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HomeMy WebLinkAboutMiscellaneous - 795 JOHNSON STREET 4/30/2018 (2)N O � O O D = o Z 8o z o o ;u o rn Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,;,''his certifies that ...... .....................kc, C,........... Ls permission to perform ...... 1). Lt.,) plumbing in the buildings of...........1.! at ..... 5 Fee .A�� ... Lic. No. .................... Check # lo� 2U2-1:::; �. ........................ .................. .......... ......... . ....................... . . ..................................... .................. I North Andover, Mass. ............................................................. PLUMBING INSPECTOR Qx MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITY MA DATE _ ^/ PERMIT # ___�_ U JOBSITE ADDRESS �r _U p h ��h OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL [ EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: 0/ REPLACEMENTU PLANS SUBMITTED: YES Q NO[] FIXTURES 1 FLOOR- BSM 1 2 3 4 5 1 6 7 8 1 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM i -- DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER_ _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [ NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY BOND Q 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 Og ONLY: OWNER F-1 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application a tru an ccurate the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be ' co is wit ent provi ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Nichofas Savvas LICENSE # 15234 SIG ATURE MPQ JPQ CORPORATION[#PARTNERSHIP[]#LLCFI#_ COMPANY NAME INicholas Savvas ADDRESS 11A Ma Jo Lane CITYDerry --i STATE NH ZIP 103038 �i TEL 9788043303 FAX CELL SAME EMAIL savvasLlg@gmail.com w H 0 z z o � F w w w h Q,t t -i O El z N 11 O F � w � w r7 W O w w z C w 5' Q N N �4 0 zz52 w � � a V J IL CL a �+ C LLI z w LL CA w F O z z H U W z c� a w O 0 a � � t -i Date ........J l.�..� �. ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..:...ti1.IT.".`..v U..S.. v.)'f� S .................................................................. has permission for gas installation ...... inthe buildings of..........(.'C �...................................................................... at.��?`x.NJ..................................... , North Andover, Mass. Fee .21.?.Ni ..... Lic. NoY;?3' ............................... GASINSPECTOR " Check # �Z — t ` - ^ �- 1-2 cj I q 11�74� )A � 017� " 11\1 WL IVI\ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ONO 0 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY [] BOND 0 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 � AGENT 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 n a rate to th best of my knowledc and that all plumbing work and installations performed under the permit issued for this application will be in corn e . f�i all erti en�t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME INicholas Sawas LICENSE MP 0 MGF ® JP [3 JGF [3 LPGI CORPORATION # PARTNERSHIP# LLC 0#L COMPANY NAME: Nicholas Sawas ADDRESS 111A Mary Jo Lane CITY De STATENH ZIP 03038 TEL 9788043303 FAXSame CELL EMAIL sawasplg@gmail.com NA 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - - CITYU91MA DATE �" PERMIT #165 z JOBSITE ADDRESS GY1i7 OWNER'S NAME GOWNER ADDRESS TELr� FAX TYPE OR OCCUPANCY TYPE COMM CIAL - EDUCATIONAL RESIDENTIAL _ CLEARLY NEW: [ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES[] NO APPLIANCES Z FLOORS— BSM 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER1.�, - i -__ I_ BOOSTER ti �- 1-�-- CONVERSION BURNER t f e COOK STOVE _ l�__�, „ _ I i 2-.. ... .���....... — — --'i — a� _ al_ _ = .. - 1-----;�-_--- _-__ I i DIRECT VENT HEATER �_. v�A__1._��__�; DRYER -_- FIREPLACE_ .... im_:.. 1 t — 11\1 WL IVI\ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ONO 0 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY [] BOND 0 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 � AGENT 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 n a rate to th best of my knowledc and that all plumbing work and installations performed under the permit issued for this application will be in corn e . f�i all erti en�t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME INicholas Sawas LICENSE MP 0 MGF ® JP [3 JGF [3 LPGI CORPORATION # PARTNERSHIP# LLC 0#L COMPANY NAME: Nicholas Sawas ADDRESS 111A Mary Jo Lane CITY De STATENH ZIP 03038 TEL 9788043303 FAXSame CELL EMAIL sawasplg@gmail.com NA 0 b m �i F O z z o U W J a� Q � l � v �O a Z o ;Fj w �- w c W O U w a � � z 3 w ¢ a LLJ W� a O > w L W QO � J IL a ui LL H O z z 0 H U W a CQ,7 x 0 The Commonwealth of Massachusetts ,A Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 .W' Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nicholas Sawas Address: 11A Mary Jo Lane Derry, NH 03038 Phone #:9788043303 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 3 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- listed 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.1 required.] 5. ❑ 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' coma. insurance reouired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.M 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: Hartford Policy # or Self -ins. Lic. #:76 WEG GD3975 Expiration Date: 2/15 Job Site Address: T� 1( A!) _,�eq r1 Ls . City/State/Zip:�<�/yv/ 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 theL�A for insurance coverage verification. I do hereby certy/tfndeethe pains and penalties of perjury that the information provided ¢bovg is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # f S// 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 Date........... ..... .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that HI r &,j IRO t,,elf has permission to perform ......... . ....... ....................... ........ ......... ....... .... . .. .. .... . ... .... ......... wiring in the building of.....!.... j CP .......................................................................................................... at ...... ............ . North Andover, Mass. .......................................................... Fee ... ... . ........ Lic. No. ................. .11-14 . ............ ....................................................... ELECTRICAL INSPECTOR Check # r � � f Li� '.i,. 2GZ-v�vvx sj-21-di'� T M Commonwealth of Massachusetts Official Use Only Permit No. I� Department of Fire Services Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [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: 9 /`79 - / y City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to erform the electrical work described below. Location (Street & Number) O p �_N Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Q No ❑ (Check Appropriate Box) Purpose of Building �r,, q Utility Authorization No. Existing Service Amps 106 Volts Overhead Undgrd ❑ No. of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�.�� Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires j No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- E] rnd. rnd. No. o Emergency Lighting Units No. of Receptacle Outlets —Battery No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatina Devices No. of Ranges j No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number " '"" Tons ..""""."""'.... KW """""' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 4 0 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work- ILL -160, (When required by municipal policy.) Work to Start: 9 — i 3- N 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 cove office. e is in force, and has exhibited proof of same to the permit issuing oce. CHECK ONE: INSURANCE ✓J BOND ❑ OTHER ❑ (Specify:) l certify, under the painsnd penalties of perjury, that the information on this application is true and complete. Pee- t FIRM NAME: - / C � k e ! r q f! er-i LIC. NO.: p� T Licensee: % t chi � -e vers Signature �— IC. NO.: f q T le (If applicable, enter "exempt" in the h5ense me ber line.) (� Bus. Tel. No.( Address: eS_ 0 A,_Q_ & .� � d,, /•1 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ �" Signature Telephone No. _16_ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with=the provisions of M.G.L. c. 143, § 3L, the t C permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: i Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGHECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: I Inspectors Signature: `, Date: —=—/ FINAL INSPECTION: Pass S4, Failed Re- Inspection Required ($.) ❑ Inspectors Comments Inspectors Signature: U Da e: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com e The Commonwealth ofMassachusetts Massachusetts . Department of Industrigl Accidents Office oflnvestigations 600 Washington Street .Boston, MA 02111 •www.massgov/ctza Workers' Compensation Insurance Affidavit: Builders/Cont°actorsLElectriclansfflRimbers Applieant Information Please Print Ledbly Name (Business/Organizaiionlindividual): 1 (,4 4-�f 7-r- ' y -&—j Address: ro Ca City/State/Zip:y e IVA JOWO AM l Phone M �� � G;� r 7-71 Are you an. employer? Check the appropriate box: Type of project (required): 1. [� 1 am a employer with 4. ❑ I am a general contractor and 1 6• New constructiongzpF loyees (full and/or part time). have liiredthe sub -contractors listed on the attached sheet `!• Remodeling 2. 1 am a sole proprietor or partner- ship and'have no employees These sub -contractors have 8. Q Demolition working forme in any capacity, workers' comp. insurance. g• Q Building addition [No workers' comp. insurance 5. Q We area corporation and its MCI Electricalrepairs or additions required.] 3.E] I am a homeowner doing all work officers have exercised.their right of exemption. per MGL ME] Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4), and we have no 12,QRoofrepairs insurance re ed.] t employees. [No workers' 13.[] Other comp, insurance required.] ,Any applicant that checks box#I must also fill out the section below showing their workers' compensation policy information. i Homeowners who submitthis affidavit indicatingthey kedging allworK and then no outside contractors must submit anew 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. -Taman employer that is providing workers' compensation insurance for Puy employees Below is the policy and j oh site information. Insurance Company Policy 4 or Self ins. Lic. #: Expiration. Date: Yob 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 reg* d.under Section 25A ofMGL o.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 maybe forwarded to the Office of Investigations of the DIA. for insurance coverage verification. -1do liereby cert& uner the pains and penalties o f perjury that the information; provided above is true and correct, — t'7_j WE Official use only. Do not write in this area, to be 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 / / / / / ' ' I / ,a Date ...r.* / ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING r e- � This certifies that /, / has permission to perform .......... wiring in the building of......../ ................................................................................................... at ...... 71,5— �T ............................. .... J� .........�.......................................:.................... ....... I North Andover, Mass. .... .... .. ....... ......... — Fee.l�� ......... Lic. No.:?11..y .... ........ ...... ELECTRICAL INSPECTOR Check# 00 �r V _t 4 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. NO c 3 Occupancy and Fee Checked [Rev. 1/071 (leave blank I 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 PRINTW INK OR TYPE ALL INFORMATION) Date: J --Z2-/3 City or Town of: NORTH ANDOVER 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) 77,r v k ph S -+,_ Owner or Tenant 4 C, Cr%4 .� Telephone No. Owner's Address q� ph S f , Is this permit in conjunction with a building /1 ng permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �J l (�� Utility Authorization No. - Existing Service JCV Amps / IX Volts Overhead Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: rol No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of Luminaires Swimming Pool Above ❑ In- rnd. grn, No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners No. of Ranges No. of Air Cond. Total Tons No. of Waste Disposers Heat Pump Totals: Number ""' Tons I No. of Dishwashers Space/Area Heating KW No. of Dryers No. of Water KW Heaters Heating Appliances KW No. of No. of Signs - Ballasts No. Hydromassage Bathtubs No. of Motors Total HP OTHER: 'lowin table may be waived by the Inspector No. of Total Transformers KVA Generators KVA o. o mergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Alerting Devices V........... No. of Self -Contained ... Detection/Alerltinu Devices Local ❑ Munici al ❑Other Connection Security Systems:* No. of Devices or E uivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Ea uivalent / Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: J b O - (When required by municipal policy.) Work to Start:J_-9,'L— 13 Inspe tions to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true anti complete. FIRM NAME:. th I C� q v S LIC. NO.: Licensee: 14h ICr1 -ef I—" ae�f Signature �— LTC. NO.:,;, (Ifapplicable, enter "exempt" in the license number line) Address: % Bus. Tel. No.•�603 `1 �� = 7 11 ,3-0 C-Ot- 1 `9' 0t^, uc> d,/[I (� 03 S 7.3 Alt. Tel. No. *Per M.G.L c. 147, s. 57- 1, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [:1 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ v` o ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the f' permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed J on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an rr 1 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: n Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: n/m k.,, Inspectors Signature: % Date: I I DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com K r t: lcx The Commonwealth of Massachusetts - Department ofIndustriglAccidents Office ofInvestigations 600 Washington Street Boston, MA. 02111 qu www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;;ib1Y Name (Business/Organization/Individual): 6 IC44- r4 k (frj c r ' Address: S ` 03V3 S City/State/Zip: Qh [Jwtn /U�-� j Phone #: t7 U3 c-73-- ? 7/' Are you an employer? Check the appropriate box: - Typo of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction _employees (full and/or part-time).* have hired the sub -contractors listed the attached sheet. �• ❑Remodeling 2.Z lam a sole proprietor or partner- ship and'have no employees on These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. [1 We are a corporation and its 10.. Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] i employees. [No workers' 13.❑ Other-e,-•,Qv-J4Y comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they ire 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. )"am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Policy # or Self -ins. Lie. #: 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 ofMGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or oneyear 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certio under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Of use only. Do not write in this area, to be 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 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 ofhire, express or implied, oral or written." An employef 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 ofpublic 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 -contractors) 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 maybe 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. Anew 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 CoxxMORM-61thof Massachvsetts Departmeut offadustdal .Accidents Office of Westigatims 604 WasMzgto» Street Boston MA 02111 Tei, # 617-727-4900 ext 406 or 1-877;MASSAFF, Revised 5-26-05 Fax# 617-727-7749 COMMONWEALTH OF MASSgC HUsms ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIAN '$SUES -NE ABO UCEHSE i0: MICHAEL RAVERS fl 50 COMPROMISE WAY/ f� SANDOWN,+'`- NH '/0 387-� t „� 2114JR 3 2064 07/3 1/1 , 885955 - I i i GENERATOR DATE: ") 1, o APPLICATION LOCATION: Uo h a� S4- OWNERS NAME: GENERATOR kw /D t.�J NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS"' CONTRACTOR: VIT6109SHUITAW ELECTRICAL RESIDENTIAL 6 3) �-4 7�f — 7W 9 GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: �� �✓U h S�� �� "'ZONING DISTRICT: *CONSERVATION APPROVAL •: NAh Andover MIMAP May 22, 2013 038.0-0069 767 JOHNSON ST a :"seri •:':':_' -:.._:---: _":":aU.0 ';-�.....;;.._: ' 038.0-0091 y :_ _. ; _.. tlu .::_. ••::-:_:...: ; V2 •=_: •'-- tib -- b -•.r.. 03.8:0:0098 038.0-0029 ...,_ .. 777 JOHNSON ST - 107.A-0069 :' ; 797 JOHNSON ST R2 ' 795 JOHNSON ST 1? 107.A-0068 038A-0106 ` "= 808 JOHNSON ST 805 JOHNSON ST '- 038.0-0060 107.A-0067 815 JOHNSON ST 107.A-0026 107.A-0027 107.0-0014 107.0-0088 107.A-0063 107.A-0060 825 JOHNSON ST 107.A-0064 1Q7.C-0002 107.A-0061 -- Rail Line -. Wetlands Zoning Interstates Exempt Lands — Interstate Busine 5 1 District O Busine 5 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — Major Roads 0 Busine s 3 District ■ Busine s 4 District ORT M Meters Data Sources: The data for this map was produced by Merrimack Valle Planning Commission MVPC Roads M Genera Business District f N 1. O '�• using data provided b the Town of Y 9 ( ) 9 p y North Andover. Additional data provided by the Executive Office of L tEasemenls ��ao O Planne Commercial Dev << O '. CornDevelopment Dist 3.� • • O Environmental Affairs/MassGIS. The information depicted on this map is MVPC Boundary C] Municipal Boundary Zoning OverlayInduslri O Corrido Development Dist O G Corrido Development Dist 1. -'- 9 I 1 District 41 for planning 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 0 Adult Entertainment Induslri 12 District " y « ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN B Downtown Overlay District !3 Induslri 13 District • o ... f i OF NORTH ANDOVER DOES NOT ASSUME Historic District � Induslri I S District •• <ur-�•�• ' Reside 1 District •�71 o��r�o ���.� ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 0 Water Protection ce Reside ce 2 District Ss ❑ Parcels R-sde ce3 District ACMU § .^. Hydrographic Features j de ce 4 District Streams 1" = 112 ft " •(`(� rde ce 6 Distdct tle ce 6 District �wge esidential District This certifies that ... �. `.,.;; ;.1.)&. .a ............... has permission for gas installation ........ ........ in the buildings of .. North Andover, Mass. Fee . .. Lic. No..(�..� .................. .. . -`� GAS INSPECTOR Check # 8677 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY��''"� ��- MA DATE f.3 PERMIT #. — - —!I _ JOBSITE ADDRESS �%, _ IDA! , S7f _ OWNER'S NAME GOWNER ADDRESS e _ TELFAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL RESIDENTIAL CLEARLY NEW: ;.__i= �l RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESF-1 NOD APPLIANCES 1 FLOORS- BSM1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER).-;� DRYER FIREPLACE FRYOLATOR FURNACE ---.l AE— GENERATOR-l 1, J _ 1I f ,�___I I 1. �__.i _ I J GRILLE INFRARED HEATER LABORATORY COCKS f a j- � rn --- I (- .I --J MAKEUP AIR UNIT OVEN _ —� -...£ F--- 1—- POOL POOLHEATER ROOM / SPACE HEATER F,OOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER i ......... INSURANCE COVERAGE have 0 a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ©I BOND I -_i 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_i AGENT D1) 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 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 P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER G SFITTER NAME = _. "^O L LICENSE # 1, 'it) SIGNATURE MP MGF f JP [j JGF LPGI �]_(- CORPPOOR'ATION D# PARTNERSHIP D#= LLC COMPANY NAME: ^�d..._ `-`` - ADDRESS : -_-�1 `^L%11��- CITY STATE ZIP TEL FAX CELL . EMAIL F O z 0 F U W a W ..r o 0 z O N El W >- L W O� O a U W z W � � Cl)CO) CL W 5 o > L W o a a a U J H a a- < a s w LL H O z z 0 U W P4 �7 , O � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): s`Ti�'` O Address: City/State/Zip: A,re_,trit employer? Check the appropriate box: Type of project (required): 1. eK&60 #: Ci ) F- Q.? - Jk Lo ( A; a employer with �_ 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have Hired the sub -contractors listed the attached sheet. * �• Remodeling 2. El am a sole proprietor or partner - ship and'have no employees on These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ 4kctrical repairs or additions required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they ace 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: At i& C A rt ct Policy # or Self -ins. Lic. # ( ( Expiration Date: /� Job Site Address: -s- Cis - y n S CM1 J City/State/Zip: N �1 84 ter P 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 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. 1 do hereby cert under th a1,4, 4rnd pFnalties of perjury that the information provided above is true and correct. Shone #: .719— Official use only. Do not write in this area, to be 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 #' r y ..,o lb -%e 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 permitilicense 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 Commonwealth of Massachusetts Department of lndustrial Accidents Office of Investigations 600 Washington Street Boston, MA, 02111 Tel, # 61.7-727-4904 ext 406 or 1-8777"SAFB Revised 5-26-05 Fax # 617-727-7749 wwwauass,govldia i r ,r r f r ! vr -i. N m < ii c7v cn m' 1 mr Fn mr. • c E -n ; c MM D m Om. m M o z cncn r M r m D -•I t C) Z D W D� ,. \ m O �Q Oii: i D ,� !t D i m —�jD nk z MCA py' f0 -0�! v t rm �. C �I i I G7 c . :N m `'' m w m o` �f. Lncn ignature , r 9 9 t GENERATOR APPLICATION DATE: 51,113 LOCATION: -7 fS- OWNERS NAME: 04A, om cc zt J II.`,, GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS" CONTRACTOR: \-awUl<<rf i PHONE NUMBER: OM'W-110 I ELECTRICAL RESIDENTIA (�D COMMERCIAL TEMPORARY LOCATION OF GENERATOR: le R S Lke -F nA Cave -f - "ZONING DISTRICT: *CONSERVATION APPROVAL i �/ Date ... �V-1 r'. �� ... . f HORTM 1 TOWN OF NORT MOVER PERMIT FOR GAS INSTALLATION This certifies that . �- .. has permission for gas installation . ..:'amu'. in the buildings of ................ at North.Andover, Mass. Feer?.. Lic. No G GAS INSP4CTOA'� Check # 5963 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �v Mass.I Date � 20 Permit Building LMadOn �� J(j Y1 K j,ti 5 Owners Name Type of Occupancy New[] Renovation ❑ Replacement- Plans Submitted: yes ❑ Nod_— Installing Company Name AT Alleg 00�Z� Address�0�_ Z (JZ �✓ Business Telephone Name of Licensed Plumber orGas Fitter Check one: Certificate ❑ Corporation ❑ Partnership C�( k i`� r� Flo. INSURANCE COVERAGE: 4 have a current I^ I insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes Y No p it you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWTIER'S INSURNACE WAIVER: 1 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 s perm application waives this requirement Signature of Ovvner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knovNedge and that all plumbing work and installations performed under the permit issued for this application will be in compliance vrith all pertinent provisions of the Massachusetts state Gas Code and Chapter 142 of the General aws. Type of License: By �mber S gnature r'L ensediPIumber-or-�s-Fitter Tick ❑ C V tte r APPROVED (OFFICE USE ONLY) paster License Number p� 0 PPRI ❑ Journeyman �E' E w O (D m O ~¢ >' m z P z 'E _ V) W FW- u� W z O a O O> I- u� z �o W � UJ UJ . j�Z�—LI U J Q~ W Q LLJ Z Q �' m Z O � O W L 0 LUh- raw c� = O C7 = C7 U1 cG > 0 n. O. SUB-BSMT BASEMENT ET FLOOR 2ND FLOOR 3P.D FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name AT Alleg 00�Z� Address�0�_ Z (JZ �✓ Business Telephone Name of Licensed Plumber orGas Fitter Check one: Certificate ❑ Corporation ❑ Partnership C�( k i`� r� Flo. INSURANCE COVERAGE: 4 have a current I^ I insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes Y No p it you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWTIER'S INSURNACE WAIVER: 1 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 s perm application waives this requirement Signature of Ovvner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knovNedge and that all plumbing work and installations performed under the permit issued for this application will be in compliance vrith all pertinent provisions of the Massachusetts state Gas Code and Chapter 142 of the General aws. Type of License: By �mber S gnature r'L ensediPIumber-or-�s-Fitter Tick ❑ C V tte r APPROVED (OFFICE USE ONLY) paster License Number p� 0 PPRI ❑ Journeyman Date. f "oRT„ TOWN OF NORT ANDOVER 4ao PERMIT F PLUMBING This certifies that .... .....! .. .. ........ has permission to perform--.v-�-t......%� ...-•--?..... . plumbing in the.buildings of . .....:. ........... at .. 7..q,5..... a`�� - ..... , North Andover, Mass. Fee '— ..... LI c. No.. .% U R,3... . l , !`.......... . PLUMBING'INSPECTOR Check # r I� 7359 �' 1:IYTI IRGC MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING '"°' /� City/Town: Q Ll MA. Date: aN � 1�) �{���11� 3/ 20A�11?ermit# I Building Location: / �� [ © '5r") S ( Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: &I Plans Submitted: Yes ❑ No ❑ 1:IYTI IRGC INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 0/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage 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 ❑ hereby certify that all of the details and information I have suhmitteri Inr a„+—Al --Ain- +k,- -1.11Y 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: --al"4 - a TitlePlu ber Signature o icensed Plumber City/Town aster APPROVED OFFICE USE ONLY ❑Journeyman License Number: G Z Z N Y O U W a z Y } a U) J -j Z U H W w a m z W cn a cn z W ~ U) W z a z_ n X W O m� W o ~ o Q� z W 0 W o IY W z cn J 0 U a u_ o a 1.3: a _° Z Q- z a W W F a a= Cf)- o~°°° .Q.I SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 1HFLOOR 71H FLOOR 81 H FLOOR �— Check One Only Certificate # Installing Company Name: /9t% �t IIca L) yyt �t U o I U (Corporation Address: ll b C� D C City/Town: !di .L State: ❑ C %C!��/ � r Business Tel: ! �(( b b (� I Fax: ❑ Partnership jj.F4rm/Company LName of Licensed Plumber: .-- `I(L°'4E(3 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 0/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage 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 ❑ hereby certify that all of the details and information I have suhmitteri Inr a„+—Al --Ain- +k,- -1.11Y 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: --al"4 - a TitlePlu ber Signature o icensed Plumber City/Town aster APPROVED OFFICE USE ONLY ❑Journeyman License Number: G ,* 6163 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0& --�z S-�r.—OAI'E Thiscertifies that ............................................................................................. has permission to perform ........ /?/5,4W /,r)7-/,- .. ............................... Z,� ................................. !�� Ip e wiring in the building of .... ..... 9 ................................................... 7 at.................................................................... North Andover, Mass. — 00 Fee .S'3..---... Lic. No.&.�(.7.,;7 ELECTRICAL Iy Check # :I •��I I' y I •,�P' I �Y B �� r��� Permit No. �Pawy a Fen Checked MPUCARON FOR PERWTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE Wr M THE MASSACHUSSTS ELECTRICAL CODE, 527 CMA 12:00 Q -y (PLEASE PRINT IN INK OR TYPE ALL INMRMATION) D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) `-r�SCu sn— owner or Tenant (/Y 717 eIN�W\ Owner's Address is this permit in conjunction with a building permit: Yes [n No (Check Approprim Box) Purpose of Building Utility Authorization No. Existing Service Ampa...L. Volts Overhead Underground No. of Meters New Ser -vice Amps Volts Overhead Underground M No. of Meters Number of Feeders and Ampscity Location and Nature of Proposed Electrical Work \-LA\ V\e--J l a Na of Lighting Outlets No. of Hat Tube No. of Tm ato<me s TOW KVA No. of Lighting Ritata Swimming Pod' AboveBelow c6naaten KVA and No. of RwApwA Outlets No. Of 0112 No. of Emergency Lighting Battery Univ No. of Switch Outlets No. of Des Burners FIRE ALARMS No. of zone No. of Ranges No. of Air Cond. TOW Toru No. of Detections W No. of Disposals No. of Had TOWToW Pumps Ton KW Initialing Device No. of Sounding Devices No. of Dishwashers Space Ara Heating KW NO. of Sam Corrtainm �O1�0tl0�g Ds Mon icip _ Other No. of Dryers Honing Devices KW Conncctioru atio No. of Water Heaters KW Na Of No. of Signs Beilssla No. Hydro Massage Tubs No. of Mown ToW HP Iharesu TAadv&pod srraetofle0fflra YM i BcND[:3 anno WmkiDSwt �S DOPM fEMNAME P" --V 1 ��i S ��-7m r dual dEh"Wbik s Lk=Na Lbmm wdow liNa 3 i AL I� OWDWSPOJRAMBWA IRIamawaefgdzlimwdmwt dleireeanoeWW*aisa Na — arddetmyspamorift'm,d vii f:,equi�s e4'vala�tasre4;ea{>J►Maseaduadbcer,e>alr�a (Please check one) Owner rj AgM Telephone No, pgR�. FEE 2 c ;I '�11 l,.., y I 'Jets I ♦Y Permit No. OecOPOttcy & Fees CheckedI low APPUCATIONFOR PERMITTO PERFORMELECTRICAL WORK ALLWORK TO BE PFAPORMED BV ACCORDANCE WITH THE MANACHUSSTS MXCMXAL CODE, 327 CME 12:00 (PLEASE PRINT IN INK OR TYPE ALL MRMATION) Da C � Town of North Andover To the Inspector of wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 3 Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes[n No (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Service Amps Volts OverheadUnderground No. of Meters New Service Ampex Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical work L%\ Yom',- ( ;—c - No. —c - No. of Ugbdna Outlet Na of Hot TWO No. of Irstw ann f TOW No. of Lighting Futures Swimming Pod' Above Below Oa KVA around � erst rs KVA sela No. of ReceptOutWs No. at 011 Bursarsri No. of F.rr wpwy Liss Battery Units No. of Switch Outlet No. of On Burnm FME ALARMS Na of Na of Ranges No. of Air Cond. TOW Tons No. of Delxtiao and No. of Disposals No. of Had Total Total P111110 Tan KW inidadng Devices Na of SouaNtrg Devices �! No. of Dishwashers Space Area Heating Kql No. Of Self Contained Loud Mmicipd Other No. of Dryers Heating Devices KW Corutnctlorrs a No. of Waser Heaton KW Na of Na of slons Bellaais No. Hydro Mauge Tubs No. Of Mown ToW HP 1hwaftrilkdvddpa s=lDl1eOft YM M dMCUS111- wsLmANcs Boren OUM 0 WcdcbSw `Q R mi kI I 1:111101W>edd FEMNAME kFA,e A L;mtsle —:7 , 6f �t CC`s / 94ndw EL' 1r�otthnet.lea�d FF i Est�dVatzdEhcWc& s \ RW Urs eNa LiameeNo AkTdNa �� Yom- (/0 '*. ' owr>ofsIIV.AJRAr�wAIVII�IanawaelhatlheLioQlsd �dleine:srneao�vi�or�stast�legtivalsY�tec}��,MaeOacfislbama�llaM het (Please check one) Owner Ageat Telephone No. pgD, FEE S rt k J ® /c. �P- P7�-1 6124 Date ................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /- t, 0 0/f/z:/i,� ................................................ ....... * ..... .... has permission to perform ......... ........... ... tli�� ........ wiring in the building of .... /-.-.7 ... .................... No d at ............... 7 ... 9.'. % . ....... Andover, Mass. 4� Fek/ ........... Lic. .................... 1 - ELECTRICAL INSPECTOR Check # 703 a a Commonwealth of Massachusetts Official Use Only Permit No. 124( r Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (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 INFO ATION) Date: _-�cf ,,/ City or Town of:s �1� 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 Tenantyt Telephone No. Owner's Address Is this permit in conju 'on with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Vjt/j ccs T -i -"AG. /t7» ,6; Utility Authorization No. Existing Service �J Amps 1,;o Volts Overhead [�T_ 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: �QZ_ Com letion of thefiollowing table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA 11 No. of Lighting Fixtures Swimming Pool Above In- o. o +mergencyig g rnd ❑ d. ❑ Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS 1,N4. of 'Zones No. of Switches No. of Gas Burners No. of Detection Ad initiating lypx4pa. No. of Dishwashe Space/Ar eating KW Local/El Municipal ❑ Other Connection No. of Dryers ms, Heating Appliances KSecurity Systems: No. of Devices or E uivalent No. of Water No. of No. of Heaters KW Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP/� TeleN of Devi es or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector 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 covera is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: / (When required by municipal policy.) (Expiration Date) Work to Start: �7- • _�Fo - ep 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: LIC. NO.: Licensee: C�3 Signature LIC. NO,r� _ (If applicable, ter ' exe pt" in the license number line.) Bus. Tel. No .�27s.5S/—s %5z/� Address: j%/��[:�/�/s0!, Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware th t the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ No. of Ranges No. of Air Cond. Total Tons No. of Alert' Devices g No. of Waste Dispose Heat Pump I Nu bei Tons KW I No. of Se)( -Contained Totals: Detecti /Alertin Devices No. of Dishwashe Space/Ar eating KW Local/El Municipal ❑ Other Connection No. of Dryers ms, Heating Appliances KSecurity Systems: No. of Devices or E uivalent No. of Water No. of No. of Heaters KW Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP/� TeleN of Devi es or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector 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 covera is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: / (When required by municipal policy.) (Expiration Date) Work to Start: �7- • _�Fo - ep 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: LIC. NO.: Licensee: C�3 Signature LIC. NO,r� _ (If applicable, ter ' exe pt" in the license number line.) Bus. Tel. No .�27s.5S/—s %5z/� Address: j%/��[:�/�/s0!, Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware th t the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Commonwealth of Massachusetts JY. Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Xl1T_. Occupancy and Fee Checked [Rev. 11/99] 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 INFO ATION) Date:, City or Town of: � 111PId -- 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 • ( 6 e_ rr� Telephone'No: Owner's Address P Is this permit in conjugetjon with a building permit? Yes El' No (Check Appropriate Box) P CD 'ld' urpose o mmg Utility Authorization No. Existing Service% ��.J Amps »c� / ;f 4) Volts Overhead Undgrd ❑ No. of Meters l New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: --� No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans wu mu oe waived by the Inspector o Wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o. o Emergency ig g rnd. d. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS of 'Zones No. of Switches No. of Gas Burners No. o Detection d Initiatin evices No. of Ranges No. of Air Cond. TotaTonal No. of Alert' g Devices No. of Waste Dispose Heat Pump Nu ber Tons KW No. of Se -Contained Totals: Detecti /Alertin Devices No. of Dishwashe Space/A7/Heating KW Loca,❑ Municipal Connection ❑Other No. of Dryers Heating AppliancesKW Security Systems: No. of Devices or Equivalent No. of WaterNo. of No. of Heaters KW Data Wiring: Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors TotalHP/,2, Telecommunications Wiring: com of Devices or E OTHER: Attach additional detail if desired, or as required by the Inspector of Ivires. 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 covera . in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 1 BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work:(Expiration Date) (When required by municipal policy.) Work to Start: e> Vic,') _ `2 �- 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 oil this application is true and complete. FIRM NAME: LIC. NO. j Licensee: �i -� �:..t ' � '''CG Signature•, (Tf applicable ter "exergpt " in the license number line.) LIC. NO,,-.-. Address:. /�) —� yr • Bus. Tel. • �J la c!.':. ;� Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware th t the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: S 0lit (fuininunuicalfil of Massa di us ettri 0 � 1 Department of Public Safety Permit No. _ C�6 .. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12a"! S Occupancy R 1 ,v c Iev kr,l 3/90 !leave hlanNl APPLICATION FOR PERMIT TO PERFOR I FI-ECTRICAI_ "''ORK All work to be perimmed in accordance with the Massachusens Flo, np,.pl r :• CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of )AI An1)l/6/? In tl„, hi,fivctor of Wi,­.' The undersigned apphoi for a peimit to perfortu tho vlectrical work described below. Location (Street R I Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes II No (Check Appropriavg Box) Purpose of Building; t ltilitq :\n!hori7ation No. ns,•th,•.,rjl�U Undgrd ❑ Overho.)d l_ J Undgrd Existing Service Amps / Volts New Service _ Amps / Volts Number of Feeders and Ampacity - n Location and Nature of Proposed Electrical Work ke 1011(7°.C`1�t'►i e�fi ,/ _/_ dz / )0A 0 No. of N1eler� No. of Meters OTHER: NOV - 8 INSURANCE COVERAGE: Pursuant to the requirements of Massachttsttes Genera: Laws have a Current Liahilily Insurance Policy including Completed Operations Coverage or its suhomlli.fl iw% i!, nt. YES C: Nn ! of same.to this office. YES (a NO O If you have checked YES, please indicate the type of coverage by checking the appropriate hox. LTJ INSURANCE BOND ❑ OTHER❑ (Please Specify) (Expiration Dow) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME Philip A. Pagneranl Licensee ;_ i66X 633 2a„ Final LIC. NO. LIC. NO. Address Atkincpnr N W- p2R1e X- Bus, Tel. No. I. -603-352�A•065 Alt. Tel. No. J7 <3��_a�� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance, o , .,,1r ,,, ;t,, uho.)ntial Pquivalent as mrluired by Massachu•, n,, .General Laws, and that my signature on this permit application waives this requirement. Ocaner \e. of (Please check ones Telephone No. (Signature of Owner or Agent) C k 7�- / -xK PERMIT FFFF SZZ2 0 M IAL No. of Lighting Outlets No. of Hot Tubs \o. of Transformers KVA Above In- ( No. of Lighting Fixtures Swimming Pool ernd. ❑ grnd. L—� Go,nerators KVA _ '<o of Emergency L, hoop, No. of Receptacle Outlets No. of Oil Burners Ii.tri,,ry Units No. of Switch Outlets No. of Gas Burners___ r!pF ALARMS Nn of 7ono� No of Detection and I No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Dr, lr, . Heat Tola l oral No. of Disposals No. of Pum s Tons K\\ I:,, of Self Contain -I _- 1 ),•lection/Sounding f , . u ,••. No. of Dishwashers Space/Area I leatin K\',' - (� Mnoteil .•! j j -- Connection U(Aher No. of Dryers Heating Devices K\,V No. oT No. of I ov. Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: NOV - 8 INSURANCE COVERAGE: Pursuant to the requirements of Massachttsttes Genera: Laws have a Current Liahilily Insurance Policy including Completed Operations Coverage or its suhomlli.fl iw% i!, nt. YES C: Nn ! of same.to this office. YES (a NO O If you have checked YES, please indicate the type of coverage by checking the appropriate hox. LTJ INSURANCE BOND ❑ OTHER❑ (Please Specify) (Expiration Dow) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME Philip A. Pagneranl Licensee ;_ i66X 633 2a„ Final LIC. NO. LIC. NO. Address Atkincpnr N W- p2R1e X- Bus, Tel. No. I. -603-352�A•065 Alt. Tel. No. J7 <3��_a�� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance, o , .,,1r ,,, ;t,, uho.)ntial Pquivalent as mrluired by Massachu•, n,, .General Laws, and that my signature on this permit application waives this requirement. Ocaner \e. of (Please check ones Telephone No. (Signature of Owner or Agent) C k 7�- / -xK PERMIT FFFF SZZ2 0 S E /17-1G 0 1 Date .....S/ 1 _ . 2669 f HOR7M TOWN OF NORTH ANDOVER OL PERMIT FOR WIRING Oki' This certifes that ................................... ..�......(..t .......Q.....r .t.............................. has permission to perform .......... �. 5� ��U.S.h. t /( F��4 acw eel% wiring in the building of .......C. �!t?. L ................................ at ....�.-? �.......1.. .4!..�........................ ............... .North Andover, Mass. Fee....../:.vv Lic.No. ...:1.��!........................................................ ELECTRICAL INSPECTOR 1/09/95 13:29 15.00 PAID WRITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File ' MASS CHUSETTS NIFORM AppUCATION FOR PERMIT To DO PLUMBIN V.4� �L�-�"A J.. IJ ID L4Vow 0 ',1 Perms a7 DOWN � ., . •ner's ' New Oon TM of oxuparlt v Renotiation O om- Replaeernent 0, p{ tested: es O No t • MURES ' .. 'FI— VA ✓ + sud�•dSMT. • : ; a�ssMeNr I 1ST FLOOR i •2ND FLOOR 3RD FLOOR 4TH:FLOOR STH FLOOR 6TH FLOOR FS THFLOOR TN FLOOR .j Installing Conony Name of Ucensed plumber Wel In a LIA%w s .Oyd Nse<) . �y Sy' #.K� ShC F<s•• VV. wt<a~ w>K K y WoOsMs W OZ 0 Z 'C W z z OKI'0 13C Z81 iW =K C W Q a 0.= 9ye dC .. y C J N} F• p S a. e7 (~ 1i 0. p x Z "C w 0. K u. W = 0 0 y w .. W �' O 0 S S K < d rC aC s K O F < 1 >C 28 CHATHApA O"°' } CertJkilo ! • 111 Carporatlon . Parte nNp .. E*7Y 1W00. 1 hsve a CurrenUablity k%surarm policy or Its substantW equMalent vvfilch meets the roquiromenie of MGL Ch.142 Yet' IT No O a You'hwe chRciced jW. please Indicate %* type ooveraoe by chat ltln the Q appropate box A Iq► hKu tioe poky. Othar type. q; Ir,4cowly p Bond 0 dWNER'81NSURANCE WAIVER: 1 am aware that the licensee sl_ oes not Mve the kuumme cM� QuAer 142 of the Mast General Laws, and that my signature oe required by on this penntl appiicallon tfraMes tis 90 req hirenLd Check one: ne un o er or er s en Owner ❑ ❑ 1 Eby eerUfy that 011 of t1» dttalls and Information I We t"I'dedge arld that ell plumbing work and Installations per DwU06111 provisions of the M"I&Chusetu State pal 0 c I entered) true end a0aurate to the best of trey ,on will be In oaompur" WM aq riowm Type of1,loem: MNUW O (� f^v�. .a. ' -may-._ a. �'�'�!•^+v'-,.•r. .. .. s.r .. _ ..., ....x. '°rd ,•a,�tS..ve,,...t • t �A•.••...., .- ,.,. «..� •. ... rrwx.i,.w+w•N i .,rF YY 4Y.. (7�b #•_; `Y' A 1 '�•. .. .. -. ... • `• • •.".r +•RO • • ..., ,.. f': •.t-.. a F::: .: ""'%'! _ Sty Y• • • • • • • , 30 19 F ct 0► axe a».fi'r' •F�-'i �. :r� • , n rt.rt• M ' �'Pt y+rx , r.,rs t i+# - •. TMS.,#Si,.£ .« .. r • ' •...'.n•n:o..xr+...,.,»—..n+•.W'rn n. ... e . .+.rn a.,,r - ,. .r ,a a Y r >r ANA 16. 06 16 �. : �'., ( __ •#••• .p{....r... v+4v+.F i"!•�•ry ....,.Y•¢n4 'SMw..�vM •r r. t is w I i .9' M. 4 � • • l { ' 4r<.!-#-r•:•#a r.. �+ • ..,+kin•---..:.,t•:, .....,. . . r.. ,. AV- .. - - • • t k.a .. )•Yr •� .rW •• Y aw «•• ., r ... ,.,,.i.. + .....n R•rC n. ..i i � • C r . , . • .i M.,.Nlnw rMM'r.Y._,.r'F `A `,w - • 4.°:) �'' •!�� .. '� 4s'•' { �•,�.{ y Priv tr• ri.• ,. ka . '"�'' ,,it7l.. .. N^1�rnt,•{,k �` n*, ., t. ,. .si:rr-J!' - - t 1� A Date. /.l -' " ��" Y5- TI) 266? TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ScMus�� This certifies that Wil-?! C,(.� /•?��C .. , �. , , , has permission to perform�f14E-. plumbing in. the buildings of .. . t!`11G1�✓:..... . at ...7.���?! .. ......... North Andover, Mass. Fee,Z 7 :�... Lic. NoC�30 .. ............................. . j,Li `� PLUMBING INSPECTOR ( /C 9.35 —f O I-V Iffm 27.50 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File PER31IT NO. � 674 & APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP ID TE BOOK 'PAGE ZONE SUB DIV. LOT NO. -I LOCATION PURPOSE OF BUILDINe /r � 7 -SIZE OWNER'S NAME NO. OF STORIES OWNER'S ADDRESS /' y � BASEMENT OR SLAB ARCHITECT'S NAME _ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME7ffd,/ - SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED /! /!&� TORE OF F E E A79 5,2!(? PERMIT GRANTED woy. 8 IZED AGENT 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 15 a `%� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNERTELJ CONTR. TEL. A tl 3 s A 7 CONTR. LIC. q H.I.C. N ` o9 J3 t 7 At- Ott IS �-- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OfFiCES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 I3 CONCRETE BL K. _ PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ '/. 1/2 1/. FIN. ATTIC AREA N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 �_ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARD!✓'D COMMON ASPH. TILE STUCCO ON MASONRY _ _ STUCCO ON FRAME BRICK ON M N Y BRICK ON FRAME _ ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I-1 POOR ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE GAMBRELMANSARD I A HIP BATH 13 FIX.) TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOII L B'M'T 2nd _ Tit 13rd ELECTRIC NO HEATING r i THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. I of O I: c� I o � icv v cccc � momom c '�. cc Ljj z 0 1-+�d yr H C/) O s PI � ,rx o m o N E Q E ... co w CC i 0 _ a a a CD o Z a .. C3 QC y o c= GD CM O CA .cmc E m on (w z C� p CD ` m �i cc .� m W CD 2t,= � CD 0 oa .cc.10 m Cl. ECD" a y 'C3 0 c �:oioc C 0 CD • �' O Q N 0 C3 Cup V h O V CIO LL - C y n O .0 C F CO3 CL O Q tvw� m m LL F�- H 'CL= m c UA V _N E `- V m N Q 'O V Of O Dg c z t- cc •� 8 a " 0 1-+�d yr H C/) O s PI � a o z E `L w CC i 0 a CD Z a C3 QC y GD CM O CA E m on (w z C� p CD O C-) �i cc .� O CD 2t,= CD 0 oa Cl. a y 'C3 0 c C 0 CD Q 0 C3 _z V CIO LL - C .0 C _c Q CO2 CD Q Z z Z CL