Loading...
HomeMy WebLinkAboutMiscellaneous - 9 CHADWICK STREET 4/30/2018 (2)Al N O co O n S _ 0 Dv o w 0 co � o �' o � o m Pm -m+ Al Date... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Thiscertifies that.�„1......................4.....l......................................................................... has permission to perform .................. Tl�.................�".. �-� plumbing the�iy�ild ing�s of ...` ... u.'.. (( �,ll��j �G((.............................................. at ......... .................................... North Andover, Mass. ham........ Fee.��.......... Lic. No. !. 0 7.................................................................................... 26C37e1(P& AS � 2() PLUMBING INSPECTOR Check # �,?k J&d- 20114-- ►,n MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �vr�c./ _ MA DATE PERMIT # Od JOBSITE ADDRESS C� 5� ! — OWNER'S NAME POWNER ADDRESS G ,' TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL EP RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YESEQ NO FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _j _J1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 1 -. — [ __.._ __ _I I=== -- _ _. J= __._._. €..__DEDICATED DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _1 _.___.__1 _.._.._ ________€ _�_._1 — _f ------_1 FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK 1-11F77-3 _J LAVATORY (J � _._._ l _ 1 -------S _-___.I ____I _____ .__----J .v___1 _____ € ROOF DRAIN l _1 _. _—I ._ _ ! _ I ___.J __.___I .____.J ._..__i -__._.1 _ _.._.J . _.-.._.I SHOWER STALL SERVICE / MOP SINK _ ! _._ J _ __I ,_ _ __. __.1 _.. __ ___. _..1 __ . _.___I € TOILETJ. ___j URINAL € —I ____G _--._J ___.J _._._ti _..____ __.._J __--j= WASHING MACHINE CONNECTION _.._ _1 ! ! -- __-_I= i ._..._J -..__1 WATER HEATER ALL TYPES 1 f € . - _._{ I 1 . I -_ ___1 WATER PIPING I i IF- -1 ! i OTHER BMW INSURANCE COVERAGE: Q 1 have a current liabilltv insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES .._., NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY VR"'O' OTHER TYPE OF INDEMNITY Q BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 101 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true an 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 c plian with erti prov'si f the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME `� ! LICENSE # \ ATURE IMPLro�JP�7J CORPORATION F.] ( PARTNERSHIP D#1 31 LLC COMPANY NAME r � --�-- � ADDRESS CITY <��,�j�,�_�__..___-.. STATE ZIPTEL - s ` FAX �— _.. (CELL^I EMAIL c/_- _ -- .t..._ --...--------- ►,n o z Li_i W LL '1% The Commonwealth of Massachusetts F Department ofjndustrialACcidents 1 congress Street, Suite 100 d Boston, MA. 02114-2017 e^M Sy'V9 www.mass.gov/dia • Workers' Compensation Insurance Affidavit: Builders/Contractoxs/Electricians/plum ers. TO BE FILED WITH THE PERMITTING AUTHORITY. nr,.., - Print - Name (Business1619 atio-.n&dividual): XV y� l i Address:71 1 City/State/Zip: �,, �1co � A) H OZ%phone # Are you an employer? Check the appropriate box: 1,❑ I am a employer with employees (full and/or part-time).* 2. am a sole proprietor or partnership and have no employees Working Forme in • acity [No workers' comp. insurance required.] any cap 3. ❑ I am a homeowner doing all work myself; [No workers' comp. insurance required.] t 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 proprietors with no employees. 5. ❑I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6, We are a corporation and its, officers have exercised their right of exemption per MGL c. 1 4 and we have no employees. [No workers' comp. insurance required.] Type orproject (required): 7. ❑ New'donstriiction 8. [] R.emodeliiig 9. ❑ Demolition 10 [] Building addition 11.0 Electrical repays or additions 12XE plumbing repairs or additions 131] Rb6f repairs 14.Other *Arty applicant that cheoks bbx#1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit, oxafFida itattchid an indicating the areditional doingshowing the name of theand then hire contractotside rs and state wrs must hether or not those t a new affida"it entit es h have h $Contractors that check this b ..,.,t..,, if tlin sub -contractors have employees, they must provide their workers' comp. policy number. am an employer that is providing workers compensation insurance for my employees. information. insurance Company Policy # or Self -ins. Lic. #:. ,below is the poltey and job sate Expiration Date:_ City/State/Zip: Job Site Address:thnumber and expiration date). Attach a copy of the workers' compensation policy declaration page (showing the policy y Failure to secure coverage as required under MGL enalties2xnthe form of criminal25A is a Op and/or one-year impst rpunishable WORK ORDER and a fine of up to $250.00 a xisonment, as well z p py of this statement may be forwarded to the Office of Investigations of the DIA. for insurance day against the violator. A co verification. I do hereby V provided use only. Do not write in this area, to be completed by city or town official. ale is trge ani correcr. permit/License # City or Town- Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone Contact Person' 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 receivet'or trustee 6f 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 b6 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 r'equiired." 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=contractor(s) name(s), address(es) and phone number(s) along with their certifcate(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. B e 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 PIease be sure that the affidavit is complete and printed legibly. The Department has prgvided 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. Iu addition, an applicant that must submit multiple pennit/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 'ONWEAUff-OF c _ BOARD OF , lot "LU 113ERS AND GASP i TTEF.S i SSJES THE . C1t. LOWI NG L I CENSL', � to ! 1GEP:S-0 "S A MASTER 'LUMBER ' JOHN B '(LITTLE JR o'o Box is NH 03874-o'8 t'OIvtMONWEALTH OF MASSAGHU � w} 1 BOARD OF s PLUMBERS AND GASFITTERS •I ISSUES THE FOLLOWING LICE ' L IC ENSED AS ;� JOUPLUM ` . I .nMN B TUTTLE -'A c 'a PO Box 18 NR 03974-0018 j.A3RO!1x x� . \.4 -` •,_tee+` `- Date.?.�J .... !..) ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... ti ... .. I 7 ............ a. I . .... has permission to perform ........... 41 ...... wiring in the building of ........�. ..%....... at........ .. ...... Feejj­U. ...... .............. Lic. No . ......... Check #/ 5�0 ................................. . North Andover, Mass. ................................. ELECTRICAL INSPECTOR 9 (flmmonwealg o f Vamac4adetb Official Use Only cc�� cc77 Permit No. l e(J partment of ire Semlce,6 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank)- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 02.00 (PLEASE PRINT IN INK OR P�(�ALL IN 0 TION) Date: City or Town of: A ti si)�,1� To the Inspector of Wires: By this application the undersigned gives notice of hior he intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant �l1V AA: �� WLI Y' t Telephone No. `Z �OZ-6,0� Owner's Address 3LP-0 MAJf-CL 31- t Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of BuildingAy--5,e Utility Authorization No. / Existing Service /0 0 Amps/A0 //,Z�e4 Volts Overhead 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: °� ji 18,E G �/ Ol1 t'� r„» ,te,:,,. „f,bn fnllnw;"y tahle may he waived by the Inspector of Wires. 1 s . ....... ... No. of - Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above in Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices Rea Number...Tons KW """""" Self-contained No. of Waste Disposers Totals DetNo. cof Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection E] Other Heating Appliances KW Security Systems: Devices E No. of Dryers No. of or uivalent No. of Water, Heaters No. of No. of Si s Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring• No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent OTHER: d l' d' d re -;-1 b the Inspector of Wires. n Attach addition eta; ;f esrre , ora I y Estimated Value of Electrical Work: l0 - (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjuty, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: L ,e Signature LIC. NO.:j��q3 (Ifapplicab e, enter " em t" in the license nu ber line. us. Tel. No.: / Address: Alt. Tel. No.: (o *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S"License: Lic. No. OWNER'S INSURANCE WAIVE I am aware that the Licensee does ,not have the liability insurance coverage normally required y la By my si tore b ow, I hereby waive this requirement. I am the (check one �wner ❑ owner's agent. Owner/ ent ERMIT FEE: S 11 ti Signature Telephone No. b- 91, u .", k Ew. SSUE AS .A* JEP;H'EN W CON 17 ROSE AVE L E FOLLOWING:.>LILtNa- URNEYMAWILECTRI-CIA s Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUI- ING AUTHORITY. Name(snsiaess/Organizadon/Tndividual): Addxess: 17 ✓ ?moi 412 City/State/Zip: Are you an employer? Checktiie appropriate box: .. I'M > - 40 -1 -MI 1. am.a employer with employees (full and/orpart time).* 2. 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] I Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 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 proprietors withno employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insnrance.t 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.] Type of project ()Vequired): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 eElec�ical ding addition11. repairs or additions 12.. F1 Plumbing repairs or additions 13.0 Roof repairs 14. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing Al work and then hire outside contractors must submit a new affidavit indicating such. YContractors 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, tliey must provide their workers' comp. policy number. am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: 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 o. 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. Ido hereby certify under theXains andpenatties ofperjury that the information provided above is true and correct Ml!!�41FAOVA Of use only. Do not write in this area, to he 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. PIumbing Inspector 6. Other Contact person: Phone #: The Commonwealth ofMassgchusetts Department of IndustirialAccidents a.: ; d 1 Congress Street, Shite 100 - - Boston, AM 02114-2017 www mass gov/dza s Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUI- ING AUTHORITY. Name(snsiaess/Organizadon/Tndividual): Addxess: 17 ✓ ?moi 412 City/State/Zip: Are you an employer? Checktiie appropriate box: .. I'M > - 40 -1 -MI 1. am.a employer with employees (full and/orpart time).* 2. 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] I Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 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 proprietors withno employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insnrance.t 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.] Type of project ()Vequired): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 eElec�ical ding addition11. repairs or additions 12.. F1 Plumbing repairs or additions 13.0 Roof repairs 14. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing Al work and then hire outside contractors must submit a new affidavit indicating such. YContractors 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, tliey must provide their workers' comp. policy number. am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: 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 o. 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. Ido hereby certify under theXains andpenatties ofperjury that the information provided above is true and correct Ml!!�41FAOVA Of use only. Do not write in this area, to he 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. PIumbing Inspector 6. Other Contact person: Phone #: 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, of 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=contractoi(s) name(s), address(es) and -phone numbers) 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 maybe submitted to the Department of Industrial Accidents foi• 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-iii'sured 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 NORTH FO A R SSACNUS� This certifies that Date. -)-. 13 :.o.3. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING C.?.I.IA.��.`�r.., 4 I`�.......... bas permission to perform . �1-- c? i l -c t- . ? 4 I� I . ; M plumbing in the buildings of ........ 1 C° at......... ` ......... , North Andover, Mass. Fee... ..Lic. No. 3. .-�)'u?. 1.1c1,:�. �.�.�'"`.... PLUMBING INSPECTOR Check # 3 L( MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUIT ETTS ' ' Date 3 v Building Location q C140 t- i C $ t Owners Name vizir j 6 Permit # Amount Type of Occupancy%� t; S//J �I�f -i A L New Renovation Replacement 0---/ Plans Submitted Yes No ❑ (Print or type)f / / Check one: Certificate 1{ � Installing Company Name (.71yi C / ; p t /T ❑ Corp. Address 60 I- L / /yGV* d S7 - Partner. %/ Ul:/y s Business Te ep one �Z- 7 u A 7 �- / -ia irm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 Signature Owner ❑ Agent ❑ S 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 inst 11 i s peilormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu e tat g P m ing Code and Chapter 142 of the General Laws. BYign repcensed-FlqwDer yumbing License Title a-1 ? 0 I City/Town License Numuer Master Journeyman n APPROVED (OFFICE USE ONLY LT "• � 1 - WMMMMMMWMMMiiiiiiiiiiiiMMMMMM iii ,.•MMM0MMMMMMMMMMMM0MMMMMa�� (Print or type)f / / Check one: Certificate 1{ � Installing Company Name (.71yi C / ; p t /T ❑ Corp. Address 60 I- L / /yGV* d S7 - Partner. %/ Ul:/y s Business Te ep one �Z- 7 u A 7 �- / -ia irm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 Signature Owner ❑ Agent ❑ S 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 inst 11 i s peilormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu e tat g P m ing Code and Chapter 142 of the General Laws. BYign repcensed-FlqwDer yumbing License Title a-1 ? 0 I City/Town License Numuer Master Journeyman n APPROVED (OFFICE USE ONLY LT Date. q;�' j 3.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..� ? .L. i 4�. � � � U..... � ............... . has permission for gas installation . a .'C Y'.... in the buildings of Tei. w I ..1).4 r.%, .ti . � .................... at .. q...0 ! A 4 ! C. � .............. North Andover, Mass. Fee ... 3.Q .. Lic. No., 4Y n .... ! /.0 M �'�'� . GAS INSP CTOR Check # 3 42 r i:? ✓IASSACHUSETTS UNIFORM APPLICATOR FOR PERMIT TO DO GAS G or print) Date j t10} Iwx I H ANDOVER, MASSACHUSETTS Building Locations A 1) t-/ G Permit # 1 Amount S IV, `4P DOV U- /� Owner's Name Tlloj,-As h v/? Ail NG New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type) / Check one: Certificate Installing Company Name /ifLL/��()IA /��2 (y/�-!� f �7"T� �rp. / �el C Address ❑ Partner. IV /AX)1)0VFsIL /1/-tS usiness Telephone 9-> 52 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter :J (`L ULL 4/& , INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®-'-- No 13 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy F1 Other type of indemnity ❑ Bond F1 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: S , ;ature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bast 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 Massachuss State Gas C dend Chapter /42 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Sigdture of Licensed Plumber Or Gas'Fitter Plumber �L yt/vl Pas Fitter License Number ©- Master ❑ Journeyman z T WG z W 't SUB-BASEM ENT B A S E M E N T 1 ST. F L O O R 2ND. FLOOR 3RD. FLOOR 4T H. F L O O R 5'r If. FLOG R 6T II . F L O O R 7T 11 . F L O O R UST H. F L O O R (Print or type) / Check one: Certificate Installing Company Name /ifLL/��()IA /��2 (y/�-!� f �7"T� �rp. / �el C Address ❑ Partner. IV /AX)1)0VFsIL /1/-tS usiness Telephone 9-> 52 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter :J (`L ULL 4/& , INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®-'-- No 13 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy F1 Other type of indemnity ❑ Bond F1 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: S , ;ature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bast 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 Massachuss State Gas C dend Chapter /42 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Sigdture of Licensed Plumber Or Gas'Fitter Plumber �L yt/vl Pas Fitter License Number ©- Master ❑ Journeyman t, OFFICE PHONE # Clifte C1r0MM1'nLUeZJ[th of 4Ea5fiZ[riU5ett5 Department of Pubiic Safety BOARD OF FIRE PREVENTION REGULATIONS 527 OV1R 12:00 (508) 388-8129 Office Use Only Permit No. re e- Occupancy S Fee Checked __ L 3/90 cleave blank) APPLICATION! FOR PERMIT TO PERFORiy1 ELECTRICAL WORK A:l work to be performed in accordance with the -massachuseas Electrical Code. 527 CI -IR 12:00 pp/ (PLEASE PRINT IN INK OR TYPE ALL INFORXiATt^"" Date—] w 7 b City or Town of _ N1)- k bo�)To the Inspector of Wir The undersigned applies for a permit ,o perrorrR the electrical ,Mork described below. Location (Street w Number) Owner or Tenant Owner's Address V Is ;his permit in conjunction •.%i h a building permit. YesX No L! (Check Appropriate Box) Purpose or Building k Utiiitr Aucnorizaron No. Existing Service amps r Voits O%erhead❑ Undgrd 1:1No. or .vteters New Service —Amps r Volts Over;,eid ❑ Undgrd ❑ No. of ,vie:ers Number or Feeders and Amoacity Location and ,Nature or Prooused Elect.;cal Work 044� No. Hvdro :vtassa¢e Tubs No. of •vlorors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of .masiachus;tai General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES XNO = : have submitted valid proof or same to ;his orrice. YES NO If you have checked YES, please F-1indicate the type or coverage by checking the appropriate box. INSURANCE j ® BOND t_1 OTHER❑ (Please Specify) 0IP (Expiration Date) Estimated Value or Electrical Work i Work to Start G_ �V Inspection Date Requested: Rough Final i"7�(4 Signed under the penalties or perjury: /n� FIRM NAME 43 / AA V licensee &IeNwOP,D 94-,IIC. NO. E (oo� , Signature LIC. NO. A - l $ Address &hy�P'S 9 WiZs/ a[)IC1(3Bus. Tel. Nos11'21 94-5. �a Alt. Tel. No.O� 3? —6� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required 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 �� TOTAL No, Or Li¢hrtn¢ Outlets •..:o. or mor Tuns I :,;o. of Transiormers KVA Aou�e in- I F]�rnd. No. of Li¢htin¢ %rurei Swimm:r.Q Pool lmd. fel Generators KV.A i�w�i No. or Emergency Lignung No. or Receotac!e Ourlers No, or Oil Burners Bar -,-2,v Units No. or Switch Outlets I No. or Gas Burners FIRE ALARMS No. or Zones No. or Detection and Initiating Deices No. or sounding Devicei .No. or Ran¢es i otai No. of Air Conditione•s Tons No. Disooials Heat i otat i Ora. or No. Or P -:moi Ton; K'ry No. or Seir Contained No. or Dishwashers I Soace! k' ea Hexane ,K'N Cetet:ionrSounding Devices Huntc:oai ❑Other No. or Dryers I Hearne Devices KW Local❑ Connection I .No. or -No. or Low voltage No. or Water Heaters Viv Si¢ni Sailasts I Wiring. No. Hvdro :vtassa¢e Tubs No. of •vlorors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of .masiachus;tai General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES XNO = : have submitted valid proof or same to ;his orrice. YES NO If you have checked YES, please F-1indicate the type or coverage by checking the appropriate box. INSURANCE j ® BOND t_1 OTHER❑ (Please Specify) 0IP (Expiration Date) Estimated Value or Electrical Work i Work to Start G_ �V Inspection Date Requested: Rough Final i"7�(4 Signed under the penalties or perjury: /n� FIRM NAME 43 / AA V licensee &IeNwOP,D 94-,IIC. NO. E (oo� , Signature LIC. NO. A - l $ Address &hy�P'S 9 WiZs/ a[)IC1(3Bus. Tel. Nos11'21 94-5. �a Alt. Tel. No.O� 3? —6� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required 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 �� Location 9 No. / j Date A Ot %e NOR7q TOWN OF NORTH ANDOVER O? O� „ Certificate of Occupancy $ io j} Building/Frame Permit Fee $ ;7s`AC Eery Foundation Permit Fee $ s�cMus ,,00 —� .Qt3" Permit Fees -a $ L o Sewer Connection Fee $ Water Connection Fee $ TOTAL $ a � uilding Inspector Div. Public Works VL�sv [ 6 PERMIT NO. 4 c 1 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT Nd. LOCATIONG /2 h e/� �� PURPOSE OF BUILDING C. L OWNER'S NAME ��� �1a �l`�M NO. OF STORIES SIZE OWNER'S ADDRES S,p— BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME :�Rfe ..L� f 7�` � � /v /` SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES – SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING t ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ttf IA ORE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED /— /2o—"-19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INGFUMR OWNERTELJ (o 5 12— CONTR. TEL. A / 75 Z Z L— CONTR. LIC. # o2l 2 &,767 H.I.C.# /© 5-39-3 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE HARDW D B 1 2 I3 CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL_ UNFIN. _ 3 BASEMENT AREA FULL FIN. B-M'TAREA _ 1/1 1/2 l/, FIN. ATTIC AREA N_O B M FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ CONCRETE EARTH HARDIr✓ D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. _ WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR _ ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ LAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 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 _ to 13rd I ELECTRIC I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. O F=04 S 7 x d o x P5 LID u L% n � J `r � z t = m C :i. o u � Z r z fi. u w z L LL v > cn Li. oz O � z �° O r -I G Li. w a w w u q z Lf) o o C/)— n :x :o :w Q O O a) O Z O H M co L co C O O V _O CL COD O V .Q CO) C O V O !O CO) L O C) Q. CO) CM CM cm 0 :2 CD CLI L ' G O O Q' Q C7 Q c +-+ C i 'C oaD Z � Q CO) C C C m C 4 o ` O N =5 v C.2 CL 1 m C C3 i O m C3 \J" N CF m N m �V•' V y0„ • m m d O i N = M cm O ca r v: u'E m v c cc= -C -2m N m C aC.c m m 0� V N O i .� Z O clpRi CL N m C C =m N F- oN0mo►- :ago m W C L �.= N =.= -.- Z ,9 'E V - V N o v `D oma,'« c V� a m a � m :x :o :w Q O O a) O Z O H M co L co C O O V _O CL COD O V .Q CO) C O V O !O CO) L O C) Q. CO) CM CM cm 0 :2 CD CLI L ' G O O Q' Q C7 Q c +-+ C i 'C oaD Z � Q CO) C M } t - i • Q c}� � 4� V7 r C n O t oo p Z C W j d �•-y ]K N Vf = LAJ w c O ¢ O.O 'n C 0= 'n � ♦.-1 1 � � r G � { K ti N p m 6 In \ � dCc 1 Location Date �L TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee s�cMus ioMivi�Wher Permit Fee Sewer Connection Fee 7 Water Connection Fee ; $ TOTAL $ r � - Building Inspector/ .. Div. Public Works PER1tIT«vo. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 4AGE 1 MAP +,`O. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 1 PAGE ZONE SUB DIV. LOT NO. LOCATION �/ Ji_`I _ (�/f u fL 1I PURPOSE OF BUILDING C. f �j� '.rl_��Q� _ �ri(c K.(� T�J,c3 u��3LL OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 2e,, .2,C)tz a�G T It.4 r7.2T `? SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR t DATE FILED TURE 09F—gWNEp OR AUTHORIZED FEE PERMIT GRANTED �'` (/1/2-7 19 l 7-- OWNER TEL. NOE L.# - 2 C0NTR. LIC. # 00 77 G 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN MWA&�ILU-YOR 1 OCCUPANCY SINGLE FAMILY BATH 13 FIX.) TOILET RM. (2 FIX.) _ STORIES MULTI. FAMILY _ ASPHALT SHINGLES _ OFFICES APARTMENTS WOOD SHINGES KITCHEN SINK _ SLATE CONSTRUCTION 2 FOUNDATION TAR 8 GRAVEL 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE RADIANT H'T'G UNIT HEATERS GAS BRICK OR STONE 7 NO. OF ROOMS OIL HARDWD B'M'T 2nd _ 1st 13rd _ _ PIERS PLASTER _ _ _ _ _ DRY WALL UNFIN. _ _ _ 3 BASEMENT AREA FULL FIN. B'M'TAREA '/. 1/2 '/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B 1 2 _ �_ DROP SIDING WOOD SHINGLES EARTH ASPHALT SIDING HARD D _ ASBESTOS SIDING _ COMMON _ _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING 5 ROOF II 10 PLUMBING GABLEHIP GAMBREL MANSARD BATH 13 FIX.) TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK FORCED HOT AIR FURN. SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER STEEL BMS. & COLS. BUILDING RECORD J 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. t �I TILE DADO 6 FRAMING 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 GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING 50. z 0 E at .r 0 Z I' go c R a c one D 0^0 1.11cl a 0 a c a— �] o a e C. be LY d. ... F .r H C � y H 61 a0r 6� O Q • LUF" fes'} H •O 5 4 H J u40 ECLE C6 wu F Z d Coo O im GC O ~ t a+ O 0 Q W W W u Z Z Z W 0 O z y� CJ z o z u �c < m C J m m L C Im E L s C, J L V L m Y O S O m O 7 ¢ U ii m ii ¢ m ii ¢ iI m to z 0 E at .r 0 Z I' go c R a c one D 0^0 1.11cl a 0 a c a— �] o a e C. be LY d. ... F .r H C � y H 61 a0r 6� O Q • LUF" fes'} H •O 5 4 H J u40 ECLE C6 wu F Z d Coo 6a t a+ w u • y� CJ o C C z 0 E at .r 0 Z I' go c R a c one D 0^0 1.11cl a 0 a c a— �] o a e C. be LY d. ... F .r H C � y H 61 a0r 6� O Q • LUF" fes'} H •O 5 4 H J u40 ECLE C6 wu F Z d Coo FOLD ALONG LINE W Q W Q CO. Z n6,0 O ` N W AA 00 O OY � o0zz = �+ CS fL1 a¢w LU O y z N z Z O a m (71 J Q W U) > W 0G N V 4 N W j J N ulm r LL�o VN <� t0i > O 222 y UM a C, O O w "O O 0 m � FOID �LOwG e C 1`1 d O r 00 r s-ro a=� DCII" cc 0c Z►OW H Z? cc tin O WNZ Or 4 M W ZO %..9 0' W Z 2 � QO X .p w 2 w Occ O" M im 1 00 M 1 LA N O N N Z n6,0 O ` N W AA j j W V O =O ZY; �ZWF C N o0zz = �+ CS fL1 a¢w LU O uzw LL = Z z Z O a m (71 m F.'.j-'•. N