HomeMy WebLinkAboutMiscellaneous - 878 WINTER STREET 4/30/2018Dat t OP. ..........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......K._ P .......... S............! ........ ...... ...............................................
has permission to perform A, 4 C
...... ................ ......
wiring in the building of ......... 4
P.OJ6'z— ... ................................................................................
at ................................ (FP ........................... ............... . North Andover, Mass.
..............................
Fee, � . . .......... Lic. No�0 ... '..' ... .....................................................................................
ELECTRICAL INSPECTOR
Check #
13u^95--).
2-W
ILI
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Commonwealth of Massachusetts Oficial Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
,M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code QvIEC), 527 CMR 12.00
(PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: 2e / G
City or Town of: NORTH ANDOVER To the Inspector f Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Crit A S f
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a�� building permit? Yes ❑ No Rr (Check Appropriate Box)
Purpose of Building �. 1 d1r—:? �.'a. Utility Authorization No.
Existing Service 299 Amps 12e -7-1.',--Y0 Volts Overhead , 0 Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the following table maybe waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
s Total
of
Trsformers KVA
Tran
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool rnd. ❑ rnd. ❑
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Detection and
No. of Switches
No. of Gas BurnersTot
Initiating Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
Heat Pump
Number
Tons
KW
No. of Self -Contained
No. of Waste Dis osers
P
Totals:
•........................
I .......................
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal Other
Local ❑ E]Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
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, oras required by me lnapeccur UJ rr &F c3.
Estimated Value of Electrical Work: % 1,00
(When required by municipal policy.)
Work to Start: 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, tinder tltepar s rind penalties operjury, that the information on this application is true and complete.
FIRM NAME: E`w ��► ''' v 't LIC. NO.:�_
Licensee: � ` / `✓ ✓� Signature .G� LIC. NO.:
(If applicable, enter "exempt" in the licen n mber line. Bus. Tel. No.: �%fS� 2y61
Address: 2.5 P',A—.1 •1 � ��i-o ice? t� D'3 Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PEttMIT FEE: $
Signature Telephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the p
e
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an 1'
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and maybe deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑
❑ Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass n
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass IN
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signat re:
Date:
FINAL INSPE TION:
Pass M V
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
4 o4
Inspectors Signature:
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com
IN
The Commonwealth of Massachusetts
Department of IndustrialAceldents
a ; d I Congress Street, Suite 100
Boston, AM 021142017
&--- - www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERAUTTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Iudividual):cpps/� r �7
Address: £i l� `r0✓1 �CJ�
City/State/Zip: � .`S�:J� f' 03` Phone #: y �� Z '?6- 7
Are you an employer? Check the appropriate box: Type of project (required):
I. ❑ I am a employer with employees (full and/or part-time).* 7. Q New construction
2.8 I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling
any capacity. [No workers' comp. insurance required.]
9. Demolition
3. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
❑
10 E] Building addition
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole 11..S Electrical repairs or additions
proprietors with no employees. 12. Q Plumbing repairs or additions
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. Q Roof repairs
These sub -contractors have employees and have workers' comp. insurance.#
14. Other
6. Q 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.]
*Any applicant that checks box 91 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees.Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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.
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
Phone #:
A' -
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub=contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line. -
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
' COMMONWEALTH OF MASSACHUSETTS
- 60ARp OF ,
CTR I L I A N.S;
I SSUES THE FOLLOW 1 NG'11''CENSE ;
AS' A RE'G JOURNEYMAN ELECTF:ILCIAN }Q..
{(VLN SULLIVAN
W .
• 25 NEWTON 'ROAD
PLAISTOW. N`H 03865-2406
51911` E 07/31/16- 43591
Date .....
.....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... ........ ............................
has permission to perform ........ a �4-,t �......... ...................
wiring in the building of ........ 5 ...... ..............................................
at .............. ............ 1WA1.1rt!FR .... S,;;;.Pr . ..... . North Andover, Mass.
Fee .... Lic. No.C-0/9.7 ........
ELECTRICAL * *1* N-S'P*EC,T'dA— * .... ..
Check# 2 F
7116
J,
CuMIlii"001tete eltl► of MastSOl80l"Retts
LF
naport'A'Y1ent Of Fire '�4}PNIC66cy tmd. Fee CllaaltedPREVENTiON RFGIli,F1Tl()N� 91 laavablanrc � ..,..
BQAFica Q
AIR'R1�1 �►TIC)N FOS. �'E�'�11)i�"�t"�'t�WF�E�R��f�������M �I�At, mti 12���
Act wnrh to bm gerihrmecl in er rn ,
(PL
pRINfi11 nvK o� ryPr � 1 INFt?ft��.�T1�N lv rltaw p �1 Wires:
Cigar or Town olfe _ _ �
rdv 11118 at1p11CARla1+. tl1e 4111C1arel�ncti �,1'es 11JClG�' 0 4115 �t ,c, ,ntentirnl to lar*rfo,�11 tl,a nlacty{cal want daaaribaal 0810w,
Locatlni► (Street & iVutttber)
oven ar or Tarn,arat , ,.
Tolopboine No.
owa,er's AddtIataa F :- ------ -- --._ pproprhato BOX)
Is citta pe"Alt IAA �aA1,1jt1ARR)IaAl w11101, a bulb€btng blCA'llAltn M a S t !
t`t#lity �ttltilol•##oll i`fa.
pillypose. of tl (� Na. at llAataRe
AaAps ,,,.,,•,�'....,..____�''ott� tD1el•b,a;aAdltaad�r
�
iR1vtolitkol$ 9arAee , llsal tsl No. of Nfagars
'�lR� ..�.,., A,exAtt,t �.__.� nit� ()� Ql•11�entl ❑ ` �.
lYlAtntltaAt' of Feadeira< attad A,!nt,p®clty
of pl opogcd Electricatl woi is
Location A610
No. of 1te11e11104d > 11#at a
No„ of Lighting falls#iota
No, of u5btlltglFlrxRulva
No. of >Riiliaaptnala Otlt#ets
�No, of Switch"
No. of 1tn,rtge!s
No, of WARte DIRPOR"i
No, of lalsttwnahel's
'Na, of IIlI'9'I+t�a
of Wafter
i#aNt+�ra
No, of C90 -911W (Piddle) I+n!as
No. of klat Tubs
9wt111Alling Pool
rod.
No. unwrn
�f4. ofGAA !IA I Ile, •s
No. of All. Cand, T
�w� �i�nc+'iArarA Itesltlllg KW
I�metIAlpl.A,pllllalaAa:es 1CW
1111w fnienc iRallnsts
Hydroinamige 04111tilbS f+ltt. of 11'Iotors'Total He
n
KVA,
ALARMS I No, Of' ZOaraa
of A18111148 Oavlees
Data
0NltRIll4Hltall Q Oust•
C'nnne� fon
Irirrrhnwfrfi(iulrnJrtcrtdifRcafr,4rf.nrnsrarlnirod4},r/iaainpaa+nl'o(tvn+ax.
IINSURA.N+CV COVERAGE. t.hlleao W01v0d by the o,,,'er, no pet•,r,t for t11e pal-folrrnance of electrical work may jostle unless
t11a licollsoe provides proo1'of liability nlsur Ire inclt,d,r.g "cclilila}t*tcd g3erat!ol1•' coverage or al substantia) equivalent. TAC
undersi ffilti l cartif 0 tllltt stied cover � it1 force, atnd has t,chil�it�d pi not of aaeme to tho pct -mit iasuina ofttco.
CHECK ONE: INSURANCE BoNn �] 0TI't -A n 1911c:ct0\1 _2G(�-�j� �,�� 6— 0
• .xpiratien ate)
Fstimated Vilitto of Flectrioal Worlc (tilled required by mti lmPal policy.)
Work to Sigvt inspections to be 'tqueiied in ucarn•da,lce wit11 MCC Rule. 10. mild upon complatign,
r cOrT� ,sassier ttta pains a"! .oalastfrf,et ofpq# jlar�l',, that rite hA101-11lat(na to this applikil dors is 1!'110 and am ytlatta.
FIRM NAl1rlR: •..�. � _a� �%_� e�.. )v L � LIC, NO..
L,IeatlaNs __. _ 51Rnaturc ____ _ LIC. NO.:
#olr PJ hC,;/n.:n . .eu� , " !n rJi.r hcm.�tc"airaw'o"i'e
• l Bills. TAI. i ia.' - -ZZ .
1-1
AaldAaao:�C�L L All. Tot. No.:
QW1N>�>� it AN . t W V !. that t 1c �_� �ensa:a: r1nr�.v rrnl irinF the habrhtv insurance cavet'a,p1c 110t'tt1nlly
t'equited by law. By ttly signoture below. ! nerchy wail'e ii„s equurnlenf. I ant the tehec}c one awner gowner,901011111
Owner/Agent
S1 wAatalre _._. 1'elepboae No..� �,._� _. �. laiRMIT,FE.&. $ J
0 1 NORTH_ .1
SS
Date .��.
TOWN OF NORTrVNDOVER
PERMIT FOR PLUMBING
CH
This certifies that.... ... � tc-B
has permission to perform.............. * .................
plumbing in the buildings of
-1.................
.... .....
......
........
at 47-.......... I North Andover, Mass.
Fe&Z-V. Lic. No.. �.*...............
P UmN NSPECTOR
Check It 9
72U2
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
r
e �P Mass. Date G� Permit # efj
R c
Building Location %r� L1 J,'� �� Owner's Name,- 'c�.
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company -Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate
Address 35Pleasant Street EX Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 781 —438-7776 M Firm/Co.
Name of Licensed Plumber - Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked,, please indicate the type coverage by checking the appropriate box.
A liability insurance policy M 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner O 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 performed under the 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.
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Title Sigaure o cuPL �
ed PlumMer L
at
City/Town Type of License: Master [X Journeyman ❑
APPROVED OFFICE USE ONLY) License Number 8322
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Installing Company -Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate
Address 35Pleasant Street EX Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 781 —438-7776 M Firm/Co.
Name of Licensed Plumber - Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked,, please indicate the type coverage by checking the appropriate box.
A liability insurance policy M 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner O 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 performed under the 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.
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Title Sigaure o cuPL �
ed PlumMer L
at
City/Town Type of License: Master [X Journeyman ❑
APPROVED OFFICE USE ONLY) License Number 8322
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No 2801 Date.01./��.��./�l.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... .......... ... X-5it..In5 .......
has permission to perform ........ I_- ...........5....s ........................
t e
, GI
t wiring in the building of ....... La!d...............
i".. I ...........................................
at ..... ............ c ........................... North Andover, Mass.,�'
Fee.3—(..Q .. Lic. No. ............... ........ - .........
ELECTRICALINSPECTOR
Check # 1-3
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts Official Use Only
1`3 Department of Fire Services Permit No. �. Vol
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (Imve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance n•ith the Massachusetts Electrical Cod-. (MEC), 527 CMR 12.00
(?LEASEPRDYTININKORTFP ALL INFOTION) Date: a-1, -.-�6ao
City or Town of: Q r --R-) J -_bo ve(-- To the Inspector of Wires:
By this application the undersigned glees notice of his or her intention to perform the electrical work described below.
Location (Street & Number) t ) 1 Y A f t -z_ � f
�f�n'ner or Tenant ( (� ('' r� r U -Z 7.- e,,. Telephone No.
P Y - 25-- 57S
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No
Purpose of Building Utility
Existing Service Amps / Volts Overhead ❑
New Sen•ice Amps 1 Volts Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Workr-
(Check Appropriate Box)
.uthorization Na
Underd ❑ Na of Meters
Und;rd ❑ No. of Meters
Complerion of the follaxinz table nzav be Waived by the Inspector of iFires.
t4,e
No. of Recessed Fixtures�Na
of Cell. (Paddle) Fans
INo. of Total
Transformers KVA
.No. of Lighting Outlets
INo. of Hot Tubs
(Generators KVA
No. of Li;htingFixtures
Above ❑ In-
SnimmingPool smd ornd.
o mergency ignting
Batten• Units a a
INo. of Receptacle Outlets
INo, of Oil Burners
FIRE ALARMS INo. of Zones
INo. Snitches
INo. Gas Burners
of Detection and
of
of
INo,
Initiating Devices
INo. of Ranges
Total
INo. of Air Cond. Tons
Na of Alerting Devices
INo. of Waste Disposers
(Heat Pump I Number Tons I KW
INo. of Self -Contained
Totals:
Detection/Alertina Devices
No. ofDisliwashers
ISpace/AreaHeating KW .
Municipal ❑Other
ction
No. of Drvcrs
�Heatin� Appliances RW
ecuri ystems: /�
es or Equivalent
No. of Water R'W
No. of No. of
I
Data Wiring:
Heaters
Signs Ballasts
` Na of Devices or Eauivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wirino:Na of Devices or Equivalent
OTHER:
.Yvocn aaauionot netov y acsirea, oras requirea ov me Inspector of W-ires.
LNSUR4NCE COVERAGE: Unless waived by the owner, no permit for the perfonnance of electrical «work may issue unless
the Ii== provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The
undensimed wnifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CIECK ONE: INSURANCE ❑ BOND ❑ OTHr-R ❑ (Specify:)
Estimated Value of F.1- trical Worlc 9N.." (When required by municipal policy.) (Expi.-ation Date)
Work to Start: ick 7 0� Inspections to be requested in accordance with NEC Rule 10, and upon completion.
1 cert fr; under the pains and penalties ofperjury, that the information on this application is true and complete .
FIRM NAME: ADT Security Services 111 Morse Street, Non o MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Si;natur /� LIC. NO.: 1533C
(lf applimble. aver "czempl " in the license number linc.) Bus. Tel. N o.: .7R1 -27P-11'41
Address / Alt Tel. No.: 603-59_4-59 resi
OWNER'S INSURANCE WAIVER: l am aware that the Libensee does not have the liability insurance coverage normally ONLY
required by law. By my signature below, I hereby naive this requirement. I am the (check onc) ❑ n•
owner ❑ oner's agent.
On•ner/Agent
Signature
Telephone No. PERl111T FEE: S�
dy/No.2507 Date...... ...........
t �aOR7M ,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that /. U ....�fv1-(% l
.....�................
.....................................
has permission to perform .......2.. � /� . f.'..�.......� (;t i?..V.9 .......................
wiring in the building of C" /?/U'? {_
r.... ............................................................
J` .
' at .........�. 7..5�...... /�.�.r.1..l�f t.�...s ................. . North Andovew4s.
Fee... 5... .. Lic. No..4 f% .? l/.`.>ik�-
�� ......
3v � INSPECTOR
Check # � � ✓v
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
-7k C_ � r_ 5 -19 -
Office Use Only �/'� 7
011E �IIriiIIIUnWralo of agga 11 gettg Permit No. (J
ki
lBel7attment of Public ,_%IIfPtg Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank)
APPLICATION .FOR. PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ->e '3i -20�
City or Town ofd&Zarz �To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) ���' 6-2,L-!v"q
Owner or Tenant k_
Owner's Address _ sa-W1_ r
40 this permit in conj ction with a building permit: Yes ❑ No LJ (Check Appropriate Box)
Purpose of Building : Utility Authorization No.
&isting Service Z" Amp J <a Volts Overhead �� Undgrnd ❑ No. of Meters
New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work tidL- f/
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑
grnd. grnd.
Generators KVA
No, of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
No. of nes
FIRE AL/and
No. of Dd
No. of Ranges
Tot
No. of Air Cond.
toyrs
Initiatin
No. of Disposals
No.of Heat Total Total
Pumps Ton KW
No. of SvicesNo. of SedNo.
of Dishwash rs
Space/Area-Heat g KW
Detectig DevicesNo.
Localict ❑ Other
of DryersHeating
Devi s KW
ction
No. of No. of
Low Vol ge
No. of Wa r Heaters KW
Signs Ballasts
Wirin
No. Hy ro Massage Tubs
No. of Motors J Total HP Ile-
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws r --
I have a current Liability Insurance Policy including Compllq d Operations Coverage or its substantial equivalent. YES r NO ❑ 1
have submitted valid proof of same to the Office. YES Q NO ❑ if you have checked YES, please indicate the type of coverage by
checking the ap priate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ /
Work to Start Inspection Date Requested:
Signed under the Pen_alties of perjury: ,
FIRM NAME
Licensee _
Address
Rough 4d/<4 s2 C_ Final
Bus. Tel. No.
Alt. Tel. No.
(Expiration Date)
LIC. NO. 4ZZ!9'9.5—
LIC. NO.� sem'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Ow Agent
(Please check one) A
" TelepholV
one No. � PERMIT FEE $
(Signature of Owner or Agent) x6565
Location
7 �- r -
No. Z12r Date
TOWN OF NORTH ANDOVER
f p
' Certificate of Occupancy $
# i #
�'�'°'••°'''<� 9
cHuBuilding/Frame /Frame Permit Fee $
sJ�se
r Foundation Permit Fee $
Other Permit Fee $ _
TOTAL $
Check # 1112 /�
15412
Building Inspector
TOWN OF NORTH ANDOVER
,. BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
gm a
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: 41 0 a 41-
Buil io o uildings Date I
SECTION 1- SITE INFORMATION
1.1 Property Address:
S'i
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
/, /O ' A gl O , / )0- J �1
1.3 Zoning Information:
Zoning Diift d Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Rapfired Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT
2.1 OwnerofRecord
c4&)-' l/�/
Name (Print) Address for Service :
Signator Telephone 7 �y 3 2—
� 0
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
- 7-; o/L S
Lic nsed Construction Supervisor:
t
Address
ignature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor /
Not Applicable ❑
Company Name
Z ' ` STQ//tel
L/
Registration Number
Address
C
G 7 7�- !i
Expiration Date
Signature Telephone
Ma
M
X
ic
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7
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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 buildi it.
affidavit Attached Yes ....... K No ....... ❑
-Signed
SECTION 5 Description of Proposed Work check au applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL;USE-ONI:Y
>
1. Building
3
(a) ee
Multiplier Permit F
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
ow
4 Mechanical HVAC
5 Fire ProtectionI
6 Total 1+2+3+4+5
/
Check Number
SECTION 7a OWNER AUTHORIZATION TO IRE COMPLETED WHEN
OWNERS AGENT OR C�O+NTRAC,TrOR APPLIES FOR BUILDING PERMIT
I, /�/L J /— S as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf in Zna ers relativ o work autho K ed by this building permit application.
of Owner Date
-Signature
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
as Owner/Authorized 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 ne
y
Signature of Owner/Agent Date
,,
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TIMBERS 1 s 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DINMNSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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Vropoe;o.r
Free Estimates GUTTERS, INC. Fully Insured
"Your Home Improvement Specialist"
All Types of Home Improvement
Seamless Gutters Vinyl Siding and Trim Work
www. j nrgutters.baweb. com
Haverhill, MA: (978) 372-4088 114 Hale Street, Suite 204 Nashua, NH: (603) 595-2272
Andover, MA: (978) 475-3723 Haverhill, MA 01830 Portsmouth, NH: (603) 433-1811
Woburn, MA: (781) 937-4212 Manchester,NH: (603) 666-5502
Boston, MA: (617) 423-3559 Toll Free Nationwide: (800) 966-9238
Toll Free Mass Only:, (800) 552-0030 Fax: (978) 372-0360
PROPOSAL SUBMITTED TO PHONE _______TDATE
Carla Bruzzese 978-725-5581 2/20/02
STREET JOB NAME
878 WInter Street Roof
CITY, STATE, and ZIP CODE JOB LOCATION
North Andover, MA 01845
JOB PHONE
lVe VropWk hereby to furnish material and labor - complete in accordance with specifications below, for the sum of:
Seven Thousand Three Hundred Eighty-five and 14/100
Payment to be made as follows: dollars ($—
Due Upon Completion of the Job
All material is guaranteed to be as specified. All work to be completed in a Authorized -
workmanlike manner according to standard practices. Any alteration or deviation
from specifications below involving extra costs will be extra only upon written orders, Signature
andwill become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,
tornado and other necessary insurance. Our workers are fully covered by Workmen's Note: t s proposal may be l)
Compensation Insurance. _ withdrawn by us If not accepted within ('`� days.
We hereby submit specifications and estimates for:
J—N—R WILL STRIP SHINGLES FROM SAID BUILDING AND DISPOSE OF
IN A LEGAL FASHION. WE WILL BE APPLYING AN ALUMINUM DRIP EDGE
AROUND THE PERIMETER OF THE ROOF. THEN A 15 LB. WEIGHT FELT
PAPER WILL BE APPLIED TO ROOF DECK. THE SHINGLES THAT WILL
BE USED IKO'25 YEAR, GAF, CERTAINTEED, ATLAS, ELK OR EQUAL VALUE.
WE RECOMMEND THE USE OF IKO 25 YEAR BECAUSE IT`S AN ORGANIC
BASE ASPHALT SHINGLE THAT HAS TWICE THE ELASTICITY AND MUCH
GREATER TEAR STRENGTH THAN FIBERGLASS SHINGLES. (CUSTOMER WILL
HAVE THE CHOICE OF THE SHINGLE COLOR). ANY CARPENTRY WORK WILL
BE AN EXTRA CHARGE. ANY ROOF BOARDS THAT NEED TO BE REPLACED
WILL BE AN EXTRA CHARGE AT THE COMPLETION OF THE JOB. THE JOB
SITE AREA WILL BE CLEANED ON A DAILY BASIS. ANY REMAINING OR
STRAY NAILS WILL BE PICKED UP USING A MAGNET. THIS IS OF COURSE
TO PREVENT ANY INJURIES FROM HAPPENING.
J—N—R ALWAYS COMPLETES THE JOB IN A TIMELY, EFFICIENT AND
.PROFESSIONAL MANNER THAT OUT PERFORMS AREA COMPETITION.
I. TRULY PUT FORTH EVERY EFFORT TO PROVIDE CUSTOMERS WITH THE
HIGHEST QUALITY STOCK AND PROFESSIONAL SERVICE.
PRICE INCLUDES s'j`tG FEET OF ICE AND WATER SHIELD.
PRice includes 30 Year designer architectural shingle at no extra
01cce tance of cost.
� �TO�D�aI -The above prices, specifications
and conditions are satisfactory and are hereby accepted. You
authorized to do the work as specified. Payment will be made as Signature
outlined above.
Date of Acceptance: Signature
Y
2O))77)tCJ�It/.11eQ��� O� ICC!'JStYCllilslf%�d
Bn2rd of Building Regulations and Standards
� HOME IMPROVEMENT CONTRACTOR
Registration: 108503
Expiration:
08/19/2002
Type: PRIVATE CORPORATION
J N R GUTTERS, INC
Jonathon Raymond
114 Ha;e St. _
Havertu!!, MA 01830
Administrator
✓iir. T�a�rrmraouuca�l� o�✓Irl,(rascrriuraella
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
rr
Number: CS 051635
't' Birthdate: 05/29/1935
t Expires: 05/29/2003 Tr. no: 10219
..t..,._u:�,....,�
Restricted To: 00
THOMAS J SAYERS _
116 WASHINGTON ST
GROVELAND, MA 01834 Administrator
North Andover Building Department
Tel: 978-688_954,
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid. waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
_� 11 IIZ-G- /7-7
(Location of Facility)
Signatur f Permit Applicant
Date
NOTE: Demolition permit from tide Town of North Andover must be obtained for
this project through the Office of the Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Print
Name:
Location:
City _ Phone
am a homeowner performing all work myself.
�I am a sole proprietor and have no one working in any capacity
�am an employer providing workers' compensation for my employees working on this job.
Company name'
Address
r
Phone #' 51' 7
Insumn..ce Co.. PQlrc►t_#
Address J/D0 0, U A4 m i /Ij CL i �R ScJi
e
crtV: ✓ �� �} Phone*. 9 7g- S 2-%— P
tns�ur_artce go. T- �1/ iP i//I GC' S / N Poricy # @ 2 3/ S 33
Failure to secure coverage as required under Section 25A or MGL 152 co lead to the imposition d criminal penalties. of a fine up to $1.500.00
and/or one yews' imprisonment as well as civ penalties in the form of a STOP WORK ORM and a fate of ($100.00) a day against rrie. t
understand that acopy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification.
I do herby certify undelyhe pains and penakies of pedury that the inhonnatim provided above is true and correct
Print
Official use only do not write in this area to be completed by city or town official'
[]Check Y immediate response is required Building Dept
Contact person: Phone 4.
RM WORKMAN'S COMPENSATION
# 2z7-- 322 -�/o g -
E]
Building Dept -
0
Licensing Board
p
Selectman's office
Q
Health Department
❑
Ofher
a
j 1oj29/oi
B.K. McCarthy Ins. Agcy. Inc.
100 Cummings Center Suite#101F
Beverly MA 01915-6105
978 927-8899
INSURED
JNR Gutters`, Inc.
114 Hale Street, Suite 204
Haverhill, MA 01830
COVERAGES
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURER A:
INSURERS:
INSURER C:
INSURERS AFFORDING COVERAGE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS 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 SUBJI*CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI-
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRLTR
TYPE OF INSURANCE
"Y0,60waffiam '
POp� E _
P/IIICY SXPtRA RON :
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LOABLI Y
CLAIMS MADE FXJ OCCUR
16 8 0 8 7 7Y6165 IND 01
06/12/01
06/12/02
EACH OCCURRENCE $1,000,000
FIRE DAMAGE (Any one are) " s3 0 0 , 0 O 0
MED EXP (Air one person) $5,000
PERSONAL a ADV MURY $1,000,000
GENERAL AGGREGATE s2,000,000
GENT. AGGREGATE LIMIT APPLIES PER:
POUCY PRD LOC
PRODUCTS-COMPm'+Am s2,000,000
A
AUTOMOeLELIABILITY
X
X
X
X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
Drive Other Car
I810865H6659IND01
06/21/01
06/21/02
I
COMBINED SINGLE
mm) $500,000
BODILY INJURY
(P -P n) $
) I $
(BODILY INJURY
PROPERTY )$
GARAGE LIABILITY
ANVAUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
A
EXCESSLImuTY
X OCCUR ❑ CLAIMS MADE
oMcnm E
X RETENTION $5000
ISFCUP1987W676INDO
06/12/01
06/12/02
EApIOC(XIRRENCE s4,000,000
AGGREGATE s4,000,000
s
$
s
B
womERscaaPENSATTaNA+��
EMPLOYERS• LIABILITY
IWC231S330775-011 --
-fl9f 09/20/01
-09J20/02
:�r.0 sTAr� . :DTH•.
YUMrrS
E.L. EACH ACCIDENT $100,'-.000
EJ_ DISEASE - EA EMPLOYEE $10 O O O 0
E L. DISEASE - POLICY umrr S5 O O O O O
OTHER
DESCRIPTION OF ADDED BY PROVISIONS
Evidence of Insurance
JNR Gutters, Inc.
114 Hale Street, Suite 204
Haverhill, MA 01830
iBOVEDESCRIBED POLOCIESSECANCELLED BEFORE THE EXPIRATION
ISSUING INSURER WILL ENDEAVOR TOMAIL ]_fl_ DAYS WRITTEN
RCATE HOLDERNAMED TOTHE LEFT, BUTFAI.URE 70DOGOSMALL
ION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Date..G..a�.?.
NORT"
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
SACMUSi�^�'`
f)
This certifies that ....
has permission to perform ..�_.�.-�-�! ..�!�:-..�.�? . ......
E plumbing in the buildings of ....
...........................
at ............... , North Andover, Mass.
3n . /v.... / i
Fee,... ...... Lic. No... .. �,._ .. � ........
�,.� p ' PLUMBING SPECTOR
Check H Q
6514
I
AIASSACHINM A 2 UNI
FORAA APPUCATION FOR PERMIT TO DO PLUMBING
(Pfi,tT
—�^� Mass_ Date
Buokong Location �� Lc/siv panni! # L y
//� Owne:'s Name .:C� �
TYPe of rr� 6-9 ..
New D Renawation D ZSubm
FIXTURES D No G
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�-BSMT
BASDrtp�
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
TTH FLOOR
.8TH FLOOR
irstallim company Nan>c X Check Ofm
0VOURAH�
PRW mobw Ac" -el
1 tam a cuu tE l r or its
You No D eOuWWent which mee3s the � of MGL Ch uZ
yM pease WW=ate the type Cly by 0.*.g the apptpp boot
A liability bmsarcie fey
o:h« type of kWmwft 0 Bond c
ms's 9SURANCE WAM t l.am aware.that the
1e2 of the Masa General Laws, andthat- 1tO mmm
does not bare tAe kmxance coverage ►wed
. �► a on v.s appl-cabo, wanes ttus
Sonatwe of Owner or Ownersgger t Check one
owner —
V V.
1 CW* that an at Ute u
vW t W Ctf 71ry eand d �riion 1 gave s�r� dite� in 00"
aA�n We oft aW
bG;itj IMiIl1 a!f D"Ons O¢tht PkNMM w= aW ���s pmjaff� loerthe acc u u 0
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