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HomeMy WebLinkAboutMiscellaneous - 88 PHILLIPS COMMON 4/30/2018Date .............. J41 .. y< TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION M�C.s. This certifies that .................... ....... . ........................................................... . has permission for ga installation ..... . ... . .... . 7 in the buildin 0. ...... . .... ....... ..... ...... ......... . ................................................ at ...... ............ . ..................................... North Andover, Mass. .. Fee .. ........ N Lic. 1 0. . ......... ..................................................................... GASINSPECTOR Check #. 9.8 5': hereby certify that all of the details and information I have submitti Knowledge and that.all plumbing work and installations performed provision of the Massachusetts State Plumbing Code and Chapter PLUMBER/GASFITTER COMPANY CITY: IT (ACI I -e.1 -off STA 0 TEL:S ?36- Z/ 9 3 CELL: k9 36- Z MASTER [JOURNEYMAN ❑ LP INSTALLER ❑ (or entered) regarding this application are true and accurate to the best of my ider the permit issued for this application will be in compliance all Pertinent 42 of the General Laws. \ tb LICENSE # 5Sq SIGNAT RE ADDRESS: i t- A ZIP: " FAX: -- X\4 EMAIL: )RATION LJ/k PARTNERSHIP ❑ # LLC ❑ # MASSACHUSETTS UNIFORM A PLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY CITY: ArdoMA. DATE: Q h qL(S-PERMIT # 105 v JOBSITE ADDRESS: I 1 OWNER'S NAME: l �� ADDRESS: GZ-a--- 'i 11 1 em Mo a TEL: Q %(1 ' U � 3 ' 3S7© FAX: OCCUPANCY TYPE: COMMERCIAL [` EDUCATIONAL ❑ RESIDENTIAL I NEW:X RENOVATION:.❑ REPLACSEMENT: ❑ PLANS SUBMITTED: YES ❑ NO APPLIANCES -1 FLOOR -4 Bsmt 1 2 3 1 4 5 6 7 8 9 10 11 12 13 14. BOILER f BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK " MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER U.NVENTED ROOM HEATER ATER HEATER INSURANCE COVERAGE have a current liabili insurance policy or its substantial eqi dvalent which meets the requirements of MGL. Ch.142 YES LPr'NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [r OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee hoes not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this p6rmit application waives this requirement. 1 , CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitti Knowledge and that.all plumbing work and installations performed provision of the Massachusetts State Plumbing Code and Chapter PLUMBER/GASFITTER COMPANY CITY: IT (ACI I -e.1 -off STA 0 TEL:S ?36- Z/ 9 3 CELL: k9 36- Z MASTER [JOURNEYMAN ❑ LP INSTALLER ❑ (or entered) regarding this application are true and accurate to the best of my ider the permit issued for this application will be in compliance all Pertinent 42 of the General Laws. \ tb LICENSE # 5Sq SIGNAT RE ADDRESS: i t- A ZIP: " FAX: -- X\4 EMAIL: )RATION LJ/k PARTNERSHIP ❑ # LLC ❑ # No A y aas, a �1 Workers' Compensation Insurance Name (Business/Organization/Individual): Address: 31 -i=r)xTA* S Are you an employer? Check the appropriate box: 1. E' I am a employer with 3 4. ❑ la employees (full and/or part-time).* ha 2. I am a sole proprietor or partner- iisi ship and have no employees Th working for me 'many capacity. err. [No workers' comp. insurance col required.] 3. ❑ I am a homeowner doing all work 0:8myself. [No workers' comp. rig insurance required.] t C. 5. ❑ We 9flndusirial Accidents of Investigations ,ss Street, Suite 100 , MA 02114-2017 massgov/dia ivit: Builders/Contractors/Electricians/Plumbers Phone #: /' '07' 7? k-' E-36-- Z 15 -3 a general contractor and I hired the sub -contractors on the attached sheet sub -contractors have :)yees and have workers' insurance.* re a corporation and its ;rs have exercised their of exemption per MGL Z, §1(4), and we have no :)yees. [No workers' i. insurance reouired.l Type of project (required): 6. ElNew construction 7. E]Remodeling 8. ❑ Demolition 9. E]Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.E 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. 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 subcontractors have employees, they must provide tl{eir 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 Job Site Address:_ Attach a copy of the workers' compensation policy c Failure to secure coverage as required under Section 25 fine up to $1,500.00 and/or one-year imprisonment, as of up to. $250.00 a day against the violator.. Be advised Investigations of the DIA for insurance coverage verifi I do hereby certifv under the Pains and 7 R:3 4�' Zf i Official use only. Do not write in this area, to be City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. 6. Other Contact Person: >6 Expiration Date: tf City/State/Zip: N ('✓/� -laration page (showing the policy number and expiration date). of MGL c. 152 can lead to the imposition of criminal penalties of a ill as civil penalties in the form of a STOP WORK ORDER and a fine At a copy of this statement may be forwarded to the Office of the information provided above is true and correct. by city or town official Permit/License # Clerk 4. Electrical Inspector S. Plumbing Inspector Phone #: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY} AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES'NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policyries) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Bernadette M. Davis, CPCU EA Stevens Company, Inc NAME: PHONE 389 Main St. {781)322-2324 E-MAIL No): (781)397-7672 P- 0. BOX 188 A RESS:berndetted@eastevensins.com Malden MA 02148 INSURERS AFFORDING COVERAGE NAIC 4 INSURED INSURER A.Hart ford Fire Insurance Com an 19682 MAGNIFICO BROTHERS PLUMBING INsuRERB:Safet Ins 39454 HEATING &GAS FITTING LLC INSURER C :Twin CityFire 9459 31 FOREST STREET INSURER D: MIDDLETONMA 01949 INSURER E., COVERAGE$ INSURER F CERTIFICATE NUMBER:Naster 2014-15 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE REVISION NUMBER: 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. LTR TYPE OF INSURANCE A GENERAL LIABILITYI R POLICY NUMBER POUCY EXP wDO - OMITS GENERAL LABILITY NCE S 1, 000, 0C A [X5COMMERCIAL CLAIMS -MADE OCCUR SSBAUQ5370 /24/2014 /24/2015 ccurrence $ 300,00 WAGG-R.EGATE e person) S 10,00 V INJURY S 1,000,00 GEN'L AGGREGATE LIMB APPLIES PER: EGATE S 2,000,00 $ POLICY PRO LOC ------------- PRODUCTS - COMP/OP AGG S 2,000,00 AU I UM081LE LIABILITY S B ANY AUTO COMBIN D SINGLE MIT Ea acadent S 00 00 ALL OWNED SCHEDULED AUTOS 8 053535 —11-0 BODILY INJURY (Per person) S AUT $ NON -OWNED HIRED AUTOS X /24/2014 /24/2015 BODILY INJURY (Per accident) S AUTOS PROPERTY DAMAGE Per accident S X UMBRELLA LIAB OCCUR S A EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE S 1,000,001 X DED RETENTIONS 10,00 8SBAIIQ5370 /24/2014 /24/2015 AGGREGATE S 1,000,001 C WORKERS COMPENSATION S AND EMPLOYERS' LIABILITY' ANY PROPRIETORIPARTNER/EXECUTIVE X TW . STATU- OTH-�— ER EXCLUDED? ❑ N/A _ (MandatoryOFACER/Min (Mandatory in NH) If describe under 8WECRJ9050 /24/2014 {24{2015 E.L. EACH ACCIDENT S 500 00( SCes, DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE S 500,00( E.L. DISEASE - POLICY LIMIT I S 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hartford Fire Insurance COmpany ACCORDANCE WITH THE POLICY PROVISIONS. One Hartford Plaza Hartford, CT 06155 AUTHORIZEDREPRESENTATIVE Thomas Cares, Jr/ML ACORD 25 (2010/05) tNRn95 mnnnSt m ©1988-2010 ACORD CORPORATION. All rgitsreserved. Tho APnOn nornn onA Inn^ oro runic►oroei mzrlrc ^4 ernrsn ' Op�R� �t m IYlIYIOItl dU C , r - 0F iUTASgC ySHUSETTS BOARD OF r" PLUMBERS AND GASFITTERS G. ISSUES THE FOLLOWING LICENSE REGISTERED AS A PLUMBING CORP MARK MAGNI'FICO ~ ��` � 14AGNIFICO BROS PLB&HGT,GAS tITTI 31 FOREST ST MIDOLETON ,� MA 01949-201$ IX = 3266 05/01/16w _ 20466b AJINiONlIVgALTH OF MASSACHUSETTS 2 _ PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE ` LICENSED AS A MASTER PLUMBER;,. y MARK B MAGNIFICO {.a f � ; h..N r .' �. 31 FOREST STREET „ �E.. W MIDDLETON MA O1 4 f. 9 9-205 X3559 05/01/16 204667 m E,nMi�PAttl1MEA 7-1sA'"A CHUS TTS BOARQ OF r PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER ,r. MARK S MAGN I F I CO z 31 FOREST ST r°I"DLETt3I� MA 01949'2018 23002 45181/16 204668 w -_ i •35 A� •" di a • - �4' TOTAL $ Building Inspecto Div. Public Works Location �<� dyU - �5v RA i L L 103 �j� h4 M o No. 2 % Z Date7-2-72, NORT1l TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 6/z4457 2- s • : Building/Frame Permit Fee $ 71 �SAC/1USE Foundation Permit Fee $ M'—/00, Other Permit Fee $ '--� Se er Connection Fee $ `' Mater Connection Fee $ TOTAL $ Building Inspecto Div. Public Works Location &I lt�- alp> I i L( i'(�z Ot;4i,, m D/U No. X72 Date AORTPI TOWN OF NORTH ANDOVER 1, Certificate of Occupancy $ 150, Building/Frame Permit Fee $ CHU Foundation Permit Fee $ RECEIVED 0 Other Permit Fee $ P 1 �A Yl�- C , , Aj r Connection Fee $ JUN 2 4 ,"2 Water Connection Fee $ NO. Andoverj TOTAL $ /-50 Collector , KCR) Building lh'soi-dt'or Div. Public Works Location 4199? r of N° eT : NORTH ANDOVER c? °off 0/%C p Certificate of OcM icy $ ° Building/Frame Permit Fee $ Foundation Permit Fee $ s�cNusE Other Permit Fee $ Sewer Connection Fee $ 2_2.. Water Connection Fee $ /1frt.7. TOTAL $ Building Inspector f � f-� �G' Div. Public Works °k `�� 9A PEXALBT 4;;q.-- ` t APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. PAGE 1 �� (Pj- � � �_ MAP 4-40. I LOT NO.—� 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE zo"E SUB DIV. LOT NO. LOCATION _ — PURPOSE OF BUILDING - ^ OWNER'S NAME NO. OF STORIES 2-1 SIZE 2 U ce OWNER'S ADDRESS93��- $� `t B BE MENT OR SLAB ARCHITECT'S NAME , . t�©� V`i _ SIZE OF FLOOR TIMBERS IST �11 2ND Z� Q' 3RD lJ U BUILDER'S NAME _;,�„� n„ _ a SPAN • DISTANCE TO NEAREST BUILDING /� r, VV DIMENSIONS dF SILLS. \!� DISTANCE FROM STREET rl (�, --- POSTS DISTANCE FROM LOT LINES - SIDES ` REAR aOl GIRDERS ' AREA OF LOT �� 2 FRONTAGE ICX( HEIGHT OF FOUNDATION' ( THICKNESS //� I V IS BUILDING NEW ! p - QC, �1 SIZE OF FOOTING /i\ I1 C 7( IS BUILDING ADDITION \ N, MATERIAL OF CHIMNEY IS BUILDING ALTERATION - R O IS BUILDING ON SOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER 1(7- BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER y C . .,! IS BUILDING CONNECTED TO NATURAL,GAS LINE INSTRUCTIONS PERMIT FOR MMM Q` SEE BOTH BIDES REGULATED BY PARA. 114.8-S. B.C. PAGE 1 FILL OUT SECTIONS 1 - 3 ^ " PAGE 2 FILL OUT SECTIONS 1 - 12 �. v DATE.9-� FEE PAID ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 1 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1 DATE FILED (ol c(lg2 SIGNATURE OF OWNER O T FEE R OWNER TEL. PERMIT GRANTED CONTR. TEL. # d- 19 CONTR. LIC. # U `j PERMIT FOR FRAME/BUILDING OLK PERW FEELESS A FE:-.._ - - /oo , w DATE: FEE PAT:)/6?•'�' D�-'E FRAME PERMIT $ t 3 PROPERTY INFORMATION LAND COST T0'1)6() EST. BLDG. COST EST. BLDG. COST PER SQ. FT. gf EST. BLDG. COST PER ROOM 17,000 SEPTIC PERMIT NO. 15 1 � 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 4 I• _ BuliblNG RECORD - u 1 OCCUPANCY�1- SINGLE FAMILY ; STORIES' MULTI. FAMILY_7r OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 3 ; CONCRETE BL K. PINE I i BRICK OR STONE HARDW D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT' c.. AREA FULL FIN. B'M'T' AREA' 1/ 1/7 1/ V••�J FIN. ATTIC AREA NO BMT HEAD ROOM FIRE PLACES MODERN KITCHEN _ 4 WALLS I "9 )J -J FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES _ Y_? B 1 22 f —I_ —{I_ �— 3 _ CONCRETE '.EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY _ HARDY./'D COMMCN ASPH. TILE STUCCO ON FRAME ...�..' _ BRICK ON MASONRY!' BRICK ON FRAME ; `ATTIC SIRS. & FLOOR _ CONC. OR CINOER'BLK. WIRING STONE ON -MASONRY STONE ON-FRAAA - SUPERIOR_ ADEQUATE POOR I NONE ' 5 ROOF 10 PLMBING GAB LEHIP BATH I3 FIX.) GAMBREL MANSARD SHED TOILET RM. 12 FIX.) WATER CLOSET 4— _ FLAT ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd I ELECTRIC THIS SECTION MUST SHOW ;EXACT DIMENSIONS OFLOTAND -DISTAN.CE FROM -'•NAT LINES. -AND -E XACT-,DIMENSIONS •OF,BU.lLbING'S.,- WITH "PORCHES. GA- RAGES. ETC. SUPERIMPOSED. TMJS'REPLAOES-PLOT PLAN._.! i • A , Yin "IT.=� . ,.� u i � ►Ata c ,;-n ::.a . � ; J' �L 1 t01M 331 3TAG 1st 3rd- -NO HEATING � �... TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) a0 PERMANENTDDRESS ASSIGNED BY D.P.W. STREET. -1 (RA. APPLICANT S PHONE Z� DATE OF APPLICATION (Q (l q 2- TOWN USE BLLUW THIS LINE CONSERVATION CO&IISSION DA'Z'E APPROVED_ DATE REJECTED 1�'zf eg / DATE APPROVED V1 �711?;;� SERVATION ADMIN. DATE REJECTED BOARD OF HEALTH HEALTH ySANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT �?4, SEWER/WATER CONNECTIONS , .P h"r 5 n FI E PT. RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED DA'Z'E REJECTED This form shall be signed by the agents of the Planning and health Boards the Conservation Coirunission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw.,," L_ �7z b' f h� = = W O m p H Z Z m L O C L N ae p Z u Z J d L O O C � O 96 h Z V JL W=` O V AN _ O c O W H Z u L cm m O _ l0 C C6 W W a' Z ` 7 o Y o E CC U u- ¢ U- CC m U. Q U. m tQ w • jt V� t3 01 • Cd ;O C:j 41a: c u .y w e •r Q : Z A: UN LU cl 77 �3 J ' E QCc 6 �, QO _• a To y cn v v ° CL. 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EX/ST/.(/C PE'LO,PpS. i yf i 24 1992 t; .._._._.- UILDi PL O T �L.41v /N O,PAiYN FO.P C'a�e,o /%�EPP/rt�.9GY E'.vG�.dEE,P/.c/G SE.Pv/lES 6� P-4,P,� sr,PEET ANoOYEP, /17.4SS,4C.s/vSErTS oi8ro >E L=Z ul kod- F LU u It E 0 z Co C/) wi a rA gLU low,Oo GO z �I h o O .Q F \\ _CL L Gd O V_ „ rl z �I h I ; m o O .Q F \\ _CL Gd O V_ „ rl FL F CL O m /� v m L C rn 'O L C J a O C LU r 0.2 W 7 C a 7 C Y , o b ¢ U U- � ii Q m U) I ; m °st 41 liftl a W LA P Em .Q F „ R a y F CL O s .e �U�/� F •E s w ° 'b a °st 41 liftl a W LA P Em .Q H Q .�' E a a 4 � 4 Ck. C � v v C o � o C a I�uo, EIZL) c 10 l O O 000 v V O O v V 0 v m .m a •= t N2 2059 �� �aORTM F Date.... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that — ..� �.......................................... has permission to perform N ?P �..� t c Q .... ....................................................... ......... wiring in the building of e. k� ! r�. c/ at .............C�....�5...... �!:.. �...`. 6......t:..� 04 d tom. , No � -( h Andover, MiGs. Fee ' C.l. �... Lic. No -4T 1.3� 5 - 01 � ELECCRICALINSPE�TOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer t }' th r, OTHER UI 4t (fnmmnnWZ3J0 gf 4fltt>3gnr#iugrftS i9epartmeat of rublir —Adetg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. p�U Occupancy & Fee Checked 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 1 :00 (PLEASE PRINT IN INK OR PEAI �L INFORMATION) Date Z %y City or Town of b UQit�. To the Insp �w ie The udersigned applies for a permit to�er�orm the electr�al work deWribed below. A A Location (Street & Number) r i fvneK— Owner or Tenant Owner's Address I Is this permit in conicti n with a building permit: Yes El No W/ (Check Appropriate Box) Purpose of Building `CM1k C Utility Authorization No. Existing Service Amps _� Volts Overhead ❑ Undgrnd❑ No. of Meters New Service �LL—)J_ Amps J ZYYVolts Overhead ❑ Undgrnd i- No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets( No. of Hot Tubs I No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ I 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 FIRE ALARMS No. of Zones No. of Detection and No. of RangesNo. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local[]Municipal ❑Other No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO ❑ 1 have submitted valid proof of same to the Office. YES K NO C. If you have checked YES, please indicate the type of coverage by checking the appropriate box. ������ �5„ 7N C INSURANCE XBOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ (Expiration Date) _ Work to Start Signed under the Penalties of perjury: FIRM NAME ti7 41.3, Licensee -S 1/19.-✓Ufi.� Inspection Date Requested: Rough �.� - T,oc- C) 1`1, Final LIC. NO. LIC. NO. �s. Tel. No. �� — <7 Address L!/ie,��s/1�iy6 �(.i, /yo, ��/.�l�nLi2��g Alt. Tel. No. 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. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ y x6565 This certifies that Date. /_ ,-. r . ".. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ..,#. `' . F ....................... plumbing in the buildings of . L/*A..4' c 5.? "I. /= /'............. . at. �� .. N . 1. i ... (� ty. . ` ......... North Andover, Mass. Fee. Lie. No.. 7 S..... ....... ........ PLUMBING INSPECTOR Check # 2-�, I S A { New - . Renovation Type of Occupancy Replacement d rrQmrrn V c Plans Submttted' ❑ .. --.._ s a _ No (Print or type) . -. C�hec Ane: Certificate Installing Company Name Andover Plumb. & Htg. Co. , Inc. 'Corp. 2122 Address 20 A wean Dr. Unit -10 _ El Partner. Methuen, MA 01844 Business Telephone - _ ( 978) 685-8383 Firm/Co. Name of Licensed Plumber. Georc]e LaRos . Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy Other type of indemnity El ' Bond ❑ 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 — ignature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p ed under Permit.Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State robing CQdter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY Yignature of LicetisearIumoer Type o0lumbing License 9983 icense MumoerMaster. Journeyman /- - z- Date. ....C- ...- ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Nis certifies that ................ ........................ has permission for gas installation .................. I in the buildings of . L4-1 L-1 (:I,- t! h//Z'/- ............ ... ........................ North Andover, Mass. at Fee. 7. . . Lic. No.. ........ ........... GASINSPECTOR �-' Check # n L I t- 3 on 7 8 rr L NLASSACI UTIYUN r1PP CATON FOR PERMIT TO DO GAS F -FITTING T 'Type or print) .PARCEL Date NORTH ANYDO t' Building Locations 7 g �%� (�✓ ��� ___ Permit # r Amount S Owner's Name New Renovation Replacement Plans Submitted Print or ., V - address 20 AeAec,., lir. j„) ; -41�Inii X11 e-+hL—e in -a Mo- n I S3 u 4 Business Telephone eg7g� 1895-8383 1 Name of Licensed Plumber or Gas Fitter Chec one: Certificate Installing Company 1� Corp. 2121. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE " Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ if you have checked ves, please iodicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the ,lass. General Laws, and that my signature on this permit application waives this requirement. Check one: 11 Sisnature of Owner or Owner's Agent Owner ❑ Agent El i hereby ce-dN 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 vlassachusetts State - Code and Chapte 42 General Laws. o i /fit___ By: Title CityiTuwn APPROVED (l)FFICF USE ONI.YI S, ature oW Plumber ❑ Gas Fitter haste- Joumeyman Plumber Or Gas Fitter 49 R,--5 License INumner y U C Z N Cr m r w it C G Zr C y r -r ^ Z Z C z F z C C: y — z %r C CA) M ,i�j n L F z z- -t w �/•• w z C C — w SU 13-13A SEM ENT BekSE.M E`1T IS 174. FLO G R 2.N D% FLOOR 3 R D. F L O O R .4'r III FLOG R 5T II. FL<) O R 6T rt . F1,0 0 R 7T 5. FLOOR. 3'r II. FLOG R Print or ., V - address 20 AeAec,., lir. j„) ; -41�Inii X11 e-+hL—e in -a Mo- n I S3 u 4 Business Telephone eg7g� 1895-8383 1 Name of Licensed Plumber or Gas Fitter Chec one: Certificate Installing Company 1� Corp. 2121. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE " Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ if you have checked ves, please iodicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the ,lass. General Laws, and that my signature on this permit application waives this requirement. Check one: 11 Sisnature of Owner or Owner's Agent Owner ❑ Agent El i hereby ce-dN 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 vlassachusetts State - Code and Chapte 42 General Laws. o i /fit___ By: Title CityiTuwn APPROVED (l)FFICF USE ONI.YI S, ature oW Plumber ❑ Gas Fitter haste- Joumeyman Plumber Or Gas Fitter 49 R,--5 License INumner � G� �- �'� Location i f No. Date NORT1y TOWN OF NORTH ANDOVER 419 : Certificate Occupancy • of $ s,cHu Eco' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 166-24 y----�-. G `-Building Inspedar 9 If 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION**"******************* APPLICANTcIGriY Nw) Ak Vf a LOCATION: Assessor's Map Number SUBDIVISION N 5 Ll�k'lb STREET. 0 COM,MbYi PHONE PARCEL LOT (S) 5T. NUMBER 07-0 ************************************OFFICIAL USE ONLY*********************************** REPMENDATIONSqFj)OWN AGENTS: CONSERVATION ADMINIST TOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 j RT6A6E INSPECTION PLAN /Town_ uo ANR'�IFR State , F- r 2. SC i I l : ----------------------------- --------------------- rS----- -- -------- ----:L__- BuyerS_yaN °Eia[�M[ ____ y --- L ----- PI in No.iqq g ------------------- n per City/Tovn of_____ N Tax Assessors Map. V15", LcTr 2,----) 12, e44 S.F. . ��\ 10" ... l-e:"r 1 s 22, r • � 00.0 r V PV 1 l l - ►P L,,__�M MC)'J )J -----ANhwER_ CNK __--------------------------------------------------- ereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is =nded or represented to be a property line or land smt . y It cannot be used for establishing fence, bldg! , Yills or built s• No responsibility is extended herein to the land owner or occupant. The location of the original building(s) as sl zn was in Compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizol nsional requirements, or is exempt from violation enforcement action under Mass G.L. Thee VII, Chap. 40A, Sec. 7, unl 'rvise shown herein. Subject building(s) lies in a flood zone designated lone: amity-Panelll Z p pr _pQ p_zg --- G--- _ —----- and shown on FIRM ------ -----------`-------------- Dated: _!� =1_ 8 Job No. az JCD, INCORPORATED, LAND USE & DEVELOPMENT Cq%LTANTS 4 AUTUMN LANE, METHUEN, M 01844 348-683---- Q ' Town of North Andover Building Department 27 Charles Street �usEttS North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Please print Q� 1 DATE 2 0_3 `_ n JOB LOCATION Y �� 1 J comm or"-\ Number "HOMEOWNER Street Address Section of Town IV -M -72 - Number Home Phone W rk Phorie \.) PRESENT MAILING ADDRESS mil City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certif' that Building Department minimum inWe n pr cedures comply with said proan re rehl HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFICIAL Town of No. Andover nts and that he/she will Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Cf) M M C/) 0 v CA d C CA Cl)CD 0 Z y CLCO�• r O O- = y c v CD cclCL o cr "C d CD CCD O CD C CO V1• -• CD av CA O �C CD . v CA O 'v Z CD � o C CD CD t C 910 p _ O �• N cr N d0<m .� CO) � m 0 m C) O H N. CL m CD Z Fn - Sr m ,.a ?d = con* O O N 0 O=rm m > >-0CD 0 0dc w n p y: Cm09 :® rr^^ CD co ami acn09 N r O, � Q �y Vr�// �l �w r -L CL I !- g �.s " co m CA Cf) ? y 0 n m C o CO m 0 �� : 00 z =r �° oa Cn ►� CD�- bh m m CSD h e co: �. CCD a•.� 0' w S Ct7 w (IQ m w n oKc A. Ct I 0=3 0 9