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HomeMy WebLinkAboutMiscellaneous - 727 WAVERLY ROAD 4/30/2018Date ... 1-......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ... �'CehzPfrr� in the buildings/of ..... �!�! � ......................... . at .... �"z�s "l/!e�-l.. .. ,North over, Mass. Fee..?A Lic. No..Z?�LG33. . ���?.;.O�ee Y GASINSPECT Check # 113-31 8204 Date.. 9453 01 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. •�/ ..91. ........ . has permission to perform plumbing in the buildings of............. ...... . at ..../-4!� . �i,er//... ............. Orth Andovveer, Mass. Fee!-P4v . Lic. N o. &Irll....... PLUMBING INSPECTOR Check # I6---3 FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: NORTH ANDOVER , MA. Date: Permit# Building Location: — jkoWP&'/t'L !;e /(9 Owners Name:��/44/ A110l1�✓'4 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑: Residential 0 New: ❑ ' Alteration: ❑ Renovation: ❑ Replacement: 0 Plans Submitted: Yes ❑ No F1 .. FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2] Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent El 1 hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title 21 Plumber Signature of Licensed Plumber Cityrrown ❑ Master , y pJoumeyman License Number: APPROVED OFFICE USE ONLY 9 z z y Y O V m N Z F Y J V W 0 W IL W W ~ W Tin ZQ Q N Y Q N z_ 0 QZ Q 0 M Q Wa d Q to w O a Q w z N w J Z X V m u_ w Ix, O V z Q U. 3:a. Y z W W W I=— = a LL N J J co Q m m D D C9 = Y to WH O SUB BSMT. BASEMENT I X 9 FLOOR 2 NOFLOOR 3 FLOOR 4 FLOOR WH FLOOR P FLOOR 7 . FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: HALLORAN PLUMBING � Corporation Address: 826 DALE ST. City/Town: NORTH ANDOVER State: MA ❑ Partnership Business Tel: 978-685-9504 Fax: ❑ Firm/Company Name of Licensed Plumber: THOMAS HALLORAN INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2] Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent El 1 hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title 21 Plumber Signature of Licensed Plumber Cityrrown ❑ Master , y pJoumeyman License Number: APPROVED OFFICE USE ONLY 9 FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: NORTH ANDOVER , MA. Date: 61-14- /1 Permit# Building Location: Z2 3— 41411C;'l jy f?O Owners Name: 41111%vlr 171/'I' le'i1` Y Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential El New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 0 Plans Submitted: Yes ❑ No FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy R] 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent El By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the oesi or my nnowieage ano mat au pwmomg worK and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Q Plumber El Gas Fitter Title Signature of Licensed Plumber/Gas Fitter ❑ Master CitylTown ❑Journeyman 3 j ti n APPROVED OFFICE USE ONLY)❑ LP Installer License Number: `" 4 W W Y = rn O= W mLU O W W 0 N H fn fY zO Z 9 z p CD 0 W w IY 0 I'- 5 > U) V LU z t/> 0 Q W to 0 Q W= � ti > V W z w J H F O Z J 0 W w � = W o W W W z cc>- R O W D Q N Q W W Q w m w Q> O 0 Q z 0 r j > z I- _ 0 L) 0 u. 010 X z J O a 0 tW- >>> O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 Ku FLOOR 4 FLOOR -5 'FLOOR 6'H FLOOR 7 1H FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: HALLORAN PLUMBING ❑ Corporation Address:826 DALE ST. City/Town: N.AN DOVER State: MA ❑ Partnership Business Tel: 978-685-9504 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter:THOMAS HALLORAN INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy R] 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent El By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the oesi or my nnowieage ano mat au pwmomg worK and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Q Plumber El Gas Fitter Title Signature of Licensed Plumber/Gas Fitter ❑ Master CitylTown ❑Journeyman 3 j ti n APPROVED OFFICE USE ONLY)❑ LP Installer License Number: `" 4 -y The Commonwealth of Massachusetts Department of Industrial Accidents 4 u Office of Investigations d 600 Washington Street Boston, MA 02111 f M ,www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician "s/Plumbers Applicant Information Please Print Leeibly Name .(Business/Organization/Individual): 7 1114 L&d 4AI Address: .2vz 4 19.4Lle!�_ S7— City/State/Zip: /11allorl1 4;orlVad�z /M'_Phone.#: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with C> 4. ❑ I am a general contractor and I employees (full and/or part-time): *` have hired the sub -contractors 2.I am a sole proprietor or partner- Iisted on the attached sheet. ship and have no employees 'These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. required.] S. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):,, 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 fie up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date Phone #: not write in this area, to be completed by city or town official, City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6.Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ctPerson: 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." f 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,operatera 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-contiactor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 Washingtori Street Boston, MA 02111 Tel. # 6.17-727-4900 ext.406 or 1-877-NlASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia Town of North Andover tAORT , q� O 4tteo abs 4 Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �` o SS4CHU5� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION LOT NUMBER / SUBDIVISION DATE REQUEST FILED ra PIP DATE READY FOR INSPECTION 3 2 - FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INFECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THTRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING I CONSERVATION _ DATE PLANNING DATEy l �i /0 l D.P.W. — WATER MER i10616r ATE _ `� �Z_ d` 541i D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRI THE INSPECTION Q ST DATE. a SIGNATURE / DPW AUTHORIZATION I CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number �`� Date—oZ i— d j C8 -9-o©) . THIS CERTIFIES THAT THE BUILDING LOCATED ON 10-14- / 8 A- %a 17 46-1,4 U e-rz � Rel MAY BE OCCUPIED AS �� J'5-',"�w ///,vh 0/2W SAE ) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ;,,o CERTIFICATE ISSUED TO ZVA v r / �/ `T12y S p ADDRESS Building Inspector CD m m CD U) O S7 w S Cl) 10 0 CD n Z y co 06 o 0, _ O d =• y O C CD CD O CD CD o CD C O co) CD O CO) = O I �CD 0 OT I 44 c?oc ? Z O �• (a O CT N mc G O C9 C.* C2 rr, c Z ?� H CL 0 Er m n�tv O y CD 0 0CS N p D O� C Q to ~' O OC y n Ll W .4O CD c �CA r CriC2 C/) o=r V/ CD ON CCD n G d 0 CA O :c l,J � N O d N :_ . N C d :6 Cr C � Cn O `C 5. N ' CD to ll, n .. m o Cn ?cA N 3 CD o� co a - =r o tk OCD O CD o c° � ;gyp �► C', J r� W` Cob CD: d Nib&'� �. s• -4 0 �o N y :a 00 ~ -Gi � fD, w x r �' p ��., O C w � r 07 � d O n a 0 0 A —) 4+ R 4.P r d l< x tz o co p z 1 to Q 0 c 1 .. I CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number Date 3- THIS CERTIFIES THAT THE BUTIDING LOCAwn nN f7o?5 IWA-(/2!'LY PW MAY BE OCCUPIED AS ��-' �� �'�!`e�' ` ���� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. V-6, Rve, M l.6 2,47-41 CERTIFICATE ISSUED TO AO O'e-R Z,1 k c' g ADDRESS Of �ds,C"„'c Building Inspector O -• VJ O Q y a o e m m sm cl) f v Z HmaC 3 �• �-O H -� °:m H T _ a o =r CDC cod o CO) H N o ... _ _ O =rmCD O - - D: o co Or. p O ...r n O ZyN: CO) o n LH '0 O • m 'fir CDC y ,cam z y r t� a. 0, 3 CL d O C7 O c = —• /�� �a Cn 0mti p O 'Zj C/) O m . Clcm, m O p0 N ;�� m �� H add � 'D n id CZj) o c mCD a CDO 0 rt c , y p o rn a y H� � �. m 0 C CCD y Q O 3 CD m CD cn _. CDH it CL C2 y Z D cocm m CD P 10 O wCD x �/Imb r: c CD d � . CD Z cL Cl) 0 dc o� CD s , LE C/)� o r zn �o w tz a\ d o A 0- tz o O tri O c r n e 00 1 O Q z 0 Ut omi 0 O C Location � 'ion wA bIR too, 'c Date C?�� Check # ) V i 4.5 .1. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ CI Buildiri94spector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a_. BUILDING PERMIT NUMBER: DATE ISSUED: C / L SIGNATURE: Date SECTION 1- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard 3 O Side Yard S Rear Yard 3 U Required Provide Required— Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SEC 1100 2 - PHOPEKl Y 0WINERSHW/AU'1'H0KtZ ED AGENT 2.1 Owner of Record N e rint) Address for Service : 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licei&d0,onstfticti6n Supervisor: A d� ress S gna e t-7 Telephone 1/ egistere ome Imp Company Name Address Address for Service: Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number I Expiration Date 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 building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Addition ❑ IMx41[11►rolm *IYluE11111Dooxcli ltl:UreI11WE61111K�l Item Estimated Cost (Dollar) to be Completed by permit applicant �()FFjCIAL USEF(QNLY� a� 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) . . J` 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 He b authorize X7 to act on My e alf, iii all iature of Owf ECTION 7b C this building permit application. AGENT DECLARATION Date 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 Sianariue of Owner/Arent Date f CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE. -I"=40' DA TE: 90/23/2000 Scott L. Giles R. P. L. S. Frank. S. Giles 50 Deer Meadow Road North Andover, Mass. AP #27 PARCEL #15 M CONNOLLY AP 027 PARCEL #34 M LET17-10 N 6'23^ N 62045_ _ \\ u� z �� EX/ST/NG W4 TE/� 5 /DE EASE' NT 41t X tK J GO � n� ��, O tiry �� P I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING NORTH ANDOVER BYLAWS CONFORMITY OR NON -CONFORMITY WHEN BUILT WHEN CONSTRUCTED. ri OF 9 LES H 13972 0 %lSTER�� Qua L LAO X00 FORM - U - LOT RELEASE FORM a r -- INSTRUCTIONS- This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ...............................................■.............................. APPLICANT �C//���`�� �` %/lD(/f / PHONE ASSESSORS MAP NUMBER LOT NUMBER Cv SUBDIVISION LOT NUMBER STREET tA)A U IRW 1 ``-C STREET NUMBER OFFICIAL USE ONLY ........................................................................... CATIONS OF TOWN AGENTS �� CONSERVATTONADMDOMTOR DATE APPROVED C kb DATE REJECTED CONAgNTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR -HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONMIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONSNiEN'I'S RECEIVED BY BUILDING INSPECTOR DATE m m m Cf) 0 m H -v CD 0 L� CA d O CO2 n' C C y c� CD O CD Ma ml CD a. H CD COD C e ?'o $ m --i La: O �. m V2 O m 0 X9 m n Z No•►c�. �� y �. a) O N T �a,.,n o �0md o y N � N O =r CO C _ D O n -4 Oet O O N C2 Q W O m.4.VE C �H� R r a =a== C/) _ Co CL �?. V/ � O O N C COL O n y cn ca3 m cn EC -14 o m Z moo`* C % m bd o . o CD pqer. CD G! m e. CD a_ :a a&A -I Cf) E3 cn 4 H b o aqO CA O a o rA O n g 0=3 0 9 O C CD ►s Location /6)11 G(,//q (/Z&Y ?d No. � Date /J- "? / - C d MaRTM TOWN OF NORTH ANDOVER - _ L Certificate of Occupancy $ •s' Building/Frame /Frame Permit Fee $ scMust 9 Foundation Permit Fee $ ^w Other Permit Fee $ TOTAL $ Check # d c 4 3 6 /`� � Building Inspector h ,-, CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE. -I"=40' DATE: 10/23/2000 Scott L. Giles R. P. L. S. Frank. S. Giles 50 Deer Meadow Road North Andover, Mass. CEL #,f!5 MA C NNOLLPAR Y N 63 N 62 I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER WHEN BUILT '23" E x� ,626 SF to EX/ST/NG 15, II WATER EASE P #27 PARCEL #34 MA LETIZIO OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. of y� LES H 13872 c STt LAIM �p0 Location �n I 13 )A Cel? r' Y /?0 No. / Date 6? /© b() TOWN OF NORTH ANDOVER °+ Certificate of Occupancy $ �''•°' E<�' Building/Frame Permit Fee $ fCMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /-SDr Check # y 9 q 3 C r f ':building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT4, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r• BUILDING PERMIT NUMBER: Soo, DATE ISSUED: c1b —49 0 o SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: W� 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: ,/ Ok/N/ driSE r% Zoning ffsU—id Proposed Use 1.4 Property Dimensions: ?�� i Lot Area s F; --t. g, ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record are (�'nnt) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION -3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: / Licensed Construction Supervisor. Address Signature T ephone Not Applicable ❑ e7 S `y 6;;z License Number ExpifatimKDate 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date rture Telephone 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 afl in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Descri ti of Proposed Work check all applicable New Construction V I Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description'of Proposed Work: I SFCTInN 6 - FSTTMATFD CnNSTRiiCTION COSTS I will result Item Estimated Cost (Dollar) to be Completed by permit applicant OMCIAL USE ONLY . 1. Building O' G d (a) Building Permit Fee Multiplier 2 Electrical or d (b) Estimated Total Cost of Construction 3 Plumbing '-f G 0' Building Permit fee (a) x (b) 4 Mechanical HVAC C7'- '5 5Fire Protection C> Cr O 6 Total 1+2+3+4+5 S G 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 e by authorize to act on y ehalf, in all m to work authorized by this building permit application. r,Sig ature of Owner Date r 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 of Date NO. OF STORIES SIZE y BASEMENT OR SLAB =y SIZE OF FLOOR TI?VMERS 1 2 3 SPAN DMIENSIONS OF SILLS DIIv ENSIONS OF POSTS DIMENSIONS OF GIRDERS p HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING o�2 p X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND d IS BUILDING CONNECTED TO NATURAL GAS LINE 0 92. P�,v.�✓191�P.��da BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: C$ 058622 Birthdate: 03/15/1955 ,Expires:•03/1'5/2002 Tr: no: 22381 Restricted To: 1G JAMES W WRIGHT JR _ 25 COX LANE,: METHUEN, MA 01844 Administrator rJ Y FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT r-- PHONE ASSESSORS MAP NUMBER XLOTNUME'R SUBDIVISION LOT NUMBER % �( STREET /?Z ZSTREET NUMBER 2� ' 2% (, �.................... ...................c ................................. OFFICIAL US ONLY RECOMMENDATIONS OF TOWN AGENTS . .�..... .................................................... ."c11ommon yr?(�' �` S �,p DATE APPROVED CORSERVATION ADMINISTRATOR DATE REJECTED COMMENTS o J� � ✓fes r /Z/,- DATE APPROVED Th%WIPE"NER !/ DATE REJECTED COMMENTS DATE APPROVED FOOD SPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INS CTOR -HEALTH DATE REJECTED COMMENTS �( PUBLIC WORKS - SEWER / WATER C9ECTIONS �.- 11 _ r DRIVEWAY PERMIT DATE APPROVED FME DEPARTWEPT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE M GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBU LDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. lY- ,gip ,�/ Permit ,Applicant Property address Map /Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date ofthis bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction rurming with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. RTI" I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE G OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR ROUNNDS O FUS Y THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. Telephone (978) 685-0950 DIRECTOR Fax (978) 688-9573 ,ED , -1 U00 DRIVEWAY PERMITS DATE 2000 LOCATION 7? -5-72-7 BUILDER phone OWNER kweltl ' `� hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 3879 Date ... C.— � - TOWN OF NORTH ANDOVER RE --_PT This certifies that ...P`�t -T- has ........................ ......................... has paid ........ �c:�i Cly .....r ....................... for ...... .. �>.ea`2-7 ......... t % . -7 Received by .............. (/� ► �l l .1 .......................... fit"............ Department ............................... `..L'.!�`Jl.! � �............. ' ........................... WHITE: Applicant CANARY: Department PINK: Treasurer F�'6 * 5 1! C -Q zP© 4NECTION-5 ier, Mass.. \� IP ;?q -- ¢ A�" C� _ Street, J/ D �L DCc Street i '' PERMIT TO CONNECT WITH WATER M//AIN The Board of Public Works hereby grants permission to :i ;'.1 e-6 LJ' it .f to make a connection with the water main at - bt) 0 V If subject to the rules and regulations of the Division of Public Works. Inspected by Date See back for rules and regulations 4 �- Street Boarl of Public Works 878 This certifies that .. Bate .....`�.' z.l.—. TOWN OF NORTH ANDOVER RECEIPT .................... 7 .......`!..............`Y'.!f .j..�. ..4.r hasp id ...,..... l r C... 5 Dc.). ... ' °. ..... ................... for .... ., f 4�� ......... �2 �,.t .....�...t�I............�-+ C Received by........l + 1, y.......................................:....l c .................... Department ............................. t9.. ?.`. `e.� .... 6 V'���. .............. WHITE: Applicant CANARY: Department PINK: Treasurer ISE 27 7 4 't. 4ECTION Mass. IIE Street, Ae Street G(- 0 PERMIT TO CONNECT H SEWER MAIN � The Division of Public Works hereby grants permission to t to make a connection with the sewer main at aoe, P®Gc subject to the rules and regulations of the Division of Public Works.. Street Division of Public Works By Inspected by Date See back for rules and regulations MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 TITLE: LOT 1B Waverly Road CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 7-28-2000 DATE OF PLANS: 7/1/2000 PROJECT INFORMATION: 725-727 Waverly Road North Andover, MA COMPANY INFORMATION: R & J Builders One Osgood Street Methuen, MA 01844 978-681-5023 COMPLIANCE: Passes Maximum UA = 639 Your Home = 533 Area or Cavity Cont. Glazing/Door Perimeter R -Value ------------------------------------------------------------------------------------------------------------------------------------------- R -Value U -Value UA CEILINGS 1144 30.0 0.0 40 WALLS: Wood Frame, 16" O.C. 3020 19.0 0.0 181 BSMT: Conc. 8.0' ht/5.0' bg/8.0' insul 768 10.0 0.0 65 GLAZING: Windows or Doors 431 0.380 164 DOORS 84 0.350 29 FLOORS: Over Unconditioned Space 1144 19.0 0.0 54 HVAC EQUIPMENT: 86.0 AFUE ------------------------------------------------------------------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Cquditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 12 % f the design lamas specified in Sections 780CMR 1310 and J4.4. Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 7-28-2000 Bldg.l Dept.l Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-19 I Comments/Location I I BASEMENT WALLS: [ ] I 1. Conc. 8.0' ht/5.0' bg/8.0' insul, R-10 interior cavity Comments/Location i WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.38 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I j DOORS: [ ] ( 1. U -value: 0.35 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 86.0 AFUE or higher I Make and Model Number i AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures i shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or i gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no i more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure l difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can w be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): ----NOTES TO FIELD (Building Department Use Only)------------------------- PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Company name:- :z-2 Address / —i �- %n G G/J S 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify u¢derf the pains and pValties of perry tit the information provided above is true and correct. Sionature Print na ,/ 27 �. Phone # Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Sm c n o aj Ln : < Z in m O ° � ° mCL fD O z � �, O a? s a- (DD ° H O m _ -0 01 a m N lD fD n > _> c 3 rrl O � 0 � fD n W 0.0O = fDC, fD D C �� o Q d D CD UD� � � O m n.3 ma Lncu 0 .-. C O E :3o : 91 a * * TO O a O 77 0 z 0 m y (� a LO Oaj .. O O O� 3 °'(D O c➢Em -� ::r o y x gr .�. "nCL I I cl, s o C v� y F Z 0 a U) m m m cn 0 CD o •. .. PIM av _• O to CD CD N 'o CD .O� 0 O CA S C) 0 c CO) Cl) CD 0 CD CD y• CD CO) C ca O Q y = no S. CD 'o y = m n m n Z H W d C ?� CO) �a„*a o �c m of o Fn - CA CD N O 3E W cD m a = H m O to �� .M . n O 0 -LA: C7 . c N to Cr7 oa^.^': VJ mCD m N CD , CA ca (n mMCD �o o O ,moo: c CD 0 C4 C* CD o CD J A o C: d d d d: h y O MA C = m 1 I O ri omi 0 0 c 3 O %� d Y10O w o G y o O w o G 0 ?7 w n o C p r4lu O ^ o O n 7 O x I O ri omi 0 0 c -01 ' /- C- I - / 2 7 Date .................................. N2 u 0 VtORTFt TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. ............................................... has permission to perform ...................................... ..................................... 1 wiring .. / s wng in the building of ...... ....- :..:'.t* ....................................................... X - at ..... ..7...............' f'/ .............. —, North Andover, Mass. Feer/ ...:............. Lic. No.............. ................... ................ ...................... ELECTRICAL INSPECTOR Check # " WHITE: Applicant CANARY: Building Dept. PINK: Treasurer The Commonwealth of Massachusetts Department of Public safctv BOARD OF FIRd PREVENTION OCULATION'S S27 CMR 1200 of((ce Y.e 1701 t'.re(t 716. occwpency a fee o.eck.s 3/90 (lege blank) APPLICATION FOR PERMIT TO *PERFORM ELECTRICAL WORK M Work to be periormed In accordance with the Mawehuseru Electrical Code.;427 CMR 12:00 (PLEASE PRINT IN I2M OR TYPE ALL INFO ION) Date City or Town of L 4?fi— To the In;; for of ares:. The undersigned applies for a permit� to /� perform thn electrical work disc be below. Location (Street b Nts:aber) . A Owner or Tenant Owner's Address a Ss this permit in conjunction wit a building permit: Yes 9 No ❑ (Check Appropriate Box) A.trposo of BuLldLn Utility Authorization NO. Existing Service Acps / Volts Overhead ❑ UndgrG C❑ No. of Haters New $eTt►iCe 2ipAzps �i % volts vietucaid . [ .11�i. v� •�ttr:� Nuaber of Feeders and Aopacity, Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Tota KVA No. of Lighting Fixtures Swicin Pool Above In- g rnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners Bate Emergency cy Lighting Bette Unica No. of Switch Outlets No of Gas Burners FIRB:ALARMS.. Ho. of Zones.: No. of Detection and Total No. of.Ranges. No. of ALr.Cond. tons. :Initiating Devices. No. of Sounding' Devices No. Disposals Total No. of pU00s of TonTotes No. of Self Contained Detection Sounding Devices Local Municipal ❑Other ❑ Connection No. of Dishwashers Space/Area Heating iW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of 110. o Si ns Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of -Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESEJ NO [J) I have submitted valid proof of same to this office. YES91 NO ❑ If -you have checked YES, please indicate the type of coverage by checking the appropriate box. 1 INSURANCE © BOND ❑ OTHER ❑ (Please Specify) 1 f1 � paras on ate / Estimated Val lue,rof Electrical Work S 14 090 Work to Start 11?_q1611 Inspection Date Requestedt Rough .lY W Final 7 11 Signed under the pe alties of perjury: FIRM NA!(E� . Vincent Electric Company, Inc. Licensee f! / �. L � IGt f i s� Signature)Y16� Address 3 Edwards Road, Burlington,MA 01803 us. Tel. o._ _ Alt. Tel. No. OM'NEw S INI�'U WCE WAIVER:' I on aware that the Licensee does not have the insurance stantial equivalent as required by Massachusetts Generalws-I: ,and that my signature A7967 . N0. 2 - overage or its IUD, on this permit application waives this requirement. Owner Agent tPlease check one) io Telephone No. PERMIT FEE Signature of Owner or -Agent) �� f 1' N2 461 �A C) Date. ..:.... -..G... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that... ... ...f.. ..... ................. . has permission to perform ....t. �-.'.. �9. I.c. ............ . plumbing in the buildings of ... L <- at .. �. �..�... ...................... . North Andover, Mass. Fee. ,/. il� Lic. No...G'7.c: l ! ..........�:�... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4/4o/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS I 1rJ' Date Building Location Owners Name I 1 Permit # a Amount d 0 -- _ Type of Occupancy G�C. S )L;t;Z.4 1 New Renovation Replacement Plans Submitted Yes No \ J Address a VO Partner. Business Telephone G 3 —?j Firm/Co. Name of.Licensed Plumber - Insurance Coverage: Indicate the type o ias11fl- coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11Bond ❑ Insurance Waiver. I, the undersigned, have been -made aware that the licensee of this application does not have any one of the above N three insurance Signature Owner I hereby certify that all of the details and information I have submitted (or entered) in best of my knowledge and that all plumbing work and 7a�rerfo�rmnu,,i; compliance with all pertinent provisions of the Mas achulu e APPROVED (OFFICE USE ONLY Agent 7►on are true and accurate to the this application will be in 142 of the General Laws. Type of Plumbing License �� i ase Number Master oumeyman -r • •f Woommoommommomom MM M.Wo all .. • non nW W W W W Woommomm000mmoem ..., .. • �nnnn����nnnnnnn�■nnnn��n� :: � • n�■nnnn���nnnnnnnnnnnnnnnn . 13;1111109 • nna■�nn���■�n�a�n��n�nnn�nn ,. • ..-�-----..-...m..m.--..- Trint .. ACertificate ,T,stalling Company ,El \ J Address a VO Partner. Business Telephone G 3 —?j Firm/Co. Name of.Licensed Plumber - Insurance Coverage: Indicate the type o ias11fl- coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11Bond ❑ Insurance Waiver. I, the undersigned, have been -made aware that the licensee of this application does not have any one of the above N three insurance Signature Owner I hereby certify that all of the details and information I have submitted (or entered) in best of my knowledge and that all plumbing work and 7a�rerfo�rmnu,,i; compliance with all pertinent provisions of the Mas achulu e APPROVED (OFFICE USE ONLY Agent 7►on are true and accurate to the this application will be in 142 of the General Laws. Type of Plumbing License �� i ase Number Master oumeyman X45 Date./-... ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . f . ��s .:. �'..w!. !...:............... . has permission for gas installation . ...: .......... in the buildings of ...I.... ... .......................... . at ... i :........ ! .......... ....... , North Andover, Mass. Fee. 7 U:::. Lic. No...:!..: ......:..... : GASINSPECTOR ' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer JypeMASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) Date /-- g 19 6 NORTH ANDOVER, MASSACHUSETTS _ Building Locations %ii Owner's Name New ID Renovation ❑ Replacement ❑ Plans Submitted ❑ r Permit # Amount S (Print or type) dame - ` V Address i � � 1 C V0 Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner I (r, ❑ FirmiCo. jI INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ Ifvou have checked yes, pl se indicate e coverage by checking the appropriate box. 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 I421 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Sianarure of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above applicatio} are true and accurate to the best of my knowledge and that all plumbing work and install n�,� rmed under P it ssue f this application will be in compliance with all pertinent provisions ofthe :Massachu tts StatCo/eta d t I�� the General Laws. By: Title CIN/Town A,PPR0VED (()Eric;: usF imi.Y) Sienature of Lice=nsed Plumber Or Gas Fitt r ❑ Plumber ❑ Gas FJ er ic:ense N, umoer >•-1 Journeyman .r (Print or type) dame - ` V Address i � � 1 C V0 Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner I (r, ❑ FirmiCo. jI INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ Ifvou have checked yes, pl se indicate e coverage by checking the appropriate box. 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 I421 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Sianarure of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above applicatio} are true and accurate to the best of my knowledge and that all plumbing work and install n�,� rmed under P it ssue f this application will be in compliance with all pertinent provisions ofthe :Massachu tts StatCo/eta d t I�� the General Laws. By: Title CIN/Town A,PPR0VED (()Eric;: usF imi.Y) Sienature of Lice=nsed Plumber Or Gas Fitt r ❑ Plumber ❑ Gas FJ er ic:ense N, umoer >•-1 Journeyman 3457 Date...—.. ,. c .�... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .../f�:_. , c . .. ..!`.�.. ... ...... . has permission for gas installation ...,%`. ...�`fc.�. ...... in the buildings of ... LA . t'. !j. ...................... at .... -7 : �. -.. � . �`�. . r ?' . �.: -.... , North Andover, Mass. Fee ... 7 ,?.. - Lic. No. `./.c�.1.�... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer [MASSACHUSETTS UNK'ORM APPLICATON FOR PERMIT TO DO'GAS FII'I�YG or print) Date /— 9 l9 ��Type 9 NORTH ANDOVER, MASSACHUSETTS Building Locations (,v 4 U-- 4 OJdner's Name New EIZ Renovation ❑ Replacement ❑ ' Permit 9 t Amount S rj Plans Submitted ❑ (Print or type) Name Address It r4 -- l _ LO mess Ie 41�� Name of Licensed Plumber or Gas Fitter v 0 V Check one•..Ce�te Installing Company L_._! - ❑ Partner ❑ F1rm/Co. INSURANCE COVERAGE Check one: f have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No r7 Ifvou have checked ves. please indicate the t e overage by checking the appropriate box. Liability insurance policy ❑�// Other type of indemniry ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Vlass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Asent ❑ ) hereby certify that all of the details and information I have submitted (or entered) in above best ofmv knowledge and that all plumbing work and installati ormed under Pe R compliance with all pertinent provisions ofthe Massachu-sel6s State de pte�s By: Title City/ Town .A-PPR01,'ED ioFr)cf? OS !)N).v) ication are true and accurate to the =G'ene-al is application will be in iLaws. Signature of Lic::nsed Plumber Or Gas Fitter ❑ Plumber Gas Fittez:.•-'ic.-nse ivumoer SSie.' t—I Joumeyman q Date. /-..'�".-.� N2 46{00 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that . ..........1....!.,�• • ..... ............ • has permission to perform .... `..: .`.............. . plumbing in the buildings of ... .�. `..S. .. �................. . at .. �. �. ... -4. . •IA• •� �t North Andover, Mass. Fee.,/l.'!...: Lic. No....: .. ......... ...t.... �....... . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I y as' boo, MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Z DateBuilding Location i� V Owners Name i M v V �Xn Permit # Amount Yype of Occurancy / E' ,S t t T , New Renovation Replacement Plans Submitted Yes No (Print or type)_.J Check once / Certificate Installing Company Name V N �-- —1 T Address I \ \ J Partner. Business Telephone [ v Firm/Co. Name of.Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LJ /' Other type of indemnity r-1 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 -` ignature Owner R Agent 11 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 andon performed P t Issued for this application will be in compliance with all pertinent provisions of the M chus Plu e a� apter 142 of the General Laws. Y Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License i nseu Master ioumeyman •M / • ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ MOMMOMMOMOM■■■■MMMMMW ■ • • • annoo OMMO■ MMMMM■■■■■■i■MW .. • ■WOMMM■■■■■■■■■■■MOOM■■■M : .. • WWWO■■ OMMO■MMM■■■■■■�■i■■ M • • • • ■0000■■■■■ ■■ ■■■■ MOMM■ MM ••• ■ ■NWMWMWWWN■■■■■■Wi■■WWWM■ (Print or type)_.J Check once / Certificate Installing Company Name V N �-- —1 T Address I \ \ J Partner. Business Telephone [ v Firm/Co. Name of.Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LJ /' Other type of indemnity r-1 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 -` ignature Owner R Agent 11 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 andon performed P t Issued for this application will be in compliance with all pertinent provisions of the M chus Plu e a� apter 142 of the General Laws. Y Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License i nseu Master ioumeyman