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HomeMy WebLinkAboutMiscellaneous - 93 ROSEMONT DRIVE 4/30/2018PATRICK J. DONOVAN ASSOCIATES, INC. l..laim and Foss `.A> d ustments P. O. BOX 110 WAKEFIELD, MA 01880 TEL. (781) 245-5540 -- FAX (781) 245.7016 July 22, 2002 Building Commissioner City or Town Hall North Andover, MA 01845 Insured Property Address Insurer Policy Number Type of Loss Date of Loss Our File # : Michael B & Karen A Byers : 93 Rosemont Drive, North Andover : Preferred Mutual Insurance Company : PHOO100631344 : Water Damage : 6/20/02 : WAP33769 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Vern Laws, Adjuster VL/so ASSOCIATION OF INDEPENDENT INSORANCB ADJUSTERS t1A SSOC of Massachusetts Location No. 4! s8 Date 3,-)1, o a ^T� TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ ��s ",•°''cam Building/Frame Permit Fee $ JACMUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �� v 5 r�- O Building Inspector J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:, DATE ISSUED: 07 a '7/! , SIGNATURE: 6z, Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3 fobe/t'J!!n Pr At) &7Je 1.2 Assessors Map and Parcel Number: 98T5 �9 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard ' " ` �: Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ .' + >� Zona 1.3. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Sita Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Tofe (Print5 Address for Service lure Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone JLrC11uf4 3 - CONS, uUC IO smv10ES 3.1 Licensaed Construction Supervisor: Not Applicable ❑ 1�.nS T _a /� Licensed Const ction Supervisor. 63 Y�p %O Akjar ILII ,t.� _r On -� License Number AdP 016? a Expiration Defe Stgnatur Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ C an Name //69576 1 Registration Number �Ns- S�4�rrJ�-S l� Q�d- ,�j An Add r s 33616 i3a� Expiration Dat atur Telephone s e C MR, C 2 R 0 C Mr C� r r SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Buiw wql Is a"8 c ue r ex 1 Si,N 111X16 deck =--i dzo- CLr ,P\ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit applicant (a) Building Permit Fee Multiplier �Oa 2 Electrical (b) Estimated Total Cost of Construction + 3 Plumbing Building Permit fee (a) x (b) - 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING PERMIT r(5Tu as Owner/ thorized Agent subject property Hereby authorize 1 to act on My , in al m ers r ive o wor thorized by this4ilding permit application. C2 _ /00 Sigriature of Owner Date SECTIO 7b OWNER/AMUORIZED AGENT DECLARATION I, / Kas Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and lief lJ `� P _fq.'gQ ature ofer ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T OERS iST 2 NO3Ku SPAN DEVIENSIONS OF SILLS DIMENSIONS OF POSTS DM4ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X . MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f�-eCIc FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. /■.....■■!■■■■...ltt■■t!■■t!.!■.tt..■■.■■...f.......lt..lt...!ltttt!■■■■.t.■ APPLICANT A N--Pti y r S PHONE ASSESSORS MAP NUMBER 9 b 3 LOT NUMBER 5 1 SUBDIVISION LOT NUMBER STREET 6 S -p (� a /V i� STREET NUMBER 3 OFFICIAL USE ONLY ....................... ■ts■■.............................................. RECO TION F T WN AGENTS BOXER as DATE APPROVED CONS A AD DATE REJECTED CONDVIENTS DATE APPROVED TOWN PLANNER COMAEATTS FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH CON VIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT WIN 011MZT-FT171-251 COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE sus The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Work'ers' Compensation Insurance Affidavit S5 ©C,Fys Please Print am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity W 3 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #- C_. o- r_ pgBy name: Address City: Phone # Faitute to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penatties.of a fine up to $1,500.00 and/or one years' imprisonment as welt as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understated that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. l do herby certify under the pains and penalties of perjury drat the information provided above is true and carred A S Print Official use only do not write in this area to be completed by city or town official' (]Check if immediate response is required Building Dept Contact person: RM WORKMAN'S ComPENSATION #-�N- 97s- 3731 E] Building Dept El Licensing Board p Selectman's Office I lealth Department El Other D. Robert Nlicetta, Budding Commissioner TOWN OF NORTH ANDOVFR Office of the Building Department Community Developmenit and. Sen ices 27 Charles Street. North Andover, Massadiusett.s 01845 DEBRIS DISPOSAL FORM Telephone (978) 688-9545 FAX (978) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at / in: (Site location) Signature Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector v m m m U) cn0 m CO) ,a z a. O d a� .o 0 o p CL Q' CD O .... ao _ co CD CO! 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Public Works -�--3 Z-fc- +4cation �l �o. / Date' 4 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ s sE h Foundation Permit Fee $ � Cl.�cMus t Other Permit Fee $ 2"ewer Connection Fee $ NI .+ater Connection Fee $ TOTAL t Y Citiding In pector t' �� Div. Public Work LocationG�i.-J.�1.,��--�`�-^��--f.r 1 No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 112 -11�� Building/Frame Permit Fee $ y o Foundation Permit Fee Other PJmit Fee $ �` Sewer Connection Fee $ .�---- .Jy V�, z W %Sonnection Fee $ `r�r rD� 7 TOTAL $ Building Inspector 67; tJ Div. 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Qac',-O�n oOOOZzoe z p000 ZZ0 �'i-i OU M W m 0 a m a O x W 1- Q UZZV F.0 0 0 IA a Q= Z1=10� V 0 3 Q Q> w h la7 �i 5 a z y IQ O 3 f 4 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 local or state law, regulations or requirements. - ***********�*-*�-*—**Applicant fills out this section***************** APPLICANT: 1 ©� ��Z �4CZ k1Ce� Phone 0 ctq6 LOCATION: Assessor's Map Number Parcel Subdivision O 0VIS A Lot(s) Street ©c�� i e5 � � X _L St. Number ************************Official Use Only************************ REC MMENZTNS F OWN AGENTS: / Q� ` Date Approved 7(�'/u ons tion dministrator Date Rejected Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved 8 Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections lS5 7 / 7 - driveway permit SGi V 7A3 ire Depa tm2ildincgr t000- Glw e Received by Inspector ate .,* •i•,t n n 5 Ti n A C') O z m O z T Z v CA 10 C O O � C1 'v O CD c) Z y CD O 70 CL r- a� � O y aCc -0 0 CD v CDCL O c� =r CD CD CD C. 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C cn 7C w a, tTi \, CD 1 H O �O • r l 9 Ile z 0 W CR omi 0 9 0 c w� 014E Oumnwnwrab Qf ffl0fia*qtM Eepartmirat df Vublic £Laing BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 tJea t�ftly No,o Occtlpeftcy A Fee Checked _.._ 3190 paw aenk� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be Performed in accordance with the Massachusetts Electrical Code, 527 CUR 12;00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) %* or Town of�IORTH ANDOVFR Date t��n�J�, /�'S'�— — To the Inspector of Wires.. The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number)�.� /J o� ,oma , a y, _;10-1 Owner or Tenant Owner's Address osC o —'C Is this permit in conjunction with a buildingr✓ I / permit: Yes — No (Check Appropriate Box) Purpose of Building _�5 a �t� Utility Authorization No. Existing Service Amps— Volts Overhead n '—' Undgrnd ` No. of Meters •' New Service Amps _� VoltsOverhead Unagrno C No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical 'Nartc r� No. Of Lighting Outlets I No. of yet _cs No. of ?ranalormeri Tole) KVA No. of Lighting Fixtures U� i Sw,mm,ng P_o, Aocve — ;n- r crro _ Sma. — I—Generators KVA No. of Receotacie Outlets C�,? © II No. of Emergency Llgnunq No. of O,I corners Battery Units N0. Of Switch Outlets I No. or Gas :urgers FIRE ALARMS No. of Zones No. of Ranges I No. of A r CZrc. ,oiai No. of Oetection and chs initiating Oevtue No. of oisoosals I No.ol Heat 70:31 -otaI aurnzs 'ons ^VV No. of Sounding OevICei No. of Oiahwasnera INo. SoacerArea •+eat co J_ of Self Contained OelacnonrSounding Oevlcas No. 01 Oryera I Healing Cev ces KWL•ocai i—, Municicai ...Other Connection No. of Water Heaters KW No. 01 Vu )t Signs ?aaas:s Low Voltage i Wiring No. HyOro Massage Tuos I No. of Molcrs -alai HP OTHER. INSURANCE COVERAGE. Pursuant to Ino reauuame.ls Jt '.tassac'.csers ;eneral Laws I have a current Liability Insurance Policy ,nctuaing Ccmc stet Cceraiions Coverage or its substantial equivalent. YE checking the s = NO = 1 have iu in aODroDriate box. valid ar001 Of Sime 10 the ONiCe. YES 7 -VO _ If you nave checxea YES. please incicate the Nps «DOVW&go oy INSURANCE ONO = OTHER = (Please Soac.'•.) Estimated Value of E!ectncal Work S (EJ"Wauon oatel . Work to Stan J:;7, J Insoection Oale Pac6es:ec: Rougn ����� `/ Final Signed under the Penalties of Porl ,( FIRM NAME ���° �/ ✓ UC. NO. Licensee c �" S.gra:ure UC. No.3 Addriai��.S+cJ.4C.�f� �f `� Uv GJi",9 e ` Bus. Tel. No.eT AW it. .el. No. S'• �.0 S7 OWNER'S INSURANCF_ WAIVER: 1 am aware Inat the t.:censee ^_ces nOl nave ine insurance coverage or its substantial equWnt as re,' . quireo by Mass"nusetts General Laws. ana ihat my s,gnawre 3n ^,s cerm,t (Please cneca one►' aapiipflOn waives Ihii fequireent. Qwne/ AgMt i,sonone No. PERMIT ftas S40, JJ (Signature at Owner or Agent( a�Ni. N° "i Li 6 Date ... /,�1--f"� ..?4K TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies .......�. c 2 .......... has permission to perform ...... M P r;+. .........'� P ntcJc(f ................ wiring in the building of .....,11i.R .... r ...."� 5 ................................................. at .........j Yl........ led. S......................... . North Andover, Mass. Lic. No f/..� .Y' ........................................................ ELECTRICAL INSPECTOR 01/30/98 08:51 40.00 PAID WHITE: Applicant CANARY: Building Dept. 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O CL= Co O n 0 o CD p CD o CL r•h Q CD cc CD w w 3, C CD y CD CO y !O CDD � v CO) O 1 Z CD � o � CD 0 CD O -•y O Q y = r dO<O -0 y O 21O n m O m Z y O dC �• mm �- N —4 gm=m o O O y O y N O Wim: _ d O y n W , O O C. ?O� y = 1 r^ o s� /r O y V r/�' / CD S o, Ca :�r- �`► V y O ? �l Q ham.. CLO C N CL O CA m 10 ,^^ .� -CCD CD.: y CA 1 1 cy co m O O\ �a 0 0� n Z 0=r O o _ 1 CD y o CD d r: CD Cl dd: � et. rA y omi 0 �J Is7 9 ntz j CA po 1 c� C/i 0 0 � z CA z rA y omi 0 CUI. „ CO W -F► IMF -it 'rIto I;, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING / f (Print or Type) . NORTH ANDOVER Mass. Date U nj kuilding Location �-� �S"��S��rclrt� Permit #�� Owners Name -4// Inr��•�`- • New -T Renovation =J Replacement ID Plans Submitted D F: I 'I 1 P C[ r� (Print or Type) Installing Company Name.D,' (<e -lo Address <.v 4; CfA ",//, Business Telephone: Name of Licensed Plumber or Gas Fitter Check one: Certificate 0 Corp. Partner. Firm/Co. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F__] Other type of indemnity a Bond El 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 coverages. Signature of owner/agent of property Owner 0 Agent El I hcreby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of mY knowledge and tint all plumbing work and installations performed under' Permit iuued fo: this application will be in compliance with all pestlnent provisions of the Massachusetts State Gas Code and Chapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plulnber Gasfitter Signature of Licensed Master Plumber o, Gasfitter Journeyman %J U 2— License Number • i • • • Y • • • • • rrrrrrrrrrrrrr rrrrrrrrrr■ rrrrrnrorrrrrrrrrrrrrrrrrr • i�rrrrrrrrrrrrrrrrrrrr�rrr■ . ... rrrrrrrrrrrrrrrrrrrrrrrrrr .. ... rrrrrrrrrrrrrrrrrrrrrrnrr ... ■rrrrrrrrrrrrrrrrrrrrrrrr■ opt .. - rrrrrrrrrrrrrr FEE rnrrrrrr■ . .. - rrrrrrrrrrrrrrrrrrrrrrrrrr ... SOMEONE rrONE rrrrrrrrrrrrr■ ... ■rrrrrrrrrrrrrrrrrrrrrrrrr (Print or Type) Installing Company Name.D,' (<e -lo Address <.v 4; CfA ",//, Business Telephone: Name of Licensed Plumber or Gas Fitter Check one: Certificate 0 Corp. Partner. Firm/Co. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F__] Other type of indemnity a Bond El 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 coverages. Signature of owner/agent of property Owner 0 Agent El I hcreby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of mY knowledge and tint all plumbing work and installations performed under' Permit iuued fo: this application will be in compliance with all pestlnent provisions of the Massachusetts State Gas Code and Chapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plulnber Gasfitter Signature of Licensed Master Plumber o, Gasfitter Journeyman %J U 2— License Number - t - 'a' �SACNUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU' MBINa (Print = Typal NORTH ANDOVER, Mass. Date 1 _10"13 Building Location � (yV fV1 I Permit * - // 3' �9.3 Ownera Name New p Renovation p Replacement p Plans Submitted: Yea ❑ No. ❑ FIXTURES %Check one: Cedincate Installing Company ame -4�Q 1 1 C. e ID S.�._ (I Corp. Address f— p Partnership p Firm/Co. Business Telephone C Name of Licensed Plumber v �r �t C(8) INSURANCE COVERAGE: check one I have a current Ilablity Insurance policy or Its substantial equivalent. Yes ❑ No ❑ 11 you have checked y", please Indicate the type coverage by checking the appropriate box. A IIablRy Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ store o Owner a Ormer s en I hereby cwUly that all of the delalls and Information 1 have submitted log entered) In above appficatlon are true and accurate to the best of my krwwledpe and that all plumbing work and Installations parlotmed undo the perm)l lastjoo for ilia appiicatlon will be in compliance with all peflinent provisions of the Massachusetta State Plumbing Code and Chapter 112 of a+ W". n Rt del(_ `a�L�— TNN 5Ign&ttxe—oT1F=—s*d Ctty/Town license Number /0 S O Z I Type of Pkrmbing Ucanse: Master ❑ ArPTWMD (OFFICE USE ONLY) Journeyman ❑ ■■■/ol����M./■r�r1■/r/■rrr�r��� /f.71ASZ4Ifff4 lie ..rdrjr%cjr■r■■■rr■ ■■Y■►1��■■��/I1J�����rrr■■■�� %Check one: Cedincate Installing Company ame -4�Q 1 1 C. e ID S.�._ (I Corp. Address f— p Partnership p Firm/Co. Business Telephone C Name of Licensed Plumber v �r �t C(8) INSURANCE COVERAGE: check one I have a current Ilablity Insurance policy or Its substantial equivalent. Yes ❑ No ❑ 11 you have checked y", please Indicate the type coverage by checking the appropriate box. A IIablRy Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ store o Owner a Ormer s en I hereby cwUly that all of the delalls and Information 1 have submitted log entered) In above appficatlon are true and accurate to the best of my krwwledpe and that all plumbing work and Installations parlotmed undo the perm)l lastjoo for ilia appiicatlon will be in compliance with all peflinent provisions of the Massachusetta State Plumbing Code and Chapter 112 of a+ W". n Rt del(_ `a�L�— TNN 5Ign&ttxe—oT1F=—s*d Ctty/Town license Number /0 S O Z I Type of Pkrmbing Ucanse: Master ❑ ArPTWMD (OFFICE USE ONLY) Journeyman ❑ Date..................... NpRTM TOWN OF NORTH ANDOVER py` ao e.6 p PERMIT FOR GAS INSTALLATION ^r This certifies that ........................................... has permission for gas installation ............................ in the buildings of .......................................... at .................................... North Andover, Mass. Fee...... jefoghf'68NO........... .......................... 40.00 RAID GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Date.............. I...... NpRT" TOWN OF NORTH ANDOVER h.O OV P—�igCQR GAS INSTALLATION This certifies that ............../ ........................... . has permission for gas installation .., ........ ............... . in the buildings of ..............r'.......... .............. at ....' .. r........: ; .,: r : t .:. %.... ,�. �. , North Andover, Mass. Fee...'-:..... Lic. No... .:. �..r .. 1... _ ............ . GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File `4AbbA%0nuz)t t "a ut"'U"r4 Ar�t_�tc;A t ��9 =CJl E'ER (Type or Print) , LU,t�61 NORTH ANDOVERMass. �"' Date:- ,, :x:2;:4; , ... •��' � � lip Building Location %Z , 6'c Ce/ -7 Q /�%�Permtt 133-?- 9 ;T Owners Name New Renovation �] ' Replacement ❑ Plans Sybmitted II FIXTU F (Print or Type) Installing Company Name Address L"/L/r—v1 ES7X-)ve S—T— Check one: Certificat 0 Corp. Partner. L�46,yQCT i3 0 Firm/Co.__ . Business Telephone 77P - C S'r?7.33 Name of Licensed Plumber: 2( cwp?p7 % �-dyV te-&� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type .of indemnity 0 Bond Q Insurance Waiver: I, the undersigned, have been made aware - that the licensee of I this application does not have any one of the above three insurInce cQYerageS, , • • Signature of owner/agent of property Owner Agents. (� •;. beoebr testify that all of t11c dctails and in(oimalion 11ja•c subsoilIcd (or cntacdl in alwj.c applicalioo ile lout MW ate to lbs bat M w k"wkdge and tbat all plumbing work and inslallalions 11ci(nin,cd undcr rcemit 1�sucd for this applicalioe will be in �OMlpljawq wills W PqI VW100111of OW Maasatl►wotts State llumbiag Code and Cauptcl I42 the tial Laws. 8y Title• . City/Town: .A DDonvr s IOFFICF USE ONLYI Signature of Licensed Plumber Tv a of Plumbing License License Number 0 -Master ❑ JourneyaA 4 i z . to m z o X z < ►- .. a W Y J a• ?^ V< h h . Z a �! +. W III tP O Z Cl < aC z t WY. w . V Z* Z ¢ o W Q W < h to z cc a a < ok- O, W O ~~ O a W O X t] a W -� e7 a a 4 CC of J Z fr 0. �•, � • i F- rJ X CL 7 h Y a 0 1 x Z < W IL >d W N O O z O m _ f- sus-,esmT. , •'; • BASEMENT �' IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR , GTN FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Installing Company Name Address L"/L/r—v1 ES7X-)ve S—T— Check one: Certificat 0 Corp. Partner. L�46,yQCT i3 0 Firm/Co.__ . Business Telephone 77P - C S'r?7.33 Name of Licensed Plumber: 2( cwp?p7 % �-dyV te-&� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type .of indemnity 0 Bond Q Insurance Waiver: I, the undersigned, have been made aware - that the licensee of I this application does not have any one of the above three insurInce cQYerageS, , • • Signature of owner/agent of property Owner Agents. (� •;. beoebr testify that all of t11c dctails and in(oimalion 11ja•c subsoilIcd (or cntacdl in alwj.c applicalioo ile lout MW ate to lbs bat M w k"wkdge and tbat all plumbing work and inslallalions 11ci(nin,cd undcr rcemit 1�sucd for this applicalioe will be in �OMlpljawq wills W PqI VW100111of OW Maasatl►wotts State llumbiag Code and Cauptcl I42 the tial Laws. 8y Title• . City/Town: .A DDonvr s IOFFICF USE ONLYI Signature of Licensed Plumber Tv a of Plumbing License License Number 0 -Master ❑ JourneyaA 4 &At 37'1 6 Date ....... Z.le,� 2— ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING I This certifies that ...... . ................. 1-2�1--rl(.-- ................................................................... has permission to perform .. . ...................................... wiring in the building of ...... ... .. .............................................................. at ..... ;-,2 .... ................................... ...................... . North Andover, Mass. Fee�.. ...6 ........ Lic. No. .. ...................... J ........... ....................... ELECTRICAL INSPECTOR Check # 27W fbMMONR'E4LTHOFM4manmw s DEPA,1?21 POFPUBLIC�S9F.E•l y - . BOARDOFFREPRET EWONIZ%UI 4HOIiYS27(2120 EOffice Use only No. 716, s Checked-- APPUCATIONFOR PE Uff TO PEiZFORMaECMCAL WORK ALL WORK TO BE PERFMMED IN ACCORDANCE WITH THE wssAaiusm ELE MCAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date O9 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) _ 9 IC h S',� .►n,s,wa f Owner or Tenant Owner's Address "s this permit in conjunction with a building permit: 'urpose of Building ;xistingService o�oC., Amps olts few Secviee Ampj Molts umber of Feeders and Ampaeity )cation and Nature of Proposed Electrical Work lo. of Lighting Outlets -No- 1. No 1. of Switch Yes MI No [D (Check Appropriate Box) No. of 00 Burners No. of Gas ewnm No. of Air Cond. No. of Heat TOW Purnpa. i06s Space Ata Heatino Reating.Devices i er tiesters KW No. of Signs Massage Tubs No: of: Wt TOW Utility Authorization No. Overhead UnderpuW No. of MetersOverhead Undkgrotrnd No. ofMeters -- L� Na ofTmskn M W No: Of Ememme FME ALARMS No. ofZmft Tata) Na offtlec iwaW KW LtitistiagDeviees �....s. KW Na ofSottadirea:Detiices Na ofSditvunitlh":. ,r t��:Derices ikW Leal Rluoicipsi other Cotuwetiotu Q' .��� � Btsi =TdNa — 97,f A1tTelNa � Ir�URANC� WAN)=R; Iarnawazett�attheLia�edoes mtlr�weahei�ra�oeoo►@�eo*�s����,�f,�,�� Laws sanllffipeQrr�eQp�� tlxsrec�raer� Teck one) Owner Agent (!� t�'•.,.t Telephone No.PER _MIT FEE f Date. ,(/o?,/ g. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,p This certifies that . ....& .fi ................. has permission to perform .. N e !ti.. ..Ira ..44..fr.W. ".1 :... . plumbing in the buildings of ... 151.C.,1�.5.................... g at. -93 . use !?amu .z . ................. North Andover, Mass.g C9 Fee. Lic. No j.4 l 7 ... ............................. . PLUMBING INSPECTOR 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date ..-2 .. �. L.. 7 ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..,1:... �.».. s ... �.... ................ . has permission for gas installation .. { . !. '� ................. . in the buildings of .... 5../x:..0..' ............................ at ...� ./..:.. �'�,r.r ................ North Andover, Mass. Fee .: > ..... Lic. No.. ,l. .,.-7 ........... GASINSPECTOR Check # 42110 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFtTTING 'nt or T G W, �/, IT5 - Fft M—. Date —20—�jj Permit Building Location Owner's Narmv,,. e, m A Type i Plans Submitted: es[n] No En3 New Renovation 0 Replacement Z,r_ Installing Company Nam • /� .. r_ - Lit" ! • Business Name of Ucensed Plumber or Gas Fitter Check one: Certificate O Corporation O Partnership P Firm/Co. INSUPkXCE COVERAGE: C. VERU P,w.: I have aYcu eliability insuirance ra policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. It you have checked yS& please indicate the type coverage by checking the appropriate box A liability insurance policy X Other type of indemnity O Bond O 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 OwnerO Agent O I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for th' plica ' wil in compiiwith all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General or ByTIGasfitter of License: Plumber nature of Licensed umber or Gas atter Title Master License Number 1 3i 0(o _ City/Town Journeyman I NL .. - ■�i�i�it���i�ii�i�iii����■ Installing Company Nam • /� .. r_ - Lit" ! • Business Name of Ucensed Plumber or Gas Fitter Check one: Certificate O Corporation O Partnership P Firm/Co. INSUPkXCE COVERAGE: C. VERU P,w.: I have aYcu eliability insuirance ra policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. It you have checked yS& please indicate the type coverage by checking the appropriate box A liability insurance policy X Other type of indemnity O Bond O 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 OwnerO Agent O I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for th' plica ' wil in compiiwith all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General or ByTIGasfitter of License: Plumber nature of Licensed umber or Gas atter Title Master License Number 1 3i 0(o _ City/Town Journeyman I NL W 3 I' Q z F F� - •s y } t J Q Z O G W O � h ~ V O O = d ' C Q O O W 06 3 z 0 c W t O l.: J d d W W W 3 I'