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 .0 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. gy Title Sigaure o cuPL � ed PlumMer L at City/Town Type of License: Master [X Journeyman ❑ APPROVED OFFICE USE ONLY) License Number 8322 ''/2" Watts 9D bfp on water line to water boiler -- ?Z3 nZ r rn o a z `, r� O r-4 W n Z ~ Z '.t•' 4 I v7 4 cc_ N O Z Z ` a N. l Q2 :I o i a v a (0 P(d 49 t z X mQ w -w ' F `n i o a ¢ s cc O v N w X a h W 3 O O Z >` J a. ¢ F Q Y o ¢. W OLL u r U > o O S -is D a o J a c c Uj a a ca Hx } = F- LL C7 7 2 1. M SUB—BS MT, BASEMENT: 1ST FLOOR 2ND .FLOOR 3RD -FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR I , STH FLOOR T-1 . +FF 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. gy Title Sigaure o cuPL � ed PlumMer L at City/Town Type of License: Master [X Journeyman ❑ APPROVED OFFICE USE ONLY) License Number 8322 ''/2" Watts 9D bfp on water line to water boiler -- ?Z3 J Z O W N W V LL LL O ac O LL 3 O J w m w W LL CC O r - U w a N z Z V2"`Watts 9D bfp on water line to water.boiler 944 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 z O m 7 W D O z M 90 O on r M r z^ G) 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 O Z4. R.7; F w A d O; W -a o w v v cn U W -c o w ° O C2 U C i=. O U tin O w q u. O [-4 W W ao O w " cY G w a O a z O w C w W z �¢ w A w w N cn o cn ►i; a COD W_ LL cc W C.� y H V m m C) C H ME O CL H W t CD a O O L O v Z O O- O y s i C CD Q LA O O mm CL- co imp, M C L d !m CL O CL. co CQ Q C CcC .EL, CO2c CD Z ts C3 as CL C.3 CO) C � .0 C Q. CO2 0 U) U) Ir mW cr `W^ VJ c 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 i Z - fAR-.>.Ccj op OZ Y Q tY90 J� W 2WW V0-1 }aD ZOcQlu<�¢ �p0 Qa. ¢O L��6��.�YCotoiiameii� o opo<3�mo~� o a v R:f C7 t+0' ta �-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 U,of the Gdrorsl .Lava. S+8na4se of wed p Type CO Lion &Aasbm;X IN: -3c •a v O. `p d m 1 A S . Imp Z O 302 230 m 0o a > s o 0 IN: -3c v o 0 z s a 0' > c O _ 1u . s-