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Miscellaneous - 84 JOHNSON STREET 4/30/2018
5 4-1 1.%�' A9 8 8 Date .............................. TOWN OF NORTH ANDOVER RECEIPT J , x//. This certifies that ........ ..............................i...i.....^....' ... haspaid.................................................................................................. i for ...............r ...:........ Receivedby............�.) .............................................................................. Department......................................................... WHITE: Applicant CANARY: Department PINK: Treasurer i Commonwealth of Massachusetts Date 4'19 -It Estimated Job Cost: Plans Submitted: YES Business License # alb Sheet Metal Permit Permit # Permit Fee: $ NO Plans Reviewed: YES NO Applicant License # „ 4A00 -7 Business Information: Property Owner / Job Location Information: Name: Q l' ` Lfih �r1 i c �� �lLfsj-141 Name: Ki t ST d1 �C�t C� Street: 3 d l It Street: _ 94ZR) 5pn -a City/Town: Li ^ City/Town: Iy "Ver Telephone: Telephone: o� - low- a44b Photo I.D. required / Copy of Photo I.D. attached: YES Building Type: Residential: 1-2 family Multi -family Commercial: Office Retail Industrial NO Condo / Townhouses Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC f Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: L �( --�L Sefy e --e 4 k -e INbURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑ If you have checked Yes, indicate t type of coverage by checking the appropriate box below: A liability insurance policy Othertype of indemnify ❑ Bond ❑ OWNER'S INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 112 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 Agent By checking this boxy, 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 sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date Progress Inspections Comments Final Inspection Type of License: By - Title y Title ❑ Master -Restricted City/Town ❑Journeyperson Permit # ❑Jo urn eyperson-Restricted Fee $ El Inspector Signature of Permit Approval Comments Signature of Licensee License Number: 1481R -i Check at www.mass.aovldpl +� COMMONWEALTHOF MASSACHUSETTS COMMONWEALTH OF MAWbAiJSETT •• • BOAR)- QF SHEET METAL WORKERS -- -�� ISSUES TFE FJLLOWING LICENSE AS . Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Pxoper 61611ances, fire rated enclosures and pressure testing required. _ SFisi.ai esI.,aints isnsralied %7-9i&,d required 'on equipment and d ,, tv. ;:-F Duct penetrations in fire 'rdtQ •iv;9Jl:3 and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns installed 6'--0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -oft) } 1 Sheet Metal Residential Guidelines / )inspection Checklist Yes No N/A. Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximuln flexible run 8'-0" FIexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) A� d0 DATE (MMfDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/13/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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). PRODUCER Integrated Insurance Solutions, LLC 1881 Worcester Road NAME: CONTACT Dawn Nogueira PHONE IA&,No_Ext): (508) 370-0002 i (FAC X, N00508) E-MAIL dno ueira@iisa en com ADDRESS: g g n INSURERS) AFFORDING COVERAGE NAIC tr Suite 101 Framingham MA 01701 INSURERA Arbella Insurance Group _ INSURERBArb®11a_Protection_Insurance_— 41360 INSURED Berry Mechanical Services, Inc., BHJ LLC INSURERCNew Hampshire Employers Ins Co INSURER D: _ 3 Milton Way 300,000 INSURER E : 10,000 INSURER F: _, Georgetown MA 01833 COVERAGES CERTIFICATE NUMBER:CL1641327637 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUER LTR I POLICY NUMBER POLICY EFF POLICY aP MIDD M/DDIYYYY LIMITS X 7COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE S 11000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISE$_CEa occurrence S 300,000 MED EXP (Any one person) ! S 10,000 _, X 8500058241 f 2/21./2016 2/21/2011 PERSONAL &ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE 5 2,000,000 S 2,000,000 X POLiCV j 4 (_ I LOC PRODUCTS - COMP/OP AGG Pollution Liability $ 300,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aaidenq_ $ _ 1,000,000 BODILY INJURY (Per person) S B ANY AUTO ALL OWNED ) , AUTOS X AUTOS I XAMAGE ~'" NON-OWNEO X I HIREDAUTOS . AUTOS 1020018783 2/21/2016 2/21/2017 BODIIYINJURY Per accident) 5 PROPERTY( Peraccdem 15 Uninsured motorist els lit emit i S 100,000 UMBRELLA UABOCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LAB CLAIMS -MADE $ DED RETENTION WORKERS COMPENSATION AND EMPLOYERS• LIABILITY ANY PROPRIETOR/PARTNERIE(ECUTIVE Y' N I STATUTE' ER E.L. EACH ACCIDENT S 500 , 000 OFFICERIMEMBER EXCLUDED? C (Mandatory in NH) N / A EC -600-4000464-2016A 1/1/2016 1/1/2017 ! E.L. DISEASE • EA EMPLOYEd S 500,000 If yes, describe under DESCRIPTION OF OPERATION_ S below I E.L. DISEASE - POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) With a written contract in effect The Town of North Andover is included as additional Insured (978)688-9542 Town of North Andover 1600 Osgood Street BLDG 20, Suite 2035 North Andover, MA 01845 ACORD 25 (2014/01) INS025 rroram I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Nogueira/DMIV -.2kc� r , w Nff�. e'C' �- ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Name Kristen Doggett SII (II 1\I( 11. S1.Rk R I.S.I�( 3 Milton Way • Georgetown, MA 01833 978-352-5500 • 978-352.4004 lax G wv,w ber1_y07eCha01Cal coir? Proposal Number 850222201681446-1 1 EWC12-ROUND `/ Qty. Model# Description DAMPER AMERICAN STANDARD FOREFRONT 3.5 TON VORTICA 1 TAM7AOC421131S� VARIABLE SPEED AIR HANDLER W/ EEV- FLEXIBILITY AND COOL WIRELESS ADAPTABLE FOR CONVENTIONAL OR HYDRO -AIR APPLICATIONS 1 4A7A6036J1000Av, 3.0 TON SILVER SERIES 16 SEER SINGLE STAGE WITH STAND ALONE INTERFACE MODULE UP TO COOLING R -410a 208/230/1 ,or EWC 14 INCH ROUND 1 EWC14-ROUND COMM/35 SECOND PUMP PROGRAMABLE 5/1/1 DAY 2 COOL 2 HEAT 24 VOLT DAMPER 1 EWC10-ROUND ✓ EWC 10 INCH ROUND COMM/35 SECOND -24 VOLT 6 INCH PIPED R8-WRAPPED/SEALED 5FT DAMPER 1 EWC12-ROUND `/ EWC 12 INCH ROUND COMM/35 SECOND -24 VOLT DAMPER 1 HZ322 ,✓ HONEYWELL ZONING PANEL 3 ZONE TWO STAGE HEAT AND COOL WIRELESS ADAPTABLE HONEYWELL YTH6320R1001 WIRELESS FOCUS PRO 1 YTH6320R1001"/ WITH STAND ALONE INTERFACE MODULE UP TO 30OFT. RANGE AMERICAN STANDARD LARGE SCREEN HEAT COOL 1 �HEAT PUMP PROGRAMABLE 5/1/1 DAY 2 COOL 2 HEAT THERMOSTAT 1 R8 -6 -PIPE 6 INCH PIPED R8-WRAPPED/SEALED 5FT 1 DRAIN PAN -WET INSTALL DRAIN PAN AND WET SWITCH UNDER NEW SWITCH SYSTEM NEW 1 THERMOSTAT INSTALL NEW THERMOSTAT WIRE WIRE 2 R8 -4 -PIPE 4 INCH PIPED R8-WRAPPED/SEALED 5FT R8-6-0VAL 1 CLOSET 1 -FL- R8-6 INCH SUPPLY IN CLOSET TO FIRST FLOOR CEILING CEILING 1 24x24 LINED BOX INSTALL 24X24 LINED BOX nstallation MITSUBISHI ELECTRIC COOLING & HEATING Date 2/22/2016 AMERICAN STANDARD WARRANTY 10 YEARS MANUFACTURER ON ALL PARTS Clean up work area before leaving worksite COPPER REFRIGERANT LINES Electrical Permit Pulled for local town & electrician's time to inspect ELECTRICAL SAFETY SWITCH FOR OUT DOOR UNIT ENERGY SAVING PROGRAMABLE SET BACK THERMOSTAT ENSURE PROPER CONDENSATE EQUIPMENT PAD FOR OUTDOOR UNIT EVACUATE REFRIGERANT SYSTEM INSTALL NEW THERMOSTAT PERFORMING DUCT BLAST TESTING OF NEW DUCTWORK AS REQUIRED BY STRETCH CODE BY-LAWS IN LOCAL CITY/TOWN QUOTED PRICING IN THIS PROPOSAL IS GOOD FOR 30 DAYS AFTER RECEIPT SEALED DUCTWORK CONNECTIONS FOR MAXIMUM EFFICIENCY VIBRATION ELIMINATORS UNDER INDOOR UNIT WARRANTY: OUR EXCLUSIVE (2) YEAR INSTALLATION FINISH CARPENTRY NEEDED TO ENCLOSE EXPOSED NEW DUCTWORK -WIRING - PIPING INSTALLED IN LIVING SPACE OR CLOSET FIXING EXISTING ELECTRICAL OR CONTROL PROBLEMS OR AMPERAGE LIMITATIONS "ATTIC BASED DUAL ZONE DUCTED CENTRAL AIC SYSTEM TO COOL ALL THE 1ST & 2ND FLOOR LIVING AREAS INDEPENDANTLY `HANG AMERICAN STANDARD PLATINUM TAM7 VARIABLE SPEED AIR HANDLER IN ATTIC USING VIBRATION ISOLATORS -DRIP PAN -WET SWITCH & BUILD DUAL AIRTIGHT SHEETMETAL SUPPLY TURNKS W/ R-8 WRAP DOWN LENGTH OF ATTIC. THEN INSERT EWC ELECTRONIC DAMPERS INTO EACH WIRING BACK TO NEW ZONING PANEL. 14" FOR 2ND -12" FOR MAIN 1ST *2ND FLOOR TRUNK TO SUPPORT SUPPLIES TO FOLLOWING: MASTER BEDRM-MASTER BATHRM-BABY'S RM -GUEST BATHRM- OFFICE- GUEST BEDRM `1ST FLOOR MAIN TRUNK WILL BE DROPS TO FOLLOWING: LIVING RM -DINING RM -KITCHEN -ENTRY "THEN A By signing this agreement I acknowledge that I have read and Representative Date understand each page, in I i s and conditions. Customer Date_�36t, Approved by Date Page 2 1 ELECTRICIAN- CENTRALAIRBOTH WIRING AIR HANDLER AND CONDENSER. GROUND FAULT OUTLET AT CONDENSER 1 ELECTRICIAN-GFRCOND MITSUBISHI 3 Milton Wal • Georgetown. MA 01833 ELECTRIC E!; r i•�� :ih 978-352-5500. 978-352-4004 fax DUCTWORK FOR 1ST SYSTEM IF REQUIRED c c ;, q r � � o rs >, ., www.berrymecharucal Com COOLING & HEATING Name Kristen Doggett Proposal Number R50222201681446-1 Date 2/22/2016 8FT. LENGTH Qty. Model # Description LABOR 1 LW -122 WALL INLET 1 3/4-3/8 50FT-LINESET/DRAJOK 314- 3/8 50 FT LINESET WITH DRAIN FROM 2 20LBBAG-CRUSHEDSTONE 20 POUND BAG OF CRUSHED STONE 1 SHEET METAL PERMIT ATTIC TO CONDENSER 2 MAINDUCT-ROUND-25- MAIN SUPPLY 25 FT. WITH R-8 INSULATION- 1200CFM SEALED 1 UNISTRUT-4-ROD f UNISTRT AND 4 -ROD TO HANG UNIT FROM CEILING 1 R8-6-SHEETROCK 6 SUPPLY IN ATTIC WITH R8 FLEX 15FT 2 R8 -7 -OVAL CLOSET -1 -FL- R8-7 INCH SUPPLY IN CLOSET TO FIRST CEILING FLOOR CEILING 1 R8 -7 -PIPE 7 INCH PIPED R8-WRAPPED/SEALED 5FT 3 R8-7-SHEETROCK 7 SUPPLY IN ATTIC WITH R8 FLEX 15FT 1 R8 -8 -OVAL CLOSET 1 -FL- R8-8 INCH SUPPLY IN CLOSET TO FIRST CEILING FLOOR CEILING 1 R8-16- RD MAIN RETURN R8-161NCH FLEX MAIN RETURN IN ATTIC WITH RETURN BOX AND GRILL 1 R8-8-SHEETROCK 8 SUPPLY IN ATTIC WITH R8 FLEX 15FT 2 R8-4-SHEETROCK 4 SUPPLY IN ATTIC WITH R8 FLEX 15FT 1 27 -15 -ADD -10 -CLOSET ADD 10 SUPPLY THROUGH CLOSET FROM SUPPLY -1 -FLOOR ATTIC ATTIC 1 ELECTRICAL ELECTRICAL CIRCUIT PERMIT AND ELECTRICIAN TIME TO ACQUIRE/CONDUCT 1 ELECTRICATTIC/BASEMENT- ADDING 115V SERVICE OUTLET TO ATTIC OR OUTLET BASEMENT SYSTEM PER LOCAL CODE REQUIREMENTS 1 ELECTRICIAN- CENTRALAIRBOTH WIRING AIR HANDLER AND CONDENSER. GROUND FAULT OUTLET AT CONDENSER 1 ELECTRICIAN-GFRCOND THRU UNFINISHED BASEMENT WITH COVER - NEW LEG 115V FROM PANEL PERFORMING DUCT BLAST TESTING OF NEW 1 DUCT BLAST TESTING 1ST DUCTWORK FOR 1ST SYSTEM IF REQUIRED SYSTEM BY STRETCH CODE BY-LAWS IN LOCAL CITY/TOWN 2 LD -122 STRAIGHT I/ FORTRESS COVERING 122 STRAIGHT PIECE 8FT. LENGTH 2 LJ -122 COUPLER FORTRESS COVERING 122 COUPLING 1 LW -122 WALL INLET FORTRESS COVERING 122 WALL INLET 2 20LBBAG-CRUSHEDSTONE 20 POUND BAG OF CRUSHED STONE 1 SHEET METAL PERMIT SHEET METAL PERMIT WHEN BUILDING OR AMENDING DUCTWORK 2ND 10" TRUNK W/ ITS OWN EWC ELECTRONIC DAMPER CONTROLLED AS IST FLOOR ZONE WILL BE ENGINEERED TO TRAVEL DOWN 2ND FLOOR BACK BEDRM ON INSIDE CORNER THEN INTO ATTIC ABOVE FAMILY RM WHERE IT WILL SPLIT INTO 2 CEILING SUPPLIES ON OPPOSITE SIDES. HOPEFULLY THIS DROP CAN BE COMPLEELY CONCEALED INSIDE A CLOSET. HOMEOWNER WILL TAKE CARE OF CARPENTRY TO CLOSE UP IF DESIRED (OPTION FOR US TO DO ON PG 1) `MAIN RETURN WILL BE 2424 FILTER GRILLE IN 2ND FLOOR HALLWAY CEILING OUT OF VIEW FROM STAIRWAY DUCTED BACK TO THE AIR HANDLER W/ 16" DIAMETER STOCK & R-8 RATED INSULATION NIL( I I011 1 c\ I S 1 I O 1 c IS. IM. c. MITSUBISHI 3 Milton Way • George,'own..MA 01833 ELECTRIC 978 352 5500 • 978 352 4004 fax ••Fn k „,W, COOLING & HEATING a I�• , �, � �, www.beu yrnc,uranical cont Name: Kristen Doggett Consultant JAMIE BECKWITH Site Address: 84 Johnson St. Date: 2/22/2016 Billing Address: City: North Andover Proposal #: R50222201681446-1 City: State: MA State: Phone: 617-686-2446 Zip: 01845 Phone: Zip: •�•.-.•f .• � ,*'.'. As"�Yl �'y�. N', "MN'Xa rnG Cy *4S."'>i�Q<� , w y ti. 11111[]�I�� l� II�Ilill!I� L11.I�IIIIIr1 Rl�ll�l�lllil� I?ililll'JIt 111111CI'llCli tl"f i��figl I I�II�FIII?i LI'i 13111131 I I�Iltl'lll'19 tI111��U1]I 11gI1G�111lI� �IIIIlililkll 11�11p1 lllll� 'llI1�NG�1 Iil;i118C(J�I: Base System: $17,792.78 Optional Items Total: $0.00 ` BERRY MECHANICAL DISCOUNT ELIGIBLE FOR $250 MAIL -IN REBATE Model No:- TCONTECOBEE- UPGRADE Sales Tax: Included $0.00 System Total: $16,280.39 Initial Investment: $0.00 Balance: $16,280.39 Term: Rate: % Est. Payment: $0.00 Investment Type: Check Description:- UPGRADE PRICE FOR OUTI C' �Y°0''"°^ THE ECOBB3 WIFI THERMOSTAT $238.19 WITH A REMOTE SENSOR INCLUDED " Model No:- LARGECINDESER- I R Rj' COVERS Description:- 3 TON TO 5 TON $118,77 • COVER FOR CONDENSER ORDER BY MODEL NUMBER , Model No:- 4A7A7036A1000A °a:A;a,�,,�, Description:- 3 TON 17 SEER ''"" �•'r"� PLATINUM CONDENSER W/R-410a q7A.:� I��II7 STEPPED COMPRESSOR -HAS $1,344.00 UNIQUE COIL/AIR HANDLER MATCH -UPS AND 2 -STAGE r�f9C! IC�p � COOLING By signing this agreement I acknowledge that I have read and understand each p adif erms and conditions. ''�~ CustomeF ----- pais 3�V Representative $16,280.39 $1,143.45 Approved by Date Date 2/22/16 Page 1 Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation .............................. inthe buildings of ................... Sr .................................................................................... . ...... A .................... U ..... . NotAthndover, Mass. Fee. P.... Lic. No./.VY.1.... ..... ...... � I � . . .................................. GAiNSPECTOR Check# 66e) _Iw I QJ3 This certifies that.///w ) ........... ,*r ... ........ ............ I ....... has permission to perform........ ...... Date .0/2114 .............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING plumbing in the buildings of....... at.f.;q(.\.7' 4* ....................... F e e ql.-.. 5 .... Lic. No. j Check # ................................................................................... ....... ort ndover, Mass. ...... ............. ---f ................................. MBI�NG SPECTOR hereby certify that all of the details and information I have submittt Knowledge and that all plumbing work and installations performed provision of the Massachusetts State Plumbing Code and Chapter PLUMBER/GASFITTER NAM COMPANY CITY:' 1 ,(_X(I-e.t-off TEL:. 1936— _Z1 S 3 MASTER[K'JOURNEYMAN ❑ I (or entered) regarding this application are true and accurate to the best of my nder the permit issued for this application will be in compliance all Pertinent 42 of the General Laws. Ltj LICENSE# I SIGNAT RE ,_ADDRESS:_. I �6trp&+ST- STATE' ZIP: 6L.citi FAX: CELL —EMAIL: Z/ S'3 EMAIL: LP INSTALLER ❑ CORPORATION M#.3a� PARTNERSHIP ❑ # LLC ❑ # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY CITY: T1 t `doxj� MA. DATE: PERMIT # JOBSITE ADDRESS: OWNER'S NAME: )' 1Q n 2Caq� ADDRESS: TEL: ID (RIO .2 q 4 �IAX: OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLAQEMENT:A PLANS SUBMITTED: YES ❑ NOV APPLIANCESZ FLOOR -4 Bsmt 1 2 31 1 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER I CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER I FIREPLACE I FRYOLATOR FURNACE GENERATOR I GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER I 'ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I i INSURANCE I have a current liabili insurance policy or its substantial equivalent If you have checked YES, please indicate the type of coverage LIABILITY INSURANCE POLICY Ua OWNER'S INSURANCE WAIVER: I am aware that the licensee Massachusetts General Laws, and that my signature on this p COVERAGE which meets the requirements of MGL. Ch.142 YES Eq'.N.-O ❑ by checking the appropriate box below. OTHER TYPE INDEMNITY ❑ BOND ❑ iloes not have the insurance coverage required by Chapter 142 of the rmit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submittt Knowledge and that all plumbing work and installations performed provision of the Massachusetts State Plumbing Code and Chapter PLUMBER/GASFITTER NAM COMPANY CITY:' 1 ,(_X(I-e.t-off TEL:. 1936— _Z1 S 3 MASTER[K'JOURNEYMAN ❑ I (or entered) regarding this application are true and accurate to the best of my nder the permit issued for this application will be in compliance all Pertinent 42 of the General Laws. Ltj LICENSE# I SIGNAT RE ,_ADDRESS:_. I �6trp&+ST- STATE' ZIP: 6L.citi FAX: CELL —EMAIL: Z/ S'3 EMAIL: LP INSTALLER ❑ CORPORATION M#.3a� PARTNERSHIP ❑ # LLC ❑ # 9 POWNERADDRESS TYPE OR PRINT CLEARLY MASSAG-HUSETTS UNIFORM APPLICATION: FOR A PERMIT TO PERFORM" PL.U.MBING WORK CITY I i )oy, TV 1 t(CI'd,mjeAr QMA. DATE Q PE o�RMIT # JOBSITE ADDRESS `f cJl Yl c)� OWNEWS NAME Kristrl DD Ci `1 S TELI�o17'(St 'oR�q OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION::❑ REPLACEMENT: PLANS SUBMITTED: ' YES ❑. NO. FIXTURES 1 FLOOR- BSMT 1 2 '3 4 5 6 7 8 9 16 11 12. 13 14 BATHTUB CROSS CONNECTION. DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/QILISAND. SYS .......... DEDICATED GREASE SYS Y"WKv 1 u vfV1J YVA-1 CR J iJ DEDICATED WATER R.ECYCLE.SY.S DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK...... LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALLTYPES WATER PIPING OTHER 11 1 -4 - 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 COVERAGEBY'CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware thatthe licensee does not have the insurance coverage required .by Chapter 142 of the Massachusetts General Laws, and that my signature on this pe mit application waives1his requirement. CHECK ONE BOX ONLY; OWNER ❑ AGENT .❑ Si nature of Owner or Owner's 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 all Pertinent provision of the Massachusetts State Plumbing Code. and Chapter 142 of the General Laws. PLUMBER NAME SIGNATURET�///. LIC # %3 S -V -T MP [11r JP ❑ CORPORATION (�# 316 e' PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME ADDRESS: CITY , 1'►,1��/,. _ STATE ZWA ZIPCJ/S 5f 5 EMAIL TEL _9-7 fr -F26- ?.-F CELL FAX W z z 0 H 60 Qm a EIz z o }❑ o W o Uuai F- w z ¢ w > a � W a o � z w 1 LI Q � Q o, a a U W J E. a IL a *fl w = w t- w E�- O z z o F U a _ _ z z a w 0 0 a Departments of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A DJ ) 6 t Q L� y-oT� Address: 31 -cs�A S T 'e— Phone #: /' X"? k-' Z 15 _3 Are you an employer? Check the appropriate bog: 1. 2Iam a employer with 3 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.* 5. ❑ we are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.;n OtherjegD rJ, �- *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. tContractors 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: Policy # or Self -ins. Lic. #: S /Zl'�'V �% 7 (� Expiration Date: a / Job Site Address: �(�h �� 1 Y'e City/State/Zip: W&ffi( 144 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 DLA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. X36- 2/`l 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 #: AcciRvr CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYtt7 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3//20/20/ 2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must be endorsed. 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). PRODUCER EA Stevens Company, Inc. 389 Main $t. P. 0. BOR 188 Malden MA 02148 NAME: Eva Caperon PHONE (7$1)322-2324 fAX IA No): (781)397-7672 EMAIL ARESS:evac@eastevensins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A.Hartf ord Fire Insurance Company 19682 INSURED INSURER B:Safet Insurance Company 9454 MAGNIFICO BROTHERS PLUMBING HEATING & GAS INSURERC:Ttain City Fire Insurance Co. 29459 INSURER D FITTING, LLC. 31 FOREST STREET INSURER E MIDDLETON MA 01949 INSURER F: COVERAGES CERTIFICATE NUMBER -15-16 Master RFVI_CInM III IMRI:93• THIS IS TO CERTIFY THAT THE POLICIES OF 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF M/0D1YYYY1 POLICY EXP (MWDMNYM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 300,000 A CLAIMS -MADE ®OCCUR 8SBAUQ5370 /24/2015 /24/2016 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 RD- LOC POLICY B PJE $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 053635 /24/2015 /24/2016 BODILY (Per $ ( ) X HIRED AUTOS B NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident Medical owments $ 10.000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ BSBAUQ5370 /24/2015 /24/2016 C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERNEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYE $ S001000 (Mandatory In NH) D8WECRJ9050 /24/2015 /24/2016 oyes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Hartford Fire Insurance Company One Hartford Plaza Hartford, CT 06155 AtInQn Or; 112n-Intnck SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE iEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cares, Jr/EC - - - -- •-- v i V00-ZUIU Ak;UMU GUHPURATION. All rights reserved. INC095 rgntnnFt nt The annan norne snrl Inns ere rnnic4area4 rnarlre of At%nnn I M COMMONWEALTH OF MASSA DT, _?�HLIISETT PLUMBERS A_N'6_dASFITTIER-S ISSUES THE FOLLOWING LICE -NSE REGISTERED AS A PLUMBING CORP MARK MAGNIFICO gr MAGNIFICO BROS PLB&HGT,GAS FITTI 31 FOREST ST MIDDLETON MA 01949-2015 3266 05/ol/16 204666 QNWEALTH OF MASSA6HU BOARD O�-. F PLUMBER'S AND GASFITTERS IS -SUES THE FOLLOWING LICENSE LICENSED AS A MASTER PLUMBER MARK B MAGNIFICO S 31 FOREST STREET :u, 'y W MIDDLETON MA 01949-2015 13559 05/01/16 204667 RMW.ONWEAI.T!, 07 MASSACHUSETTS 664kD oF-- PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER XARK 8 MAGNIFIC6 31 FOREST ST U; RIODUTON MA 01949-2015 05/01116 204668 .. .... ... Date ... \ �Z�'.�A.�....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING . _kcx..............f PS P This certifies that .`..�P...............r� � �� C�y�ti ........................... has permission to perform ..... .►.! ! u.:. rx � 4r ............................................ plumbing in the buildings of .r North Andover Mass. —v Fee �'-... Lic. No, �.- .. M.-'............................................................ f 1 PLUMBING INSPECTOR Check it 11 45 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY tJc�rt-. tl �aov:e I� _j MA DATE.... _ PERMIT # JOBSITE ADDRESS zrk-k* OWNER'S NAME Aoe�� �- POWNER ADDRESS TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Rr PRINT CLEARLY NEW: E1 RENOVATION: Q REPLACEMENT: PLANS SUBMITTED: YES [ NO[R FIXTURES -1 FLOOR--" BSM 1 2 3 4 5 - 6 7 8 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 DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _ FOOD DISPOSER m FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) ------- KITCHEN _ _..._ _ _ _._ _.. .._.._. _ .KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION < WATER HEATER ALL TYPES WATER PIPING OTHER 1..._----.--- ..... _ _. .._ . _ ... _ .. _.. ..__ INSURANCE COVERAGE:' I have a current liability- nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i NO { IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Q 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 0 AGENT E] 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 inpliance with all Partin provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUMBER'S NAME { GEORGE A. POUDRIER- LICENSE # X5764j SIGNATURE MP[ JPEl CORPORATION#' PARTNERSHIPE3#1 LLC # COMPANY NAME) G.A,P.S. PLUMBING & HEATING= ADDRESS 3 BLACK. POINT RD CITY WEBSTER STATE ?IPS Ql?70 TEL 508+61-9349_ — FAX L08.461.-82`.„ CELL 508-789-3" _ 486 EMAIL GAPSPLUMBII����CHARTERNET 4 . J 1 it ilI IIIIII ::,--` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers plicant Information Please Print Leizibl, Name (Business/Organization/individual): (—)',AP_S Mo `{ Address: City/State/Zip: ,0ebs ; t�A &i5 -7o- Phone #: :O Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and i employees (full and/or part-time).* - have hired the sub -contractors 2. 1 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.* required.] 5. ❑ We are a corporation and its 3. ❑ 1 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' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.2 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box 91 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 indicatin_ 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: %4 6omsC)n S-+ City/State/Zip:N0,6GdCV1Y �i 6 ( [ �U5 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 certif oder the pains and pen ties of perjury that the information provided above is true and correct. Si nature: /LSDate: Phone #: �;�� �� q� 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): I. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: i 9 0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ..��a��Gc7vrz.�f f!' .t'ti.✓es plumbing in the buildings of V ......... . at ... ....... Bs ...'............ ... , North Andover, Mass. Fee.&7,-J-ULic. No../-3%�o.S .Fl!C�i�✓ � h zr,! 7"�...... PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town "/IfrI — MA, Date: �/7 i / Permit# Building Location: �y ✓6�/NSe Aj Owners Name: / Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residentiaff�r New: U Alteration: ❑ Renovation: -SUB BSMT. BASEMENT _FFLOOR OOL R Y6' -FLOOR 3R5F OOL R 4T" FOOL R 5 F OOL R WR FLOOR iM FLOOR iM F OOL R FIXTURES o: z H z z QLn w a z WLn 0 LL LL v m t=- m Ln Q x o W ate. o°= i N � Cti Q H Z Ln W u g Q h Q C g 3 -SUB BSMT. BASEMENT _FFLOOR OOL R Y6' -FLOOR 3R5F OOL R 4T" FOOL R 5 F OOL R WR FLOOR iM FLOOR iM F OOL R FIXTURES Plans Submitted: Yes n No DEDICATED h z z K N s z h 0 Q: LU o C) i Ln y a En N Z 0 W 0 = N 11 En W z 2 Q z !E Ln 3 y U ELI H z C, H 3 t- tL u' 0l Plans Submitted: Yes n No DEDICATED h K N s z h W Q: LU o C) i Ln y a En Installij;g Cvrrpuny ivame: /�'-d 1/ Chec or.a 01AV Certificate l' Address:- �;;z �/lld� % l4'=Corporation � e_ City/Town: ��'G�f'e.J'-� State: �' � Business Tel: El Partnership Fax: ❑ Firm/Company Name of Licensed Plumber: U'al/,V ,� C f a.s-, o INSURANCE ['ntrFan��. 1 have a current Iia_ bi11-1 Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YerM No E]If you have checked Yes, please indicate the .type of coverage by checking the appropriate box below. A liability insurance policy. [cam Other type of indemnity ❑ Bond El 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 Si nafure of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and ace +� x 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. a to the bes� of my BY Type of License: Title plumber Signature of Licensed Plumber 'Ry/Town 0,master APPROVED (OFFICE USE ONLY) ❑Journeyman License Number: / 3 0 9 COMMONWEALTH OF MAS$ACHUSEI7S -` AND GASFITTERS� LICENSED ENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: t i• 4 ' DOMINIC V GRASSO �I 252 BEECH AVE; MELROSE MA 02176-5004 t' • � I 13309 05/01/12 77385 -rq en1X MUtual FIRE INSURANCE COMPANY HOME OFFICE - JACKMAN BUILDING - 42 PLEASANT ST. - P.O. BOX 900 - CONCORD, N.H. 0330Z-0900 TELEPHONE 603 225.2773 COMMON POLICY DECLARATIONS RENEWAL DIRECT BILLED - INSURED POLICY NO. CPP0716478 NAMED INSURED: NEIGHBORHOOD PLUMBING MAILING ADDRESS: 252 BEECH AVE MELROSE, MA 02176 POLICY PERIOD: From 01/30/11 to 01/30/12 at 12:01 A.M. Standard Time at your mailing address shown above. BUSINESS DESCRIPTION: INDIVIDUAL IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF TEM FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. IBIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 1,511.00 TOTAL $ 1,511.00 Premium shown is payable: $ 1,511.00 at Inception. Forms applicable to all Coverage Parts: IL 00 17(11-85), COMMON POLICY CONDITIONS COUNTERSIGNED- BY (Date) ( orized Representative) AGENCY: 4610 SCULOS AND SANTILLI INSURANCE AGENCY, IN 285 MAIN STREET EVERETT, MA 02149 (617)389-4444 IL 00 19 11 85 Copyright, Insurance Services Office, Inc., 1983, 1984 Prepared on 12/16/10 AGENT'S COPY $' n'8;«'3`3 si e pu 2+ ;h 92 (Policy Provisions 00 00 A) 16 ; ZW INFORMATION'GE WEG WORKERS C01HIMATION ANDM LIABILITY POLIO 3. INSURER: HARTFC 3 INSURANCE COMP HARTF{i HARTFORD, C '" ,— 06115 NCCIHt �� Number: 13269 Corapajq-Cbde: 1 HE TFORD .g co Q Q .-a POLICY* Spix RENEWAL 0 G ZW1692 76!WE 01 N rn Previous Pohct 76G ZW1692 1O `-' 3 HOUSING 1. Named fused and Mailing Address: NEIG ' PLUMBING & HEATING (No., SUIDK Town, State, Zip Code) , 0 Ln252 i` FEIN Number. 202703711 MELROM'.1& 02176 State Identification Number(s): UIN: The Named Insured is: LIMITED LIABILITY ; ANY Business of Named Insured: PLUMBING - i73 NTIAL –= Other workplaces not shown above: 252 12 f AVENUE = MELROSBMA 02176 2. Policy Period: From 05/21/11 T6-.-.1' :05/21/12 _ 12:01 a.m., Standard time atm insured's mailing address. .—. Producer's Name: PAYROLL ASSOCIATES LLC =" PO BOX 33015 SAN ANTONIO, TX 78265 Producer's Code: 210731 Issuing Office: THE HARTFORD ill 55 FARMINGTON AVE., SUITE 301 HARTFORD ..,� CT 06115 (877) 287-1316 =' Total Estimated Annual Premium: $851 Deposit Premium: Policy Minimum Premium: $332 MA Audit Period: ANNUAL Installment Term; The policy is not binding unless i countersigned by our authorized representative. ! Countersigned by Authorized Representative 04/09/11 Date ,, Date.�lf /// :otic TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAcsw i This certifies that ........lr....117....,. .......... . has permission to perform .....L�.fftC..G.�.� ......... . plumbing in the buildings of . 41 ................ at. f�.... �. c �� c s -... ., North Andover, Mass. Fee.3Z.' .. Lic. No.. 7G. I J .-��.N-trJ�.�..... LUMBING INSPECTOfi Check #.'10e13 / • % c_ . r+ -- -2 4=0Z— o � q v � �- � •' •' �IXi�1RE5 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Tawn: der Nyn daV 2.r , MA. Date: 2 21 1a Permit# Building Location %LA -'� a\nVn5Na» 'Sk Owners Name s%.' kr Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential - - New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ® Plans Submitted: Yes ❑ NO Bj • % c_ . r+ -- -2 4=0Z— o � q v � �- � •' •' �IXi�1RE5 Z N Z 0 Ix U)N Y N Z Q W J U �! z a 0 w oc Z le Z le d 0 a az z Q i- N Q M Z U. m m ul 1 C Q W O I Q W= W. y row ©� J Z i` U. Y==0 0 F" 3= Z Q W a Y Z N UJ Lu W a a N m° 'c a o Y g °o = o a a a a ammo m= m m D 3 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3KuFLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7Tw FLOOR 8 FLOOR Installing Company Name- -E, k\-& Check One Only Certificate # ® Corporation 2�6c1� Address \\q;� Q � City/Town-, i %Nc A n Sta�� ❑ Partnership Business Tei:°'E4\ 63 1 4'iSs'-61 Fax: ❑ Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 93 No ❑ If you have checked Yes • please indicate the type of coverage by checking the appropriate box below. A liability insurance policy IQ 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 Accent 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 nnvwreaye ana maz au p!umomg woman rnstarralmns 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: `- -' I I �' W�,__ Title ❑ Plumber Signature of Licensed Plumber Cityrrmn ❑ Master APPROVED OFFICE USE ONLY) []Journeyman License Number: e_ iz Xi yrrr G :z ' CV L.: G ' AdL e_ iz Xi yrrr G :z ' CV L.: e_ iz Xi yrrr G :z e_ iz Xi yrrr G ,9622 Date........ 9-:. /-/-.................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................... 5 ... ;.v 111,41,16ww- Lx has permission to perform ....... .. ... ................................. wiring in the building of .............. ,v.v .......................................... at ..... P,.'V ..... .. .... North An over, Mass. Fee .... Lic. No..q�O.Ie4 ... ........ i�Ti.; . ...................... .. .... ..... .. ... E E RIc ZIN?SPR Check # LJVII///IVIIWGQILII VI J-1abbaw1uscLc01 Department of Fire Services e BOARD OF FIRE PREVENTION REGULATIONS Permit No. ( Z Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: , 2010 City or Town of: NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives Ihnotfice of his or her intention to perform the electrical work described below. Location (Street & Number) p Ll VO n3on Owner or Tenant Telephone No. Owner's Address _Sq Johnson c� T Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building j2eS [ Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity JJ // Location and Nature of Proposed Electrical Work: 1&npy e 6 r`ecesS //4�h 4owt/ S7s,4# /D mewmz //.g �,4 3 V Completion ofthe following Mole maybe waived by the Inspector of Wires. No. of Recessed Luminaires �o No. of Ceil: Sus addle Fans p ) No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 3 No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g 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 S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security of Devitt s or Equivalent No. of Water Heaters KW 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ,I//i at7 (When required by municipal policy.) Work to Start: 9 1 /0 Inspections to be requested in accordance with NEC 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 W. BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: silo, LIC. NO.: ZO/O Z A Licensee: Shy w., Signature LIC. NO.: 6770 f e_ (If applicable, enter "exempt" in the license nuhZer line) 10.0, Bus. Tel. No.., Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 ❑ owner's Owner/Agent PERMIT FEE. $ Signature Telephone No. J. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 4 s. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4WIM Q4W Address: 6Z3Z (7P,We � *� City/State/Zip: 64ed mW OvPhone #:(_49;r) Are you an employer? Check fie appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors I, 2XI am a sole proprietor or partner- listed on the attached sheet. $ and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ 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 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. A Insurance Company Name: Ar beJ14 ' Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: Sri John son �� City/State/Zip: Al -Ane -1~1- & 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 of perjury that the information provided above is true and correct. Signature: Date: Phone #: 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 -,-,,7 ` t (-g ps 17,10 I D-ez_ N2 2 Date.�� ..... Z�� ..... 2 6 4 V TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........... : ................... I ............................................................. has permission to perform....�.... 11 ................................................. .................. wiringin the building of ............ I ................... ; .......................... ................. at.A',................. ................................................... . North Andover, Mass. Fee..... -i .............. Lic. No, -.S .. ....... ............................................................... ELECTRICAL INSPECTOR Check# WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Mid i,UMMUIVWPALJHUPA14NX4(; 1G5KJ1,N -omce use omy DEPARTMEIVT0FPUBLIC&4FM Permit No. ,;2 BOARD OFFMPREVEMONRWUI.ATIOASS270MR 12:M OVAPPUCATIONFORPERW Occupancy & Fees Checked TO PERFORM LLEO WCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ` (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 6 l 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) c� � �rd h/ S O h s Owner or Tenant f CQ / e S e Owner's Address s� Is this permit in conjunction with a building permit: Purpose of Building DLJ , / " Gi g Existing Service /10 40 Amps/� / —�'Xil Volts New Service ;)-o e) Amps1-�O / i,;�ydVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I Yes [7n -No M (Check Appropriate Box) Overhead Overhead Un ound Underground Utility Authorization No. No. of Meters No..:.of-,Meters `C e11 No. of Lighting Outlets �-� No. of Hot Tubs No. of nsformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generator`s KVA and ground �.--___�• • _.,__..•---- No. of Receptacle Outlets ((// No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners 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 Dishwashers Space Area Heating KW No. of Self Contained J Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW • No. of No. of Signs Bailasis No. Hydro Massage Tubs 1--� No. of Motors Total HP OTHER • • :. a: �X§ hpec fiat D *Regtlested Signed unkTiie Rmllies ofiPew.. FIRM NAME xc a. S r c. S 1 Qa /^ fs 3eorilsst Etat>lde4livalatt YES F7r. NO a 7 If}cuha%edtecWYES,pL%emdcalethetjW(if ma�pbydakirgthe Ear► Die vatttedEkdtical Wok s V �J r. /ec r C liomseN®T a _ / 3 ) A/117.�� L MseNo /-/-� 9 Basins Td. Na Adrtt�c s J u�UU/ y /7 UC �/`(rn 4tiS`d�1 "'11,4 0���/ AkTeLNa OWNER'SINSURANCEWANFR;Iamaw=dxtftLiorwt�theittstraroeoo►eWa-ils9kSWn1iale#valft>tastac} WbyMassa&E&CatrALam and drat my sigttaaaea l this pamit applicadm vva*r.ts this mw*mrtat (Please check one) Owner a AgentlS 6 o -el Telephone No. PERMIT FEE $ A I- Location g1l ��N,Scl,) s �--- No. &icO Date o7 0?0 NaRT� TOWN OF NORTH ANDOVER + Certificate of Occupancy $ s� Building/FramecNust Permit Fee $ 77` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 10?6q O t 1' U f Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r 4 ,� � �, -y OR BUILDING PERMIT NUMBER:C/� DATE ISSUED: ,2 a(,9 C SIGNATURE: Building Commissioner for of Buildings Date SES C l lUN 1- b- l E IM ORMA ULO 1.1 Property Address: ToH-NsOA s -t- 1.2 Assessors Map Number Map and Parcel Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: I Lot Areas Frontage ft 1.6 BUII.DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required ProvidedR red Provided 1.7 Water Supply M.G.L.C.40. 5 54) Public 0 Private ❑ zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record &CLau Name (Prin Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 -, CONSTRUCTION SERVICES 3.1 Licensed ensed Construction [/Supervisor: I 1!1/r///��/'� / -�'^0. f= C /.4 e Y Licensed Cons ction Supervisor: Address / Y _ I Signature PP.p 1��—�LGC Telephone Not Applicable ❑ Zq 7J-7 j pZ License Number /��j��O _, _ -7/7,3)02 xpiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) ' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work (check all aonlicable 1 New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) A( I Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: big c.._ I SECTION 6 - ESTIMATED CONSTRITCTION COSTS I Item Estimated Cost Dollar to be (Dollar) s S�iFI+'ICIA>C�sS3NLY �X n ` Completed by permit applicanta 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) ^ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number JLC 1.11U1V /a U W f4tK AU I HUKLLA 1lU1V l'U BE C0MFLETED WH E1V OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, C'u / - /) - Ot--t✓6t�YL� '-e - - , as Owner/Authorized Agent of subject property Hereby authorize OU S2 4-r,- C6ZA-"-s ° to act on My behalf, in all m tters relative to wor4uthonizeo by this building pen -nit application. —0) Signature of O� Date SECTION 7b OWNEWAUTWORIZED AGENT DECLARATION I, l�lS K ,as Own Cuthorize�dAger��fubject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief )S Print Name Signature of Owme V Date Elm= M111011111 NO. OF STORIES , SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS IST 2 3 SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE PERMiT NQ, APPLICATION FOR PERMIT TO BUILD - ANDOVER, MASS. PAG —1 1 MAP NO. LOT NO. 2 PREVIOUS OWNER (LAST 2 YEARS DATE moo lc PAGE ZONE SUS DIV. LOT NO. 2rfNo SITE ADDRESS ^ � - TYPE OF STRUCTURE: � OWNERS'NAM[ / I -p�� lr TTr[L.9 OWNER'S ADDRESS .+q SCOPE OF WORK: ARCHITECT'S NAME SUILDtR•f NAM[ #We� � � � � ADORES! 1�RJn',�✓Y�I�'Tl� _ a �� L1✓�TV\� CITY/TOWN p ! 1% 30 J c7G./ f / DISTANCE TO NEAREST SUILOING / DISTANCE FROM STREET POOL: INGROUND O` CONCRETE O VINTL O DISTANCE FROM LOT LINES f1Ot: R L REAR NO. OF STORIES_ -T—W D AREA OF LOT FRONTAGE SIZE Of iLbOR TIMS[Rf : IST 2ND RAFTERS N[W I I CHANGE OF OCCUPANCY I I SPAN ADDITION I I MANUFACTURED BUILDING 1 1 DoMENSIONS OF SILLS ALTERATION .0�4 RELOCATION/ � •• •' POST Off"OLITION I I OTHER GIRDERS 2 GENERAL INFORMATION / GIRTHS [ST. [LOO. COSTv `v �� HEIGHT AND THICKNESS FOUNDATION THICKNESS AND WIDTH OF FOOTING PLAN NO. CHIMNEY - \RICK O METAL O BOARD OF APPALS DEC. NO. IS BUILDING ON SOLID I I OR FILLED LAND I 1 CLEC. PERMIT NO. ,f IS SUILOING CONNECTED TO TOWN WATER 1 I WELL i I RECEIPT NO. If BUILDING CONNECTED TO TOWN SEWER I I SEPTIC TANK I I ,% INSTRUCTIONS f[[ BOTH SIO[S / PIAN[ MUST at FILO AND AOFROVED SY BUILDING DEPARTMENT ALL CONSTRUCTION MMUSCONFORM TO MASSACHUSETTS STATE SUILOING COO[ (O� ^_/11L� JO OAT[ FILED / l CONTRACTOR'S REGISTRATION NO. Arl0-SD(0 SIGNATURE OF OV'/1[n OR UTHORI2[O AO[NT SUPERVISOR'S LICENSE NO. APPROVED BY NO. OAT[ BOARD OF HEALTH PLANNING BOARD• PERMIT GRANTSO 19 FEE on TOWN MANAGER SUILOING INSPE CTOR SWOONORG *ON as 1N3w3sva loom SONI1130 S11 vM SSS NII�IN1 NOI1V1nSN1 =1 N.l.M 'YM 111V ONlGwnld •1 3NON1 131wnua molm3dn ONINIM wool AV Sm1S011l SNOOIi t Par till put SWOON i'a'ON I isior OOOM SNIMVYi t ONIdOOm llow 13Aym0 9 myl 31V1S 23IONINS aoOM 3 0NINS 11vHdsw PWS Illi evuer4i psquwtO dl Fl I tlgt'J AOOV i wvm i NO 3NO1S MNOSyw No INO11 1119 'aN10 Au 'ONO' 3wvmi NO NOlme mNosvw No X 1 3wvwi No boon.Ls ONIOIS lAN1A S310NINS aOOM ya1S w/1NIWnly Samv09dv10 S11VM sNwnlOO Allv1 I I I I I I 1Nsw3111v• I Iw Z 1 l 18 313U3NO7 NSINIi YOIYl1N1 t NOI1vONn0i L mouonN1SNO0 'Nvld told s30v'id3N ssmL a3sodwimuns '013 '93OV N S331 ii liwvi '11f1W -VO 'S3HONOd H11M 'SONla11ne !O SNOISN3W1O LOVX3 aNV S3N1l 101 53uois j>q Allwvd 3l0NIS WONA 30NV1s10 aNV 101 !O SNOISN3Wla JOVX3 MONS 1SnW NO1103S SIMI 11 AONVdno3o 1 00033U JNIOIIne N 0 CO 4ble, 7V4" L-yL--1*+" � �J CL J I I I � s� V I I �a5e I / ---i 1 I �s Cl) I I I I I I I I I (o M � M I I I I --- II I I I 0 CO 4ble, 7V4" L-yL--1*+" � �J CL J N s� �a5e Tl- (o�(0C- ` OIST< EXIST. � f eyh META HAS 0 c 0- 0 o! Cl) O0 O c 0 � NN Z 805 C: Usa r c9.1zo �cp m � m c a �CL p U .0 C p L O 1 N <( ) rn � a A $'aa L o a2 O i-cmo r N cc tp p $ c C p . U O -D'C N � � ca 5 O 3 h� ,L Ema?° '8 'v TT O Q m� U � �J CL J N s� (o�(0C- ` OIST< EXIST. � f eyh META HAS 0 c 0- 0 o! Cl) O0 O c 0 � NN Z 805 C: Usa r c9.1zo �cp m � m c a �CL p U .0 C p L O 1 N <( ) rn � a A $'aa L o a2 O i-cmo r N cc tp p $ c C p . U O -D'C N � � ca 5 O 3 h� ,L Ema?° '8 'v TT O Q m� U INSURED House of Cabinets, Inc. 119 Great Rd. Bedford, MA 01730 ISSUE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEFIS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE$ NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY LETTER COMPANY LETTER COMPANY p LETTER COMPANY E LETTER THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI. TIONS OF SUCH POLICIES. COPO TYPE INSURANCE POLICY NUMBER LICY EFFECTNE POLICY EXPIRATION UABIUTY LIMITS IN THOUSANDS LTR DATE (MWppryn PATE WAAMDrnl EACH OCCURRENCE AGGREGATE GENERAL LIABILITY BODILY COMPREHENSIVE FORM INJURY $ $ PREMISES/OPERATIoNS 0 2 S BA 1 H 6 9 71 11/05/00 11/05/01 PROPCRTY S(PLOSION& COLLAPSE DAMAGE $ $ HAZARD PRODUCTSICOMPLETED OPERATIONS A CONTRACTUAL 51 a PO COMBINED $ INDEPENDENT CONTRACTORS 1, 0 0 0 2, 0 0 0 BROAD FORM PROPERTY DAMAGE PERSONAL INJURY PERSONAL INJURY $ 11000 AUTOMOBILE LIABILrrY eooKY •'.: -,-:� NA1RY <- f ANY AUTO IPER pERGMI $ . ; ; r . ,•. c BmLY ALL OWNED AUTOS (PRIV. PASS.) ALL OWNED AUTOS/OTHER THAN PRN. PASS. ] INJURY M A=UTl $ HIRED AUTOS PROPERTY -r',Ir'•�%:? %a '� NOWOWNED AUTOS DAMAGE =• GARAGE LIABILITY COMBINED $ - EXCESS UABILITY UMBRELLA FORM BI t. Nib OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION STATUTORY - r!": $ (EACH ACCIDENT) AND B W C 6- 01 1 6 6 9 5 1 0/ 01 /00 1 0/ 01 /01 5,,1!*': $ (DISEASE -POLICY LIMIT) EMPLOYERS' UABIUTY r� $ (DISEASE -EACH EMPLOYEE) OTHER VCOVf11r I IVIY Vr VrCIINI IVIYO/IIJV./.IIItMb CLAM11 r% SLIV AE TUG •DAVE ^CbOft_ nom, r, — -61— , — w . PIAATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAJIL ..v,• DAYS WP1TTFN NOTIrf; 1 O !r► l?a[l iwl:a I L Llnl n== IWAS[m'M TUN /�IVNnC TO MAIV GvolI NOTIOC O/TALL_ WrQOCNF O OOLI m"em OFl LummuY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR RFVRF9urAnvFQ Board of Building Regulations and Standards HOME MWROVE EENT CONTRACTOR Registration: 106450 Expiration: 7;23/02 Type: PRIVATE CORPORATION HOUSE OF CABINETS, INC. Alexander Zadeh 119 Grept Road Radford, SAA 01730 Administrator License or registration valid for individul use only before the eypiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02103 Not vie., iihout`signature BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR �t Number: CS 029637 t ' Birthdate: 01/05/1949 Expires: 01/05/2002 Tr. no: 14311 I Restricted To: 00 t' ALEXANDER ZADEH 119 GREAT ROAD �•%� �i e _ «- BEDFORD, MA 01730 w Administrator U HOUSE OF CABINETS, INC.` COST SUMMARY Customer Name CALABRESE,GARY & SUSAN Date 12/1/00 Proposal # 1 Drawing # 1 CATEGORY COST COUNTERTOP, SOLID SURFACE COUNTERTOP, NATURAL STONE 6,738.00 COUNTERTOP, OTHER CABINETS 10,500.00 ACCESSORIES 157.50 APPLIANCES BUILDING MATERIALS 2,600.00 f FLOOR MATERIALS 2,100.00 I TILING MATERIALS 335.00 LIGHTING FIXTURES PLUMBING FIXTURES 690.00 i MISC. _MATERIALS Materials Total $23,120.50 CATEGORY COST CARPENTRY LABOR $4,100.00 TILING LABOR $400:00 ELECTRICAL LABOR $6,000.00 PLUMBING LABOR $3950.00 M PAINTING LABOR PLASTER LABOR °' $2,400.00 FLOORING LABOR $2.500.00 LABOR RUBBISH REMOVAL, $1,700.00 CABINET AND LAMINATE INSTALL $I -A0.00 Labor Allowance Total $22,950.00 COORDINATION FEE $1,263.71�, TOTAL LBR., MAT & COOR. $46,070.50 e t Date.. -,-....ice........ ... . '` TOWN OF NORTH ANDOVER � PERMIT FOR GAS INSTALLATION This certifies that .............. �............ .. .....! y ..... . has permission for gas installation /.9......... . in thebuildings of ........`... �............................ . ate ...f ........ % ... . ..... '. 141 ........ North Andover, Mass. Fee:.'.... Lic. No..... ..... ............. ..... GAS INSPECTOR'-L---- Check NSPECTOR""'-- Check # / J 3 5 u x w � a c� ° W v, O w p ob v u .0 U cz C w 0 04 a: co q w pG O u CL, � w ra: r, G chi C w x w �Qz�, 0 C4 C w zW a A w z cn ° O (f) M O z c w- o m c G 5 :moo .•ate : C. C O ELo¢ L ts V • o� ; coL cn co A� O J m cm CLL) 0 La O m p•CoZ m CD 0 y O � •� Z O 2-S Q! H aCD C •C COI) or m Lu C .. -v r u. •y C + o c Z W •E C1 0 v 'y O C* 0 co S = tyv .0 c ) C !- t .0., CL ? 6 0 m 0 E L O cr— o v z °' a O y � C co cm I � •C CD Q 'ECD m m CL _0 CD ,CD O.a O � CL) O co L t—C O a CL Q1 Q cc -co C CD �..� CO) C CL — C — y 0 0 U) LLJ U) It w Irw a ; MASSACHUS,ETTS UNIFORM APPLICATON FOR PER UT TO DO GAS FITTING ✓Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New ❑ Renovations Replacement ❑ Date - 2 19 9voe .P 9� -! Permit 9 / Amount S Plans Submitted ❑ (Pant or type)` Name* (a % N Name of Licensed Plumber or Gas Fitter �`ye} e-76-1!— G t/ Certificate Installing Company Corp. ❑ Parmer ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes r7 No r7If you have checked ves.. please indicate the type coverage by checking the appropriate box. Liability insurance policy�2� Outer 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby cerrify 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 peribrmed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Gds Code and apte 142 of the General Laws. By: Title CityiTown APPROVED ()Eric:-HSF')NI,Y) Signature of Lic::nsed Plumber Or G(- Fitter ❑ Plumber %/ ❑ Gas Fitter icense iNum e. I taster ❑ Journeyman .Y (Pant or type)` Name* (a % N Name of Licensed Plumber or Gas Fitter �`ye} e-76-1!— G t/ Certificate Installing Company Corp. ❑ Parmer ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes r7 No r7If you have checked ves.. please indicate the type coverage by checking the appropriate box. Liability insurance policy�2� Outer 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby cerrify 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 peribrmed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Gds Code and apte 142 of the General Laws. By: Title CityiTown APPROVED ()Eric:-HSF')NI,Y) Signature of Lic::nsed Plumber Or G(- Fitter ❑ Plumber %/ ❑ Gas Fitter icense iNum e. I taster ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location b V J a 4h "re /1 Owners Name A? Permit New Renovation F1 Replacement Plans STb pitted Amount ve- No 1-1 FIXT-IRES J .J • (Print or ,,,/ Check one: t/ " Installing Company Name a 67 iE / � /� rp r �% C� � GO�Corp. Address �� �� FlPartner. d Firtn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Certificate 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 1, Owner n 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 Plum ' g Cgde"ter 142 of the General Laws. L By: =p=of Licenseaer Title Type of Plumbing License 14City/Town 1m�7 Master Journeyman APPROVED (OFFICE USE ONLY 7 6 0 Date. .....�'� TOWN OF NORTH ANDOVER a PERMIT FOR PLUMBING This certifies that 1.. f ........... ` ...`` ........ ....... . ' has permission to perform ...... ..: �. ..'.' ................ . plumbing in the buildings of ...... ........................... . at . `!....�: . . ........ , North Andover, Mass. 7. Fee Lic. No.fl?3.......................... . / PLUMBING INSPECTOR Check # -�- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location ' No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ �����nyyz �e i^ i�f_Itf +l;e Permit Fee $ Permit Fee Other Permit Fee 21, segerj%rection Fee -R i„ Wafter Connection Fee TOTAL $ Building Inspector Div. Public Works PiRlf T NO. a /1 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V L V t✓ PAGE 1 S4AP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE NE SUB DIV. LOT NO. �) CATION 4 Z- �Y� on 6+rte-t PURPOSE ae•..�aaes ER'S NAME C ^ I L� �. G, , G ��� �e5 a (/1• `1V�(�- NO. OF STORIES SIZE OWNER'S ADDRESS ..^^ �C/Q� BASEMENT OR SLAB t r ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAM ,n /� O„Qn ^ e6e-t�gi-m PN DISTANCE TO NEAREST BfJILDING DIMENSIONS OF SILLS DIST—ANCE FROM STREET POSTS Dr (STANCE FROM LOT LINES - SIDES REAR %Q GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS BUILDING NEW YE`5. SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY 1A,BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Wil '" BUILDING CONFORM TO REQUIREMENTS OF CODE G J IS BUILDING CONNECTED TO TOWN WATER OARD OF APPEALS ACTION, IF ANY A10 l(// IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ${.ANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR V/DATE FILED / XiGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRAr CCig m OWNER TEL. # (085 CONTR. TEL. # CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST 8T. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BVp III -DING DEPARTMEN! i_-_ - —�— ON r--1 W WD s., �¢ x A O �I ts v 9 w z d o � o W � © w 94 o w coW u °�° • ` C3`o h n x w za J N H L � z w a o j v o o CD c v o � c y O C o Ca C.3 CL c to ea ;= O O � N r Ea ~o v CO O. N •• Vo ID 1c O O 2 U ON U co O E C O O v Z co Q O y D C CD CM ca 0 'O CD O �O �E m m CD O C I-- � CD CD R � 0 CDL O O Q o -ca �a o cc Cccc v J10 CD O Q V � O C— cc CA z 0 Q cc w U) Z O U �I ts a m S � � � o W � © ui •N °C �E W • ` C3`o h n z N H L o CD c v o � c y O C o Ca C.3 CL c to ea ;= O O � N r Ea ~o v CO O. N •• Vo ID 1c O O 2 U ON U co O E C O O v Z co Q O y D C CD CM ca 0 'O CD O �O �E m m CD O C I-- � CD CD R � 0 CDL O O Q o -ca �a o cc Cccc v J10 CD O Q V � O C— cc CA z 0 Q cc w U) Z O U FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT:_-SAAAA+ Gan Lla�ro PhoneI,/ 5 9 a LOCATION: Assessor's Map Number Parcel ubdivision Lot(s) Street A'[ St. Number ************************Official Use Only************************ RECOMMEEN�D,AT�IONS OF TOWN AGENTS: Date Approvedt5 Conservation Administrator Date Rejected Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected All— D(dC,3 Received by Building Inspector/(/ ( " Date � Z l MM • � LL LU �%NSETTS b Q p CC = Q (2 DO d ir� as Q Q. !�, ►t1 N U > � W o Q a.. U) C a Z w LLI Q °C Z w J G w a °aLU N O T k T RC W Q N Q� o r www o ~ F-r� i}w 0 ooh �m V p N m o Q zz LL M0 U u. 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