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HomeMy WebLinkAboutMiscellaneous - 96 BRENTWOOD CIRCLE 4/30/2018 (2)M 1 40RTk Date .. ............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. A �. <c —t I :.... /) ` . has permission for gas installation ..tom. /: .................. . in the buildings of ...�. ':............................. . at A c :: �` � ". U ��. � . !/. � . , North Andover, Mass. Fee.2.0..... Lic. No.�25/ 1.... ...1-S INSPECTOR Check # 45 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITIING (Type or print) Date % D� NORTH ANDOVER, MASSACHUSETTS Building Locations 91 bre3n t U3d O.6 c c_i _ Permit # Amount $ Owner's Name`@�� New Renovation Replacement Plans Submitted (Print or type) - " one: Certificate Installing Company Name A0c1Cx.)P r pvt-A . �. Co. -1,n r - Corp. 2122 Address 20, 1q"a" `17r. On,F- (® a Partner. 0 Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No[] If you have checked M .please indicate the type coverage by checking the appropriate box. Liability insurance policy [2f Other type of indemnity 0 Bond 0 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 FEW I hereby certify that all ofthe 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 GVCode and Chapter 1A2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber as Fitter License Number Master Journeyman wwwwwwwwwwwwwwwwwiwwwiw �wwwwwww■wwwwwwwwww�wwiww� FLOOR wwwwwwwwwwwwwwwww�wwwwww wwwwwwwwwwwwwwwww�ww�w�w wwwwwwwwwwwwwwiwww�wwwww wwwwwwwwwwwwwwwwww�w■�ww s wrwwwwwwwwwwwwww�www■wwwwww s wwwwwwwwwwwwwwwwwww�wiw wwwwwwwwwwwwwwwwwwtw��ww� wwwwwwwwwwwwwwwwwwwww (Print or type) - " one: Certificate Installing Company Name A0c1Cx.)P r pvt-A . �. Co. -1,n r - Corp. 2122 Address 20, 1q"a" `17r. On,F- (® a Partner. 0 Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No[] If you have checked M .please indicate the type coverage by checking the appropriate box. Liability insurance policy [2f Other type of indemnity 0 Bond 0 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 FEW I hereby certify that all ofthe 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 GVCode and Chapter 1A2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber as Fitter License Number Master Journeyman Date. M-..1� ... G.. 7. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that !.�....��........... . //r I, ..G �G l has permission to perform .... �. �'''�. r ..................... plumbing in the buildings of ...r �. ! ........................... at .. `....�<� ...< <.`.... ,North Andover, Mass. Fee .� O.'.... Lic. No. %�1 f..3 .. .,.. � ..... PLUMBING INSPECTOR Check # G! Y C 5792 l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) ( + NORTH ANDOVER, MASSACHUSETTS a Q3 Date Building Location ren{- L000& �.(L p Owners Name C.LIVIA11a Permit # - e Amount Type of Occupancy ,E�. New Renovation Replacement 10 Plans Submitted Yes ® No _F FIXTURES (Print or type) I n Chec one: Certificate Installing Company Name n,,,A%0' '?�ba , S Vic,, t n• t ZV1 Corp. Zt" ❑ Partner. /(�� Firm/Co. Name of Licensed Plumber: l7@n<r, P I J rS-sP Insurance Coverage: Indicate the type ofjnsurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ 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 signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetks Stye Plumbing_Cpde an -Cher 142 of the General Laws. Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License 9q�3 iMM lNumDer Master Journeyman ❑ V ■ Location cy� Br e,�,4wmo c� cI r No. 6 If !�— Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 2 b Foundation Permit Fee $ Other Permit Fee $ TOTAL $ o f Check # 6492 Building Inspector The Commonwealth of Massachusetts '1)'1,tr S State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 7/5— 780 CMR Name (Print) APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OF OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING tiuudmg Yermtt Number: ' ^ I Date Issued: ( ` a 's— _ @— C) C' 3 t!C c 1.1 Property Address:/�j_/1 l.2 Assessors Map and Parcel Number. J/ (P L>r- Map Number Parcel Number IA Zoning Information: 1.4 Property Dimensions: Lot Area (sq) Frontage(ft) Zoning District Propos Use 1.6 Building Setback ft. HISWO YWM ve2 Front Yard Side Yard Rear Yard Required I Provided Required I Provides Required Provided 107 Water Supply 9M.G.L.C.40.4 54 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 13 Private b Zone Q Outside Flood Zone O Municipal Q On Site Disposal System 2.1 Owner o" f Recorfd '1)'1,tr S Not Applicable Q A Licensed Construction Supervisor: Quo( An i,vas 7/5— u.CylJ� (.�^f.lri Name (Print) Address: d G/a o� 3 Signature G��+ elephonAJ*—$P4 •S Te ephone 11 _ �7C/J 3.2 Registered Home Improvement Contractor: Not Applicable Q � 6�S � 2.2 Authorize gent: Registration Number / ac�Cv Address Expiration Date Name (Print Address Telephone �� �- — 4 Signature phone 11 CFr T1nN 2 !`IINCTOiI/`TihN CCDVT!`CC C/1D —n --Q i CCC —AM ]C nhl� ��LDIn V— Ar, cwi�r �crnr c.r � i.n 3.1 Licensed Construction Supervisor: Z AlLeDlOIZZ '1)'1,tr S Not Applicable Q Licensed Construction Supervisor: License Number b (,,;, 7/5— Address 5--z) DAD s% � Expiration Date 7 d G/a o� 3 Signature G��+ elephonAJ*—$P4 •S 3.2 Registered Home Improvement Contractor: Not Applicable Q Company Name / s ✓� /1ZS L/ Registration Number / ac�Cv Address Expiration Date Signature Telephone �� SECTION IOb - OWNER/AUTHORIZED AGENT DECLARATION AllC- ao caner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent IF Date SECTION 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed b permit applicant 1. Building 5-7 v�—/ 2. Electrical 3. Plumbing '/ d o V 4. Mechanical (HVAC) 5. Fire Protection 6. Total.=(1+2+3+4+5) Official Use Only (a) Building Permit Fee Multiplier (b) Estimated Total Cost of Construction from (6) Building Permit Fee (a)x(b)/ 4 0 — Number SECTION 6 - DESCRIPTION OF PROPOSED WORK check all applicable) New Construction ❑ Existing Building ❑ Repairs ❑ Alterations Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed : SECTION 7 - USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) A Assembly A-1 A-2 A-3 A-4 A-5 B Business ❑ E Educational ❑ F Factory ❑ F-1 F-2 H High Hazard ❑ 1B I Institutional ❑ I-1 I-2 I-3 M Mercantile ❑ 2B R Residential ❑ R-1 R-2 R-3 S Storage ❑ S-1 S-2 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index (780 CMR 34) SECTION 8 - Building Height and Area BUILDING AREA Number of Floors or stories include basement levels Floor Area per Floor (sf) Total Area (sf) Total Height (ft) CONSTRUCTION TYPE IA ❑ 1B ❑ 2A ❑ 2B ❑ 2C ❑ 3A ❑ 3B ❑ 4 ❑ 5A ❑ 513 ❑ Proposed Hazard Index (780 CMR 34) Existing (if applicable) SECTION 9 - STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required SECTION I Oa - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Yes ❑ Proposed No ❑ 1, , As Owner of subject property hereby authorize _}i �,/L/77S ,1�iz/1: ��C to act on my behal ' all matters relative work authorized by this building permit application.— I �—IrAt( — j - W Signature'Signature'bf Owner Date revised bldg form/state JMC North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant 23 ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector N 0QIZ� ZKO�: mD_mcn Dzch c� C/) U) D m O U) Cn N_ 0 O III I f �IIIIII I I �� I I�II�I O O 0 0 r n 1 � 7q m o �+ • 00 w r+ rte•+ O 0 "0 0 D'w a oCDrn on Ao r3 0 0 t• p p es C, ztz C s N G. am. ie eo p o' • �. a o o^a c M �-+ rn. O O p e `a c a c p •7 p Q o is 0 p N 0QIZ� ZKO�: mD_mcn Dzch c� C/) U) D m O U) Cn N_ 0 O III I f �IIIIII I I �� I I�II�I O O 0 0 r n 1 � 7q m o �+ • 00 w r+ rte•+ O 0 "0 0 D'w a oCDrn on Ao r3 0 0 t• q § § <oz z < _ § / §s+, » §$O - _ > 2 ¥ ... . / / � k» �_ § E E a (nco ¢ k \/> 15� 0 o n 00 ! k§CO° COk § / S 2 § \ r- \ � ± Ul e /q % \ $E \ ) 2I , / ° Xz Cl) % hcation• The Commonwealth of Massachusetts Department of Industrial Accidents 9MC9 ollnyestigativns 600 Washing ion Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit ❑ l am a homeowner performing all work myself.— ❑ I am a sole proprietor and have no one working in any capacity �ee�r ■�...��n77+x-e�oirrr, �ns�...ucs.�r,�.•,� _ I am an employer providing workers' compensation for my employees working on this job. J comaanv name• addr_ e�,� nhont T insaran t o volley � -- -,- -- . -,viral tinder Section 25.E of MC L 152 can lead to the imposition of criminal penalties of a fine up to 51-500.00 and/or one yea-' imprisonment as well as civil, penalties in the form of a STOP WORK ORDER and a fine 0175100.00 a day against mc. i uncicrYas-d :tat COPY of this statement may be forwarded to the OfLcc of Investigations of the DI.1 for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and corrert Signaturl ���l.�_—r-- Print name /L-' R /i Z, J Photic # official use only do not write in this area to be completed by city or town official city or town Permit/lictnse # Building Department 13 check if immediate response is rtquired ❑Licensing Board QSder:tmen's Office OHcslth Department contact person: phone 4; -Other (-1--d LDS P1A1 Jun 18, 16:31 EDT by: ALLLillian Craven (16:32) Page 2 of 2 ;.. - A. ::•::.•: .::::..........'M..:::•..::11::::1 :{::i}Lii:�:•:•!t•;:.1 :.,.::.;::::::::.:.:':;.;::;::::.:.>.:::.::.:::::•::::::::;:,;:<;;,;::<:::•::•:<.::.>;;:;::::: - DATE : :., ;' • :.,r; ': : •<r::•:>:';:'r: :}: ( IDDIY1) i ; .? > t11. � .;:•>:•::•:::•:<•>::... 06/18/03 PRODUCER — T FICATE IS ISSUED AS A MATTER OF INFORMATION INS AGENCY INC CONFERS NO RIGHTS UPON THE CERTIFICATE HIS CERTIFICATE DOES NOT AMEND, EXTEND OR EALTER 445 MAIN STREET COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE WOBURN MA 01801 COMPANY A ACADIA INSURANCE COMPANY MSURED---- ---- --- ----- —------- ----------- -- ----- ---- ADAMS KITCHENS INC COMPANY B ST PAUL FIRE & MARINE INS COMPANY C 50 DODGE ST BEVERLY MA 01915-1711 COMPANY D •-.•.THI • S 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. LTR T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMNDIYY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR OWNER'S & CONTRACTOR'S PROT CPA 13 015 4 210 01/01/03 - 1/01/04 GENERAL AGGREGATE s2,000,000 PRODUCTS - COMP/OP AGG $2 ___,000,000 PERSONAL & ADV INJURY $1,000,000 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one firs) $ 250,000 MED EXP (Any one person)) $ 10,000 AUTOMOBILE LIABILITY ANY AUTO 13A01155918 6/25/02 6/25/03 1,000,000 COMBINED SINGLE LIMIT $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY Mer (Per Person) HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY $ (Per acciderd) PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $` AGGREGATE $ -6-1-/01/04 EXCESS X LIABILITY UMBRELLA FORM CUA0 0 7 3 3 4 310 O 1 01 / 0 3 EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ ----'----' ---------..._---- $ WORKERS COMPENSATION AM EMPLOYERS' LIABILITY WCF007334210 01/01/03 01/01/04 EL EACH ACCIDENT -$ 500,000 THE PROPRIETOR/ PARTNERS/EXECUTNE MCL OFFICERS ARE: EXCL OTHER EL DGEASE-POUCY LIMIT $ 500,000 EL DISEASE -EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ATTN : BUILDING DEPT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER HAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY NORTH ANDOVER MA 01845 OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE •:: ••: •::: ••;!.:::..: :.....:::::::.... Gerard F Boyle...Jr.... LL A U) 71 m Cl) 0 m Lot CA C1 CCA CD � d � O n Z CO) = r r c O y O o p 0 co o %- CD CD o CD C O V!� CL H �C 1 � v N O "C Z O O o CD 0 CD c ?� o m S Q _.. y O Q• VA a0<_�mm 10 COD 0 m C -)Q H0ao m Z m =r -C N S m =rd ti CD -.4O O y p N O?� S O O m C Oco VE cc') Q � = CD C HCL o5 Cn CD CD CD o� �y �• - N d d Q H p� O '~ �. CO 1 N CD ooh Z Ocoo CD C!j CD cnCD CD c C: S z m 0m C,O O n .7 cn d w G cnITI w G Com" n p=i r G O m \ / r C X G a 0 W r � cn O rb 91 O a x 0 o O y 0 0 c Location No. Date TOWN OF NORTH ANDOVER l- - + s + a Certificate of Occupancy $ Building/Frame Permit Fee $ sgCHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # b q 15894 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4 " BUILDING PERMIT NUMBER: DATE ISSUTED: SIGNATURE: Building Commissioner/I or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: gicR�nirt 1.2 Assessors Map and Parcel Number: Cl 6 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred J Provided Reqwred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner ofRecord L I A u j �J1 G"LtIAku Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: /�f• (1C/I� SOMS Licensed Constriletion Supervisor: a D % -My o o o G4ffi S % . Address ✓��?«e�' '�1 \9 ��) 4 7S--1-J-3,? Signature Telephone fix X75-310 � Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T rn Z 0 y 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 .......❑ No ....... ❑ 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: IN Su; r rr\ m ,w & Po o (1VOr e-0, da 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIALUSEY(�NLY.' 1. Building c o �C�j (a) Building Permit Fee Multiplier 2 Electrical t (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �- 4 Mechanical HVAC 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 BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, AiCH.re1 as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief AA Ni I C NW F ( /?EI /fyl Print Name %f nV Signature of Owner/A e t Date t NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvMERS 1 s 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Cl) 1) m Cf) 0 CO) d C .0 = d CO) n 10 0 CD n Z co) CD O 'v CL C 0. ? y > CO O CD o CD v CD o CL d CD CD o CD C CD V� O. CD O CO) �• C =. --1 O ®• iA O Q N = F. ® S. O y mn ® Cl) cc Z N m _* o �• = So N �, P► O .da m ..a =r CL CL 0 R 1 O O N p CO) AI O � _ a O C=D N 2 O o �b n o y n ;, v w o m �H� ='iAD �O t . o '^ as 0 VJ O O N '� pay C/) CG V C dm :c CD p�N d d N V e`f N d Q rr ^^ca rL VJ O r ►� N ly d .�t0 --�C�mp N 2 O p �_ Z ..� �r O o o Ar z Ind c C o :e !^ O W N r: CD : n'o . :Q O• Cl) cli o :C CA O rD (: d cn 0 �' ~ w 0 5 O ro c G n O :d w C r Z It 0 .v w n G G ^ z C/) 'd y y al O x � n O C rij M O y 0 O C a 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) LU t Dir .Mass. Date " S� 197 r Permit # p Building Location 41 6 fl&0C1" f W `v 0 C1kC'1e0wnet's Name HIG H P F''L #,6L,Z f PF4'L_ Type of Occupancy r New ❑ Renovation ❑ Replacement 9--- Pians Submitted: Yes ❑ No ❑ B • P . # SFWFR4� FIXTURES CVDg1TrjL Installing. Company Name}j 0 FP h14 Al X K If-- I- L( � Check one: Certificate 7"'rAddress? �t1'>� �L �`y D ❑ Corporation & vaa,, Business Telephone"2 3 LIZ Partnership ❑ Firm/Co. Name of Licensed Plumber ��S l�l� 1•='/Y&/k-' INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes M--' No ❑ It you have checked yes. please indicate the type coverage by checking the appropriate box A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. 'and that my signature .on this permit application waives this requirement Check one:, Signature of Owner or.Owner'sAgent ` Owner ❑ Agent ❑ _ .. .. , "Q19LOy %-�ul u'y utak = or Me cetaiis and Information I have submitted (or entered) in above application are true and accurate to the best of my ' knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code andChapter 14 of the General Laws. TitleSEP 10100r, Sig re o Ucensed Plumber City/Town j Type of License: Master Journeyman ❑ APPACNED O I US ONLY) License Number - 2 7f NI- N Z rt4. !• > W N Y 1 fn } Q V N p Q N W W p W = _2 yr W a ar S p —= _ _ yr a x.l p x .l •C S 1st O G 2 • x .S Y (n a C F- J < sc C G C .j U- 4 v i+ !- v > H O s a N F- Z O C y 2 Z — < FW - LL Y 7 CJ m ar 3 ¢ m Q O SUB—BSMT. BASEMENT, IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH'FLObR 6TH FLOOR 7TH FLOOR STH FLOOR Installing. Company Name}j 0 FP h14 Al X K If-- I- L( � Check one: Certificate 7"'rAddress? �t1'>� �L �`y D ❑ Corporation & vaa,, Business Telephone"2 3 LIZ Partnership ❑ Firm/Co. Name of Licensed Plumber ��S l�l� 1•='/Y&/k-' INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes M--' No ❑ It you have checked yes. please indicate the type coverage by checking the appropriate box A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. 'and that my signature .on this permit application waives this requirement Check one:, Signature of Owner or.Owner'sAgent ` Owner ❑ Agent ❑ _ .. .. , "Q19LOy %-�ul u'y utak = or Me cetaiis and Information I have submitted (or entered) in above application are true and accurate to the best of my ' knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code andChapter 14 of the General Laws. TitleSEP 10100r, Sig re o Ucensed Plumber City/Town j Type of License: Master Journeyman ❑ APPACNED O I US ONLY) License Number - 2 a Date ............ . ry 206 This certifies that TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ....! ................................ plumbing in the buildings of .. ' ................................ . at ........................................ North Andover, Mass. Fee .. �....... Lic. No .......... ............................. . PLUMBING INSPECTOR 09/07/95 11:58 15.40 PAIN WHITE: Applicant CANARY: Building Dept. P K: Treasurer GOLD: File �TMASSACHUSETTS UNIFORM APPLICATION FOIZ PERMIT TO DO GASFITTMO I JPrint or Type) C NORTH ANDOVER Mass. Date r' f kuilding Location ^ Uv Permit # Owners Name New 7-1 Renovation eplacement n . Plans Subm tted t' FI>:.1.j1� , (Print or Type) Check one: Certificate Installing Company Name U Corp. Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Eff Other type of indemnity n 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 coverages. Signature of owner/agent of property Owner U Agent I hereby certify that all of the details and infotmation I have submitted (or entered) in abo-ve application are true and accurate to the best of my knowledge and titat all plumbing work and Installations petfomud under Permit issued for this application will be in compliance with all peillnent provisions of the Marsachusetts State Gas Code and Chapter 142 of tho Genual Laws, By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter ignature of Licensed -Tras Plumber or Gasfitter Journeyman License Number W N N W R a Ncz N CC O O V rA ~ H x N =- o w'e a s .Z t o w d tz m ul w N d w W o F. k to a. W Z W t- 4 N a to w a z o w x x w a o F- a y w W H x a t- z Fx, W w o o? k Fw- U Wo .-t t� t- cc w •¢ z 44 w > a w a o -. z N Q �. cc o Q ¢ - o o o z w rc _ o to w x I - rt ,w 1— O SUFI—ELSIAT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR BTHFLOOR (Print or Type) Check one: Certificate Installing Company Name U Corp. Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Eff Other type of indemnity n 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 coverages. Signature of owner/agent of property Owner U Agent I hereby certify that all of the details and infotmation I have submitted (or entered) in abo-ve application are true and accurate to the best of my knowledge and titat all plumbing work and Installations petfomud under Permit issued for this application will be in compliance with all peillnent provisions of the Marsachusetts State Gas Code and Chapter 142 of tho Genual Laws, By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter ignature of Licensed -Tras Plumber or Gasfitter Journeyman License Number • _ ._ _ ' � -. t day`., .�~ ,^,. � t -. . ' Date �7 NORTH TOWN OF NORTH ANDOVER oFt Eo a14, PERMIT FO`s STALLATION 1990 This certifies that ..... Z,. r,�... .. .... . . has permission for gas installation in the buildings of . ..... ... . L.. fdoat ...... loft�ffNorthnver,Mass. Lic. No. . O.Fee .......... . GAS INSPECTOR WHITE: Applicant CANARY: Building `Dept. PINK: Treasurer GOLD: File Location No. to (0 U3. S Date Z t TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee gk),� $ ZS Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Z Building Inspector 12/02/94,15:23 25.40 PAIN NTT . 7769 k Div. Public Works PER2111T NO. I (D jq APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP i4O. LOT NO. 12 RECORD OF OWNERSHIP IDATE (BOOK 'PAGE — ZONE SUB DIV. LOTNO. I /��`( LOCATION G��Z N 1 Wt J� J` .r PURPOSE OF �iLtL n�n�r_ UL — \) < OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB A-tCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 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 FEE PERMIT GRANTED �2 19 �4- WHITE: Building Dept. 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 CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 1 ? 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL IN. B'M'TAREA 1/1 1/2 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 �_ _ DROP SIDING CONCRETE _ WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDVJ'D .COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. 8 FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT 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 II 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 S T rNOCHEATING 1TRIC BstA 3rd I 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. WOOD STOVE INSTALLAHON CHECKLIST F�.r�r► I''�: i�� a J. . . ax Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. t Stove I I.. -.i` New_ Used B. Type/radiant Circulating C. Manufacturer 6: Lab. No. Name/Model No. �7y5� Collar size Dimensions/ Height Length Width Chimney �U�'� A. New /41 Existin B. Size (flue area) h C. Other appliances attached to flue (Numb r and flue size P D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner Unlined type 8 manuiacturor) F. Height (refer to diagrams) cap Ove, lr I r . L J171 CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wail Protection (.see steve installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER 12 if Nut j. 2" 18" 'AIN. HEARTH WALL/CENTER 13 F t ZyV .. T..r,y 4L^ .E.j.2 y S K ✓ "'T.=: f , v-'-.1-:..0 —1x .s• 2 •r'.,. 3,�� ��Vs'� WNE S r;+��e � s,v��. t �. .Pre aratio n Ins taliat�oi JO enation &Maintenance KEEP THIS MANUAL r y r m �tJLY, 1994 a t \`� � 11 � �. \ - ..d- � •L � � `*:::':-:.':i sir_:•__ .... .. � EPA Phase II Approved Tested to UL 127, UL 1482, & U.I. 907 Standards by: Warnock Hersey Professional Services, Ltd. --- �Nq�40�C�je�j� Approved for Masonry Firepl a Zero "earcu ce (Metal) Fireplace Insert, Hearth Mount Stove to Masonry Fireplace, Residential Freestanding Stove, Freestanding Mobile Home Stove & Alcove .. 'i"brtufamaamd"7 K 6 10850 117th Plus PIE • Ki Wmd,WA 98033 0 C,"rom 1"4TI `�"•` • t� f CHIMNEY r Termination Requirements•k'' t details) for more NOTE: ,,.,;,-Chimney ons Exterior :. Minimum Air Space to chimneys are Combustibles (See .. subject to Chimney Manufacturer's.;:Wall Bands greater Instructions - usual) 2" Y ) and Supports .moisture and " creosote Min. 18" clearance-'� accumulation to ceiling .. due to the lower The 790 is pictured here, temperatures. the same requirements a An insulated apply to. the 745. Chimn chase will Conne ark Floor Protection Sectio s.. reduce these (Seethe accumulations section "Floor (the proper Protection clearances to Requirements" the chimney for more must be details) maintained). HEARTH STOVE POSITIVE CONNECTION NOTE: Most factory - built chimney manufacturers make stainless steel chimney liners, either flexible or rigid. This provides a wide variety of installation options. Make sure to follow the manufacturer's instructions for installation and support. NOTE: The entire fireplace, including chimney, must be clean and not cracked or damaged. Any damage must be repaired prior to installation of the insert. Chimney must be at least 15' tal and no greater than 33' tall. Entire fireplace, including chimney, must meet local building requirements. am Combustible-- Mantle ombustibleMantle Min. 24" The 745 is pictured here, the same requirements apply to the 790. Floor Protection (See the section "Floor Protection Requiremer for more details) TAWreyuired (some �equire�' ,u a'radW on shieldAz ) , f ? Minimum 15' You should have at -i least 8' of vertical xW + a:f�chimney for every 1' LJ of horizontal run. Insulated Tee Follow the chimney manufacturer's instructions and clearances for wall penetrations. A wall radiation shield (thimble) is required. Stove Clearances (See the section "Stove Placement Requirements" Optional. for more details) insulated chase . Cap (prevents water from entering) i. art Flue Liner The liner must be stainless steel connector or flexible vent. Follow the liner manufacturer's instructions for installation and support. Airtight Insulated Clean -Out Remove damper :or wire it open - Seethe section F'.Stove Placement = Requirements" for minimum clearances required. 4 SMEWALL X k*5 r rebiw�rwb ffFFFi T � raa a P E y1 $ 1 F F p 7 s C FSaSS3 a � � SMEWALL X k*5 r rebiw�rwb ffFFFi � � raa lllrlr(711Qt � P E 7 SMEWALL X v I� s i 04,JV i : a8 g 7 N a �t eC 2 3 „ r,p�j 'A On cmc o o .+ y` OR Z CO n C 3 5 G 0' Ian a � �'p o ' No R = rr WE cam sLL o dg` Z rso m �S bSlMbo4- 6FFFaS& sa�Q4mTs �gCLmC 4i S C 3�3 6G�� p m . •.7 r' t c i �gs�'3v00S g 2ir S i. a1odQ Og m0' hw O ■w o g O ISL' m A�1 d g p 0 0 _ 6-i _TT its (A a C e . o Y10 eP MM u. vFsFF3 I-�o� � m ll_e � 33' am o zZ � c E e 6 m��� r C Lt� ag�o�e18 m33 � a 8 an .r. ■ r -, -e a P� rpc D3 01 of _ .�. _ _.. .-..t?'.�. k. kms, �_• .., . fJ.;. k*5 r Y �C � raa lllrlr(711Qt � $ E 7 F F p 7 v I� s i 04,JV i : a8 g 7 N a �t eC 2 3 „ r,p�j 'A On cmc o o .+ y` OR Z CO n C 3 5 G 0' Ian a � �'p o ' No R = rr WE cam sLL o dg` Z rso m �S bSlMbo4- 6FFFaS& sa�Q4mTs �gCLmC 4i S C 3�3 6G�� p m . •.7 r' t c i �gs�'3v00S g 2ir S i. a1odQ Og m0' hw O ■w o g O ISL' m A�1 d g p 0 0 _ 6-i _TT its (A a C e . o Y10 eP MM u. vFsFF3 I-�o� � m ll_e � 33' am o zZ � c E e 6 m��� r C Lt� ag�o�e18 m33 � a 8 an .r. ■ r -, -e a P� rpc D3 01 of _ .�. _ _.. .-..t?'.�. k. kms, �_• .., . fJ.;. KAREN H.P. NELSON? Town of Director E NORTH ANDOVER BUILDING �'`^�'.:;: ��• v R CONSERVATION a@„” et4 DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT To: Vli'G MEp - � OLZAP�-L. (,p 3�4,s-� Wt x z, e.L_. Fr^cpm : North Andover Building Department Re: Woad Stove Installation 120 Main Street, 01845 (508) 682-6483 It appears, by the visible aspect's of your woad stovc3 available at the time of my inspection that the installation complies with the requirements of the Massachusetts State Sl.ci lding Code. t uly, A19V D. Robert N i cet t i , Huildir�y In�;pec.t r^ DRN:gb c/K. Nelsen, Dir. AI O W Cn O IC 4 C/) W -, CO) coCO2 .9 Q CLL ♦r Q O Q ,all CO) 0 CO2 C O O .0 _Q C. H r�� L CD CD a CO) C O CM C O m cc 0 co Q 0 Q O 0. cmQ Q 4."ca Q Q ..j .0 Q Q Z Q C. CIO C _o U) Cn w w w VJ o' o 0 ° H W H �' a W a o w c w Q) e A as :cam O H A u Qj W q O � rYr Cf') w2 cn w° a�G U w a�' w c�° cn w a�' w r� cn cn Cn O IC 4 C/) W -, CO) coCO2 .9 Q CLL ♦r Q O Q ,all CO) 0 CO2 C O O .0 _Q C. H r�� L CD CD a CO) C O CM C O m cc 0 co Q 0 Q O 0. cmQ Q 4."ca Q Q ..j .0 Q Q Z Q C. CIO C _o U) Cn w w w VJ 3 . O it :;c o c w o � :cam O H ' O v_ V a C :9Q m N D u cm m c E • m O: O all y N Q1 O c =c y O O Ea m v cmm CLU 16 CID. _ = O CD cc Cf C C CL ®off � � CJ C CL c Q y C •O _ mwm 0 N COD W c O ev = m A C Z w .y .Q O C:LU .O C = O m .y Z Ca O m eC C y d CO3 O'� Ocm fl C) T C36 ccl :w Cn O IC 4 C/) W -, CO) coCO2 .9 Q CLL ♦r Q O Q ,all CO) 0 CO2 C O O .0 _Q C. H r�� L CD CD a CO) C O CM C O m cc 0 co Q 0 Q O 0. cmQ Q 4."ca Q Q ..j .0 Q Q Z Q C. CIO C _o U) Cn w w w VJ GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/ of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36' high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $25.00 (Be Ready). Certificate of occupancy required prior to occupying structure. Date .... ...... D� A C� "oRTM TOWN OF NORTH ANDOVER t, ti PERMIT FOR PLUMBING This certifies that . P` M-.4- .....P.� v M .� � N.J..Y .................. has permission to perform .....R. �. �^" J QL plumbing in the buildings of .. G! (� N ..................... at .. 9 �?... L� r�^'� `"' o° �) ...C. ! "� .... , North Andover, Mass. �o ,^ Fee. Lic. No..". .. T:. , �!p.? PLUMB G INSPECTOR ,Check # r i 5637 ;� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING tPrint or Type) g s aaa3 .�71/LVI Mass. Date © 19 / � t r' Building location q 6 tg r Li Q/:l n�1Owner'A �- i �J / Type of New Q Renovation Replacement O FIXTURES Permit # InsWiing Company Name M & R PLUMBING Address 16 PlincesS St. Business TelephoneTat (MI) 245--1770 NIme of licensed Plumber Check one: O Corporation .94�&—rtn ership O Flan/Co. Certificate INSURANCE COVERAGE: I have ayes ent mlity n ura ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. UJO, NoIf you have checked Vis, please indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one. Signature of Owner or Owner's Anent Owner O Agent O hereby Certify that all of the details and information i have (or ente plication are true and accurate to the best of my knotf{edge and that all plumbing work and installations and r� pe it Aor this aaplicati will be pliance with a1( pertipent provisions of the Massachusetts State Plumbi a and ter 2 theeneral Laws. Fityf.. gnature o ceberLrn umType of license: Master [� •JoJrrSeynan OTown ( 1 NL License Number �[�-11 OMNI MM 11-112112 InsWiing Company Name M & R PLUMBING Address 16 PlincesS St. Business TelephoneTat (MI) 245--1770 NIme of licensed Plumber Check one: O Corporation .94�&—rtn ership O Flan/Co. Certificate INSURANCE COVERAGE: I have ayes ent mlity n ura ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. UJO, NoIf you have checked Vis, please indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one. Signature of Owner or Owner's Anent Owner O Agent O hereby Certify that all of the details and information i have (or ente plication are true and accurate to the best of my knotf{edge and that all plumbing work and installations and r� pe it Aor this aaplicati will be pliance with a1( pertipent provisions of the Massachusetts State Plumbi a and ter 2 theeneral Laws. Fityf.. gnature o ceberLrn umType of license: Master [� •JoJrrSeynan OTown ( 1 NL License Number �[�-11 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... N,U.!"..!..V......... 1`..?. F .. .................................. has permission to perform .........� ..................................................................... wiring in the building of ....G.!..0...1.?.......................................................... " 4- .................... . No h Andover, Mass. Fee.... `� `�........ Lic. No. I ZS`� ..... �...... �:u.................... ELECTRICAL NSPECTOR Check # 455 71315 09 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use OA, Permit No. i Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number i 9KO C7 r ,.�i7cvc�� Owner or Tenant G Owner's Address Date ,� O To the Inspector of Wires: Is this permit in conjunction with a building permit Yes P� No ❑ (Check Appropriate Box) Purpose of Building ) /M t Ly Utility Authorization Existing Service 2aO Amps Voits Overhead— Undgmd ❑ New Service Amps Vats Overhead ❑ Undgmd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Meters No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESY NO = have submitted valid proof of same to the Office YEV, NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE, --X, BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME �-/ LIC. NO. q Lkensee14� z7w^,Jr O! . �(ZtEG Sign LIC. NO. Bus. Tel No. %%lf-ia 7 Address_iZ2uit_aaC�.a"ufo/��ARTel.No.C1�l%"A4'7-65SP; OWNER'S INSURANCE WAIVER: I am aware that the Licenses 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. PERMITTEE $ � S� Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grad ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Batte Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained r No. of Dishwashers 1 Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring Y No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESY NO = have submitted valid proof of same to the Office YEV, NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE, --X, BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME �-/ LIC. NO. q Lkensee14� z7w^,Jr O! . �(ZtEG Sign LIC. NO. Bus. Tel No. %%lf-ia 7 Address_iZ2uit_aaC�.a"ufo/��ARTel.No.C1�l%"A4'7-65SP; OWNER'S INSURANCE WAIVER: I am aware that the Licenses 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. PERMITTEE $ � S� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Citv, Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any Capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: ' Address City- Phone #. Insurance. Co. -_ Policy # Company name- Address City Phone# Insurance Co. Policy # -- Farre to secure coverage as required.under section 25A or MGL 152 can lead to the imposition of criminal penalties of.aifine up to $1.6w.o0 and/or one years' irrprisomrnent as wetl_as_c iYA4 nabt sinlheSarm4aBTOPYYORK9RDER and_afioe-cf ($1 -OD -W) -allay againstme I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby mtfy under the pains and penalties of perjury that the infarmabon provided above is true and correct Signature Date Print name Phone-# Official use only do not write in this area to be completed by city or town official' City or Town PermitAkensing. D Building Dept E] Check if immediate response is required . 0 Licensing Board E] Selectman's Office Contact person: Phone # ❑ Health Department Ei Other