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HomeMy WebLinkAboutMiscellaneous - 83 OLYMPIC LANE 4/30/2018 (2)1-1 4. 4-4 4:1 ca t- 0 51 -C:, "cq on -C� 00 P� -0 jz .0 48 r-" C� -0 - ;3 -2 .cj 0 r- 0, u o 0,0 ts -ti �01 u 9-5-4 P. - .3 2? 43 'C$ Tj Ro 0, P 90:1 0- 0.0. 09 �C>dl —0 C5 E rl C� "So .0 2 .0 V g -q .9 —.0 -) � 8 col ,":d: eq . 0. 0 r.q bo su 4) r - bo 4. 00 o 1-4 U >,.rz 4, 0 0 0 0" 0-0 en A 80 �g bp ,ti 2 Ed o 'o -0 .2 �U 4,, 0 N 0 -�W 0 , r: 0 z o s 0 8 u 'o 5 -.0 ZS - 0 0 11 46 Ej o �3 -Ei 4 0 Ei !�i 2 ts S I � " 1- 0 =— �4. 8 2� o � v Ad or- 0 2 0 Cj 0 0 0 Ej 23 Er '0 2 -�s Y n 03 20 0 Q M 1!4 u El 4) -Zma k Date //—. - 2 ... ?// .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that N(16?m ......... ........................ has permission to perform ...... ........... wiring in the building of ..... at ...... 04�1 I ...... ................ , North Andover, Mass. Fee..//J...— Lic.No..a Check # 10454 Commonwealth of Massachusetts Official Use Only NEW Department of Fire Services PermitNo.d�%� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] (leaveblank 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 WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned Ives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3 V Owner or Tenant S Q Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 12"'- No ❑ (Check Appropriate Box) Purpose of Building o_- tmoL)e ( Utility Authorization No. .------ Existing Service i Amps New Service _ olts Volts Overhead ❑ Undgrd U`,, No. of Meters Number of Feeders anu.ruupacuy Location and Nature of Proposed Electrical Work: Cmmnlatinn nfthe fnllnwinu tahle mnv he waived by the fn.cnectnr of Wirer. No, of Recessed Lumi"aires 2 No. of Ceil: Sus addle' Fans F'' �� No. of Total Transformers KVA No. of Luminaire Outlets 1 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ 'In- ❑ nd, rnd. o. o Emergency Lighting Battery Units No, of Receptacle Outlets (� No. of Oil Blirne.rs FIRE ALARMS No. of Zones No. of SwitchesNo. J of Gas Burners No..of Detection and InitiatingDevicesNo. of Ranges 2 No. of Air Cond. Total Tons No. of Alerting Devices . No. of Waste Disposers Heat Pum Totals: P 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 KWNo. . Heaters 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: - c (When required by municipal policy.) Work to Start: 11 — 5' l ( Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perju , tha the information on this application is true and complete. FIRM NAI 1ME: g in �A _13q/J ( e Ste, C LIC. NO.: _ Licensee: L2J11 LC4'AtM � Signature LIC. NO.: (If applicable, enter "exemp{" in the license number line.) Bus. Tel. No.: Address: * %%rrJPTa#—J Fil vci.rzi ,mac 4K- 'It, Alt: Tel. No.: ---r -- *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. I am the (check one) ❑ owner ❑ owne Owner/Agent ,. _.�....�._.. I PERMIT FEE: SIMS HIM The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 C , www.hwss gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nn.linonF r..� .._....i•.._ Name (Business/Organization/Individual): Address: q d City/State/Zip:�� A� d/2oZ /U(� Phone #:. Are you an employer? Check.the appropriate box: - I. ❑ 1 ' 'a employer with 4, ❑ 1 am a general contractor and I ployees (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 su&contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 din a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No•workers' comp. c. 1.52, § 1(4),'and we have no insurance required.] t .employees. [No workers' comp. insurance required.] *Any applicant that checks bot # I must also fill out the section below show' h ' k ' '- Type of prgject (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑;Building addition 10. ❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑.Other t Homeowners who submit this affidavit Indicating they am doing all work and then hire outside contractors must submia new affidavit indicating such. - #Contractors that check this -box mustrttnebed an edditiaral shset showier Ole name of the subcontractors and their imrkams' camp. pclic, :n:n, m„atioa. I arra an employer that is pr,?Vzd!ng:wD �tters I cor4pemaa0I1 &SUI ance, jroP iPk inforrraadon. � eP18pI0y2es: fed®w is Plae policy sand job site Insurance Company Name: Policy # or Self -ins. Lie.. #: Expiration Date: Job Site Address: Cita/State/Zip: Attach a copy of the workers'.'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a• fine up to •$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against -the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Sienature: Date: Official case only- Do not write Leif- s arr ea, dobe camp'eted by chy or town. ofjiciai City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town-Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Oth6r Contact Person: Phone #: M Date.. !� ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . A��I. ( ;O� .. ) ......... e 0 has permission for gas installation . ......... in the buildings of ... ................... at �n ...... North Andover, �4ass. Lic. . ...... Fee. . ... .......... GAS INSPECTOR Check U k 4 'LIN MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: �� 1�a�LnnA. Date:' -1 Permit# Building Location: /ri( �/� j� UJ Owners Name: � 11 V`} t, G. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential RL - New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No SUB BSMT. BASEMENT 1 FOL OR 2 FLOOR 3 FAD LOOR 5"' FLOOR 6 FLOOR 7 FOL OR 8 FLOOR FIXTURES uj W co IX a rn (n _ m= O w W 0 CO F O= mo w 21-- 1-- Z O } W OZQ, 1W112111111 n W W O Iw- 5 > w Z to �0 Q a H W W X uj > U W Z CIx CO q w7 � w Z x Lu O cn 2 l' - w OZ LU Ix M Q W W W m O Z O 0 H> z LU W f- x c� o o u_ 0 c9 x x W O CL F M>> O Installing Company Name: f Address:. lj-j M1-tTj(- VV rf City/Town:_!�3Lo (`7 62 State: Business Tel: _701 2 6 2&> Fax:, Check One Only Certificate ❑ Corporation ❑ Partnership Name of Licensed Plumber/Gas Fitter: ,— ❑ Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 9No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Q 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 ❑ By checking this box ❑; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code anfJ,E�app"42 ojt* General Laws. By Type of License: ❑ Plumber Title ❑Gas Fitter Signature of Licensed Plumber/Gas Fitter [+lblaster cityrrown p.lourneyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer v ♦ a -COMMONWEALTH-OP MASSACHUSETTS ""Ovii AN IMLICENSED A A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: j ROBERT F PESPISA j r 3 WASHINGTON ST I� BEDFORD MA 01730-24 15151 05/01/12 788102, f @mm(m F Fold, Then Detach Along All Perforations 9,171 TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING 41 'q CHUS This certifies that eV.1Vr1 ................... has permission to perform ... kr)OLA4)�>A ............ plumbing in the buildings of . . Z/.'" I ....................... at. . C).)V.M . �0 ............. , North Andover, Mass. Fee.-P'4� Lie. No .......... .. lf)c ......... Check # -75-5-- PLUMBING INSPECTOR �Zav 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town _i�iCj Nnn Jt�p( P. MA. Date: %/—/ — 1 � Permit# Building Location. 3 Oy►, � � - �� ,G7Co1 V Owners Name: (,� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No [. FIXTURES 0o a DEDICATED Z\ z SYSTEMS N W Z O Ln [ri O Q L" Z o: z� z a ¢ W WLU z m p m a oac ~ w Ln Z ¢ Q a w p v Q W Q Z 0.�' D: LO C7 4 X N Ln W I^ d = 4 u C Q Q 0 1- V > 0 O a z y H w Otl W cu Q m m D D S S y 0 FQ- 0 p 0 w Q ccn -SUB BSMT. Q 3 BASEMENT 11T FLOOR Y 2ND FLOOR 3RD FLOOR 4T" FLOOR 5T" FLOOR 6T" FLOOR 7' FLOOR 8TH FLOOR Is7sta!1M.1c, con'r la8m `-LW�1 V � � C; sc' '( One 0,-.!v Address: (�.1l{t► (1'V/' P El Corporation State: El Partnership Business Tel: Z�I_ �3�_�9�y Fax: Name of licensed Plumber: � k El Firm/Company � lr' INSURANCE COVFRar,F• 1 have a current2121 PtLr insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes JN,,No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. PJ' Other type of indemnity ❑ Bond ❑ - OWNER'S INSURANCE WAIVER: I am aware that the licensee does�Ve 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 Siqnature of Owner or Owners A ent Owner ❑ Agent ❑ Hereby certi,y that allot the detat)9 and information I have submitted (or entered) rE Knowledge and that all pl!�mbing tA' k and installatio,.s performed under the permit Pertinenf provision of the P/las"Ch usett. state Plumbing Code and Chapter 742 off] 3y Type of License: -itfe ❑ Plumber ity/Town_ [Master - PPROVED (OFFICE USE ONLY) ❑Journeyman Signature of Licensed are true and accurate to the bast of ry m will be in compliance with all License Number: 7 4 L 4 Date. /02. / el-� ....... TOWN OF NORTH ANDOVER At to 41 PERMIT FOR GAS INSTALLATION 'ISS CNU 7/ This certifies that ... /?.C. ��z'-'. .............. has permission for gas installation ... /-//� ..................... in the buildings of ............................. at ....... I North Andover, Mass. Fee3.-�- Lic. No.,/.(i. .. ...... Y. - GAS INSPECTOW Check# 2 ) -? �, 0 IV I:IXTI IRFA 0.'Ui W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: IJ n rAh N e\ 8 over MA. Date: Nov . ZZ r 'Z-(nA 5 Permit# Building Location:_(61 d \ 4 vh p � f Owners Name: S f-Sk-e_r, &� - n� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New: ❑ Alteration: ❑ Renovation: ❑ Replacement:JCf Plans Submitted: Yes ❑ No [� I:IXTI IRFA 0.'Ui W Z m N to W Q = F = w W = ZF- O q W Z V X to W IN— O O 1aa— � N W W W p m O Q W IX [L H G it W X U) 0 `l U W O U) p� 0 J Q W W O W F = p= W LL W Z Z >- N F H J Q OO m 2 W J O O Z LL W O U)�> Z W W F' _ v o o 0 0 z z O IL ga >>> O SUB BSMT. BASEMENT 1 1 FLOOR 2 Nu FLOOR 3 FLOOR Z -FLOOR 5 FLOOR 6 FLOOR TR FLOOR 81H FLOOR Installing Company Name: �ky6ro - Croy, PWmIt, n "t �}e- Check One Only Certificate # Address: 12-2) 6f -es (-ee City/Town:I. ,(Ah %\-\ owistate: f` ❑ Corporation [:1 Partnership Business Tel: b 6 Fax: 166 ❑ Finn/Company Name of Licensed Plumber/Gas Fitter: T\-Novho,-S 0" C pv\hCp�— INSURANCE COVERAGE: I have a current liabllitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 9 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy d 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 El By checking this box ❑; I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By [Plumber Title E] Gas Fitter OMaster Signature of Licensed Plumber/Gas Fitter City/Town ❑Journeyman License Number: \ 0 k 6 0 APPROVED OFFICE USE ONLY 0 LP Installer 8 716 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �Fhis certifies that ................. has permission to perform T-:-. !�-. (-� .......... plumbing in the buildings of ..................... at ... J 0 jc .................. North Andover, Mass. Fee. 3 Lic. No./.Cl/ 6. e ... ...... ........ PL 81 1 NS G��R Check# GIYTI IDCQ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: Nor4�\ ArAOve,r ,MA. Date: Nov. Z2 10k0 Permit# Building location:3 OC G.'^p Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No, y GIYTI IDCQ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 9 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 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 Owner's Aaent 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my r%nowseuge and tnat an piumomg worK and mstauauons perormea 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: ��%� C),- C � Title. iPlumber Signature of Licensed Plumber y rrown ff master CitAPPROVED OFFICE USE ONLY ❑Journeyman License Number: � d (o 0 DEDICATED Z SYSTEMS Ln F Z 0 ell If C 4A Z Y ZyU) ~ Y C a x t/f a Z W 99 Q 0 Q Q a W fY W a 3 m {A CC W �.' Q to '=' Z a N Y ae o: of vi N O z v a x ;5 a x -` ~ a LU 3 0 0 3 Z 3 A a Y W d' WW cis W Or VW �3y F Q a m a c m c c o 0 v>> x x S 5 ,, 0= o H a a a 3 3 a 3 v a oWe a �. m �, o a 3 SUB BSMT. BASEMENT 1n FLOOR 2ND FLOOR FLOOR 4m FLOOR E!T" FLOOR 6' FLOOR 7 FLOOR 8 " FLOOR (, Installing Company Name: N'J A'ro , CC4"V � Check One Only Certificate # ` ❑ Corporation Address: tZS Fofy_S* City/Town: 1'iorkh A �`nyeAtate: El Partnership Business Tel: N+b - Wb +6 Ip Fax: 6 £' k b 6 Firm/Company Name of licensed Plumber: T1n©y­,o.S O'CcoV\�r\©r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 9 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 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 Owner's Aaent 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my r%nowseuge and tnat an piumomg worK and mstauauons perormea 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: ��%� C),- C � Title. iPlumber Signature of Licensed Plumber y rrown ff master CitAPPROVED OFFICE USE ONLY ❑Journeyman License Number: � d (o 0 IV This certifies that .... ................. -e ................ has permission for gas installation . . in the buildings of .�:o .............................. at :F.3 c .............. North Andover, Mass. Fee..)..�. Lic. No... �-x. � e� .. ...... ..... - ..... GASINSPECTOR 'i Check # / ?'�- '1 '2 5947 Date. ......... ,,ORTH ZHANDOVER TOWN O��'q PERMIT- FOR GAS INSTALLATION This certifies that .... ................. -e ................ has permission for gas installation . . in the buildings of .�:o .............................. at :F.3 c .............. North Andover, Mass. Fee..)..�. Lic. No... �-x. � e� .. ...... ..... - ..... GASINSPECTOR 'i Check # / ?'�- '1 '2 5947 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FITTING (Type or print) Date /—//y C1 NORTH ANDOVER, MASSACHUSETTS Building Locations 93 0 /vi./�) t ' c' Permit # S" T Y Amount $ % 1 Owner's Name L/ 0 / / 1,v New Renovation D Replacement u Plans Submitted (Print or type)Q J / Che k one: Certificate Installing Company Name L A / �1 � / �L _ 7 Corp. Address -6-n 3ok- r6Il--f Partner. users Te ep one C�N'' 7--4CD airm/Co. Name of Licensed Plumber or Gas Fitter pv Z 51-4019? 4" 14W _..per INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy [a Other type of indemnity 0 Bond 13 'Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 - --� ----- 11" 111-11—L-13 1 Ilavc 5UU1111LLOU kUF cmerea) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and instal Ion perfcfned under P�nit Issued fir this appliestion will be in compliance with all pertinent provisions of the Massach tts ate GrCou"d Cb(at4p.r 14? of AP By: Title City/Town APPROVED (OFFICE USE ONLY) S' ature of Licensed Plumber Or G itter Plumber V, Q Gas Fitter TIcense Murnoer 13 -master Journeyman � a COD o a a °° x Q F x C Z o z w w Z W O A UF z Fr F H C7 > Z U a A W x o > o a H o SU B-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)Q J / Che k one: Certificate Installing Company Name L A / �1 � / �L _ 7 Corp. Address -6-n 3ok- r6Il--f Partner. users Te ep one C�N'' 7--4CD airm/Co. Name of Licensed Plumber or Gas Fitter pv Z 51-4019? 4" 14W _..per INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy [a Other type of indemnity 0 Bond 13 'Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 - --� ----- 11" 111-11—L-13 1 Ilavc 5UU1111LLOU kUF cmerea) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and instal Ion perfcfned under P�nit Issued fir this appliestion will be in compliance with all pertinent provisions of the Massach tts ate GrCou"d Cb(at4p.r 14? of AP By: Title City/Town APPROVED (OFFICE USE ONLY) S' ature of Licensed Plumber Or G itter Plumber V, Q Gas Fitter TIcense Murnoer 13 -master Journeyman Date. . '3 TH 0 * I TOWN O,F NORTH ANDOVER f PERMIT FOR GAS INSTALLATION This certifies that- ................. has permission for, as installation .............. in the buildings of .... 7 .................................. at ............. ......... A�. ...... North Andover, Mass. Fee,.... Lic. No./90 / .... .......................... GASINSPECTOR Check # G MASSACHUSETTS UNIFORM APPLICATION FOR P 'RMIT TO DO GASFITTING (Print or Type) Mass. Dabe -f -D ZO Permit # Building Location ' Yr% L PLC . _ 1 _ V 0 ers Name ?[:�--t v/J Type of 0c upartcy e l'r N r' New Renovation ❑ Replacement /' Plans Submitted: Yes ❑ No Installing Company Name i3oLV� 14A chprr nnw rort;ts..�b Address 14-7 2 l L)-C,n, I)J ❑ Corporation firV,, J oa z4,.- vi1 p o 8 l O Business Telephone Ct ? (o�� Z Sci 6 ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes ❑ NO w` If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Genera%Laws, and that my signature on is permit application waives this requirement Check one: Owner Agent ❑ I hereby certify that all of the details and Information 1 have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued For this applicationn compifance with all pertinent provisions of the Massachusetts state Gas Code and Chapter 142 of the General La Type of license: — BY ®-Plumber Slorditure of Licensed Plumber or Gas Fitter Tide ❑ Gas fitter City/Town ❑ Master License Number /Pogo APPROVED (OFFICE USE ONLY) a Journeyman ° i • i • IMPTIONE---m.-.-n.--.-- ..® .m..m ..............® Ichl• • ' ..............�.-..� CUMF191611M MMMMMMMmmmm MM 1,711"19• e ' ................... e s WMMMMMMMNM MMMMM NM Installing Company Name i3oLV� 14A chprr nnw rort;ts..�b Address 14-7 2 l L)-C,n, I)J ❑ Corporation firV,, J oa z4,.- vi1 p o 8 l O Business Telephone Ct ? (o�� Z Sci 6 ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes ❑ NO w` If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Genera%Laws, and that my signature on is permit application waives this requirement Check one: Owner Agent ❑ I hereby certify that all of the details and Information 1 have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued For this applicationn compifance with all pertinent provisions of the Massachusetts state Gas Code and Chapter 142 of the General La Type of license: — BY ®-Plumber Slorditure of Licensed Plumber or Gas Fitter Tide ❑ Gas fitter City/Town ❑ Master License Number /Pogo APPROVED (OFFICE USE ONLY) a Journeyman ° Z1 � s� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or T pe) rce✓�� ,Mass. w�i Date building LocationPermit # l6 d . Own rs Name .1a, 2H New '-'1 Renovation D Replacement Own Submitted =] FIXTUP.-S (Print or Type) Chec one: Certificate Installing Company Name ANDOVER PLG. & HTG. CO. INC. Corp. 1051 Address 57.31 SO. UNION STREET Partner. l; LAWRENCE MA. 01843 CJ Firm/Co. Business Telephone: 508-685-8383 i Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond E] 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 coverages. Signature of owner/agent of property Owner Agent E 1 hereby certify that all of the devils and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing .cork and installations performed under Permit iuced for this opptieation will be In compliance with all periinrnt Provisions of the Massachusetts State Cas Code and chapter 142 of the Genesal Laws. ME (Print or Type) Chec one: Certificate Installing Company Name ANDOVER PLG. & HTG. CO. INC. Corp. 1051 Address 57.31 SO. UNION STREET Partner. l; LAWRENCE MA. 01843 CJ Firm/Co. Business Telephone: 508-685-8383 i Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond E] 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 coverages. Signature of owner/agent of property Owner Agent E 1 hereby certify that all of the devils and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing .cork and installations performed under Permit iuced for this opptieation will be In compliance with all periinrnt Provisions of the Massachusetts State Cas Code and chapter 142 of the Genesal Laws. TYPE LICENSE: Plumber Glumier Signature of Lic n§ed Master Plumber or Gasfitter Journeyman'' License Dumber 1w Date..................... ,ORTAi TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION v This certifies that ........................................... has permission for gas installation ............................. in the buildings of .......................................... at .................................... North Andover, Mass. ... ....... Fedo/a/94.(%:,4Lic. No 12.50 ... PAID . .... GAS . INSPECTOR ........... WHITE: Applicant CANARY: Building Ddpt. PINK: Treasurer GOLD: File Date - 7--� .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .......................................... has permission to perform ................ plumbing in the buildings of ....................... North Andover, Mass. at ......... OY/ / n- Fee-.q'� Lic. No.'1.2.�-? ... .... ............ PLeBIN-21'NSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM �iING (Print or Type) i / AJ DO(/ ,Mass. Date �c,mit # [W Building Location 83 OG N /A,0 r C- iv,-) Owner's N. (a r -.l a 3 J AAA p t 8-15 Type of New ❑ Renovation ❑ Replacement lE""' Plans FIXTURES ,N ,\j `= I rJ rJ Yes ❑ No ❑ A Installing Company Name Pi [. ,Mel L2 • S P(r MA -T A e Q Check one: Certificate Address �� i C'L AC H mean) ❑ Corporation rY) E TN I' Fn) hl A ❑ Partnership Business Telephone - iq -7 ( 2-Arm/Co. Name of Licensed Plumber 2f r3 r=�? T fy1 SA,�t�IrYl,q req. -0- �- INSURANCE COVERAGE: I have ayes current fiablIfty insoura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked ves. please indicate the type coverage by checking the appropriate box. A liability insurance policy ld" Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e andapter of the eral Laws. v(. L Title re of Licensed Plum r 2Type of License: Master % Journeymah ❑ City/Town APPFiONED(OFFICE USE ONLY) License Number 133 1 m m O m r O O O m A m c N m O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 7 �� Date IMPORTANT: Applicant must complete all items on this LO CATION O V 00 121 C L-ayt P Print PROPERTY OWNER /I/l �, '�-1✓1 rte- Chrbc Gn a V-\ I/ Unit # Print MAP NO: PARCEL: ZONING DISTRICT: n —I Historic District yes n Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family A Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ ion Demolit ❑ Other ' OfSeptc� Dwell ❑Floodplain (]}Wetlands, 0` Water"shedtDist'rct f 'Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ✓ (Identification Please OWNER: Name: G k(-NL�5- * Print Clearly) I r\ Address: 3 Q 1 "iL (_ten e /J. 14A&0 J,2v— X6, 01 �Y S7 n , Phone: �6�� OCONTRACTORName: A,,110J0,(N)C „_- Address: t'%i 1.1 7r1S�,AAk>c r t'✓Yvx- l� I/,& c) b30 �s� C14AJgPs' SG/Yt41_4 -, Supervisors Construction License: % V0 36 Exp. Date: C �)MF -5- Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phon Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ate-IF�/. 0001 o.) FEE: $ Check No.: Receipt No.: NOTE: ersoIs contracting with unregistered contractors do not have access fo t gua an ty fund Sian f _____wner _igna ure o con rac.or. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. Tanning/Massage/Bod) r1 I Swimming Pools ❑ Tobacco Sales Permanent Dumpster THE FOLLOWING SEi INTERDEPARTMEN] D/ PLANNING & DEVELOPMENT ❑_ COMMENTS 04��� CONSERVATION Reviewed on Signature COMMENTS JHEALTH COMMENTS Reviewed Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS