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Home My WebLink AboutMiscellaneous - 795 TURNPIKE STREET 4/30/2018C O cn c vZ o m com m o i �S S �`-e-`�- ov, Date..�8" .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.:....'w�"................ V,..Jt/ ........'<..•...--. .......... has permission to perfom_,a /�✓/,`�**�/��`4 L...�l./�) ... wiring in the building of . . ........... . 4z at .... North Andover, Mass. Fee.?.A'A Lic. Nod'. .......................................................... ELECTRICAL INSPECTOR Check # 4 9,1J 8 { THECOMMONWEALTHOFMASS•4CHL C DEPARTAffi TOFPUBL1CSAFL7Y BOARD OFFDZEPREVEMONREGUL47YONS APPLICATIONFOR PERMIT TO PERFO. ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover MPSI e of Permit No. (% ,27 01R12:00 & Fee F ELECTRICAL WORK ICAL CODE, 527 CMR 12:010 Dat T he spectorc The undersigned applies for a permit to perfoQm the electrical work described below. { Location (Street & Number) Owner or Tenant OA i Owner's Address - v , Is this permit in conjunction with a building permit- Yes MV No ® (Check Appropriate Box) Purpose of Buildingf `�''i..�w- - A L eAA " ' Utility Authorization No Existing ServiceAmps d / !Volts Overhead Underground No. of Meters *7e v Service Amns / Volts'Overhead Underground No. of Meters Number of Feeders and A_ mpacity Location and Nature of Proposed Electrical Work- No. orkNo. of Lighting Outlets No. of Hot Tubs No. of Transformers Te ^s No. of Lighting Fixtures Swimming Pool Above KI Est. Below �i; Generators K� • No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of .Zones ; Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons No. of Dishwashers Space Area Heating KW Initiat!ng Devices KW No. of Sounding Devices- No. of Self Contained No. of Dryers Heating Devices Detection/Sounding Device„: KW Local Municipal ^, Other Connect;Ons 1L.�J1 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP M hmrta=COWrdge Amart to d)e MWWMET& ofMasmftsftGerlerA"vvs i Ihawaamo tLiab>7ityhm r=Pblicymdld gCMV]eie Cowragetrst aietpivakrt YES �p Ihawst>brnrttedvatidproofofsaQrlebtheOlhee YES j� !� If)mha�dledcedYF�,pT�ei &ab--theW,Clfoo by checidngthe box INSURANCE BON[ O UV R ( Spey) ... , .. WC&toStait ��..� it lD&Rec c1 RM9b Esturta>ed Value ofEictawc& $ Fmal Si�ladunder�itP�esof jury: � , _ , - -- . FMMNAME 1CeilSe” � Bt>sa>essTet IVo A}t Tet N0,T W0NER'SWSURAN WAIVER;Iamawarethatthel-i'ErWdoesnothavelheUMancecovEW0ritssubsiantia gnvalentasregMedbyMassachmcnGereralLaws rid thatmysignahueonthispeirritapplicah® t1mr0quimm m Please check one)' Owner Agent Tele � hone No. P Signalure PERMIT FEE o caner or gen The Commonwealth of Massachusetts)' Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit_ j FName Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Companv name: Address City: Phone # insurance. Co. -__ Policy # - 4 company name: , f,ddress Gam: Phone # Insurance Co. Policv #- FAture to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $170 ardor one years' imprisonment_as -vtell_as_civii.Renaftiesiniheform-ofa S?OP WORK_ORDFR-and_a.fine_of..($1AOM.)-artay.against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the MA for coverage verification. I d.9 hereby certify under the pains and penalties of perjury that the information provided above is true and correct llatUre. w aaie Prnt name P_bone.# Official use only do not write in this area to be completed by city or town official' City, IF Permit/Licensing Building. Dept [;'Check if immediate response is required Licensing Boa, p Selectman's C contact person: _Phone #: Health Depart) ' Ei Other Location No. -247 Date NORTH TOWN OF NORTH ANDOVER Ofs«•o ,•,tiG 41 Certificate Occupancy $ of �' '°',.•° •'<� asS aMusE Building/Frame /Frame Permit Fee 9 $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 11-141 e� Check # / 2-J, �j �{ {{,� ! 6 1 4 9 /� ` Building Inspect er TOWN OF NORTH ANDOVER BUELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER+ THAN OR TWO FAMILY DWELLING �A��ONE (N (MJF ti.. y �� ,ys� n P ^3 L , s Sion for Official Use On] fA.. Y„i r, ...'.. { ).. -, 3`?}.i:.7 'y Signature Telephone 3.1 Licensed Construction Supervisor BUILDING PERMIT NUMBER: DATE ISSUED: 3co 11-d11-0,3 SIGNATURE: Btu dill Commissioner/I or dBuildin Date Expiration Date Not Applicable ❑ gnature Telephone 3.2 Registered Home Improvement Contractor 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Address Expiration Date Signature Telephone Number Parcel Number 1 l 7mino L,f tet:..,,• [ll3Vq Ly LUIIMSJUHS: ZoningDistrict Proposed Use Lot Areas Fronts ft 1.6 BUR DING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R faired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System 0 �`t y v S.. _$,. ..sq 4f� +,•! Y 8. >.�A t, r.rP +i�e �`..i'�1'-'`� 2.1 Owner of Record Name (Print) Address for Service -44 —yl� '9 7 P lle,5 -P—,-31 ignature 2.2 Authorized Agent I, f Name Print Address for Service: ti Signature Telephone 3.1 Licensed Construction Supervisor s Not Applicable ❑ t�ddresrs� License Number as 07ZI %I Licensed nstructlon Supervisor: Expiration Date Not Applicable ❑ gnature Telephone 3.2 Registered Home Improvement Contractor Company Name Registration Number Address Expiration Date Signature Telephone ��ISN 4 4qCOW, "M I Z 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 Yea .......❑ No....... ❑ 5)E 4N 5 11') fl►ii S5IiQ1 if t % �%d ) �1 � �[i� S SuMa o 5.1 Registered Architect: Name: Address Signature Telephone S^21esb�re Name: Address: Signature Total Name: Address Signature Telephone Name Address Signature Name Address �jSignature Company Name: Responsible in Charge of Construction Telephone Area of Responsibility Registration Number Expiration Date Not applicable ❑ Registration Number I Expiration Date Area of Responsibility Registration Number Expiration Date Area of Responsibility Registration Number Telephone Expiration Date Not Applicable ❑ j a 5r�+4 Ala Pt�&3i1 ?,{makallapliabe} New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) OK Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 ❑ A-3 0 A4 ❑ A-5 0 1A 1B ❑ ❑ B Business [D/ 2A 2B 2C 0 ❑ 0 C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional 0 1-1 0 I-2 0 I-3 ❑ M Mercantile 0 4 0 R residential ❑ R-1 0 R-2 0 R-3 ❑ 5A 5B ❑ L S Storage ❑ S-1 0 S-2 0 U Utility ❑ M Mixed Use 0 S Special Use ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: i a - -All 112 .u'. 2 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area p5K Floor s Total Area s Total Height (ft) _ Independent Structural Engineering Structural Peer Review Required Yes SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ❑ No ❑ I, as Owner of the subject property Hereby authorize _ to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date 1' as Owner/Authorized Age Hereby declare that a statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Signed under the pains and penalties of perjury A??�Z— -��7 Print Name ,., gnature of Owne gent Date Item Estimated Cost (Dollars) to be Completed by pernut applicant 4 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of 9260 Construction from (6) 3 Plumbing Building Permit fee (g) x (b) 4 Mechanical (HVAC) � 5 Fire Protection 6 Total (1+2+3+4+5) Check Number NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEM[BERS 1 2ND 3� SPAN DEMENSIONS OF SILLS DE ---NS IS OF POSTS [jDRAENESIONS OF G RDER 3 GHOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r s T B � s �: JOSEPH WOJCIK DEVELOPMENT COMPANY, INC. 63 MIDDLESEX ST., P.O. BOX 647 NO. CHELMSFORD, MA 01863-0647 TEL. 978-251-7705 FAX 978-251-4651 NO. * 1496 Proposal Submitted to Dr. Schraders Page No. 1 of 3 Date 10/16/03 Street Job Name 795 Turnpike Rd. City State Zip Code Job Location Job Phone N. Andover MA We hereby submit specification and estimates for: Supply all equipment and labor to remove approximately 27 linear feet of existing partitions in waiting and reception area. Supply all equipment and labor to remove approximately 500 square feet of existing suspended ceiling. Supply all equipment and labor to remove approximately 500 square feet of existing floor covering. Supply all material and labor to install approximately 25 linear feet of new office partition as shown on prints dated 06/12/03. a) Wall's to be 2x4 metal stud framed 16" on center with 5/8 sheetrock on both sides. b) Wall cavity to have 3 Y2" sound attenuation blanket. c) All partitions to extend 6" above ceiling if possible. d) Existing walls to be finished 12" above existing ceiling if possible. Supply and install one 4-0x6-8 double glass door unit, one 2-6x6-8 glass door unit, one 1-6x6-8 solid wood door unit and one 4-0x6-8 sliding closet door unit. a) All door units to have wood jambs and casing. Supply labor only to install approximately 140 square feet of new carpet as shown on drawings. We Propase hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: 1/3 Down with Progress Pavments dollars ($43,800.00) Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner accprding to speci3fications submitted, per standard practices. Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry lire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Authorized Signature Joseph Wojcik Note: This proposal may be withdrawn by us if not accepted within 30 days. Arceptance of r can The above prices, specifications and conditions are satisfactory and are hereby accepted. You are auth Ize o wo c as specified. Payment will be as outlined abo /G Sign ture Date of Acceptance: G Signature JOSEPH WOJCIK DEVELOPMENT COMPANY, INC. 63 MIDDLESEX ST., P.O. BOX 647 NO. CHELMSFORD, MA 01863-0647 TEL. 978-251-7705 FAX 978-251-4651 NO. * 1496 Proposal Submitted to Dr. Schraders Page No. 2 of 3 Date 10/16/03 Street Job Name 795 Turnpike Rd. City State Zip Code Job Location Job Phone N. Andover MA We hereby submit specification and estimates for: Supply labor only to install approximately 360 square feet of marble tile as shown on drawings. Supply labor only to install casework as shown on drawings. Supply all labor only to install approximately 500 square feet of new suspended ceiling. a) New ceiling height to be 9' if possible. b) Installation to include sound attenuation blanket on both sides of new walls above ceiling. Supply labor only to relocate existing H.V.A.C. supply and return diffusers. Electrical as follows: Install lighting circuits to supply adequate power for 29 fixtures. Install 8 switches (dimmers not included.) Install 8 duplex receptacles with proper circuit. Install 6 designated circuits (4 of which is at reception desk.) Install 4 category 5 phone lines. We Ilropose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: 1/3 Down with Progress Pavments dollars ($43,800.00) Payment to be made as follows. All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to speci3fications submitted, per standard practices. Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders. and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry lire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Authorized Signature Joseph Wojcik Note: This proposal may be withdrawn by us if not accepted within 30 days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be as outlined above. Signature Date of Acceptance: Signature JOSEPH WOJCIK DEVELOPMENT COMPANY, INC. 63 MIDDLESEX ST., P.O. BOX 647 NO. CHELMSFORD, MA 01863-0647 TEL. 978-251-7705 FAX 978-251-4651 NO.* 1496 Proposal Submitted to Dr. Schraders Page No. 3 of 3 —.___._..._.._.__._..._.__.... Date 10/16/03 Street Job Name 795 Turnpike Rd. City State Zip Code Job Location Job Phone N. Andover MA We hereby submit specification and estimates for: Electrical Continued Install 1 fax outlet. Install light and GFI in bathroom. Install small sub panel. Price includes — permits, electrical demolition, temporary lights. Price does not include — service upgrade if needed, smoke/heat detectors, emergency lights, lighting fixtures. (Existing may be used if approved by inspector.) Price includes a $1,000.00 allowance for ceiling material. Be Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of` 1/3 Down with Progress Payments � FA P, �a } f �(dollars ($43,800.00) Payment to be made as follows. All material is guaranteed to he as specified. All work to be completed in a substantial workmanlike manner accokding to speci3fications submitted, per standard practices. Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry lire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Authorized Signature Joseph Wojcik Note: This proposal may be withdrawn by us if not accepted within 30 tolLl 1twork at - The above prices, specifications and conditions are satisfactory and are d as specified. Payment will be as outlined above. Date of Acceptance: Signature HeDuffee Insurance, Date: 11/10103 Time: 02,30 PH To: Art @ 19782514551 - ACORq CERTIFICATE OF LIABILITY INSURANCE 1ii10�2o 3 )RODUCER (979)433-2729 FAX (978)433-8658 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO1 David H. McDuffee Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 Hollis St, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV PO Box 1497 Pepperell, MA 01463 NSURED W D C Contractors Inc P 0 Box 647 No. Chelmsford, MA 01863-0647 INSURERS AFFORDING COVERAGE NAIL # NBLRERA: Commerce Insurance Company 34754 NSLREFB: Liberty Mutual Ins. Co, 2304: NSLREF C: NSLREF D: NgLREF E: THE POLICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE FOLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 488 kDD'L TYPE OF INSURANCE POLICY NUMBER POU CYEFFECTIVE POLICY EXPIRATION 12/15/2003 LIMITS EACP OCCURRENCE $ 1, s ODO 000 GENERAL LIABILITY X COMMERUALGENERAL LIA81UY XX6567 12/15/2002 DA�AIRI AGET0RFNTED SO 000 � (F= nrrurHnr^ $ CLPoMS MA=„_ I OCCUR MED =_XP C'An y cna Pylson) $ 5,000 A PEREONAL&ADV INJURY $ 1,000,000 GENEAALAGGREGATE $ 2,000,000 GEN'L AG3REGATE'_ MIT APDLIE- PER: PRODII 7,z - COMP/C!: AGG $ 2,000,000 'p -ICY JET F_OC AUTOMOBILE LIABILITY ANYAUTO 03MMP20973 06/17/2003 06/17/2004 COMBINEDSNCLEUMT (=dar,; den0 A XBODILY X X ALL O'WNEC AUTOS SCHEDULFDAUT0A H RED AUTOS NON -OWNED AUTOS INJURY (erpe,Eol) $ 250,000 BODILY INJURY $ ('er ac i7ent) 500, 000 PROPERTY DAMAGE $ (Ier ac-ident) 100,000 GARAGE LIABILITY AL!TC ONLY - EA AOCIDENT S .ANYAUTO EA ACC $ OTHER THAN _ AUTO ONLY: A(3G $ EXCESSNMBRELLALIABILITY OCaJR ❑ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE 1ETENTON $ $ WORKERS COMPENSATION AND WC231S330700-013 09/27/2003 09/27/2004 X �''1`-S ATII OTH- � EMPLOYERS' UAB1UTY E.L. EACH ACCIDENT $ 100,000 B ANY PROPRI_TORiPARSNERRLX-CJTIVE OFFICER/MEMBER EXCLUDED? I` yes, descr ba u;ider E.L. DISEASE - EA EMI-OYEE $ TDO, 000 E.LDISEASE-POUC"UMIT $ 500,000 SPECIALPROVISON$belwi OTHER )ESCF:UPTION OF OPERATIONS I LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS - Town of North Andover Building Dept. 27 Charles St. N. Andover, MA 01845 40ORD 25 (2001108) FAX: (978)2 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRrrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAILSUi H NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Carmen Sarver/SARVER C:ACORD CORPORATION 1988 P McDuffee Insurance, Date: 11%10/03 Time: 02:30 PM To: Art a 19782514651 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it sfflrrnative!y or negatively amend, extend or alter the coverage afforded by the policies listed thereon. SCORD 25 (2001/08) -VbftWdM North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signatywgof Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a ✓/� TOOmtmaomu2 nJrJR'.�' RI./.aelta 3 I<F BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 072148 w Birthdate, 03/01%;952 Expires: 03/01/2004 Tr. no: 17332 Re§tricted: 00 ARTHUR R MYRON 63 MIDDLESEX ST/PO bX 647 e r, N CHELMSFORD, MA 01863 CA m X /mom/� VI m CP CA .0 a Z CD O CL � d CL > .o CD CLa Q c5 CD O .... CO) 'O CD 0 CA go O CO) 'O Ci 0 d n CD CD rP CD CSD y. 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U) i-- C 3z>O � � rnz pNk rm U lP rn Z -�{ pz rn p Oz NO z� m U'd z0 -D (- Z c -_-� mT - - _ �rn CA =i rnr -rnr 3 y z 70, �� p _ Zrn �1 � rn 70 �� rn'-x N A fir- �rn� �� A O� d I I I I I D= u "� Orn DO p I=' rnd�n rn��rn �d n� ��70 � 0 �� rnz CJrn�►p � r rnrn� dz �rni3O �p z r Q Q D D D rn o rn C1► Or�C� n z G�� c< N� N N� rn m � z Z D �' rn d rn z D- r -n o Gl rn rn G, G, rn G, o r�r Z 70 iu rTi A 70 rn 'M vo W t�0 O GJ W b) W N x x 5i X vo z ' O --pp OZ Fil w o M N --j (� -°0 a 0 �m rn w n cr) Z � u S =R R D r = n D CD D � < rn Fl O �- n � rn r � 03 z _ -t7 o M �e ZZZ n (p �+ D Z o Z---- a m rn O j N W vo W t�0 O GJ W b) W N x x 5i X vo z ' O --pp OZ Fil w p M N --j (� -°0 a 0 �m rn w n cr) Z Q u =R R D r —p n D < rn Fl co Z N ® AD. z �A M ZZZ a O �+ Z o Z---- m vo W t�0 O GJ W b) W N x x 5i X vo z ' O --pp OZ ♦ w p M 00 --j n o 0 �m w w n cr) vo W t�0 O GJ W b) W N x x 5i X vo z ' O --pp OZ ♦ A p � 6 fn n o A o UN =R R D n D Fl Z N ® AD. M ZZZ � A �, O W . m rn� _ \V D C- m m r � D -�r7 D W a 1. vs -n N O C -�6 "I -ua CD ZQD m 5 �u crz O w, r � v Q. m Ua co n j CD z Q- CDO z b Z--- C 7n c M z --ic m m r D z w p M N CmJt M M u O w VO ) � CA) n cn C 7n c M z --ic m m r D z R1 O O IZUZ N lt� 3Zo d L N CmJt M M u z� D VO ) Cfl m z 0 CP N �U z 0 CQ 0 Q R1 O O IZUZ N lt� 3Zo Uri UPJ N CmJt mP u N 0 CP 0 CP 0 CP 0 CP 0 CQ 0 Q 0 C�1 0 Cu 0 U) 0 C�1 0 CQ 0 O 0 O 3 FA�z d rn z p z Fn m 0> OFnz n 0 rn z U T c m 0 N z z r d U) c U � p = c ri U Z m p N m c X N T D D z mrn m 1�1 3 3 3 3 3 3 O Z > z U' u N z Q � z u 0 z CJ lr z Q N z u N z d z T m u CP z m u 0 z m C3 U) z m CJ N z m Q 1p z Q 0 z -n . . . . . . . . . . . 3 3 om -n7(3 r- n M> m N° 4517 Date.......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that ...:a �.... ""... has permission to perform :_.. ............. �f plumbing in the buildings of s.....*..fir........................ at .. ...E.!!':-r`��``{.. ....... North Andover, Mass. Fee,?)...... Lic. No 1 1` ..... ��_ �,... �................ . ` of PL7MBINGI N/S'ECTOR Check # /� V WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR KRMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location %/M r New 1:1 Renovation 13 Owners Name Type of Occupancy .Q" - Replacement 13 Plans Date Permit # Amount qO Yes F1 No 11 &.141 IOWA= (Print or type) Installing Company Name' Check one: 11 Corp. _ ❑ Partner. . IV -1r- VQU.017 ' Business Telephone 03" ,�— ,6V Finn/Co. '14ame of.Licensed Plumber. 1�zLd Insurance Coverage: Indicate the �e of insurance coverage by checking the appropriate box: 1 �I Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Certificate ignature Owner F1 Agent I hereby certify that all of the details and information I haa submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work an sta alio performed under P sued for this application will be in compliance with all pertinent provisions of the M ac efts to P bin C r 142 of the General Laws. By i alureo rcensePlumBer ' Type of Plumbing License Title /a3? City/Town icense rqumDer Master Joumeyman ❑ APPROVED (OFFICE USE ONLY MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date � � 19 Permit # j Y /'7 Za. •r. Building Location �Owner's Name �fG>lt Type of Occupancy l�V G New Eo' Renovation ❑ Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No ❑ Installing Company Name lE'�!��Check one: Address Jr y y .k Corporation _ ❑Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have aYes cu ent i N inssurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy e Other type of indemnity ❑ Bond 0 Certificate` IY4K/ 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. Signature of Owner or Owner's Agent Check one: Owner O Agent 1 herehy certfly that all of the details and information I have submitted few entered) in the aimve applicanim arc true and accurate to if hest' my know Re and this .ill plu wo and inuallaimm perkwmed under the pen issued fnr this application will he in compliance with all pemnent prmkicw rd the "i4mch $ta t:I Cmike-. (hspte. 142 rd the al 8v tYPe of Lict•nw -Cr I I ... .... Irntmrythr THM `"hirr ndn tanmnI)/ m/u/rniI / r� nrafiner t! riry/rwn Nund.v APPR(NED wFFICE USE ONLY 1 UPI Uj UA, CA ..;.. in 1A ud •- - - - •. 10 - - -ErnTo M. ■■■■■■■■■■■■■■■■■■■■■■■■■2nd FLOOR3rd FLOOREFTEr. M. Installing Company Name lE'�!��Check one: Address Jr y y .k Corporation _ ❑Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have aYes cu ent i N inssurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy e Other type of indemnity ❑ Bond 0 Certificate` IY4K/ 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. Signature of Owner or Owner's Agent Check one: Owner O Agent 1 herehy certfly that all of the details and information I have submitted few entered) in the aimve applicanim arc true and accurate to if hest' my know Re and this .ill plu wo and inuallaimm perkwmed under the pen issued fnr this application will he in compliance with all pemnent prmkicw rd the "i4mch $ta t:I Cmike-. (hspte. 142 rd the al 8v tYPe of Lict•nw -Cr I I ... .... Irntmrythr THM `"hirr ndn tanmnI)/ m/u/rniI / r� nrafiner t! riry/rwn Nund.v APPR(NED wFFICE USE ONLY 1 H z G W d H z Vf H W V 0 O V L a I, v z 1 �! � N N w } C7 J � Z H O v k N O o o z W-1 < V L6 . �• O 3 LU a m d C. 0 z 0 96 z = m c � Ga96 Z z Q m z p -+ W N o m C6 V 96 D . a c CA W W v -War -- TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installationG in the buildings cif ./...f at Fee(.� Lic. No. ��... . wes/A4 �9.A ? 7 2 fir. oo PAID WHITE: Applicant CANARY: Building Dept. ........r.........:. North Andover, Mass. VGAS INSPECTOR PINK: Treasurer GOLD: File Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installationG in the buildings cif ./...f at Fee(.� Lic. No. ��... . wes/A4 �9.A ? 7 2 fir. oo PAID WHITE: Applicant CANARY: Building Dept. ........r.........:. North Andover, Mass. VGAS INSPECTOR PINK: Treasurer GOLD: File