HomeMy WebLinkAboutMiscellaneous - 74 JOHNSON STREET 4/30/2018c
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This certifies that ... d� c ,fin �� S S S S ............
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has permission for gas installation ..l k:e4h r t,'F
in the buildings of .... ? r 3% k1 -c �T,
at .. 7Y. 1.' ............:,. North ndover, Mass.
Fee .a.S. ��... Lic. No. AW�5 .. .... .... .. ...
GASINSPECTOR
Check #y-�—S 12 �S b
83uli
y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY R4 — A DATE -"... PER IT # _
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JOBSITE ADDRESS OWNER'S NAME
GOWNERADDRESS/
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: X PLANS SUBMITTED: YES NO
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO Lj
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ( BOND L]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
klassachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER (J AGENT [l
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true
and that all plumbing work and installations performed under the permit issued for this application will be in compilk
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAMka. S- ENSE # ff�
MP )0 MGF 0 JP [] JGF LPGI �,-], CORPORATION 0# PARTNERSHIP
COMPANY NAME:
CITY
FAXI I CELL
and accurate to the best of my knowledge
ace v0tlQ1Wertine?%Drovision of the
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N° 9627
Date. I. ?/!. fi/I Z
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that i osAf...r><<?
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has permission to perform
plumbing in the buildings of ..
at ... �... r� �?!1'~ '` . } ..........,. I. North Andover S.
Fee. 60. oJ.. Lic. No...�CQ.`1�. 5 .........I - - . * . -��?!.-L--�—..
PLUMBING INSPECTOR
Check # Iq-SP 512 4'rO
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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SIGNED
PHONED BACK CALL RNED ❑,
SEE YOU ❑ AGAIN ALL ❑
WAS IN ❑
URGENT ❑
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SEE YOUO❑ AGAIN ALL ❑
WAS IN URGENT ❑
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY 7C / � . MA DATE=7 PERMIT #
JOBSITE ADDRESS OWNER'S NAME
P OWNER ADDRESS „ ,. TEFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAO
PRINT
CLEARLY NEW: ® RENOVATION: REPLACEMENT: Zj PLANS SUBMITTED: YES E] NO
XTURES 1 FLOOR
4THTUB
ROSS CONNECTION DEVICE
EDICATED SPECIAL WASTE SYSTEM
EDICATED GAS/OIL/SAND SYSTEM
EDICATED GREASE SYSTEM
EDICATED GRAY WATER SYSTEM
EDICATED WATER RECYCLE SYSTEM
ISHWASHER
RINKING FOUNTAIN
DOD DISPOSER
LOOR / AREA DRAIN
ITERCEPTOR INTERIOR
ITCHEN SINK
4VATORY
OOF DRAIN
HOWER STALL
ERVICE / MOP SINK
OILET
RINAL
IASHING MACHINE CONNECTION
LATER HEATER ALL TYPES
/ATER PIPING
ETHER
BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 I 14
INUUKANUh UVVEKAGE:
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES X NO Q
YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND
►WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
lassachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ® AGENT Ll
SIGNATURE OF OWNER OR AGENT
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
nd that all plumbing work and installations performed under the permit issued for this application will be in complir witall Pertinent provision of the
lassachusetts State Plumbing Code and Chapter 142 of the General Laws. _
'LUMBER'S NA LICENSE # TURE
IPA JP® CORP RATION #=PARTNERSHIP0# LLC[J#
:OMPANY NAME ADDRESS
:ITY STATE ;ZIP (% TEL/,a/ /z�
AX � CELL EMAIL
Check #
15 01-7 8 f Building Inspect
. Location
y 7
U
No.
Date
NORTH
TOWN OF NORTH
ANDOVER
3?O�,t`•D +_•,BOOL
i
s
Certificate Occupancy
• i ; ,
of
$
�' b''••°''t�'
,SS4CNUSE
Building/Frame Permit Fee
$
Foundation Permit Fee
$
y
Other Permit Fee
$
TOTAL
$ Z5,
Check #
15 01-7 8 f Building Inspect
TO
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DATE',`
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PHONED BACK❑CAL
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CALL
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WAS IN URGENT ❑
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
W !
BUILDING PERMIT NUMBER �f DATE ISSUED:
/
AAI
SIGNATURE:
Buildinj Commissioner/I , for of Buildings Date
SECTION i- SITE INFORMATION
1.1 Property d ess:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Numb
1.3 Zoning Information:
1.4 Property Dimensions:
Zonis Distrid Proposed Use
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
-Required Provided
1.7 Water Supply M.GL.C.4 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
yq ` e Zone Outside Flood Zone ❑
Public ❑ Private Ll` � '
municipal ❑ On Site Disposal System ❑
P Po ys
SECTION 2 - P,ROPERTV-CfWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
f�
Name (Print) Addre's's :
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
�7
Addre
a _ —y 3
!
97 Y O ? Y
Expiration Date
Signature Telephone
3.2 Registered Home Improve nt Contractor
Not Applicable ❑
_,,-K r• /
2 6
Companyme
Registration Number
Address
9
Expiration Date
Signature Tele hone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all appiHicable
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ I Demolition ❑ I Other a,-Ip'ecify i4.0 n o vY 'L G .ge,.q U f
Brief Descriptiro/fin of Proposed W/o�rk:
00 r
7—K G .2tr-/A— RecF_ff/`H
I SF.CTION 6 - F.CTIMATFn rnNCTRrTrTrnN rneTQ
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
0 O � �.,.
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
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4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
.a.�, i avi• i s v r� i'.n" "..%JJM1L %JL JLU1V I V ISL' l; V1V1YLL� I r:L W HkA
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
SECTIONA OWNER/AUTHORIZE2—AGENT DECLARATION
Date
I, /� �� -✓�«t 4 as Owner/ uthorized A 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 e
Signature Owner/A ent Dat— e
y 1
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST 2ND 3 Pm
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
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INSURER: THE TRAVELERS INDEMNITY COMPANY
1.
INSURED:
RAYMOND DAMPHDUSE & SONS
ROOFING CO INC
73 BUTTERNUT LANE
METHUEN MA 01 a44
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6KUB-663X466-A-01 )
RENEWAL OF (GKUB-663X466-A-00)
NCCI CO CODE: 11347
PRODUCER:
INTERNET INSURANCE AGCY
522 CHICKERING RD
NORTH ANDOVER MA 01845
Insured Is A CORPORATION
Other work places and identification numbers are shown In the schedules) attached.
2. The policy period Is from 08-22-01 to 08-22-02 12:01 A.M. at the Insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
B. EMPLOYERS LIABILITY INSURANCE: Pan Two of the policy applies to work in each state listed in
vm item 3.A. The limits of our liability under Part Two are:
im Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 100000 Each Employee
in
C. OTHER STATES INSURANCE: Pan Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT WC 20 03 06
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications. Rates and Rating
Plans. All required Information Is sub)ect to verification and change.by audit to be made ANNUALLY .
OF
DATE OF ISSUE: 08-21-01 ML
OFFICE: ORLANDO INDUS AFF 161
PRODUCER: INTERNET INSURANCE AGCY 753XF
M952
ST ASSIGN: MA
From:f �' ,d R r'r 1C/
(Name) Millman)
To:.1ATKIND L SAVIOOSK JR. AD SONS 1OOM9 CO., INC., SOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01942
I (we) hereby authorize the Contractor to furnish all materials and labor necessary to install, construct and place the
Improvements described below in -on building located at No. _ / �J // f,' S I Rr
Street,
City i ) " ✓ _ State _ ,' ? > 7 1 S In accordance with the following specifications:
r791 ! �/3
1_4 %
/7
Ail of the above work to be done In a good and workmanlike manner.
All men and equipment Insured. Premises to be left clean upon completion of work.
For the total sum of dollars.
Entire Sum to be paid immediately upon completion in accordance with plan as shown below.
TOTAL CASH SELLING PRICE .......... III—
DOWN
_DOWN PAYMENT IN CASH .............
DEFERRED BALANCE
UPON COMPLETION
j
The undersigned agrees to keep property mentioned In this agreement property insured against loss by fire including the
Contractor's interest therein.
This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance
ti this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements,
written or oral except as herein set forth. It is the intention of the parties hereto that this contract shall be binding upon their respective
heirs, executors, administrators, successors and assigns.
Customer agrees to pay a reasonable sum as attorney's fees and Court Costs if placed in hands of attorney for collection.
The owner further agrees that in event of cancellation of this contract after acceptance by the contractor and before the work's
commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract.
Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his
reasonable control.
We, the undersigned, certify that we are the sole owners of the property herein described on whictr said work or repairs are
to be performed.
iN WITNESS WHEREOF; the undersigned has (have) hereunto set his (their) hand(s) and seals) the day and Yea, written above.
Accepted By
RAYMOND E. DAMPHOUSSE, JR. AND SONS
ROOFING CO., INC.
"i' D r a d Ti . Citic/ if
sband
Wife4�r
Mai! Address
Of diffe(ent Orom above)
1 ole ioowmonweaa
I a���iaaaacLivaet�
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
r i
Number -CS . 046636
Birthdate: 06/02/1948
1 Expires: 06/02/2003 Tr. no: 10578
Restricted To: 16 3
RAYMOND E DAMPHOUSSE JR _
75 BUTTERNUT LANE
METHUEN, MA` 01844
Administrator
4
HOME IMPROVEMENT CONTRACTOR
Registration: 101862
Expiration: 06/29/2002
Type: Private Corporatio
RAYMOND E. DANPHOU SSE, JR.
Raymond Damphousse, Jr.
-7;�' Whtternut lane
ADMINISTRATOR Methuen MA 01044
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