HomeMy WebLinkAboutMiscellaneous - 920 JOHNSON STREET 4/30/2018 (2)Date.
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0"".. -. ��o TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..../7 1"�F. 6 (G A/7
has permission to perform .... i . � ................. .
plumbing in the buildings of��..�?!.�`..'................. .
at ... . �7 2 . "...'° / ":./. `." ....... (l... ,North Andover, Mass.
Fee .. .... Lie. No..2 .. ?. . ......
PLUMBING INSPECTOR
Check # G
8037
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
�,q � Date
Building Location &0 �#' Al j4) /--, :f%Owners Namei�'//jGr /Pry /'/Ndr�%/%�jpermit # 1 ?
Amount ;?o
Type of Occupancy'/��/�,�
New Renovation Replacement ® Plans Submitted Yes No
FIXTURES
(Print or type)//�� Check one: Certificate
Installing Company Name d L 1—d 16gl 1 ,OGS 11n f Ji,u — 11 Corp.
Address 3,c/,- 0&16; 5-r []Partner.
Ql/�iU/,f����%'� %MIS} el$ j S
Business Telephone 4-X S-- ''j 6-0 "j ' 1:1 Firm/Co.
Name of Licensed Plumber. 7ZW AiKe z G e •,1 11,'
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 11 Other type of indemnity 11 Bond
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
threeinsurance
Signature Owner 13 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 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.
BY igna or Licensee rIMUDer
Title of Plumbing License
City/Town
PRicense um er �— Master Journeyman
APPROVED (OFFICE USE ONLY
Date. .+ ........
Of NORTH 41,
TOWN OF NORTH ANDOVER
9
• PERMIT FOR GAS INSTALLATION
This certifies that ..�A....l �� 1 ?'° 1:! ...........
has permission for gas installation 11A..-. .............
in the buildings of F. Ar" Iv t! ...........................
at .... . North Andover, Mass.
Fee. .... Lic. No.. . ..... ......
64S INSPECTOR
Check #
6751;
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date 4 - 2-0 9
Building Locations 970 5% Permit #<�
4zly� y'oy mef/`,/ P/� t /SAmount $
Owner's Name
New Renovation Replacement ® Plans Submitted
(Print or type) `` Che k one: Certificate Installing Company
Name - ///�`� V/P#+� PJ/
Corp.
Address C Partner.
/LEE!% 9 Mf 016 y.Sr
us�iness Te ep one (,�,f 5a �1 13 Firm/Co.
Name of Licensed Plumber or Gas Fitter 1,007 111144el? q-•/
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ® No0
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy M Other type of indemnity 1:1 Bond 13
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:
Signature of Owner or Owner's Agent Owner Agent 0
-_ ___1 - --• --- .-•- -- •-••_ • ••-11.,.,,.•[1L.%,u k-1 cntulcu) to wove appucatlon are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber 4R da Y"?
Gas Fitter License Number
Master
® Journeyman
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SU B-BASEM ENT
BASEM ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) `` Che k one: Certificate Installing Company
Name - ///�`� V/P#+� PJ/
Corp.
Address C Partner.
/LEE!% 9 Mf 016 y.Sr
us�iness Te ep one (,�,f 5a �1 13 Firm/Co.
Name of Licensed Plumber or Gas Fitter 1,007 111144el? q-•/
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ® No0
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy M Other type of indemnity 1:1 Bond 13
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:
Signature of Owner or Owner's Agent Owner Agent 0
-_ ___1 - --• --- .-•- -- •-••_ • ••-11.,.,,.•[1L.%,u k-1 cntulcu) to wove appucatlon are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber 4R da Y"?
Gas Fitter License Number
Master
® Journeyman
W Now -
Date ...... 9 ......
.... .......... ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............
has permission to perform .............. ..... Sy. T1
wiring in the building of ........ ... meq.� ......................................
at .............. t� ...... ... S7- North Andover, Mass.
Fee ........... Lic. No.
,A- Check #
762;
tlf
Official Use Only
(,,onvnotuuoa� o� �a�aclsu�Qt`�
ryry�� Permit No. 1210
..Uapartmen# o��ira �arvicad
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (M ), 527 CMR
00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION} Date: -
City or Town of. /V NN0DJV\— To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention tQ perform the electrical work described below.
Location (Street & Number)
Owner or Tenant �At1 C.
R
Telephone No. 17Y 627 3236
Owner's Address
Is this permit in conjunction with a buildinpermit? Yes El n
g (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Ict o �r'7
Location and Nature of Proposed Electrical Work•7C
STPirI
, ra— y, nm rno tahle may be waived by the Inspector of Wires
�., . F , �....... ( / / - P" i t r
r Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: b (When required by.municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE GE: 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:)
1 cert, under the pains and penalties of perjury, that the information on this application is true and complete/ 53 3
FIRM NAME: P�-C S�curl-r�{ S�rUCCPs _ LIC. NO.:
Licensee: G( 2 Signature LIC. NO. S
Bus. Tel. No. `� ��'S9f�0
(Ifopplicable, enter 'e. em l" in the licede num er line.) �9
Address: e L I N -FM e l� ��t5 , �Alt Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safcry S License: Lic. No. SS 0 O �/ %"
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/AgentVa."ERMIT FEE: $
Signature Telephone No.
No. o ota
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
A ove n-
Swimming Pool rnd. Elrnd. ❑
o. o mergency ig ing
BattUnits
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS4an
. of Zones
No. o Detection
No.of Switches
No. of Gas Burners
Initiatin Devices
Total
No. of Air Cond. Tons
No. of Alerting Devices
g
No. of Ranges
No. of Waste Disposers
eat ump _ um Fe _ons
Totals: `
o. o e - ontaine
Detection/Alerting Devices
Space/Area Heating KW
Municipal ❑ Other
Local Connection
No. of Dishwashers
No. of Dryers
Heating A
g ppliances I{KWNo.
ecurity ystems: *
of Devices c uivalent
No. o KW
o. o 0.0
Ballasts
Data Wiring:
No. Devices or E uivalent
Heaters
Si ns
of
Telecommunications Wiring.
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or E uivalent
I0/? . la7• 7
�., . F , �....... ( / / - P" i t r
r Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: b (When required by.municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE GE: 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:)
1 cert, under the pains and penalties of perjury, that the information on this application is true and complete/ 53 3
FIRM NAME: P�-C S�curl-r�{ S�rUCCPs _ LIC. NO.:
Licensee: G( 2 Signature LIC. NO. S
Bus. Tel. No. `� ��'S9f�0
(Ifopplicable, enter 'e. em l" in the licede num er line.) �9
Address: e L I N -FM e l� ��t5 , �Alt Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safcry S License: Lic. No. SS 0 O �/ %"
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/AgentVa."ERMIT FEE: $
Signature Telephone No.
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Date .......l...T..../." ....
TOWN OF NORTH ANDOVER
100 PERMIT FOR WIRING
This certifies that ......................1/L......c 'UGL%..........................
has permission to perform /� �%P� !�� Ane44ce......�"(4S
wiring in the building of ......... G /yj f4 SLS ..........................................
^.
at �..... 5... .�................. ,North Andover, Mass.
:: .p ............
Fee . 2O— '...... Lic. No. btt 5A-55PC........ I/f/- :[..,�lT-a A.A
ELECTRICAL INsnc-roi
Check # S7 Z
8611
ENE Commonwealth of Massachusetts Official Use Only
- Department of Fire Services Permit No. �� !
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER To the
By this application the undersigned gives notice of his or -her intention to perform the Inspector
electrical work described below.
Location (Street & Number) C(
Owner or Tenant („ ck✓l S Telephone ne No .
Owner's Address _ �S ��� _ �-6
Is this permit in conjunction with a building permit? Yes ❑ No
(Check Appropriate Boa)
Purpose of Building_(>—
-,-o�—� Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Und rd
g ❑ No. of Meters
New Service Amps / Volts Overhead
❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
/'? I
--••»�•• »uu«<�.«� uumu u aesirea, or as required bythe Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Stark 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 cverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete. _
FIRM NAME: a l� f' �-� t l e y] "14 L [ �G LIC. NO.: Z � J 6 o
Licensee: �� ( ���4� Signature
(If applicable, enter "exempt,, in a license number line.) LIC. NO.:
Address: �'_ SCI , L& -e �►'; 6 1 � �� /' Bus. Tel. No.:
Alt
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License:'Lc
L l. 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
Signature Telephone No. PERMIT FEE: $
r j www massgov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le
Ably
Nanle (Business/Organization/lndividual):_YL- (,
Address:
City/State/Zip:/ , l f �l/� Phone #:--- 22 g — 6
Are you an employer? Check the appropriate box:
I. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time),*
2. 1 am a.sole proprietor or partner-
ship and have no employees
working for me .in any capacity.
[No workers' comp. insurance
required.]
3. Q I am a homeowner doing all work
myself [No -workers' comp.
insurance required.] t
have hired the sub -contractors
listed orl the attached sheet t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 1.52, § 1(4),and we have no
.employees. [No workers'
comp, insurance reauire41
Type of project (requires:
6. ❑ New construction
7. 0 Remodeling
8. Q Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
ME] Other
- •--••• -•. • wpJ YVA K { must a,so nu 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.
;Conttactors that check this box must attached an additional sheet showing the name of the sub -contractors and their worker:' amp. policy information.
1 ant an employer that is proWdwg:workers' compensation insurance for my. employees: Below is the
information policy and job site .
Insurance Company Name:
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do herebycejy under the pains and pep�dties of perjury that the information provided above is true and correct
The Commonwealth of Massachusetts
k j !
Department of Industrial Accidents
Office of Investigations
It oil
600 Washington Street
Boston, MA 02111
r j www massgov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le
Ably
Nanle (Business/Organization/lndividual):_YL- (,
Address:
City/State/Zip:/ , l f �l/� Phone #:--- 22 g — 6
Are you an employer? Check the appropriate box:
I. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time),*
2. 1 am a.sole proprietor or partner-
ship and have no employees
working for me .in any capacity.
[No workers' comp. insurance
required.]
3. Q I am a homeowner doing all work
myself [No -workers' comp.
insurance required.] t
have hired the sub -contractors
listed orl the attached sheet t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 1.52, § 1(4),and we have no
.employees. [No workers'
comp, insurance reauire41
Type of project (requires:
6. ❑ New construction
7. 0 Remodeling
8. Q Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
ME] Other
- •--••• -•. • wpJ YVA K { must a,so nu 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.
;Conttactors that check this box must attached an additional sheet showing the name of the sub -contractors and their worker:' amp. policy information.
1 ant an employer that is proWdwg:workers' compensation insurance for my. employees: Below is the
information policy and job site .
Insurance Company Name:
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do herebycejy under the pains and pep�dties of perjury that the information provided above is true and correct
V,
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 airy 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 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 insumnce'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-contractor(s) 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 cant' 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 enta* their
self-insurance license number on the appropriate Line.
City or Town Officisis
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 permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, needd 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 bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give as a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE
Revised 5-26-05 Fax # 617-727-7744
www.mass.gov/dia
Location
No. Date
*ORTH
TOWN OF NORTH ANDOVER
O.0,69 r•,yC
�
Certificate of Occupancy
$
Building/Frame Permit Fee
$_
��b"'•° ^'��'
ss�cMuat
Foundation Permit Fee
$
e
Other Permit Fee
$
Sewer Connection Fee
$
g
•
Water Connection Fee
$
TOTAL
$
7 Building Inspector
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I OCCUPANCY
SINGLE FAMILY I I STORIES _
MULTI. FAMfjj::::::::�]_j OFFICES _
APARTMENTS
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE_ 3 i
2 13
CONCRETE BL'K. PINE _BRICK OR STONE HARDW D _
PIERS PLASTER _
DRY WALL
UNFIN.
3 BASEMENT 11
AREA FULL FIN. B"M"T" AREA
111 1/3 1/1 FIN. ATTIC AREA
N_O B M FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B I
DROP SIDING CONCRETE _
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDII-'D _
ASBESTOS SIDING COMMON
VERs. SIDING ASPH. TILE �_
STUCCO ON MASONRY
STUCCO ON FRAME
ONE ON MASONRY 1 11 WIRING
ONE ON FRAME
SUPERIOR I�POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
kBLE 1 I HIP t 11 BATH 13 FIX.1
WOOD _I NOSHINGESKITCHEN
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6 FRAMING IG
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WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT .HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd
ELECTRIC
lot 13rd
NO HEATING
BUILDING RECORD
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.
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'Lease print)
DATE
JOB LOCATION y Q
umber
i)MEOWNER" %)e\ v A V-
ame
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
') (SV 1\S�)n S�,- lU
Street Address
Home Phone
'RESENT MAILING ADDRESS
ection of town
ork Phone
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 HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended tq. be-, a one to six family dwell-
ing, attached'or detached structures accessory t.o such use 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, on a form'acceptable to the Bulding 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.
i'he undersigned "homeowner" certifies that he/she understands the Town of
,orth Andover Building Department minimum inspection procedures and
1�quirements and that he/she will comply with said procedures and
equirements.
[OMEOWNER'S SIGNATURE
,PPROVAL OF BUILDING OFFICIAL
'dote: Three family dwellings 35,000 cubic feet, or larger, will be
-equired to comply with State Building Code Section 127.0, Construction
:ontrol.
.... ..:...::::.. .::::::::.::::..
_.......
PRODUCER
Dan HurleInsurance Agency
Chestnut green, Suite 24
Seven Federal Street
Danvers MA 01923-3620
INSURED
Sound Construction
Paul Landry dba
64 Nesmith Street
Lawrence MA 01841
.......... ....T--�--T::.:
DATE (MMIDD/YYI
05/27/97
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
A Preferred Mutual Insurance Co
COMPANY
B
COMPANY
C
COMPANY
D
CQViAGLB
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YYI DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $110001000
A X COMMERCIAL GENERAL LIABILITY CPP0100524582 10/31/96 10/31/97 PRODUCTS - COMP/OPAGG $1,000,000
CLAIMS MADE ®OCCUR PERSONAL d ADV INJURY $ 500,000
OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE S 500,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
FIRE DAMAGE (My one fire) S 50,000
MED EXP (Any one Person) S 5,000
COMBINED SINGLE LIMIT S
BODILY INJURY S
IPer person)
BODILY INJURY S
(Per accident)
MCMAINA
Alberta McMain
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHAWIRM E NO OBLIGATION OR LIABILITY
OF ANY KI UPON THE COMPANY, GENTS REPRESENTATIVES.
fH0 R ESENTATIVE
. ; j wi.nn .' rieenewT u:
PROPERTY DAMAGE $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
........................................
OTHER THAN AUTO ONLY.
EACH ACCIDENT S
AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE S
AGGREGATE $
$
COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/ INCL
PARTNERSIEXECUTIVE
OFFICERS ARE: EXCL
0TH
WATSWORKERS
TRY LIMIT I ER
EL EACH ACCIDENT S
EL DISEASE - POLICY LIMIT $
EL DISEASE - EA EMPLOYEE S
OTHER
MCMAINA
Alberta McMain
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHAWIRM E NO OBLIGATION OR LIABILITY
OF ANY KI UPON THE COMPANY, GENTS REPRESENTATIVES.
fH0 R ESENTATIVE
. ; j wi.nn .' rieenewT u:
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 01845
WILLIAM J. SCOTT
Director
In accordance with the provisions 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 c 111, S 150A.
The debris will be disposed of in:
IA
XA n A
(Location of Facility)
Signature of Ormit Applicant
N`'`om ► 9' t7
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this
project through the Once of the Building Inspector.
r
r
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530' HEALTH 688-9540 PLANNING 688-9535