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Miscellaneous - 719 JOHNSON STREET 4/30/2018
N I p -+ O to o Q O z o -0 1 N z o � o 70o m o rr 10040 Date ..... ��. 1f- / /I .... TOWN OF NORTH ANDOVER Igo PERMIT FOR WIRING This certifies that ....... A).tIY.7-..W.i ....... .. .. .... ... ...... . '5. ...7 --Z-z has permission to perform ................................. wiring in the building of ..........&,/ e �--q- ................................................................ at ............... '....... W .........S, TqA_Andover, Mgs. Fee ..... Lic. No. 27.qe qe....................................... lde..W4� ELECTRICAL INSPECIMR(/ Check # 2012 Massachusetts Electrical Code Amendments 527 CHAR 12.00 § Rule 8: In accordance-with the provisions of M.G.L, c.143, §. 3L, the Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. Amer a permit application has been accepted by an Inspector of Wises appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. " Permits shallbe limited as to the time of ongoing construction. activity, and maybe.deemed_bythe,Inspector_of_Wires abandoned_and_imalidaf he_.. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installin&entity stated on the, permit application. ❑ The Permit Extension Act was created by Section 173 of Cbaoter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers ibis purpose by establishing an automatic four-year extension to certaiwpermits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008. extending'through August 15, 2012. Rule 8—Permit/Date Closed: * Note: Reapply for new per ❑ Permit Extension Act —Permi ate Closed: �' l,ommenwea& o f MaaaacLetfa Official Use Only c7 Permit No. Apartment of}ire Servieea Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ( ), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date: I I City or Town of: �0 (`�(� n 1rP r To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfo the electrical w k described below. Location (Street &Number) n5of) 9T Owner or Tenant QS &f -LL, Telephone No. ) - Owner's Address ' a me - Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Overhead ❑ Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install residential security system Cmmnletinn nfthe fnllnwina tnhlo mm, be M)gj1)ed h,v tho 1 -n -m nfW;roo No. of Recessed Luminaires : No. of CeilSusp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Units cy Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals: P Number ' " " ' Tons " "' " KW "'' ' ' "' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalen No. of Water KW . Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring No. of Devices or Equivalent OTHER: Estimated Value oTe{ 0() Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of le cal Work: I y�� (When required by municipal policy.) Work to Start: q/ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc. ,r,% � ."A I7 LIC.NO.: 7024C Licensee: Paul DelSignor Signature IJ .0� i][C. NO.: 7024C (If applicable, enter "exempt " in the license number line) lus. Tel. No.: 888-722-9282 Address: 22 Briarwood Drive, Westford, 14A 01886 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SSC 0 0 0 0 0 9 6 9 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 o d Signature Telephone No. PERMIT FEE. $ Date ... 9-..c2,. e, ..... .... ....... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4L :,This certifies that ........ ...... .. ........................................................... as permission to perform . j� ............................................................................ wiring in the, building of ...... .......... .................................................. t . at 6 ....... .... ........... ......... ...... ............. . North Andover M . ass. CTRIC -/ Fee .............. Lic. Nd-Z;IfA�� ....... ...... il�� .... .. .. .......... A y Check # 11 A CompAonweafth. of 1142assachuseti s; Department of Fire, SerOces, „jf -)AP E) OF FIRE PRE\/ENTION REGULATIONS Officint Usc0hliy Permit Ne. _ _( C,3 -/ Occupancy and Fee Checked��.� Rev. 11/991 tU"..11iankl APPLICATION FOR. PERMIT TO PERFORM ELECTRICAL WORK. fill wort: it) be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 1100 (PLLASL I' YT IN IINT OP. TIPL1,11NF0RA1AT10N) Date: is k itv or Town,0 d (✓ _ To the Inspector' of fires: By this application the undersA,4 n ce of 's or her intention t perform the electrical work described below. Location (Street: Sc Number) Owner or Tenant —1 Telephone No. Owner's Address Is this permit in conjunction with a building permit? !'es No E] (Check Appropriate Box) Purpose of Building �[,t1�1 n! �', Utility 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: Completion of the followin table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KNIA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Ligliting Fixtures Swimming Pool Above ❑In- 1:1o. o mergency Lighting rnd. rnd. -Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners No. of Detection and initr'n4'nm iln No. of Dishwashers No. of Dryers No. of Water K� Heaters No. Hydromassage Bathtubs OTHER: Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts No. of Motors Total HP Local ❑ Connectio ❑ Other Connection Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Eumvalent Attach additional detail i/desired, oras required bI, the lii.vpeetoi-of Wirev. 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 ;�MND is in force, and has exhibited proof of same to the permit issuing office. CE CHECK ONE: INSURAN❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: // - 6S_ Inspections to be requested in accordance with MLC Rule 1 �� �t7 P 1 0, and ujioti coitipletiidi. I c•ertifi,, under the porins incl penaltie' of perl'ur t tithe information ort this application is trete and complete PDRIVI NAIiIE:�''p�� d - c� LIC. NO.: 6� Licensee: 5A ✓» e Signature W OLA LIC. NO.:C / 7 I)F,;L (1/ applicable, enler "exe�m �l win the license numh � � !' e.) ``'' ,, Bus. Tel. No.:92 — I✓ Fe —aG'� Address: ��QQ A (_lSP'YZ �. K) n1l�VEZ fyl,/ _ Aft. 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: $. —� No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self Contained Totals: Detection/Alerting Devices No. of Dishwashers No. of Dryers No. of Water K� Heaters No. Hydromassage Bathtubs OTHER: Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts No. of Motors Total HP Local ❑ Connectio ❑ Other Connection Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Eumvalent Attach additional detail i/desired, oras required bI, the lii.vpeetoi-of Wirev. 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 ;�MND is in force, and has exhibited proof of same to the permit issuing office. CE CHECK ONE: INSURAN❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: // - 6S_ Inspections to be requested in accordance with MLC Rule 1 �� �t7 P 1 0, and ujioti coitipletiidi. I c•ertifi,, under the porins incl penaltie' of perl'ur t tithe information ort this application is trete and complete PDRIVI NAIiIE:�''p�� d - c� LIC. NO.: 6� Licensee: 5A ✓» e Signature W OLA LIC. NO.:C / 7 I)F,;L (1/ applicable, enler "exe�m �l win the license numh � � !' e.) ``'' ,, Bus. Tel. No.:92 — I✓ Fe —aG'� Address: ��QQ A (_lSP'YZ �. K) n1l�VEZ fyl,/ _ Aft. 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: $. —� N 161 Coll'PrSol"lFfl!'c'afth, of _ 0111- 1,91 Usc rm'p Department of Fire SerOces, t l)ccupanc} and Fee Checked H-(--)ARD,:)F FIRE PREVENTION REGULATIONS [Rcv. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A i I wort: w be performed in accordance with the Massachusetts Electrical Code NEC)- 537 CMR 13.00 (PLEASE MYT 11VIN1, OR, TYPE ALL INFORMATION) Date: City or 'Tomm of: To the inspector of ff'ires: By this application the undersigned gives n ce of 's or her intention tci perform the electrical work described below. Location (Street & Number) Owner or Tenant' -1 '� Telephone No. Owner's Address Is this permit in conjunction with/ a building permit? Yes No ❑ (Check Appropriate. Box) Purpose of Building6(j(sfi/ it% �" Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und grd � ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 6-/ Com letion of the followin table mall he waivecl by the lnr ect • Of' No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans n( o n es. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool . rnd. ❑ rnd. ❑ o: o Emerge BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total . Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/AlertingDevices 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 Water Kms, Heaters No. of No. of Signs Ballasts' Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Allach additional llelall It desired,, ar as required try Ila' hispeclor a/ 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 cover is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE � BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start.g- inspections to be rcqucsted in accordance with MEC Rule 10, and upon completion. 1 certify, under theyyp,, ains and penaltie of per•ur,}y pL the information on this application is true and complete FIRM NAM E:(— j� iUJ V0 - LIC. NO.: Licensee: 'aA ✓i-) Signature W _ LIC. NO.: 7 (7/ applicable, enter -exena)i - in the license numb I' e.) �, )) Bus. Tel. No.: %F Address: J 0 LS -7'- l - N ,(�J(wJ��(f Alt. Tei. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee do nt hc1 the liability insurance coverage normally Y 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: $ 2--(T _ o j h' wAM 0 Date. "0R'" 4.0 TOWN OF NORTH ANDOVER O1ti ' O PERMIT FOR PLUMBING This certifies that .................... . has permission to perform .................... plumbing in the buildings of ...TLO.� h.'< ......... . at ...��'� ...��.� !. c, v+-.. ��%`......... , orth Andover, Mass. V ` Fee. ��.'�. Lic. No. �.� �.��... ....... �.-0�- --------- LUMBING INSPECTOR Check # Q Y 6572 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location70 —j0 4 ti l6 K 51 Owners Name /y ✓" Ae Permit # � Amount Type of Occupancy New 1-1 Renovation El Replacement 0 FEKTURES Plans Submitted Yes ❑ No ❑ (Print or type) installing Company Name 12 US Address 6 6 A/ Ale-K�P T%-11SS& rQ d/N'7S — � //'o Check one: Corp. Partner. , Firm/Co. Name of Licensed Plumber. / " ! 9 v^G ( Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity D Bond 10-1 Certificate 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 11 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 Massachuset s State Plumbing Cod and Chapter 142 of the General Laws. By:igs nature or Ltcensea rtumder Type of Plumbing License Title /l k g y City/ Town i1—se lNum (ems Master Journeyman APPROVED (OFFICE USE ONLY If `.7/9' Location �y No. Date �oRTM TOWN OF (NORTH ANDOVER 0 - a i Certificate of Occupancy $ s,CN�s 10— Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # (x D a a 18391 Building Inspector 0 � rs L i - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING . •:: .�ia� w"EP�� es z...... � . �.k"Y.yq� 9..:, ,. P, �, .x dr'� ,. ., . . � '� � ���.' „!� S.v°ry';f �°sa' '+.: ,• BUILDING PERMIT NUMB lop DATE ISSUED: o /2 ©�• SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -7a- K.),, Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.Q. 54 yt 1.5. Flood Zone Information: Zone Outside 1.8 Sewerage Disposal System: Public ❑ Private 0= i y : Flood Zone ❑ Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWnRSHIP/AUTHORIZED AGENT Historic IS ric : @SNO 2.1 Owner of Record `" 4 --�- Name (Print) Address for Service 1 ! F P Sign re Telephone 2.2 Owner of Record: ,a Nacre Print Address for Service: n, Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 �o.✓�� 3 �� �� S �t'✓� Licensed Construction Supervisor: C S O License Number G�g� ness ��' O 3 Zo�G Expiration Date Sig ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 C) a q 6 Company Name 5� A M Cli � ..e �'().(V 5 Registration Number ill /I/o� r s q `� _L� _ nw� (� �° �" a 7 3 Expiration Date Sighture Telephone C�i 9 I �i 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 r in the denial of the issuance of the buildin 22rmit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Workcheek all applicable) New Construction*,,Q Existing Building 0 Repair(s) 0 Alterations(g).,: Addition ❑ ,0 Accessory Bldg. ❑ Demolition " ❑ Other ❑ Specify J Brief Description of Proposed Work: 3Ck"r -kit `C) s•e SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be t ::OFICi USE ON3f� Completed by permit a licant�� k 1. Building (a) Building Permit Fee ✓ f? a OO O A Multi tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) Lv 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 n c5 Check Number SECTION 7a OWNER AUTHOA ZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, v*— :r', o, "e S ° -re s4^ as Owner/Authorized Agent of subject property Hereby authorize to act on My beh#14n all matters relative to work authorized by this building permit application. Si ature f Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,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 Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 11D 3RD SPAN DIMENSIONS OF SILLS 131]v ENSIONS OF POSTS DUv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I—N . a: %.v isilsvn► rUsen UJ jyjassacnusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nlinort T.. F.........s..... Name (Business/Organization/Individual): _re_,5-v-a Address: City/State/Zip: A10 t-C+Vw 5 k^c^_ MA Phone #: C- GV N-a-o'a- S Are you an employer? Check the appropriate boa: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I loyees (full and/or part-time).* have hired the sub -contractors 2. B I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] G officers have exerci ed th r ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t s el right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] :Any applicant that checks box #1 must also fill out the section below showing their workers+ Type of project (required): 6. ❑ New construction ?• remodeling 8• ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11 .13 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other Homeowners who submit this affidavit indicating they are doing all work and then hireq-1Jbnuu11 policy Mtoo outside Victors must 'ta anew affidavit indicating such IContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information I am an employer that is providing workers' compensation insurance for my employees. Below 1s the informapolicy and job site tion. 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-yearimprisonment, 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 herebn under the pains and penalties of perjury that the information provided '---7— above is true and correcx OVIcial use only. Do not write in this area, to be completed by city or town official, City or Town: PermWLicense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S_ Pliamhinn i..n..e...__ 6. Other Contact Person: Phone #: Information and Instructions 01 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." z partnership, association, corporation or other legal entity, or any two or more An employer is defined as an individual, p rP� of the foregoing engaged in a joint enterprise' and including the legal representatives of a deceased employer, or the y receiver or trustee Of individual, partnership, association or other legal entity, employing employees. However the or the occupant of the owner of a dwelling house having not more than three apartments ncconstructiond who eorthrepair�wok on such dwelling house dwelling house of another who employs persons to do maintenance, 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 cormnonwealth 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 coma etely, by checking the boxes e that thapply eir toyyo yourof situation and, if necessary, supply sub-contractor(s) name(s), address(es�and phone number(s) along g Limited Liability Partnerships (LLP) with no employees other than the insurance. Limited Liability Companies (LLC) or carry workers' compensation insurance. If an LLC or LLP does have members or partners, are not required to the employees, a policy is required. Be advised that this�a odd Sum to sign and dabe submitted te heDaffidavvtt- The affidavit should Accidents for_confirmation of insurance coverage to the city ortown that the application for the permit or license is being requested, not the be returned Department of e rettrial Accidents. Should you have any questions`fegarding 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 ..If;,,c„raMce license number on the appropriate line. City or Town Officials etc and printed legibly. The Department has provided a space at the bottom Please be sure that the affidavit is compl the Office of Investigations has to contact you regarding the applicant of the affidavit for you to fill out in the event t. er which will be used as a reference number. In addition, an applicant Please be sure to fill in the permit/hcense numb that must submit rnultiplepermit/license applications need only submit one affidavit indicating current in any given year, policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or P ed or marked by the city or town may be provided to the mom).°' A copy of the affidavit that has been officially stamp applicant as proof that a valid affi4vit 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 lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registri.tlOn:,, 120296 Expiration.-- 11/19/2005 1y06:D8A,, TESTABUILDING & REMODELING J, JAME&. TESTA 2v p 5 APPLETON STREET KANDOVER, MA 01845-, Administrator _Amts m 5 APPLETi ks BOARD OF BUILDING: I Licenser CONSTRO CTIONSO PtR ISOR,' 54718' 3 ERI-* . z o me c 'Fs O 9 �Op to ei C.i CZ c cc A o •- 0 Ed CF V 4 CL cc SCR v$ �m m3. v m Co sc O ea :C y Em 41 �m> r 0 c O Q. C � M O z c O CL mM 3 CL .go CL.S .E�5� CL 44 A Oil c I r d= m o_ GO P. -A I I �i E z a ® h ® c cm CD CD :Ift ® v � ® o � 0 � CL0 cc c CD 0 CL V H cc C CL h G cc W LU uj C4 O Q \NG � a w w � � a � Q A w z cn cn . z o me c 'Fs O 9 �Op to ei C.i CZ c cc A o •- 0 Ed CF V 4 CL cc SCR v$ �m m3. v m Co sc O ea :C y Em 41 �m> r 0 c O Q. C � M O z c O CL mM 3 CL .go CL.S .E�5� CL 44 A Oil c I r d= m o_ GO P. -A I I �i E z a ® h ® c cm CD CD :Ift ® v � ® o � 0 � CL0 cc c CD 0 CL V H cc C CL h G cc W LU uj C4 JL F Q \NG . z o me c 'Fs O 9 �Op to ei C.i CZ c cc A o •- 0 Ed CF V 4 CL cc SCR v$ �m m3. v m Co sc O ea :C y Em 41 �m> r 0 c O Q. C � M O z c O CL mM 3 CL .go CL.S .E�5� CL 44 A Oil c I r d= m o_ GO P. -A I I �i E z a ® h ® c cm CD CD :Ift ® v � ® o � 0 � CL0 cc c CD 0 CL V H cc C CL h G cc W LU uj C4 16 Location n - No. Date r �' -"23 NORTH TOWN OF NORTH ANDOVER 3?O�,"•D .•,SOL ♦ y • ; , Certificate of Occupancy $ cNuBuilding/Frame Permit Fee $ l s�sE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C-�gf of 16196 ��— —Building Ins'ector �w TOWN OF NORTH ANDOVER .,BUILDING DEPARTMENT APPLICATION TO,CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING } u .a: '� G" ;:i�`« 5� ���.x.4�. �'"'7' :.� •., k d �' �i.A�i'� � 3•.ir s 5=y l•,-+..ew � � d �. BUILDING PERMIT NUMBER: DATE ISSUED: ` a d 0-3 SIGNATURE: Building Commissioner/I �tor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: B q 0 fV S 0 "V a3 , cao�' O v '(/g Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft . Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided' 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSI3IP/AUTHORIZED AGENT 2.1 Owner of Record C� J r $ 0 Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 65 ® '5 W11 F License Number Address �a � -®a y Expiration Date &E --a-C) 3 c3v.�A Signatutt Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Ir)LC?-")- Q G Company Name GV Registration Number Address Expiration Date Si nature Telephone OU rn z rn 90 0 Mn ic 10 rn z G) It .7 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 .......P" No ....... 0 SECTION 5 Description of Proposed Work check au licable New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) lid Addition ❑ Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: zy 10 i 4-C h -eiy I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost(Dollar) to be ( )9�Ifi7s Completed by permit applicant F ONLY �f , 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing 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 as Owner/Authorized Agent of subject property Hereby authorize to act on ' My be ; " i all matters relative to work authorized by this building permit application. CR Signature of er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 2 ND3 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 BUILDING CONNECTED TO NATURAL_ GAS LINE .J 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: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: -Te is v A Location: �. ► �c1�. r -� City /V, A <`! 8 rry% VN Phone # 97`S — S - oDL I am a homeowner performing all work myself. 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: Address City: Phone # Insurance. Co. Policv # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as welLas_civil.penaltiesinlheian-f-a-STOP.WORK_ORDER-and_a.fine.of_($1110.OQ)-aAW against -nom 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify Signature. Print the pains and penalties of pejury that the information provided above is true and correct .# Gy S ;- o'--',? Official use only do not write in this area to be completed by city or town official' City or Town Permit/licensing. El Building Dept ❑Check if immediate response is required [] Licensing Board E] Selectman's Office Contact person: Phone #. ❑ Health Department F, Other rl 4 m m m cn 0 m CD •Z CD O CL r d d 0. � O O v CD CD O c CD Qv tO CD O CO2 10 CD 0 _0) O H O CA kw� d Cl) CD 0 CD CD CD CO) I CD 0 CD 1� n O z cnC �dO z I O �• N O O` O G: O, S ID 10 V! ®CO CL 0 ® Cl) =r -C C-0), •-) .O.eCD N T �0.^.- o m �� ® O o y CO) o i 1 > > CO) 'D O to 0 O o Ze•90 0 CD OCR C =� . J2o s 5 ® OCD N m oO CD m m_ o. o ►✓ti N G Q C So O° c N C9 .. oo y _fib m O1 H C — 'CD . CD o 0 CD O � �00 in e= H �• eo ate• cn CD Cn PT" d rt ^+ z O ►1j r-+ Mr" d'CIO, H O aq It 7d ry �D p tr110 ij n y p t•° 5:0z co p '1y n O Pd IIIO CL n C z GO O C n C/A O r o a tw 1 e 3474 Date. 3..-.�-./..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .-:�. �. �t .�?... ............ has permission for gas installation . Uri. n ............. in the buildings of . ..�/. i." {..f ........................... . at .....�../.. 7... North Andover, Mass. �Y Fee. ,.2.2.-.. Lic. No....f.el.:':G.. ... ,GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A Z.) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING Q'n9l. Pt Type; / u Mass. Date ,x'22 permit # 6 _Ma/ - Building Locatlo' Owner's Name =<^ �r Type,of.Occupancy New ❑Renovattan p Re �lacement � ,Plans Submftted: Yesp No p Instailing.gompany Name CALLAHAN AIR CONDITIONING & HEATING Check one: Address91 BELMONT STREET ❑ Corporation NO A OVER ,MA- 1 RL S ❑ Partnership Business Telephone 978=689=9'233 ❑ Firm/Co. Name of Ucensed- Plumber or Gas Fitter JOSEPH K. CALLAHAN Certificate # INSURANCE COVERAGE: t have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142 Yes B No ❑ If you have checked ye. please indicate the type coverage by checking the appropriate box A liability Insurance policy 0, Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage requited by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: signature at Owner or -Owner's Agent owner❑ Agent ❑ 1 hareby cartily 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 neral taws. / 7e of Ucense: Tiue Plumber ga ur o se' um er or s �dter Gas6tter M=3440 CityRown master Ucense Number At,i'nONF Journeyman N N W Y! N N V • Vl W ul W in of cc rC O 0 V = m 0 � = J- = 0 .( 3,* Z a• 0 f W lC H -C cc W 0.. C 4 0! X W 2 W V W Vh W F. { H 0: H in ' F, S W o W F- J _ P tom' x 'W cc C C :ii > U. W (- W J N W ., 1 In os 2 O O W a O O P } Sua, BSMT• BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR GTH FLOOR i 7TH FLOOR STH FLOOR Instailing.gompany Name CALLAHAN AIR CONDITIONING & HEATING Check one: Address91 BELMONT STREET ❑ Corporation NO A OVER ,MA- 1 RL S ❑ Partnership Business Telephone 978=689=9'233 ❑ Firm/Co. Name of Ucensed- Plumber or Gas Fitter JOSEPH K. CALLAHAN Certificate # INSURANCE COVERAGE: t have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142 Yes B No ❑ If you have checked ye. please indicate the type coverage by checking the appropriate box A liability Insurance policy 0, Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage requited by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: signature at Owner or -Owner's Agent owner❑ Agent ❑ 1 hareby cartily 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 neral taws. / 7e of Ucense: Tiue Plumber ga ur o se' um er or s �dter Gas6tter M=3440 CityRown master Ucense Number At,i'nONF Journeyman Location 17Jq M�. y Date NORT►, TOWN OF NORTH ANDOVER F `n Certificate of Occupancy $ } o Building/Frame Permit Fee $ 29, Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ l7 TOTAL $ �! A--`.-' V Building Inspector 12858 10/22/98 14:55 79.00 DQTn Div. Public Works Location Nq- . Date MORTM TOWN OF NORTH ANDOVER F p + Certificate of Occupancy $ ; ; Building/Frame Permit Fee $ s�CHust Foundation Permit Fee $ Other Permit Fee $ ` Sewer Connection Fee $ Water Connection Fee $ TOTAL $' �- i' Building Inspector j, 1=16122/98 14.55 78.00 PAID Div. Public Works m � w Z W � ... mcn N x A � C � z 1 .... s x w y ¢ w � 9L ° 0 0 � 0 0 uJ W Z G CJ Z W W Y2 z U Ulz z z r P '^ W �' o V, 0 y L 0 C L•:• N U �. Z !J' N v7 C L` 7n 2 Vf Jf J1 W^ - F� rO w O i r rn. Q v l �- In V LU ann z W z z W U z i W U Z Z Z w W C 4 J1 .n W Z � 'J U x l J Z Z Z C? 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C c c V �O 'O .d O 0.. �z♦ V CO)CD C cc C C H N2 21 '17 Date. //- �,/- ................................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....................... .. ......... perform has permission to pe ..................................................... wiring in the building oL,.........I/v . .... ...... ...... ............................................ ........ . North Andover, Mass. Fee .............. Lic. NogV,0.9 . .................................. INSPECTOR ' —,*** ELECTRICAL " /98 G — WHITE: AppllcanPONZARY. ildPI %pt. PAID K: L�,,eIXV THE CIOMMONWE4LTHOFMM4a&MM1 DEPARTMF VI OFPUBLICSAFL7Y 9�'Io BOARD OF FIRE PREWMONREGUL4TIONS5 C 12.00 Office Use only Permit No. C71// l Occupancy & Fees Checked APPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ) ' /`� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dates /(, Y Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 719 Owner or Tenant To the Inspector of Wires: Owner's Address 5A M 1:�' Is this permit in conjunction with a building permit: Yes ©"No (Check Appropriate Box) Purpose of Building W k Ll.-, ,/%) ( �Utility Authorization No. Existing Service Amps / Volts Overhead Underground o No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 6t^ / ,, yv C, 7707 47 ru 12 7 77 %Y 74 77 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground M No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER L�rxrCaaa� Rast>arittotheracgmanatsofTvia�sad>asdlsCalLaws IhawaalmtLiabtl*irtum=PniLyu gCor>plele ComagDcritssksWrialeWiva YES © NO M Ihaw a6mimadvalidpriofofsanetgtheOffix YES L NO If}whaawdv&WYES,pleasemk*th Nxofw&aWbydxiagthe INSURANCE ©/ BOND OTHER (PleffieSpacify) WorkloStatt //— V-0�'J- IngxvU rtD*Regxsted Signed urder�ieR��alties ofperjtayC_� Gv�4.c. t� r j . �.r9 JJ f� FIRM NAME Est nxiodvaluedHeMxal Work $ Rough Frnal _ Lioa�seNa 14 6 3? 9 BtanessTel.Na —d6 ,A Lr"h .�...� ..�..��. Alt. TeLNa OWNER'S INSURANCE WAIVER, Iamawm Ilathel-imm r$reitwratoeo7=Wtxitssul0Me#vakrtasre#WbyMamdxqtZG=rALaws andfivimys�mt onthispari$Wpflcadnwaivesthemw'KUTlart (Please check one) Owner " Agent o Telephone No. PERMIT FEE $ , --2 -0 Date.... ..-..... ./ t2 ..............-3 . "0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ......... . . ............................................... .. .... ........ hadKJ ...... ....................................... permission to perform ............... wiring in the building of ... ...... ............................................... "t 9 19 at..................................................... North An/do er, Mass Fee......... �) ........ Lic. No I ............. ..... . ....... ........ .... EE-CTRICAL IN ECTOR Check # T( 4401 Ah rIVJTLJJI DQI Mw MM�� yl lJL.VI IV.PIL VL-I�vyVL. 1 rIVL VL/ VL Cornmo►twaa[th o�///iwja�f ua0UjO'(1116:tl Usc Only JJefsarinienE o�.}ire �arvices Permit No. !�� W, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fe: Checked Rev. 11.199] (leave blank) APPLICATION FCS? PERMIT TO PE�;F��� EL�CTI�22a All work to be pc•lbrntcd in a�cort ancc with the Massadtuscns 1:Icctrical Code (EIEC), 527 CMR 12L WORK 01L CASE PRINT 1N INK OR TYPL•-:1L.L INFOCity or. & f,! ION) Datta; -- To the lits1�ector o 1,/tees: By this application the undersigned gives uo ofhi r her futeati t to perform the elcctricat work described below. Location (Street sC Number) 7 l' c� Owner or?cnant Owner's Address Telephone ilo. Is this permit in conj tction with n building permit? Yes nine ❑ Purpose of Building (Clteck Appropriate Box) Utility Authori=%tiotn No. Existing Service Amps �Volts Overhead ❑ Uudgrd ❑ No. uNNIeters Nen• Scn•icc `_ 'Amps / Volts Ovcnce:td• ` ❑ Undgrd ® No. oftl•Ieters. A, umber of Feeders and Ampacity Location and Nature bf Proposed ilectrical York; No- of Recessed Fixtures Cvn, !e!(orf o%thee ollvf No. of CeiL-Susp. (paddle) FAns (able nrav be nai► l rlre t 0.0 "rota No. of Lighting Outlets No. of Hot Tubs T ansformcrs KVA Generators KVlq No. of Lighting, )Fixtures Sitinuuiug fool eve ❑ rt- ❑ rud. t 0 . oerger m°cy fig tpltg end_ Batte XLnIts No. of Receptacle Outlets No. of 011 Burners, FIRE ALARI•Ia No. of Zones No. of Switches No. of Gas Burners Pte. of Detectiosx•and No. of P-anges No. of Air Cond. rota] Iultla to Devices t Tons No. of AIertfitg Devices ,? t o. of edi� entailed No. of:vaste Disposers Heat nip unz er " ons "Totals: No. of Dlshtinaslters SpacdArea denting K{tiY Detecdon/Alert:in Devices Local ❑ i�lwti,clp2 Connection Other No. of Dryers Healing Appliances ICtiy Securit y ysten-ts: NO. o. of � ater FIeaters KW t o- o 1 0.01 No. of Do or Equivalent Aata tiViriirD: Si! nts Ballasts .,_ ,..,. v. yc�•rc:CS Or No. HS•dromassage J3atlntubs No. of llotors Total ZiI' I'clecorttrnunications OTHER: No of Detir•es or .ltrach additional derail if desired, or as enquired by the hgFecror of Wires. ° INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of clectrical work niay issue unless the licensee provides proof of liability insurance including "Completed operation" coverage or its substantial equivalent. 1'lie undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK Oi`iE: INSURANCE eOND ❑ OTI3ER ❑ (Specify:) Esdinated Value of Electrical Work: (When required by municipal policy,) (Expiration Datc) Wort: to Start — --6]31 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj-, "'filer the pains arrd peirdrlties qfp rjurj; that the igfornratiort otr this applicativ'r is true atr,i complete MUM NAME LIC. N 0.: '� Liccnscc: ice Signature . s LIC. NO.'. f � � (lfopplicabia etc • ve, r"i,r 11 re, ` , tbe' li,rc f Address: r� ® Bus- Tel- NO2-7f, r9 � OWNER'S IYS .a NCE 1 .�LiV . ant aware Uiat the Jjcensee dors riot have Sy liability t.InsTel. coverage normally required by law. � my signature below, I hereby waive this requircmcnt. I an n the (clicck enc) 0 owno�� er ❑ ncr's a �tnt. Owner/A;cnt Sienaturc Telepbone No. Pj;Rtl, rF,t L•: s Date . -a 0.. O . <:�•' :otic TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......V. r .`. S. 1 v w� has permission to perform ...'elf "... J. '. �.... � 4 � ............ plumbing in the buildings of at ....../ ............................... . Nort Andover, Mass. Fee. 3 4? ... Lic. No.))Z.Z l M M `"�' .. . PLUMBINGINSPECTO'R Check # 5561 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 2 / S} Owners Name ( A/L1 Date V Permit # Amount Type of Occupancy New ® Renovation ® Replacement ® Plans Submitted Yes ® No 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 V I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bet of my knowledge and that all. plumbing work and installations performed under Permit Issued for this application will be in coikpliance with all pertinent provisions of the Massachusetts tate Plumbing Code and Chapter 142 of the General Laws. By: Signature oi.Licensea rium Der Title . Type of Plumbing License City/Town icense Numoer Master ® Journeyman APPROVED (OFFICE USE ONLY i' f (Print or type) Installing Company Name ��u �S S , �� ``� V5 `'� �i Check one: Certificate Corp. Address v 6 / P Partner. _ SX(/i..SS�cG�O Business Telephone /S`— 7 E: 6 Firm/Co. Name of Licensed Plumber: V - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy El Other type of indemnity 11 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 V I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bet of my knowledge and that all. plumbing work and installations performed under Permit Issued for this application will be in coikpliance with all pertinent provisions of the Massachusetts tate Plumbing Code and Chapter 142 of the General Laws. By: Signature oi.Licensea rium Der Title . Type of Plumbing License City/Town icense Numoer Master ® Journeyman APPROVED (OFFICE USE ONLY f (Print or type) Installing Company Name ��u �S S , �� ``� V5 `'� �i Check one: Certificate Corp. Address v 6 / P Partner. _ SX(/i..SS�cG�O Business Telephone /S`— 7 E: 6 Firm/Co. Name of Licensed Plumber: V - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy El Other type of indemnity 11 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 V I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bet of my knowledge and that all. plumbing work and installations performed under Permit Issued for this application will be in coikpliance with all pertinent provisions of the Massachusetts tate Plumbing Code and Chapter 142 of the General Laws. By: Signature oi.Licensea rium Der Title . Type of Plumbing License City/Town icense Numoer Master ® Journeyman APPROVED (OFFICE USE ONLY Date ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... 3v r I. . r � . V.. S i has permission for gas installation ... < `. �.... Y2 .0 C), .. . in the buildings of �''t'` . �'. . . `- .................... . at ..':!S... �o '" North Andover, Mass. Fee.?.Q,.:�Lic. No.(`.�?V...GASINSPECTOR Check # 0 3-) 0 4326 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO D01 ' FITT NG (Type or print) Date -2 - P-0 Q / NORTH ANDOVER, MASSACHUSETTS Building Locations �! l� S O S Permit # Amount $ Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print4TH. • • FLOOR ortype)hec one: Certificate Installing Company Name v 1^ � .j {' S S u "`. e, �, > H Corp. Address 10 6 k -r `"' p C ❑ Partner. •-TxLl S S'0�00 ,-^ Cr 777 r, f T 77 Business Telephone ' '' - k/ — — / b (02 ® Finn/Co. Name of Licensed Plumber or Gas Fitter ---ILI S v- �' v' CJ ,a f' -f INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑- No ❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0-- Other type of indemnity ❑ Bond ❑ Owner's Injurance 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 ofiOwner or Owner's Agent Owner ❑ Agent ❑ • 1 lfVl V V�' %.c1 LILY ulaa au v1 uIV uc+.alls mu miormatnon 1 nave suomluea (or enterea) m above appticahon 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 ofthe Massachusetts St� a and Chapter 142 ofthe General laws. VED (OFFICE USE ONLY) Signature of Licensed Plumb e Or Gas Fitter ElPlumber ❑ Gas Fitter License Number Master ❑ Journeyman