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Miscellaneous - 73 BRENTWOOD CIRCLE 4/30/2018 (2)
Date.. / .................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................................. ......................... has permission for gas installation.... 41 ............................................. inthe buildings of ........... .............................................................. V"3-0 .................... North Andover, Mass. at.. _-S .......... le -k . ........... Co. kt Fee .... Lic. No!') -m. ........... NO ............. e ............................................ GASINSPECTOR Check # 9579 '� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE �— - � PERMIT # JOBSITE ADDRESS L OWNER'S NAME GOWNER ADDRESS ?, / ��,r TE �" F AX PST OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: [ RENOVATION: [] APPLIANCES 7 FLOORS- BSM BOILER (� BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE j INFRARED HEATER _ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER [ ROOM / SPACE HEATER [� ROOF TOP UNIT TEST UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER REPLACEMENT:Lj PLANS SUBMITTED: YES 0 NO E3 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ou NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [�],! OTHER TYPE 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: OWNER 0 AGENT _D�_I SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true a accur to to a best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compf ce with e r ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ----- — LICENSE # I SIGNAT RE MP 4 MGF 0 JP JGF LPGI CORPORATION ©# PARTNERSHIP [J#= LLC D#{— -------� COMPANY NAME:WitADDRESS p . CITY �� y _I STATE ZIPGJ 1 TEL -� T FAX _ !CELL EMAIL V ro. H rQ� H H U W W z� d O N El W } O w O H o- 4 Z a X � .W 5 C0 WCO a W o W U a o w a Ln r5 U 13 - IL a' D w x w F- LL H z 0 H U W a C7 _ The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston, HA 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legib Name (Business/Organization/Individual): Address: City/State/Zip:e /A &Y - //`i e�dhone #: / V-3�/`� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I (full and/or part-time).* have hired the sub -contractors 2Xemployees It am a sole proprietor or partner- listed on the attached sheet. 2 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.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.) t 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 tie doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam 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. 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a da against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations e D for insurance coverage verification. Ido h ereX cert u tlz� Signatu Phone #: Official use only. Do not write City or Town: ofperjury that the information provided above is true and correct. __11p Date �U 4 / `/r this area, to be completed by city or town official. Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone 0 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not producedacceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of 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 (ifnecessary) 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 Go onwoalthofMassachvsPtts Dop.artment ofZndustrial .A,ccidents Office of Investigations 600 Washington Street Boston} MA 02111 TO, # 617-727-4900 oxt 406 or 1.-877MASS.AFE Revised 5-26-05 Fax # 617-727-7749 vvw.mass.govfdia 10,000�7 p Date..........�.7................ TOWN OF NORTH ANDOVER _g,�,, PERMIT FOR WIRING + o , This certifies that 0^ ``- e r, l c�tit�gck �T has permission to perform ...... 'e'..!.`..?P,2e.......................................................... wiring in t .... � u�!. U. �? .. `-1 ✓z C 1-e. ........................... rth Andover, Mass. Fee.....'.......... Lic. No.. t»�•f � ELECT ICAL INSPECTOR Check # �2- 1281? FrA ip 3. ;o Commonwealth of Massachusetts official use only Department of Fire Services Permit No. !� > BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes $electrician's cell #� Occupancy and Fee Checked contract # $ bid permit # if applicable) [Rev. 1/07) (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: /� _ �'%r✓ City or Town of: .�®,�1iY /,�, 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) 1;� j�e o f, Owner or TenantE,���� � Telephone No.,��/ ;F�.,Sd Owner's Address ri ��G✓ch+o�` Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. ` Existing Service \ \ g �O� Amps Volts Overhead ❑ Undgrd No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com lesion o the ollo'v table ma be waived b the —Inspector o Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans 0.0 otal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergency ig Ing rnd.. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o etection an Initiatin Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices No. of Waste Disposers Heat Pump umber Tons KW No. of Self -Contained Totals: Detection/Ale'rtin Devices No. of Dishwashers Space/Area Heating KW Local❑ unicipa w El Other Connection No. of Dryers Heating Appliances KW security ystems: No. of Water No. of No. of Devices or Equivalent Heaters KW No. of Data Wiring: —Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: OTHER: No. of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER X❑ (Specify:) General Liability 12/31/14 I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Boissonneault Electric Corp. LIC. NO.: 11823A Licensee: ;v1 moo. rr-C.nl.ll Signature ��---'` (If applicable, enter "exempt " in the license number line.) � �IC. NO.: Address: 36 Chuck Drive— Dracut MA 01826 Bus. Tel. No.: (978)454-038 Alt. Tel. *Security System Contractor License required for this work; if applicable, enter the license number here: No..s97s)asx-9n72 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/Agent ❑ owner's a ent, Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 1C C✓ ,r City/State/Zip: Phone #: .? j�j Are you an employer? Check the appropriate box: 1,2 I am a employer with /� 4. F1 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- 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.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition ll�ffElectrical 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. tContractors 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 1s providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. ����/i'< • ems,,. /C<• �� ��.� �,.. c F Policy # or Self -ins. Lie. ,rr- 9 Expiration Date: zr Job Site Address: �^-%�or�o/ r�<.E City/State/Zip: /1i�.,��o�.e'� /�l/>l 0 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pains �and penalties ofperjury that the information provided above is true and correct Signature ;� U �-`" r Date /O / / Phone #• 's';-1,�e - �-V- % -7 Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of 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 fillgd 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 Washington Street Boston, MA, 02111 Tel, # 617-727.4900 ext 406 or 1-877rMASSAJFB Revised 5-26-05 Fax # 617-727-7749 www.Mass,8QV1dia A �G[':'VK I L I AN ISSUES THE FOLLOWING LICENS A =REG ;JOURNEYMAN .ELECTRI,C;It NEALN���er'' •1 E B01 SSONNEAULT 100 GILMORE $T J nWELL EXPIRATION DgTE SERIAL NI c DATE: LOCATION: 7 %��,.� �a� r✓ �'��cZ� OWNERS NAME: GENERATOR kw oW _Z2 CONTRACTOR: PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: ZONING DISTRICT. ere - "'PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL �j b-� North Andover MIMAP October 6, 2014 63.0 0002 35 BRIDLE'P TH 063.0-0 8 103.0-0 - - ,. •>' 063.0-0004 50/5RID/LE P jTH 063:(3-0039_. •..• =" _ _ - 063 0 0 - - d9-6R1.DLE,PA•€ti `-P 63.0-0030 _ lI0i3 7.0� IDI E PATH 37 BRENTWOOD,CIR 63.0-003 Di: 063.0-00 7 'BRIE,PA- r �j//// 49 -BRENTWOOD CIR :rt t_ 063.® �j �i a<ft 61�BREN.TWOOOD�R :4 40 BRENTWOOD CIR ter otection- 73 BREN-l/7NOOD CIR � O6/3 �Oflb/ �'•" � �p003 66'BRENTW60�D CIR 85 -SR -EN i 00D GIR 89 BRIDLE PATEi 0 04' 063.0-00 7 f 103 BRIDLEPATH 63.0-0"4/BRENTNi00D CIR 4 0. 4 t 97/BREN.TW DEI 0/ / I 1 064:0 50 "t 9 'BR-ENTWOOD CIR 064.,0-060 a e 64.0-0 52 0 .0-0059 1.09,BREN.TW00D/CIR � 064:0-003 —. Rail Line a Wetlands Zoning Interstates 0 Exempt Lands _ 1 93 Busine O Busine s t District s 2 District Hon—tal Datum: MA Stateplane Coordinate System, Datum NAD83, — SR D Busine - ■ Bu me! s 3 District s 4 Dislnct p0111i Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads C, Easements ■ Genera D Planne Business DistrictQf rtC 'q� Commercial Dev �« ��� O _. ba s O North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is MVPC Boundary C3 Municipal Boundary Zoning Overlay - CCorrido O Corrido O Co do Indust Development Dist Development Dist 3 ( Development Dist F 9 1 Distract # for tanning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, B Adult Entertainment II Industri 43 Industri *. 12 Distract .y # # "s 13 District n RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Q Downtown Overlay Distract - Q Historic District - m Industri * o • il S District • •��+••�•• ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ® Water Protection - - Reside GtReside ce 1 Districtr•��y.(6J ce2District SSACMUSYt THIS INFORMATION ❑ Parcels Ii Reade ce 3 District H Hydrographic Features d de ce 4 Distract — Streams 1" = 122 ftde «�. de ce 5 Distct ce 6 District �a a esidential District 3 \V` t 9. .4 92'� WA �r, a r` �` ��' yy, t�n¢+F a •:' "",% t s 'y � i' Pi 4 .� W : � '}� t ms's,: �" `� �'r' `S..t.€'. e t r `A ✓ ,•- s a �� � � ,y.��+.�,� r a ,�..� •s ` *fit � A �+.: 311 R' ^ • � � \� \ �F � 'nom � H��F h � ,y\�%. •i� =Y"` '`��*.T`. ;'., iT p>•Y:.°.> fes.++, Z to Date../. :stip TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... _ ..:-r....' - r.�-C ......... has permission to perform ............. plumbing in the buildings of.......-f--,c��'................... . at ........ ......... North Andover, Mass. � Fee..-� ..... Lu. No ........... .....1�....... .�............. . PLUMBIN INSPECTOR Check # e?4 & 7424 �Lx f MASSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING (Print or Type ; Mass at 2, 0 'o mit # Building Lqcation n blameAv Aflippi New 0 Renovation 0 B.P.4 /Lkd_Type of Occupancy Replacemente 'SFWFR FIXTURES C Plans Submitted: Yes 0 No 0 .-qFPTT(' is ns,talljng-Com pany-Name-!9� &d. e"ils ..Cert1fJ.cate....- R1. 0"Corp6ration r n IF I L.A-t I &A, IF K I Y Iki I L-ol jJ L-.1 0 1 0 Partnership,. lusiness T61ephone v<,mico. lame of Licensed: Plumber or.Gas Fitter INSURANCE COVERAGE - I have, a current liability insurance policy or Its substantial equivalent, which meets the requirements of MGL Ch. 142. a Yes q,,-' No.o If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy � Other type,6f indem:nIty 0 0� OWNER'S INSURNACE WAIVER: I am -aware that, the lic'ensee does not have the insurance coverage required by Chapter 942 of the Mass. General Laws, and that my signature on this permit application waives this requiriFineint. Check one: Owner ':a'r'b r� ,,;�.be h,t Agent 0 Wne s % nter hereby certify that ail -.:9f -have,sub-mittedj -e, edln-above;applicatl 1. 1 on�aretrue -and. accurate -to.the-bes.to1 y knowledge and that'aWplu bing-)koTk the permit Ps or-thi 'w - and lnstallatio,ns.p..O!�tor,.tp-�, 8:appllcati6n will be'n compliance with I pertinent provisions of the-,,!4assachusetts State Plumbing Code,,a of the eral Laws: By Stailuire of.Licen<ed'Plumber Title City/ToNvii Type of License: 6.196-1 t e r APPROVED (OFFICE USE ONLY) .0 Journeymanq qLicense Number— • FEW "@*T--=MMMWMMW0MWMWNM0MNMWMNM MO." MISEUMMMOMMMMMMMMMU M�0 ns,talljng-Com pany-Name-!9� &d. e"ils ..Cert1fJ.cate....- R1. 0"Corp6ration r n IF I L.A-t I &A, IF K I Y Iki I L-ol jJ L-.1 0 1 0 Partnership,. lusiness T61ephone v<,mico. lame of Licensed: Plumber or.Gas Fitter INSURANCE COVERAGE - I have, a current liability insurance policy or Its substantial equivalent, which meets the requirements of MGL Ch. 142. a Yes q,,-' No.o If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy � Other type,6f indem:nIty 0 0� OWNER'S INSURNACE WAIVER: I am -aware that, the lic'ensee does not have the insurance coverage required by Chapter 942 of the Mass. General Laws, and that my signature on this permit application waives this requiriFineint. Check one: Owner ':a'r'b r� ,,;�.be h,t Agent 0 Wne s % nter hereby certify that ail -.:9f -have,sub-mittedj -e, edln-above;applicatl 1. 1 on�aretrue -and. accurate -to.the-bes.to1 y knowledge and that'aWplu bing-)koTk the permit Ps or-thi 'w - and lnstallatio,ns.p..O!�tor,.tp-�, 8:appllcati6n will be'n compliance with I pertinent provisions of the-,,!4assachusetts State Plumbing Code,,a of the eral Laws: By Stailuire of.Licen<ed'Plumber Title City/ToNvii Type of License: 6.196-1 t e r APPROVED (OFFICE USE ONLY) .0 Journeymanq qLicense Number— i 6336 Date.... .... ... ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ M..R ........ ..... ... .... ... ....... ....... . ................................... has permission to perform ..... . wiring in the building of ...................... ...... ...................................................... ...... Z:� .................... 1!�� .......................... ,North Andover, Mass. Fee ... Lic. No. ?� ............. .. I . ......... . -1 ELECTRICAL INSPECTOR Check # t J Commonwealth of Massachusetts Official Use Only Permit Mn C16 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l 1/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfomud in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPEALL INFORMATION) Date: /�j 7zarz City or Town of Nap-r/le 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) Owner or Tenant � dy�j F _Z ® Telephone No.cJ;r 4�yk a Owner's Address _ j 13 E GGC101> C i ecl e _ Is this permit in conjunction with a building permit? Yes ❑ NoCK (Check Appropriate Box) Purpose of Building / �, , 4 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 thn fnlinudna tnhZ-o mm ho conium 1.., il— i— ... .-.. No. of Recessed Fixtures No. of Ceil.Susp. (Paddle) Fans No. of _ - Totav Transformers KVA No. of Lighting Outlets No, of Hot Tabs Generators KVA No. of Lighting Fixtures Above in -E] Swimming Pool rnd. ❑ rnd. E]Batte o t Emergency ing Units 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/Alerting etection/Alertin Devices No. of Dishwashers Space/Area Heating KW ocal ❑ Municipal ❑Other Connection No. of Dryers No. of Water Heaters KW Ideating Appliances KW No. of No. of Signs Ballasts ecurity Systems: ISIVO. of Devices or uivalent Data Wiring: No. of Devices or uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Waring: No. of Devices or uivaient OTHER: Attach addittoaW detail if desira4 or as required by the ]mpe&er of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (Eg. BOND ❑ OTHER ❑ (Specify:)1,4qyQ x L c1oG Estimated Valve of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: /-a 3 - o 6' inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: r r Z%e y LICN • D� Licensee: ;aL A—�q._, A signature (/f applicable, enter "exempt 11in-the !cense �nim number line] Address: �'(owe/ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. Imo- LIC. NO.: Bus. TeL Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ® owner ❑ owner's agent. PERMIT FEE: $c�c�, co Locations No. O -z' 7 Date J# N0*701 TOWN OF NORTH ANDOVER F s A i y .6 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check /f � 7V 19020 `` -Building-Inspector y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING av r.nr! BUILDING PERMIT NUMBER: �'�� DATE ISSUED /O, SIGNATURE: MIn Commissioner/InEeEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1 ✓ /) o / CII�� ` V� jr Q r 1.3Zoninng`Information: 1.4 Property Dimensions: Zoning Dia;ic_t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Provided —Required 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 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 E l i z"C,iA &;d y3 3 ren ft-j oe Name (Print) Address for Service Y 7f 4 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone - ECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor In C . Not Applicable ❑ 6 %j% J—G Company Name (1 Zoo SU� (g�. J U I � ZZ� NQ ,& j4 yC/. Mt' Registration Number Expiration Date ' 7[ 613,3'71 Signature Telephone T M X Z O 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. Si ned affidavit Attached Yes ....... 13 No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ It, Exist' 13uilding 11Repair(s) 11Altq ons(sk-. Addition 11 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Ad 0 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant $' _ � � OCTAL tJSE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) l/f 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 00- Olt) Check Number (p 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, A-Ui G e"s 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 Si ature of Owner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1ST 2 ND 3 RD 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 L7 a �i W W !d 1. t .Z F T h W ti F- Si V y T i i O .y A .E ID C1 to w U 0 O co 0 E co co Z o, O CO) D C O O! i O O CM— h O O 'fE— m m CD CD CL ~ ♦L-+ Z O � 310 O 0 O CL. O CL Ca CO2 S cc V C CD CL �..� t/! O C C c CO3 LLI 0 UA U) 19 W uj cz W U) ICE o V) a O z a 0 rl G Z t U w p � �' a�' is w �a U � 6 W a�' U cu w QC a m w ,w W r� 0 cn o cn 1. t .Z F T h W ti F- Si V y T i i O .y A .E ID C1 to w U 0 O co 0 E co co Z o, O CO) D C O O! i O O CM— h O O 'fE— m m CD CD CL ~ ♦L-+ Z O � 310 O 0 O CL. O CL Ca CO2 S cc V C CD CL �..� t/! O C C c CO3 LLI 0 UA U) 19 W uj cz W U) AIN The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations t m 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ tlirahP-jU Address: %3 off_A�" (J cl t rc le.. /State/Zi Ol �Y r Ci S3 1_-/ ty p: lY 0 � �f, i�n�o ✓C.i lliit Phone #: 9% � (� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employee's (full and/or part-time).* have hired the sub -contractors 2. ❑ 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 required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL 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 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other -tiny appucant mar cnecxs oox v 1 must also till 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 suck tContracton that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' camp. policy inforrrration. 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. Lit. #: V C (pOd 54 a OO I oku T VV Expiration Date: Job Site Address: 713 64_Ci►*J010Cl C/I'dx— City/State/Zip: Ala • "dye. /,//I 0li°r' 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 y tine 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 ofup 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 ofperjury that the information provided above is true and correct Signature: Phone #: "I % Oficial use only. Do 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 Contact Person:. Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: ,j DAVID CASTRICONE ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 10456 200 SUTTON STREET, SUITE 226, NO. ANDOVEIZ, MA 01845 7 HILLSIDE ROAD, BOXFORD, MA 01921 In North Andover 978-683-3420 In Boxford 978-887-6147 MA2 U 6 2US:J In HaverhX 978-374-7314 Itwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, toY1sh all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below describ : Owner's Name ......... ElkR.42. ............................................. T�.g.�...-". - .tx�./....... .� .....�.....�,t.n ,, hone #.... Job Address.... /`. W. ... City... (Vb.,.... v..tlhz.{`............... State......f U Specifications: .....................g....shi.......le..s...................ply .... new .....d...Ylp ...... edge .......... to ... all .....e..d....ges.................................................................................................................. Strip existinng. ✓p............................................................................................................... ............................ VApply feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane In valleys and bottom edges of any unheated areas of house. ` ..................................................................................................................................................... Apply felt paper underl ment. ✓install ridge vent to t ,� 7— �f ...n f... _........................ ... .........g...............4LL'................................................. /.. /Aid . `� /.... (/xeroof usingz shin les with a_ year warranty. 1��•..........................................................................................8............................................................................................................. �ounterflash chimney. �I'Tew vent pipe flashing. 1*f al disposal of all debris. ............................................................................................................................... . Area(s) to be worked on: //,/(�........................................................................... ....................................... h6r. ... .tr..D ............ /.:�Y'QST.1..................................................................................................... �a..U.�. ......... .....r .......:............................ �..................... !................................................... ... F.......s. �. ................ >3. ...sem .A....... ---......UL S'p................................. �+ �� , ....,S.k.z. .. ........a /.4.W....... r.�. . - /��. ..............-....'..9...�.vD............................................ ...................................................................................................................................................................................................................... One Year Workmanship War nt of Transferable) Manufacturer's Warrant s sp clfled by facturer ,� J Materials and Labor to co $......�.. ..( �.Q., Payable ........., f/.�—......... on L....... ... l....... Payable ............................. on.................................. t/ialance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whilejob is in operation. Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or conditions resulting from application of materials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic or other living spaces, water stains when roofing shingles have not had adequate time to cure). Upon completion of above work, all undersigned agree to execute and deliver to contractor, theirjolnt note in accordance with his (their) above obligation as requested by contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It is agreed that, if permitted by law, contractor .shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates. The undersigned warrant(s) that he is (they are) the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) names(s). There arc no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is the contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all patties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place Room 1301, Boston, MA 02108 Tel: 617-727-8598 Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner who secures his own construction -related permit or deals with unregistered contractors shall be excluded from access to the Guarantee Fund. Approximate starting date of work..................................................................... Completion date .............................................................. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner has three business days to cancel this contract and incur no penal�t�,�as� IN WITNESS WHEREOF, the parties have hereunto signed their names this .....: ... day of .. .................. Accepted: an d__ mliecal --IV 6 (� Signed...................../.I................................................................... Owner Signed... 1rL X ..........:(�.. / Owner Per....................................................................... / Representative P P"f%Q%-JA%-& flubs i 15 UNIFORM APPLICATION FOR PERMIT TO ®O PLUMBING — (Prinl or Type) NORTH ANDOVER,?� Mass. Building Permit # 3 3 Locallon _ ,� a4F)rrco OOD elk Installln� ...:..Address New ❑ Renovation mara Na Name Replacement ❑ Plans Submitted: Yes ❑ No. E]------ FIXTURES Business Telephone. C!5100-- ...Noma 15100-...Name of Licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or No substantial equWent. Yes ❑ No ❑ -if you have checked y", please Indicate the type coverage by checking the approprlhte-,box. A liability Insurance pdtc Other y d Indemnity ❑ Bond ❑ - OWNER'S- INSURANCE -WAfVER 1`A-m'aware-that the Ilcensee does not have' 'the'iri'aurince-coveraa-go required by Chapter 142 of the Mass. General .I.Aws,._and_that: my signature on this permit applicatlomW&Nes:ahla requirement »' _ - - Check one , - - - .�., Owner ❑- ;.--Agent ❑ w_ stun o of or Owners. en _. I hereby certify that IN of the detaMs and Informatlon I have uAmitt•d lot entered) In above application u• bue and aaxuat�;:to the Desi of mY; - knowledge and thai aN`piumbinp watt"knd'tnsialtat{ona p�itoim•d Under the p•rtM Isswd Wa 1ppwca wit bi h o�mpAana with all perlln•nl provtsbna of the AAassachus•t1a Stat• Plumbing Code and Chaplet 142 of the ri,921w We signal e GtylTown Ucense Numbet %! Ml UVED (OFFICE USE ONLY) Type of Plumbing Lk•nss: Master Journeyman 0 :O �� F s } M V < N YI a.�. r u=. W P u a * '~ s w o 16 a s� s . y o 0 a« « o at s 0- .a. .a - W. x. 44« o 44 o Q„ 46 a t < s Y. = " a M °s ss O M _ at 1 '. < :0. "a►' o o < 8t a ar .s - ><Ns—f fMT. fA6tMaHT 2"0 FLOOR 3110 FLOOR 4TH_ FLOOR aTH FLOOR AA a'TH FL0011,` TTH FLOOR aTH FL0011 Business Telephone. C!5100-- ...Noma 15100-...Name of Licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or No substantial equWent. Yes ❑ No ❑ -if you have checked y", please Indicate the type coverage by checking the approprlhte-,box. A liability Insurance pdtc Other y d Indemnity ❑ Bond ❑ - OWNER'S- INSURANCE -WAfVER 1`A-m'aware-that the Ilcensee does not have' 'the'iri'aurince-coveraa-go required by Chapter 142 of the Mass. General .I.Aws,._and_that: my signature on this permit applicatlomW&Nes:ahla requirement »' _ - - Check one , - - - .�., Owner ❑- ;.--Agent ❑ w_ stun o of or Owners. en _. I hereby certify that IN of the detaMs and Informatlon I have uAmitt•d lot entered) In above application u• bue and aaxuat�;:to the Desi of mY; - knowledge and thai aN`piumbinp watt"knd'tnsialtat{ona p�itoim•d Under the p•rtM Isswd Wa 1ppwca wit bi h o�mpAana with all perlln•nl provtsbna of the AAassachus•t1a Stat• Plumbing Code and Chaplet 142 of the ri,921w We signal e GtylTown Ucense Numbet %! Ml UVED (OFFICE USE ONLY) Type of Plumbing Lk•nss: Master Journeyman 0 A Date ...... ..�... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ./.(.. has permission for gals installation . . in the buildings of��`.� . at. %��r ....... Fee. ,;�,r.... Lic. No.. Check # A�7 4645 iJ lIrAA .............. Orth Andover, Mass. GAS INSPECTOR `= 33 84 Date.' 9J.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING trt '4 This certifies that........... ......... . has,liermission-to.) .. 13. !- ��.perform................... . plumbing in the buildings of . ................ at ..: ..134eIr! 7 4 .c: 1. a... .1)-L , North Andover, Mass. Fee.. dr.'-...Lic. No. 'W.91 ....... ic-o ,r'...... LUMBING INSPECTOR 05/26/97 n:58 30,04 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPUCA (Print or Type , Mass. Dati � 11 G Building New ❑ Renovation ❑ FOR PERMIT TO DO GASFITTING 4165 Zremit # fz' is Nam t - Type of Occupanry Pians Submitted: Yes❑ No ❑ Installing Company Name :2 r .,e g T A . ` A(n Al A Tri r Q Check one: Certificate Address 30 0r )A C H 1v% A- ry 1J . ❑ Corporation 1h i= T H UE L r1l A D( ❑ Partnership Business Telephone /d 91 -7 S "7 f g-'Fi rm/Co. Name of Licensed Plumber or Gas Fitter "R () (A E P T A- 5 A M M 11 r A r INSURANCE COVERAGE: I have a current f bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have Lchecked yes, please Indicate the type coverage by checking the appropriate box A liability insurance ' rty policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe r ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. Title City/Town O IC ONL T%License: E),Plumber n ure of cen u or atter tter er License Number V312) Journeyman Y Y Y Installing Company Name :2 r .,e g T A . ` A(n Al A Tri r Q Check one: Certificate Address 30 0r )A C H 1v% A- ry 1J . ❑ Corporation 1h i= T H UE L r1l A D( ❑ Partnership Business Telephone /d 91 -7 S "7 f g-'Fi rm/Co. Name of Licensed Plumber or Gas Fitter "R () (A E P T A- 5 A M M 11 r A r INSURANCE COVERAGE: I have a current f bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have Lchecked yes, please Indicate the type coverage by checking the appropriate box A liability insurance ' rty policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe r ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. Title City/Town O IC ONL T%License: E),Plumber n ure of cen u or atter tter er License Number V312) Journeyman j • � t W Q O O 0. NI W S U a- I W Y N O H N Q = o .o c W N O r . Q U. O OIC Z 0. O O 0. 0. 3 z G � W a m V J IL a. Q W W W NI W S U a- I W Y N Date .... /,q//3.j©..Y.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 4�...............................................................^�j IfI ry fit�v �abs....... . A mm 4er` sc' e- cv.0 tY has permission to perform ... ....." ...............1".................................... .......... wiring in the building of ......01 .R. K.../.4.l. %.......................................... at .......f7.:3 ....LS., Yw.T tt�oa�... C/.(�......... , Nio�h ` dover, Mass. Fee ... �? . Lic. No. ............. . / Ni �r i r ��e r. ...................... .............. .......... ..................... ELECTRICAL INS�'ECTOR Check # � � r' 5522 TRE COMMONWF 9 LTH OF MASSACH USETTS DEPARTI I EW OF PUBLIC S 4FEI Y BOARDOFFLREPREVE MONREGULA7lONS527CM12 010 i Office Use only i Permit No. Occupancy & Fees Checked OV APPLICATIONFOR 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` Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the el �trical work Location (Street &Number) 1 7, Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building )I .� S G A M 1 Existing Service �� 01::� AmpsIZQL24LIVolts New Service Amps / Volts Number of Feeders and Ampacity I. a Overhead Overhead k C (Check Appropriate Box) Utility Authorization No. Underground ® ' No. of Meters Underground EM No. of Meters Location and Nature of Proposed Electrical Work XK S TA LL (-,- D IJ E—W ✓n ,c 7--6.-YZ— •c:Z No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above Below Generators KVA KVA ro und round 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 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydra Massage Tubs No. of Motors Total HP OT?IER- hmualneCove[aga PutsuanttotEm4mmieWofNbwd>useasGffnW aws IbaNcaan3ib b-kyhmnanoefbhcywjudorgComplee CDNUaWOritssubsalegtuvalat YES IE] NO IbavesubtifodvaMpfudofsamelotheOffim YES r -7p If you hawchododYES, Pimmin&lheMmofcow age by chedartgthe ' box LJ INSURANCES BOND r7 OITIER R (p9e Spey) t W«kloSait -Lo -- 13 FIRMNAME 0-14-0 1 /acl c ► r Etit�Vahrof] al%k $ 6 Rough Fant �1 0- 1 q--044 LimmNo. LimmNo Bt&=TeLNo. T' `" . •" Alt TeL No: O%V.tl'SINRRV-4CEWANFR,IamawaledutheL;cmwdoesnothawtheirmuanoeoo Orzatsu"WegtrivaifftastequaedbyMa%ad ugc%Cc erallaws 4Udrat my signamm on dm petlrrit application waives this tegtmenm (Please check one) Owner Agent Telephone No. PERMIT FEE $ signature or Owner or Agent