HomeMy WebLinkAboutMiscellaneous - 84 BEVERLY STREET 4/30/2018I
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .........
has permission for gas installation .......
in the buildings of ... //� �e e--,*,.
...................................
at -/--Z,?!� ........... North Andover, Mass.
Fee��?.'. Lic. NoU4-��
............
GAS JNSPECTOR
Check #
7
MASSACHUSET,rS UNDDRM APPLICATON FDR PFRMrr TO DO GAS WrING
(Type or print) .
-NORTTI ANDOVER, MASSACHUSETTS
Building Locations 5T
Owner's Name
New Renovation Replacement 1M Plans Submitted
n kii
Date ?-Ilp-16>
Permit # .;71,3-'r
Amount $ Zd �X'
(Print or type) Check one: Certificate Installing Company
Name— Corp.
Address S'J 1�5 1-)Ofl e 5.>- A/ Partner.
97)' 65�--
Business Telephone Finn/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes M No[-]
Ifyou have checked M, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ED I Other type of indemnity 0 Bond 0
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe
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 rl
i nereDy cemiy mat an ot me aetwis ana miormanOn I Dave SUDM]Uea kOr enUTM) In 3DOW appliCabon are tn1e and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions ofthe Massachusetts State Gas Code and Chapter 142 ofthe General Laws-
ITitle
OVED(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Pl-umber 4-,2 V k 3-7
Gas Fitter License NuMber
1:3 Master
M Journeyman
6�z) ry
A 0
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
/ '/ -. , . ".1 ...........
This certifies that
has permission to perform
plumbing in the buildings of ........
...........................
at. . �F ........ North Andover, Mass.
He-.�� ...... Lic No.,:;�.V.C;. ......... rl� . .............
'w
Check # PU�NI20G INSPECTOR
6 5 U L'�
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Building Location Owners Name Permit #
0 Amount
TypeofOccupancy bWiFZL1N6
New rl Renovation ri Replacement 191 Plans Submitted Yes No rM
. 1:1 Uj
FIXTURFS
Fj
(Print or type)
Installing Company Name lyt4z z 0 A:114 4/ 40v/
Address P 0,
4:�a441
Check one: Certificate
E] Corp.
riPartner.
ElFirm/Co.
Name of Licensed Plumber: _73/2-7 /Vog�z-vA,-PL/
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy M\111 Other type of indemnity Bond
L^—i n
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
Signature Owner El Agent n
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By: ri—g-nature 51 Mcensea Flumoer
Title Type of Plumbing License
c�qF33
City/Town License Numoer Master F1 Journeyman IVI
APPROVED (OFFICE USE ONLY
, 3 d, J --v
go Date.. e.513 ... ......
I
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
This certifies . . ....
.... . ..........................
has permission to perform ......... . ..... ......................
wiring in the building of ..... .........................
�.F� Y4 ................. North Andover, Mass.
....... Lic.' I .... ...............................
INSPECMR
08/23/99 13:47 5o.00 pAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
ThE COMMAW"WHOFARMaIUSEM Office Useonly
DLPARTA1EW0FPM1K&4FVY Permit No. /6-34--
BOAM OFFMPREVEMONRE6T9ADOAN527CM 12A0 1 Occupancy & Fees Checked
"FL [CA I 7ON FOR PEMW TO PF"ORM EL E=CA L WORKI
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cmR 12:00 -3 1--7
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below
Location (Street & Number) 25 y Z5 Pell,
Owner or Tenant �0 -f
c,-- 9
Owner's Address 5�plt �--
Is this perinitmi conjunction with a building pen -nit:
Purpose of Building I -47m,
Existing Service Z,19-0 Amps/,,,3b / 0)'I�,Volts
29 4-�) Amps 1,7o / z�-/eVolts
New Service 47
Yes F1 No
Numller of Feeders and Ampacity Y,
Looit ion and Nature of Proposed Electrical Work
Overhead
Overhead
To the Inspector of Wires:
WAP PARCEL
(Check Appropriate Box)
Utility Authorization No.oll�17SY
11
Underground No. of Meters
Underground No. of Meters
No. of Lighting Outlets
No. of Hot Tu
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
ground
El
2round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Bumcrs
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Di3hwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municip�l
M
Other
No. of Dryers
Heating Devices KW
.0*
Cormcctions
I I
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No.JHydro Massage Tubs
No. of Motors
Total HP
OTHER--
lm=ecawraw PmmttothemqmamtsdNbsmdmgotcelffalLam
YES ff NO
lbawsktrid3dmfid toilrOffike. YES IaNO Y3mbawdmd<cdYES,*wmci��r�FcfwxraWbydvc�the
qTrupiwebox
INRJRANCE 130IND GMER ftase Spedy)
Estnn�`Va1wdBaobcalWc& $
Wc&tosw 3 j"I hpxfimDieRcc� Rougb Fmal Av
on-, I P',
I F TTP s—F —&M -A Wo IMA U2 RE
— Adr 9 �
OIX7t,�S INSURANKT WAIVER 1amaw&etiAfrl-A)ms6&esywthw
(Please check one) Owner r-1 Agent
Signature of Uwner or Agent
��n/,
Alt TeL No.
iud bv Nlas,,-admBeas Cicr=il Lav8
Xe - C�-o I
Telephone No. PFRMrrFEE$Sb CCA��—e,6
Location
No. Date
'S.
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
3
"k-111:C�-ISIL110
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # =�? -S -3 8
5 L;
, P( /t I ( (I.,
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
REWOV.
WELDING PERMrr NLTNMER: �/a DATE ISSUED:
SIGNATURE:
Building Commissi2!�E�r of Buildings Date
SECTION 1 -SITE INFORMATION
1. 1 Property Address- 1.2 Assessors Map and Panel Number
001 o o 3,��
Map Numbei Parcel Number
1.3 Zoning Information: 1.4 Property Dbmskn&-
Zoning Disirict Proposed.Use -Lot Area (sf) Frontage (11)
1.6 BURDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required joffvide ReqWred Provided Required Prov . i4
1.7W9" Supply MG.LC.40. StM) 1.5. Flood Zone Information: 1-9: S—aw D4.d Syt�
Public 0 privaft 0 zone Otoide Flood Zmw 0 mmkipat 11 on S6 Disj�61: Systm
SECTION 2 - PROPERTY OWNERS11IMUMORIZED AGENT I
2.1 Owner of Record
�e- V I K, VL b ()l C
Name (Print) Address for Service:
Signature Telephone
.2.2 Owner of Record:
Name Print Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable . 0
LiceAsed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
C/ Y;4 A, f % h F, �!-Y
Com�irry Name
/05- Wq v -el?
Address
57s—
Not Applicable 0
-.. I j jq 6' [ 2, -
Registration Number
Expiration Date
9 %
SECTION 4 - WORKERS COMEPENSAT19N (AiG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECrION 5 De3cription of Proposed Work (c*k all applkable)
New Construction 0 Existing Building 0 Repair(s) 0 Alt.erations(s) 0 Addition 0
Accessory Bldg. 0 Demolition 0 . Other 0 Specify
Brief Description of Proposed Work:
71&
SECCTION 6 - ESTIMATED CONSTRUCTION COSTS
t t
�7
in Estimated Cost (Dollar) to be
Completed by permit applhicant
I Building (a) Building Permit Fee
Multiplier
(al Building Permit Fee
Multi lier
2- Electrical (b) EstimatWed Total Cost of
C structlo 7�
on
struction S2- 6 0
I P lit f
3 Plumbing Building Penmnit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 , Total 1+2+3+4+5)., Fheck Number
SECTION 7a OWNER AUTHORIZATION TO BE COWLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUHDING PERMT
L 0 ��f as Owner/Authorized Agent of subject property
Hereby authorize to act on
My !!!tg all matters re "ve to work authorized by thi I s building permit application.', - L/
lv%-2� t� "e,
Signature of Owner 'r-7 Date
q1F.r-rToN7h OWNFR/AUTF4OR1ZED AGENT DECLARATION
as Owner/Authofized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Naing-4.
Sioature of 9
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR MDERS 1
2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DEVIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
TMCKNESS
SIZE OF FOOTING
X
MATERIAL OF CHRVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
D. RobertNicelta,
Building co"Imissioner
TOWN OF NORTH ANDOVER
Office of the Building Department
Community -Development and Senices
27 Charles Street
Noilh Andover, Massachusetts 01845
DEBIZJS DISPOSAL FORM
Telephone (978) 688-9545
FAX (91-8) 688-9542
In accordance with the provisions of MGL c 40 s 54, and as a condition of
4 -
building permit # zz 7 the debris resulting from the work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c
11, s 150a.
The debris will be disposed of at / in:
(Site location)
Signature of permit applicant
3- 1-t — o -�--
Date
MichaelMcGuire, Local Building Inspector James Decola, Eleancal Inspector Jamesaozzi, GaslPlumbing Inspector
FEB -27-02 02:38 PM JOSH2 978 4759988 P.01
Estima�es
r opon
Post of
Fully 1r5u,-Pd
105 Hav"POWI Street
THOMPSON'S ROOFING
Methuen, 10A 0184d
(978) 691-13z,i
Shing1ts — Slate — Rubber Roof
Single Ply — Copper Work
�;�70 SAL,],)�&VTED TO
Kevin
& LJLlr,)
—
nedu
-
117, TF,
---
2-1 1-()?
i
Street
Joe NAME
C -17Y. 61 AT L AND -,';L;
�LOCATION
-
iAA 'Ji84
5
73s
.. ...............
We hereby Submit Wedkaiions anij Pstirriates for:
r ; P - F -�, 1 '3 r,-, e-� 4�
RQ, ri.,:l j h( -)a �:ds arld if any neeci rep),acemEnt it wil.:
IV
cos�, f
') a t
-8 )
Ins tiil .I-uminum dr,'kp
e d q e
A;:)c)lv ice Airi�-1 u?..+-
;., I
- � Z;i CIC U ZL. UP ail Laong edges
Apply 15ib. Icit' papor on resL of roof area
Reshingle %ViLh -'1 25 year ArchitecL Shingle
new flanqt.-s around soi, pipes
Welt-erp]700L chimney fla"3".1ing
cu� -'.11 a cidgF, V--rit
Rti�.�mcVe &11 related debris -
Total cost maLert.dl and labor ***,,* �5,200.00
2S, Ye,jr- Aar(-aity on material 10 Year guarantee on
Co n s L r t j C.,j r) I i C. it; lD 6 0 1. 12
1r.provernont 41281512
InSt".111 1 Sccalll!e-t�$ gULtPr with dOwn pipes on sidewals, side of hoijse
Tcta� cOsL OF material
i , tmd labor 550.00
VAC J)0005r hpreby to furnish rnileri2l and labor — compiete in 3ccordanco with aOvo apenification3, for the 3,M Qf�
p2rYmAnt to tw' r'sA"jk' �*'s
All ingtc-e..a! in I!,, ig, as spwfi-d. All wcrl; 10latoriipki�adina workinarCkerrigrIft,
alcAinq to SIB, A,,Iy &era -dor) or dcvimon from above spwificalions lnvrllylr�;
eDera r'a�'5 will bc, ev-ut-utud on;y upcn writtHi Di�der6, and WIll bisf�crns an axt�a charge over am
ah'Ve lh8 Wumjl,�. All agrePm6nis conhYie.-il Lvjn strikes, accident,, or Oel�jys i;,e�ono uji!
CON(Ol 0-16T ILI tarrY �ire Wrixic, arid othei necessary insurance. Our worliors Are 1LVY NOW: This propogal may,
, zzrmod by Workrnar't Cornj),juso!Iun k-3urarce. withdrawn by us if riot aorepte�a with! —,jays
zirreptattict fit proped — T'he above pfices, SpooffinatitrI19 ar�rd
oorlditions are sahs!au'nry and af.-7 hereby aco4pted. You am authorized to dc the
,ified. PaYi'ncn! -11 be inade as ci�ltlined above.
W'Dri, as sper Stgriature �(\Ii
r
Di; t
f., of signsture & -A .4
4
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C E R T I F I C A T E 0 F L I A B I L I T Y I N S U R A N C E
PRODUCER 01 (MM/DD/YY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
PELHAM INSURANCE SERVICES INC UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
r122BRIDGE STREET THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PELHAM NH 03076- 1 N S U R E R S A F F 0 R D I N G C 0 V E R A G E
INSURED INSURER A: Liberty Mutual
INSUR � B: The Maryland
Thomas Doyle DBA INSURER C:
Thompsons Construction & Roofi
8 West St. INSURER D:
Salem NH 03079
INSURER E:
COVERAGES
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER
DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
GENERAL LIABILITY
B ExI COMMERCIAL GENERAL LIABILITY SCP 34865353 EACH OCCURRENCE $1,000,OOA
CLAIMS MADE ExI OCCUR 04:17-01 04-15-02 FIRE DAMAGE (Any one fire) $ 300,00'0
MED EXP (Any one pe
n%iiitrson) $ Io,00O
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000
E ]POLICY E ]PROJECT E ILOC PRODUCTS - COMP/OP AGG $2,000,000
AUTOMOBILE LIABILITY I -
I ANY AUTO COMBINED SINEE -LIMIT
I ALL OWNED AUTOS (Each accident) $
I SCHEDULED AUTOS BODILY INJURY
I HIRED AUTOS (Per person) $
I NON -OWNED AUTOS BODILY INJURY
(Per accident) $
PROPERTY DAMAGE
GARAGE LIABILITY (Per accident) $
I ANY AUTO AUTO ONLY - EA ACCIDENT $
I OTHER THAN EA ACC $
EXCESS LIABILITY AUTO ONLY: AGG $
I OCCUR CLAIMS MADE EACH OCCURRENCE i
AGGREGATE $
I DEDUCTIBLE $
I RETENTION $ $
F WORKER'S COMPENSATION AND EXI WC STATUTORY E I OTHER $
A EMPLOYER'S LIABILITY WC2-31S-314995-019 04-21-01 04-21-02 E.L. EACH ACCIDENT $ 100,000
A
W
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0
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P
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L
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0
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�R CO
S
M
L
P
I
E
A
N
BS
IA
LT
II
T0
Y
N AND ] E.L. DISEASE -EA EMPLOYEE $ 100,o0o
OTHER E.L. DISEASE -POLICY LIMIT $ 500,000
D I PTIO T S/LOC
ESCRIPTION OF OPERATIONS&OCAT I M/VEH I CLES/EXCLUS IONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Job: Roofing Job at 6 MIDDLESEX ST. NO. CHELMSFORD, MA
CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FRANK DEAMICIS THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR
6 MIDDLESEX ST. TO MAIL 10 DAYS WRIT -TEN NOTICE TO THE CERTIFICATE HOLDER NAMED
TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION
TO
NO. CHELMSFORD, RFPRL�IAINILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
MA 01863 REPRESENTATIVES.
v
AUTHORIZED REPRESENTATIVE
(7/97) A) _S' d -
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