Loading...
HomeMy WebLinkAboutMiscellaneous - 98 MILLPOND 4/30/2018N O r 05 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING tn.-- (Print or Type) a . Im NO . ANDOVER , MA Mass. Date -19 746 Permit #_�G� Building Locatlon lod MILLPOND Owner's Name NO.ANDOVER,MA Type of Occupancy ' RES New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ ' No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certlflcate '-r'z Address 91 BELMONT STREET CS Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Flrm/Co. Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes R] No O If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Zi 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 taws, and that my signature on this permit application waives this requirement. Check one: owner -0 Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this appllcaU will b In pftance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral law BY Type of Ucense: 14' Plumber cnalur o c nse um a or Gas ,iter Title stiller aster Ucense Number M-3440 City/Town Joui neyman Af r K7yr-D (OFFICh USE 0141.yl N N W N y N U W W N ¢ O U � 2_ .O w < m !n F- W W o — a c o .'LU .. < 1= W ¢ W C7 C O w lL W F' U J y Q W < W W > ¢ w { ¢ < O O W 2 O f Y o o. F- O SUB—BSMT. BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR BTH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certlflcate '-r'z Address 91 BELMONT STREET CS Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Flrm/Co. Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes R] No O If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Zi 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 taws, and that my signature on this permit application waives this requirement. Check one: owner -0 Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this appllcaU will b In pftance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral law BY Type of Ucense: 14' Plumber cnalur o c nse um a or Gas ,iter Title stiller aster Ucense Number M-3440 City/Town Joui neyman Af r K7yr-D (OFFICh USE 0141.yl 'Y.-�4�..0'-.fes+wi+._u� -.. -c _ _ _ ,� .�. � _ _, y _;..�.�._.Y•..wM�n-vRY+1 y+a-r�:.__ .,...,`1y��, rb >.To _ 2�i Date.:/. .�//...G.. T r NORT., TOWN OF NORTH ANDOVER OF ,, a o gti0 0r PERMIT FOR GAS INSTALLATION �9SSACMUSESt� .. Q This certifies that .. �` �J.� .�,� .` .69 .... ... g' has permission for gas installation : in the buildings of ....4.. e!�................... ...... at .... ............ . North Andover, MMs. Fee.4' Lic. GAS INSPECTOR nu WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: f e Location ��%' y�� (� �U�`' pq r1 No. Date e"—� �j T©3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /00— Foundation a0— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C191b 1645) OT Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �... BUILDING PERMIT NUMBER: DATE ISSUED: ' �. l- AMSIGNATURE: Building Commissioner/IngWor o Bui din Date SECTION i- SITE INFORMATION - - I A Property Address: 4-P M.1l Pa1d �R C"4 1.2 Assessors Map and Parcel Number: 9sA 9 F Map Number Parcel Number N �ya rr /"1 _� 1-4 0c, 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 Reclttired Provided 1.7 Water Supply M.G.L.C.40, 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record •4`tn,,—4-� V ®��(� S z 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 upervisor: Ic r h G.I.J1, Licensed A struction Supervis : /- zG vrr CSA- vl �y Address f �K ignature Telephone Not Applicable ❑ ' 6Sk Z 3 License se Number Expiration Date 3.2 Registered Home Improvement Contractor (�_+ I L' y [�nJ,1 �^� �Ehe �firIYCG 1 uT Not Applicable ❑ �+ /O Company Name V Registration Number Address i ss% Expiration Date ature Telephone rn (V' w 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 a Hcable New Construction ❑ Existing Building X Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant OFICIAiTSE�NLY 1. Building c�j // �_ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction j C --- CL J 3 PlumbinE Building Permit fee (a) X (b) / O 4 Mechanical HVAC 5 Fire Protection 6 Total . 1+2+3+4+5 Check Number / LG - SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CO TRACTOR APPLIES FOR BUILDING PERMIT I, 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, 11 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 Print Nam Aature of Owner/A Ient Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 ND3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print A Location: 40 City L r^t n C. -L. `r Phone # ` 1,P- 5'•1'7- ,s iFvV I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. Comnanv name: 6J 1e -, r,: (r -c r-/ Address City Law n� c _ Phone#. C 7o/oy73o/2-oo •z Company name: Address City: Phone #.- Failure : Failure to secure coverage as required: under Section 25A or MGL 152 can lead to the imposition of crirrdnal penalties of,a fine up=to $1,500 and/or one years' imprisonment_as_welLas_ciydjx o tiesioshelmmn-cfA-STDPYAOM JRDERand_afm -cf_($UnW)-ajday mm 1 understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for gage verification. I do hereby certify under the pains and ona/ties of perjury that the mformr hon provided above is true and correct ect Print Official use only do not write in this area to be completed by city or town official /-?- 0. -# %iy-sr7-1-5V1 City or Town Permit/Licensing D Building: Dept QCheck if immediate response is required Q Licensing Boarcl Q Selectman's Office Contact person. Phone # Q Health Department Q Other 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 c 11, S 150 A.. The debris will be disposed of in: (Location of Facility) "Signaturermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector Glenn Gary General Contractors 60 Island Street Builders Lic. # 058238 & 065519 Lawrence, MA 01840 Home Improvement Lic. # 105965 & 122124 Telephone 978-557-5981 978- 469-0055 Lawrence Haverhill Fax 978-557-5439 Glenn Gary Buddy Latham CONTRACT PROPOSAL FORM General Description of Project: Kitchen Renovation .Total,Cost° Estimate- I Acceptance of Proposal I After sheetrock Installed Upon Completion $9;865.00 $4.932.50 82.46625 IR? 466 ?5 . All material is guaranteed o be as 'specifiecJ All work to be camp etetl; in a wocrpanle cnaline_cording tt} standard practices. Any alteration or` deviation front above specificattbns ilsvolvng extra i:osts virrll be exeCu ed ony upanwrrtten , `o"rders and wilt pecorrte an ektra charge over and above the;esiimate; All agteemei►ts are Conttrlgertt •upon stnkes accidents or delarseyortd' our control Evner to tarry all required insurance i7nh3rApery tjeing worked by the contractor, Coritr`act'or'Will, provide fuwGWoikine s,Giim 'ensall orWi , anc�.ftir #Fic; e i310 .ei5_i sed at.tl a sits... Please review this Proposal and if acceptable please sign both copies and retain one for your files. If there are any changes please modify this Propoii6l by marking the changes and providing us with the document for review and preparation of a final Proposal. This proposal ma withdrawn if not accepted within 30 days. �._ , Iq/YW,� Accepted: By: Date: (custorh r Signat Francis L_ tl7a Date • Demolish kitchen cabinets and counter top • Remove sheetrock from kitchen ceiling and walls • Remove sheetrock from one dinning- room wall to provide access for electrician • Remove sheetrock from basement utility closet to provide access for electrician • Frame soffits • Sheetrock soffits, walls (kitchen and one dinning room ), kitchen ceiling, and utility closet • Install wall and base cabinets supplied by owners • Install W Hardy backer to kitchen floor • Install kitchen floor tile( tile, full flex mortar, and grout supplied by owner) • Install the backsplash ( tile, mastic, and grout supplied by owner) • Install bead board supplied by owner • Install 2 support brackets supplied by owner • Install 2 1/8" crown molding supplied • Prime and paint (new sheetrock ) • Plumbing per layout to comply with Mass state building code ( fixtures supplied by owner) ....._...--. ,..-� _..._� ! ,Electncal�, to,„pode�tor��lude,8,recesset�igf�ts,��petiteeklanging-fixtures,: and..under 'catiifit#lighting (fixtures supplied by owner) Fec {P�K .Total,Cost° Estimate- I Acceptance of Proposal I After sheetrock Installed Upon Completion $9;865.00 $4.932.50 82.46625 IR? 466 ?5 . All material is guaranteed o be as 'specifiecJ All work to be camp etetl; in a wocrpanle cnaline_cording tt} standard practices. Any alteration or` deviation front above specificattbns ilsvolvng extra i:osts virrll be exeCu ed ony upanwrrtten , `o"rders and wilt pecorrte an ektra charge over and above the;esiimate; All agteemei►ts are Conttrlgertt •upon stnkes accidents or delarseyortd' our control Evner to tarry all required insurance i7nh3rApery tjeing worked by the contractor, Coritr`act'or'Will, provide fuwGWoikine s,Giim 'ensall orWi , anc�.ftir #Fic; e i310 .ei5_i sed at.tl a sits... Please review this Proposal and if acceptable please sign both copies and retain one for your files. If there are any changes please modify this Propoii6l by marking the changes and providing us with the document for review and preparation of a final Proposal. This proposal ma withdrawn if not accepted within 30 days. �._ , Iq/YW,� Accepted: By: Date: (custorh r Signat Francis L_ tl7a Date Cf) C/) 0 m CID CO2 Cl) 'O O CD St Z CA CCl �� ' � C CLCA nC O � o v co D O CL cr /�w,,/=r = CD lot CD O CD 0o w C co CO) CD CZ O CO2 co CD v CA O ICD Z C. -A► O CD O CCD I m re cn rn O -•HCQ y =m O 0 y �- O m C7 _ n O tioa= �• 0, .�.� � •dr m � T ,••r =r C L -+ CZ 0 m mCD O y O y O CD = m CD N = x > > C : C —1 t0 �. CD O 0 Z.: C') � . CD C S N a S a o m S P .I :� a ,....-..ter: 0 o - C -I C- = Cfl -I C-),= CL c o CD CD ca d y N CI d O .W CZ CD /� � CO3 CCD CCD cmO CD q4Q CO) rs M , cn Cn O Cn AW '-y p'- o pGq w oCc mrl O� oGa -? w n g O t� cp -o" O. Q .� CO2: c d m CL c7 C2: it CD Cn O Cn AW '-y p'- o pGq w oCc mrl O� oGa -? w n g O t� cp -o" O. Q z 4) OMI 0 0 c Jw Date .6....... .......... -........ .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... rclz.3 ... has permission to perform .......... / e--_- It ..... 11 ........ wiring'in the building of ............ ... ....k' ........................................... at ..... Al t..& .............. C. North Andover, Mass. Fee.. ......... Lic. No. ............. ................... Ed- i',CAL INSPECTOR Check # 4574 Official Use Only / Permit No. Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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) Date To the InsAectoAof Wires: Town of North Andover The undersigned applies fora permit to perform thee / Location (Street & Number g l I ' � Owner or Tenant \t) 0 Z Owners al work described below. Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. F,aasting Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work--L/-_i Overhead ❑ Undgmd ❑ No. of Meters HER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy incl ompleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the O YES NO = tww have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Ple pecify) o� GOG (Expiration Date) Estimated Value of EI al Work$ r 1 Work to Start Inspection Date Resquested 9 Rough Final Signed underlbviPenalties of pe t FIRM NAME© UOV�j C.%J 7�r�i LIC. NO. Licensee Signatu LIC. NO.No Y �� Address 7 y�'�' S� S7 Sal eM �Us- JTT No. 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) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures tlJ Swimming Pool grnd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets �DD' No. of Oil Burners Battery Units No. of Sv, W fl 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 1 Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self contained No. of Dishwashers 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 No. Hydro Massage Tuds No. of Motors Total HP HER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy incl ompleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the O YES NO = tww have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Ple pecify) o� GOG (Expiration Date) Estimated Value of EI al Work$ r 1 Work to Start Inspection Date Resquested 9 Rough Final Signed underlbviPenalties of pe t FIRM NAME© UOV�j C.%J 7�r�i LIC. NO. Licensee Signatu LIC. NO.No Y �� Address 7 y�'�' S� S7 Sal eM �Us- JTT No. 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) Telephone No. PERMITTEE $ (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City 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: *r Address City: Phone #: Insurance. Co. ----PoliqY # Company name: , Address" Cifir Phone # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the irnpoeffim of aiminW penalties of.a fine up to and/or one years' impnsorxnentaswdt_as_curd..penaltmssJnJheSwm-ta�STQPVYCMDRDFRond_afin&-dA$1iW-W)-agiayjagainstme_ i understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby eertily and r the pains and penalties of perjury tAat the information provided above a true and correct. Signature Print name Official use only do not write in this area to be completed by city or town official' City or Town PermitA icensing. Building Dept Elcheck if immediate response ,is required . 0 Licensing Boats/ E] Selectman's Office Contact person: Phone A E] Health Department Ei Other Date. .fo-!.��U3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .��? ..... O has permission to perform`.®.� . �.................. plumbing in the buildings of .. .®�.� k16 .................... at. ... ..t.,.. ��r..... ..CQ ....... North Andover, Mass. Fee 3�.... Lic. No.......... I � ....PLUMBINGNSPECTOR a Check # _ f s 5633 MASSACHUSETTS UNIFORM APPLICATION FORfPERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Jcr .^ii / / 6072-3—' � U�. Date b/— / / � 6 ? Building Location �� P1 / t'1 f0 Ge/ J i- J Owners Name �J 0 t1 Aj U �� r ` Permit # Amount Type of Occupancy New Renovation ® Replacement IZI Plans Submitted Yes 1:1 No El FIXTURES (Print,type) �, Cv�� ��� Check Installing Company Name [] c, ® Partner. Firm/Co- Name of Licensed Plumber: St} ��/�9'�% � (- c ,,e 4 Aa Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EJ Other type of indemnity 0 Bond Certificate 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 M Agent n 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 Massach t bing Cod and Chapter 142 of the General Yaws. By: Signe of icens um r Type of Plumbing License ,A Title a36:3 I City/Town icense NumDer Master ® Journeyman APPROVED (OFFICE USE ONLY