - Mass. Date -ZZ 19 Permit# on� .: Building Locati �( 4oM,5ao�3 Owner's Name A(-, ��jp _ (��; ~� Type of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted Yes ❑ No ❑ FEATURES z m (n rn O Z ~ C } U Q Z W W p Z W N tau Q = ~ Z m 11- z z z Q jr W a w m Y R a Z jr W p W Q W Q g ¢ W - ❑ Q , z ¢ o_ 0U. iW- Q Q = _ CL Z = 3 Y O. p Q Y W u. X Q Er Q > a = m T) ❑ a p Q o a ¢ arc 4 0 a r=- YgmusF3og3 = E- Wu. ❑ ❑ Q3 mo SUB-BSMT. / BASEMENT 1 ST FLOOR V 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR STH FLOOR 7TH FLOOR STH FLOOR AA --fi�nnTTT-1 FT Installing Company Name C_11/ Check one: Certificate Address ❑ Corporation �'(�_ 1.7 Partnership Business Telephone—C6 x-11— 1— El Firm/Co. 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 I No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNERS 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: ur of Ow A cent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered) in above application are true and :curate to the best of my knowledge and that all plumbing work Installations perfor ed under the permit issued for this kation will be in compliance with all pertinent provisions of to Ste PI apptnd Chapter 142 of the general Laws. By BY gna ure o is7tt, m er Title Type of License:Mester ,1Ou of Cityrrown License Number � !-' APPROVED OFFICE USE ONLY} 3 Date..��.J f..9. �'...... C1 ar HORTM TOWN OF NORTH ANDOVER 8 ,+..6 O �? + p` PERMIT FOR GAS INSTALLATION U � F. 9 +,n o •• 4h y,SSACHUSES d .r This certifies that ./. .: .r :11 . . . . . . . . . . . . Q. has permission for gas installation . . . . 0.�. �'. . . . . . . • . . .S in the buildings of �.�. . :: . . . . .�!. . . . . . . . . .. . . . . at . !-. .� . . . :�. . . !.'. :.: . .: . . . . . . . . . .. North Andover, Mass. Fee. . Lic. No.. .� .'. . . . . . . . ..�. ... . . . . . . �. . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer C0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING ' Z nt or Type) �Q 00 Mass. Date=!— 19 _ ) Permit# 3 Building Location >� 140 50T3 565Owner's Name kKF16, LA:s&uv z ype of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted Yes ❑ No ❑ Cl) Y Cl V7 U) N V Q � Q w cn W O� U m Z g = Ir Z O w !a Q Q z O Z W Q m W � W_ W O E o. Q W Q W Q w F 0 fl > _ U' H Z W H Z W W O W > LL LL,U J W Q W > a: W j Z Q M Q 5 O O W M O W i- ¢ = O O = LLZ 3 o O g v a¢ > a a F- O SUB-BSMT. BASEMENT i ST FLOOR 2ND FLOOR y 3RD FLOOR 4TH FLOOR 5TH FLOOR 8TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Nfme L.�J� (vUM6Check one: Certificate Address A ❑ Corporation (J Partnership business Telephone — � ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter (^i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yesl� No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNERS 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: L-SOwner ❑ Agent ❑ i r r r r' 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 undera rmit issued for this application will be in compliance with, all pertinent provisions of the Massachusetts State PI g 9: Ch 142 of the General Laws. By Type of License ULPlumber Title ❑Gasfitter Signalua o1 Licensed Plumber or as Fitter Master Citv P�� F U LY) Journeyman License Number