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HomeMy WebLinkAboutMiscellaneous - 72 WAVERLY ROAD 4/30/2018N W., 0 40 Date.. 5-111 TOWN OF NORTH A OVEF PERMIT FOR GAS 17TALLLATI -211- R, le This certifies that ..................... ej<i. j� ... has permission for gas installation . �� �. 11 /, ' V. .......... in the buildings of .71n C4-1.if V'e4. (�/ ................... at ................................ North Andover, Mass. Fee. ... Lic. No...T9.3. Check # 3S-7-7 GASINSPECTOR 5972 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS F rnNG (Type or print) Date f / 0 % NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New D Renovation 1:1 Replacement Q— Permit # Amount $ �-- W* Al' Plans Submitted 1 SU B-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOGR 3RD. 4TH. FLOOR FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. Z w w H b e x a w z w 4 w > W x > d SU B-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOGR 3RD. 4TH. FLOOR FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. FLOOR FLOOR (Print or type) T Name , �1 . 5 Address R p SC r")4.( Name of Licensed Plumber or Gas Fitter czw w p O w Z F $ o z > H w x Ch k one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0-- No13 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13-- Other type of indemnity 13 Bond 13 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 OwnerAgent El I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and insta ions p rformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach s Stat Code an ,Chapter 14 of the lsneral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of LicensecrPlumber O s PluFitter mber 3 Gas Fitter 77ense um er Taster Journeyman Date..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �41 Nz� 9, "/-/. This certifies that ...................... has permission for gas installatioQ C;". in the buildings .......................... ...... North,Andover, Mass. at 4 Fee4\�.,. Lic. Nox� ......... Check # S708, a NLASSACHLSEMUNWORM APPLICATON FOR PERM TO DO GAS MT NG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 7cZ Permit,# V`�UlJ Amount Owner's Name �■ New ❑ Renovation Replacement ❑ Plans Submitted ❑ (Print or type) /�� nL'IL Ch ck one: Certificate Installing Company ` �, b Corp. Address � � 41 lze_,1 '4 Partner. Business r e ep one lrm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No 13 If you have checked yes, please indic - ie type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond13 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 L .L_ ..vy — j..y umL un uL M uctuua ,mu unumiauun 'nave suomnleu for entereu) In above application are true and accurate to the - best of my knowledge and that all plumbing work and installations P.rfornic:d tinder Prrmit Issued for this application will be in compliance with all pertinent provisions ol'the MassachusettsS Lite Gas Code and Chapter 142 of the General Laws. BY: Title City/Town APPROVED (OFFICE USE ONLY) Si -nature of Licensed Plumber Or Gas Fitter PlUniher I c;� Z/_� �.5-- 0 Gas Fitter License Number Master . 011rneymatl - V' W � � W W W n z C w� x CG Q4r W tzj C7 F z r a F f-- z w^ O f� ✓ 3 D C7 J U x > A SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4T 1I. FLOOR Ae 5TH. FLOOR 1 J_* 6TH. FLOOR v 7TH. FLOOR ax 8TH. FLOOR'" (Print or type) /�� nL'IL Ch ck one: Certificate Installing Company ` �, b Corp. Address � � 41 lze_,1 '4 Partner. Business r e ep one lrm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No 13 If you have checked yes, please indic - ie type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond13 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 L .L_ ..vy — j..y umL un uL M uctuua ,mu unumiauun 'nave suomnleu for entereu) In above application are true and accurate to the - best of my knowledge and that all plumbing work and installations P.rfornic:d tinder Prrmit Issued for this application will be in compliance with all pertinent provisions ol'the MassachusettsS Lite Gas Code and Chapter 142 of the General Laws. BY: Title City/Town APPROVED (OFFICE USE ONLY) Si -nature of Licensed Plumber Or Gas Fitter PlUniher I c;� Z/_� �.5-- 0 Gas Fitter License Number Master . 011rneymatl - V' Date ......... 01 TOWN OF NORTH"'ANDOVER PERMJT.FOR PLUMBING '11�11U"� This certifies that ... ........................................ has permission to perform 7 ............... plumbing in the buildings of ................ a t ......... .. ...... North Andover, Mass. Feey.� Lie. N-o.C. ....... ..... ....... PLUMB11 G INSPECTOR Check 7084 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS %/ Date Building Location ] Owners Name Permit # 1,17 Amount _ ail',Type of Occupancy S New ❑ Renovation Replacement ® Plans Submitted Yes No FIXTURES (Print or type) �y / f� Check one: Certificate Installing Company Name h �-� ` ® Corp. Address C� ,!�'L'' f ��`"� y S Partner. r - Q GS— Business TelephoneFirm/Co. d� 0 Name of Licensed Plumber: Insurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance JIi ignature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachuAts State Plumbing Code an4 Chapter 142 of the General Laws. By: Signaiu a of i7ce umer Type of Plumbing License Title ) ,� • qS City/Town License Number Master APPROVED (OFFICE USE ONLY Journeyman e� 11) MMONNOWNWOMMMMMOMMMOMMONN (Print or type) �y / f� Check one: Certificate Installing Company Name h �-� ` ® Corp. Address C� ,!�'L'' f ��`"� y S Partner. r - Q GS— Business TelephoneFirm/Co. d� 0 Name of Licensed Plumber: Insurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance JIi ignature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachuAts State Plumbing Code an4 Chapter 142 of the General Laws. By: Signaiu a of i7ce umer Type of Plumbing License Title ) ,� • qS City/Town License Number Master APPROVED (OFFICE USE ONLY Journeyman e� 11) P" - Mir, � -1 %Ir Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ P .............................. has permis sion to perform ..... c4A-lb.,ri'-AA)�v Mlbe -7 ............. f .................... wiring in the building of ............ .......................... ............. .......... .... .. at .......... 9.t? ................ . North Andover, Mass. -i�c;�� .. It. LEcrRicAL Feel� Lie. ........... f Check # 6886, Commonwealth of Massachusetts Official Use only // Department of Fire Services Permit No. C',, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: ?- Zq- p G City or Town of: V, � �y t/ R r 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) 7 Z Owner or Tenant 5L)1,1-1 V0 -VI Telephone No. 1Fy- Owner's Address OGk�YK 19 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building e o s e Utility Authorization No. Existing Service ZOO Amps / 20 / 2 -)Volts Overhead V 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: Z - to � x �.y- iC, f C e 1.e.9 f e ` J)th yn rz�j R L tl b Pn 4 eLl Completion of the ollowingtable nuy be waived by the Ins eooct r f wi 0 •♦ No. of Recessed Luminaires No. 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 ❑In- 11o. o Emergency Lighting rnd. rnd. Batter Units No. of Receptacle Outlets ��No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices Tons g No. of Waste Disposers Heat Pump Number I Tons K o. ofel -Contained Totals: 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 Equivalent No. of Water KW No. o No. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommunications 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: Y�QQ (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 & BOND ❑ OTHER ❑ (Specify:) I certify, under the ams and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 01 j e �1eC3 LIC. NOL' Licensee:c-�_�, xe � a Signature �h� L , IC. NO.: (If applicable, "exempt" in the license number li e.) (J Bus. Tel. No.: Address: 7 Z SGc,cJ�llC�pj�`S �� j� Vwey m �\ Alt. Tel. No.. 6o *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. gyres. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Y�QQ (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 & BOND ❑ OTHER ❑ (Specify:) I certify, under the ams and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 01 j e �1eC3 LIC. NOL' Licensee:c-�_�, xe � a Signature �h� L , IC. NO.: (If applicable, "exempt" in the license number li e.) (J Bus. Tel. No.: Address: 7 Z SGc,cJ�llC�pj�`S �� j� Vwey m �\ Alt. Tel. No.. 6o *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ROA -t -j4(- 0,�, r --o C,4-� /2,,,2 Location No. Date ey 6 TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14 CU L 2 01v -Builaing ln��;ctpr'/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE. OR DEMOLISH A ONE OR TWO FAMILY DWELLING < BUILDING PERMIT NUMBER: SUED: SIGNATURE: Building Commissioner/Itor- of Buildings Date - O / SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ap Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Recgired Provided Required Provided 1.5. Flood nmution: 1.7 Waterer Supply M.QLC.40. 34) d ZIfo Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service a Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ' _6,41-105 �, �. Xe /� Licensed Construction Supervisor: Add re s 4h� 22W 69 ;3-�O Signature Telephone Not Applicable ❑ 00 / License Number Expiration Date 3.2 Registered Home Improvement Contracto..r, j Not Applicable ❑ Company Name 7 rz r�-s ® I'sdv ej , Registration Number / 9-/.`t a—lAd Address/ g Expiration Date Si nature VTele hone SECTION 4 - WORKERS COMPENSATION (M.G.L. C M7 s 2crmi Workers Compensation Insurance affidavit must -b6 completed and submitted with this application.-. Failure to provide this affidavit will result in the denial of the issuance of the buildti unit.` ;; " Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: LIVIce v i�Gr...��' . SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant 1. Building a () Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction _ S shy 3 Building Permit fee (a) x tbf MechaPlumbi 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owtter Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE. OF FLOOR TMMERS 1ST .2ND 3KU SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL, OF Cl-UMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LME _ACC RA, CERTIFICATE OF LIABILITY INSURANCE 0DATE (MM/DDNY) 3/29/2001 PRODUCER (781) 246-2677 FAX (781) 224-0973 arpey Insurance Group Inc 442 Water St PO BOX 567 Wakefield, MA 01880-4667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Colonial Development Corp dba William Barrett Homes, 1049 Realty Trust, Barrett Development 1049 Turnpike Road N. Andover, MA 01845 INSURERA: Great American Ins Co INSURERB: Safety Insurance Co INSURERC: Zurich Insurance Company INSURER D: INSURER E: (:UVtKAGt5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE LTR OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YV POLICY EXPIRATION DATE MMIDD/YV LIMITS OF ANY KIND UPON THE COMPAN TS AGENTS OR REPRESENTATIVES. GENERAL LIABILITY PAC1812522 03/23/2001 03/23/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire)—:3. 50,000 CLAIMS MADE M OCCUR —' "' MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY F1PRO- LOC JECT — ... . _ . - AUTOMOBILE LIABILITY ANY AUTO 1900226 03/23/2001 03/23/2002 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY $ (Per person) ' X X' X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) 0 PROPERTY DAMAGE $ (Per accident) 0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TC095837697 03/24/2001 03/24/2002ORY IMITS OTH ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER D SCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS R WORK AT 72 WAYERLY AVE. r I CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION AGUKU ZO-5 (1/yl) ---"/ ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, DAN & ]AN SULLIVAN BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 72 WAYERLY AVE OF ANY KIND UPON THE COMPAN TS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE N. ANDOVER, MA 01845 Dawn Abramovich AGUKU ZO-5 (1/yl) ---"/ ©ACORD CORPORATION 1988 INSURER'S AFFIDAVIT AS TO WORKER'S COMPENSATION INSURANCE I,ai�:�• �ov�c7\S `? inS. 6-dcx', 4a wa' (name, address and tide), authorized representative of Zvi, CV �t�SUC �e (insurance company), do hereby affirm that effective Z 1 a y I o\ _ (date), Ccky A ±2n__& fpontractor) is insured by said Insurance Company with Policy Number 41) Gq __7 a3 for Worker's Compensation in accordance with Massachusetts General Laws, Chapter 152, and Subsection 7.05 of the Standard Specifications for Highways and Bridges of the Massachusetts Department of Public Works. (signed) Subscribed and Sworn to before me thisday of at Notary Pnblic My commission expires 4 a lk o � / . w k § 7 oma$ | �_ 0 / . o \ xh�. a 2z2 i � E , U) cm2 �o //� . , / z % CO m x G x C/) CD m I v FR d C � ■ CO2 n CD CC7 Z y CD ■ C• � ? 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