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Miscellaneous - Exception (145)
7/19/2016 I 20947 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20947 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation in the buildings of BEATO. FELICIA at 9 FERNWOOD STREET 9.0, North Andover, Mass. Lic. No. Date: July 19, 2016 1/1 7/19/2016 ,'o Date: July 19, 2016 20946 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20946 of r1rux 4ti TOWN OF NORTHANDOVER I, PERMIT FOR PLUMBING �4SSACHUS�� ❑ This certifies that has permission to perform plumbing in the buildings of BEATO. FELICIA at 9 FERNWOOD STREET 9.0, North Andover, Mass. Lic. No. 1/1 ((yy . Date ...... Q....w 57 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................ .................. �......................................... has permission for gas insta l``ation ........................C�................................. inthe build, ings of .........6? a:- ?.................................................................................... at ............1.........'�E 2�J�c,�......................... . North Andover, Mass. Feed. ........... Lic. No..�............................................................................... ��� GAS INSPECTOR Check # rp U U., :, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 07/27/2015 PERMIT # JOBSITE ADDRESS 9 Fernwood Street OWNER'S NAME Felicia Beato GOWNER ADDRESS 9 Femwood Street TEL 978-681-0847 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL _ EDUCATIONAL RESIDENTIAL CLEARLY NEW: - RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES. NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 11 ye' l DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER 'WATER HEATER OTHER r - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT _- SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of ledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Partin t p i of e �e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Gregory K Maffei Sr LICENSE # 10059 IG U MP -, MGF . JP JGF LPGI CORPORATION # PARTNERSHIP # LLC v # 3451C COMPANY NAME: Maffei Plumbing and HVAC LLC ADDRESS 383 Main Street CITY Rowley _ _ STATE MA ZIP 01969 TEL 978-312-6268 FAX CELL 978-417-9264 EMAIL gmaffei@maffeiservices.com rA F O z 0 F U w a w a O ►� z z �- OrA w ~ w 0 aO v W 't z � m w a r4 a W sS o. O LLJ a > GL W w N a o a a a J E+ a a � ca 2 W H U- • F+ O z 0 H U W a rA d L7 O O The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invest1gations 600 Washington Street Boston, MA 02111 wmmass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Leidbty NaMe(BusinessMrganizationMdividual): Maffei Plumbing and HVAC LLC Address: 383 Main Street City/State/Zip: Rowley, MA 01969 Phone #: 978-312-6268 Are you an employer? Check the appropriate box: Type of project (required): 1. ® I am a employer with 9 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. t �• Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. [3 We are a corporation and its 9. ❑ Building addition required,] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.®.Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' MCI Other comp. insurance required.] 'My applicant that dheoks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating thcy are doing all work and then hire outside contractors must submit a new affidavit indicating such. rCoatractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 ant an employer that is providing workers' conspeusadon insurance for my emlployee& Below is the policy and Job site igjormadon, Insurance Company Name: The Hartford Policy # or Self -ins. Lic. #: 76WEGPY2413 Expiration Date: 10/22/2015 Job Site Address: 9 Fernwood Street City/State/Zip: North Andover. MA 01845 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requited under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. f I do hereby certify under the pains and penaldes of rjury that the iryormaden provided above 6 true and correct Phone #: 978-312-6268 QQ`klal use only. Do not write in this area, to be completed by city or town ga%iaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C() states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple per niNicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' - Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ,v,- COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS... Q.COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS MOM - AS A MASTER - UNRESTRICTED ISSUES THE ABOVE LICENSE TO: GREGORY K MAFFEI SR 183 HAVERHILL ST N. ROWLEY MA 01969-2120 ' 6822 10/28/14 265963 T STATE OF NEW HAMPSHIRE BUREAU OF BUILDING SAFETY & CONSTRUCTION PLUMBING SAFETY SECTION NAME: GREGORY K MAFFEI SIR LIC #: 4407 M EXPIRES: 10/31/2015 :/j MASTER 4124 TRAVELERSJ' IThe Phoenix Insurance Company P.O. Box 1450 Middleboro, MA 02344-1450 11/03/2015 Town of North Andover Building Inspector 120 Main Street North Andover MA 01845 Insured: Felicia Beato Claim Number: HXV6309 Policy Number: OVK793-976707216-633 -1 Date of Loss: 11/02/2015 Loss Location: 9 Fernwood St North Andover MA To: Board of Selectmen Building Commissioner Inspector of Buildings Board of Health A claim has been made involving loss, damage or destruction of the above captioned property which may either exceed $1,000 or cause Massachusetts General Laws Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws Chapter 139, Section 313 is appropriate, please direct it to my attention and include a reference to our insured, the policy number, the claim/file number, the date of loss, and the location. If you have any questions, please feel free to contact me at (508)946-6317 or email me at NVI LAN DR@travelers.com. Sincerely, Nicholas Vilandre Claim Professional (508)946-6317 Ext. 9466317 Fax: (877)786-5584 Email: NVILANDR@travelers.com 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. Signature P0062 Date F3162C1515308004124 00001 N I.- Date.A� -- /- - a/ Of TOW/OF NORTH ANDOVER PERMIT n17 FOF R. GAS INSTALLATION This certifies that U&y ................ has permission for gas installation ......................... in the buildings of ,/^ ................ at......................... North Andover, Mass. Fees- Lic. No..Ir';.�'? . ......................?fit. GASINSPECTOR Check # v2 66�1 I R G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DG GASFITTING (Print or Type) ,Mass. Date 263 d $� Permit # Building locations/ZJU )0()��Owner's Name Owner Tel# Type of Occupancy_ __RF, ' New ❑ Renovation ❑ replacement ❑ Plan Submitted: Yes ❑ No n FIXTURES Installing Company dame t,,- �����,�,� Address__!2/ . Business Telephone #_ Name of Licensed Plumber or Gas Fitter F /40T -P/ Check one: Certificate ���k' ET Corporation , .s : A. •, Ei Partnership n Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142, Yes 0-- No 0 If you have checked rimes, please indicate the type coverage by checking the appropriate box. A liability insurance policv w� Other type of indemnity ❑ 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 !-.1 Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issUeddfoAVis application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene 1 s. By Ty e of License: t... . - a- lumbe Sign ' re�f Licensed Plumber or Gas Fitter Title ^ -Gas fitter f License Number _.< °J- 1 City/Town -Journeyman APPROVE® (OFFICE USE ONLY/ J( � w l � H emu x O U (9 w W O0 d 0 O W dot Z of m W rD Luz O U x W a O Q r W u.! _jZ J �= !x W H W F x Z Q ¢C C, O O W O x w O iaC o u` SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR A 3RD FLOOR 4T" FLOOR 5T" FLOOR 8T" FLOOf 7T" FLOOR e FLOOR Installing Company dame t,,- �����,�,� Address__!2/ . Business Telephone #_ Name of Licensed Plumber or Gas Fitter F /40T -P/ Check one: Certificate ���k' ET Corporation , .s : A. •, Ei Partnership n Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142, Yes 0-- No 0 If you have checked rimes, please indicate the type coverage by checking the appropriate box. A liability insurance policv w� Other type of indemnity ❑ 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 !-.1 Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issUeddfoAVis application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene 1 s. By Ty e of License: t... . - a- lumbe Sign ' re�f Licensed Plumber or Gas Fitter Title ^ -Gas fitter f License Number _.< °J- 1 City/Town -Journeyman APPROVE® (OFFICE USE ONLY/ Date. TOWN OF NORTH ANDOVER PERMIT FOR,GAS INSTALLATION This certifies thatre,;��.I#rqe:l ............. has permission for gas installation 6-44. Zw? in the buildings of -110 .. ............... at .................................... North Andover, Mass. rI FqD2.. Lic. Nol."C Zr .... ...................... t:>. 91 ? GAS INSPECTOR Check 6650 v 11 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ®C GASFITTING (Print or Type) U L l Z Mass.Bate _2€3 O t Permit # -- -- ��^ Building Location U bi SI Owner's Name _! fawner Tel#i Type of Occupancy --- 0 New El Renovation © Replacement Q flan Submitted- Yes 0 No rl FIXTURES Installing Company Nasse �r";���.������ A ^v.-. Address Business Telephone # �{.,,• ., Name of Licensed Plumber or Gas Fitter Check one: Certificate A t=-t"Corporatior�' 0 Partnership n Firrn/Co. INSURANCE COVERAGE: I have a current lia?ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ffNo ❑ If 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's Agent Owner n 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 m, rulumuuge anu inat au piumomg work and installations performed under the permit issue IF is application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenQ 1 S-/ BY T e of License: 0. • lumbe Sig rt f Licensed Plumber or Gas Fitter Title ^ -Gas fitter License Number City/Town = Journeyman APPROVE® (OFFICE USE ONLY) 41( a P- zCn 1 C/) w s W° o V. Q O C3 w Q w G Q w Q WW U)W W Z a W O Q F x .-1 W ¢ W> = O O= Lu w g O �¢ O O w O x o w a I u x> q a0 tW �, SUB-BSMT BASEMENT 1sT FLOOR 2N0 FLOOR 3RD FLOOR 4TH FLOOR FM:: 5TH FLOOR I T 6T" FLOOF 4+ 7Ts FLOOR 8TH FLOOR - Installing Company Nasse �r";���.������ A ^v.-. Address Business Telephone # �{.,,• ., Name of Licensed Plumber or Gas Fitter Check one: Certificate A t=-t"Corporatior�' 0 Partnership n Firrn/Co. INSURANCE COVERAGE: I have a current lia?ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ffNo ❑ If 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's Agent Owner n 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 m, rulumuuge anu inat au piumomg work and installations performed under the permit issue IF is application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenQ 1 S-/ BY T e of License: 0. • lumbe Sig rt f Licensed Plumber or Gas Fitter Title ^ -Gas fitter License Number City/Town = Journeyman APPROVE® (OFFICE USE ONLY) Date. O/**`-. E. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. %c: 4'... P. (I. y ...... ........ has permission to perform ... ....................... . plumbing in the buildings of ..L./.,:PA ....................... . at ... ..fr,I 4-:. ,,-, .� ................ . North Andover, Mass. Fee ..30 . Lic. No..? 0 S. ?.? ......WLUPBIZNS ..PECTOR Check #I —//.& v 7523 a] APPLICATION FOR Ci (Town: North Andover ty - _ i, MA. Date: 10/02/2007 Pe rmit# Building Location: -9 Fernwood Street Owners Name: Felicia Veato 71 Type of Occupancy: Commercial � Educational t Industrial Institutional �Residential W New: n Alteration: Renovation:? Replacement: / Plans Submitted: Yes Q; No FIXTI IRFA INSURANCE COVERAGE: _ 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ✓ ' No - If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity 17. Bond L7 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent - 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By _ Type of Licens�- OOFC Title { ✓ Plumber '-Signature of Lice ed Plumber --- - Master 1- , - ----- citylTown L _ � License Numbe . r 10977 APPROVED OFFICE USE ONLY Journeyman _ - _ - Z z y Y Y} N J O V i IN— W U) a lz z 3 z 9 w �a 1-" w Tin z Q w Y Q m o z 9 K X x z O� o Q w c a C I•- 3 Tin z 0 4a X z Tin W y z 0 a LL Y= 3 o W N N° 0 1- a x t_ z a u. 00 3 a OJ Y a -C x Q w w Q Q W Q Q a m m o o 0 L o x 4 g m z W W a 9 oz 5 3 3 3 0 SUB BSMT. BASEMENT -is FLOOR 2 WFLOOR 3 FLOOR 4 FLOOR WH FLOOR 6 FLOOR VH FLOOR 8 FLOOR Installing Company Name: t175 Maple Street _ Check One Only Certificate # - -� Address: 1175 Maple Street - - City/TownrStoughton - -___� State: MA Corporation 2549-C I -- -' v - Partnership ----, _ Business Tel: 781-297-7049 --� Fax: 781-341-8817_ - I - - L --- ��-I Firm/Company Name of Licensed Plumber: J.Daniel Huntress `� INSURANCE COVERAGE: _ 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ✓ ' No - If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity 17. Bond L7 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent - 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By _ Type of Licens�- OOFC Title { ✓ Plumber '-Signature of Lice ed Plumber --- - Master 1- , - ----- citylTown L _ � License Numbe . r 10977 APPROVED OFFICE USE ONLY Journeyman _ - _ - Location No. Date lU 4 fid NORTh TOWN OF NORTH ANDOVER f s 41 ' c �o ; ; Certificate of Occupancy $ C14Us <� Building/Frame Permit Fee $ l �� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19657 (/ Building Inspector Y ' Y CERTtFI-CATE OF USE & OCCUPANCY Bidding Permit Number / Date—// - 11S CERTIFIES THAT BUILDING LOCATED ON Y BE OCCUPIED AS Ae Y- c� 6 3 ACCORDANCE WrrH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TOlev v I ti '+� f r/ A k'l A j/}'► u/1 G�-� Building Inspector 1 O c�..r — W •�/ • CO m. °' ~ CD CL O G O C.) rL 0 EL—cc ; ) ca C CFJ C.3 COD d O C z � O O. V 04) C r�lw-1 oho uCdae� w r w w W a v ro w z Q v ch w C2' cgi X" w" PQ cn O c�..r — W •�/ • CO m. °' ~ CD CL O G O C.) rL 0 EL—cc ; ) ca C CFJ C.3 COD d O C z � O O. V 04) C r�lw-1 Location Fer1A) Liu m 0 No. IL/Date �aR,M TOWN OF NORTH ANDOVER Of :•,�O 9 Certificate of Occupancy $ 01 s'„'°''<�' S�cHusE Building/Frame /Frame Permit Fee 9 $ � a ”" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # IV d 17380 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING n, 41"M1" BUILDING PERMIT NUMBER: DATE ISSUED: _ _a 00� G SIGNATURE: Building Commissioner/Inglector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 16 Map Number Parcel Number I 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Diaiic—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided I 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone information: 1.8 Sewerage Disposal System: Public 9 Private ❑ Zone Outside Flood Zone `J@E Municipal K On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIiIP/AUTHORIZED AGENT Historic District: Yes bio 2.1 Owner of Record Z7-1�1 4- 4/6, 4pe /0 Id Z!"' Name (Print) Address for Service: I Signature U Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Li sed Construction Supervisor: Not Applicable ❑ �•�.�57q'�ir� !`t � Licensed Construction Construction Supervisor:�V License Number / _ �ca✓� Address Expirationate Signatu Telephone 3.212egistered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date '� Signa Telephone i�" AN SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c161 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 DesciA tion of Proposed Work check sv a licable New Construction 0 Existing Building ❑ Repair(s) Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: , SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed brmit applicant pC, USE Q;y 1. Building ."7wi 000 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction a 3 Plumbin Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 OCA Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CO.NT/R"A�CTOR APPLIES FOR BUILDING PERMIT I, 8ev,&.. as Owner/Authorized Agent of subject property Hereby authorize to act on My ehalf, in all matters relative—to wk authorized by this building permit application. Si ature of - LJ L� Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Name 6y� Si atur A e Date NO. OF STORIES SIZE C;,P BASEMENT OR SLAB ie -e. -q' SIZE OF FLOOR TINIBERS iST02 2 3RD SPAN DM ENSIONS OF SILLS �G DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS /Cp " SIZE OF FOOTING ,.,�„,,, X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND v IS BUILDING CONNECTED TO NATURAL GAS LINE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT M--C21ZL4 Le— LOCATION: Assessor's Map Number. SUBDIVISION STREET���� �T A RECOMMENDATIONS OF TOWN AGENTS: PHONE_(g_�- dY-7, PARCEL LOT (S) ST. NUMBER /0_1C"- USE 0-/c"- USE ONLY*********************************** CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATI DRIVEWAY P FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The Commonwealth of Massachusetts Department of Industrial Accidents 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. FI am a sole proprietor and have no one working in any capacity IZII am an employer providing workers' compensation for my employees working on this job. Company name: co aejoi 4o�-74 Address r38 Goy City: Phone #: 477,6 619el Insurance. Co. Policy # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civiLpenatti inihefnrmnfa_STOPWORK_ORDER,and_a.fine_of.(.$1D0..00.)_attayam gainste. 1 understand that a copy of this statement may be forded to the Office of Investigations of the DIA for coverage verification. I do hereby certify undepgXd�of perjury that the information provided above is true and correct. Print � Phone Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing E] Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ 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 c11,S150A. The debris will be disposed of in: (Location of Faci V SicJnature66f Permit Applicant 6 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 4 6 .. e y R C O a+ V o U d W LO N V �.•c a W. �ra a > G oui as a U Q � 14 r.W O ,fl W N CL .� .W ,� O O Z O W `� , rW W 0 O �—mss :- - �•„1^ 6 Jamesco Development Inc. 28 Chard Road Tyngsboro, MA 01879 Martha McQuade, Kevin McQuade, and Christine McQuade North Andover, MA 1-978-687-0875 Addendum to the remodeling proposal dated May 2, 2004: In an attempt to lower the original estimate for the remodeling project from $340,000.00 to $275,000.00 the following items may be eliminated or downgraded to less expensive materials: 1. Finish of basement as depicted on plans drawn by SJV Design dated 11/15/05. 2. Zero Clearance Fireplaces may be eliminated. 3. The rear deck may be changed to a landing and a set of stairs. 4. Hardwood floors. 5. Carpeting allowance. 6. Built in cabinetry. 7. Kitchen cabinetry. 8. Painting to be completed by the homeowners. Must be completed in a timely manner so not to delay the construction project. 9. Outside landscaping. Jamesco Development will be in contact with the homeowners to discuss the progress of the projects as well as the budget with the new building costs. Project should take 3 to 4 months to complete. Signature of Acceptance Date Chris Finneyal dte �__ s 2- / 1 11--00' �,q blaJ04 Terms: $35,000.00 Deposit $35,000.00 At completion of new shed dormer (weather tight) $35,000.00 At completion of demolition of existing interior $50,000.00 At completion of rough electrical and plumbing $50,000.00 At completion of insulation and plaster. $50,000.00 At completion of finish trim, kitchens, and baths. $20,000.00 At completion of the job. Project should take 3 to 4 months to complete. Signature of Acceptance Date Chris Finneyal dte �__ s 2- / 1 Jamesco Development Inc. 28 Chard Road Tyngsboro, MA 01879 Proposal to Renovate the Existing Residence (25' x 50' Foundation app.): Martha and Kevin McQuade North Andover, MA 1. Gut existing structure to the sub -floors and studs. Remove all debris with 30 - yard containers from a licensed removal service. 2. Complete new build out of residence as depicted in drawings by SJV Design dated November 15, 2003. Build out shall conform to drawings whenever possible. 3. Basement to have two mechanical rooms, two storage areas, one recreation room, and one double closet. 4. First floor build out shall consist of two bedrooms, 1 and 3/4 bathrooms, a washer dryer area, an office/ T.V. room, kitchen, dining room, living room, and a front foyer. One new zero clearance fireplace will be installed. Kitchen layout as depicted in drawing. The rear porch will be enclosed with three new windows. Hardwood floors to be installed in the living/dining area as well as the foyer. Carpets to be installed in the office, all bedrooms and rear hallways. The kitchens and bathrooms will have vinyl flooring installed. 5. Second floor build out shall consist of a foyer, living room dining room, large family area, kitchen, bathroom, and a laundry area. One zero clearance fireplace to be installed in the family room. Kitchen layout as depicted in drawing. Built in shelving around T.V. in the family room. One new 8' x 10' deck shall be built on the rear of the dwelling with stairs to the rear of the property. 6. Third floor renovation to consist of a new 35' shed dormer on the south side of the dwelling. Dormer will receive five new windows to match existing windows. Build out shall consist of three bedrooms, a 3/4 bathroom, and a small play area. There shall be a small section of built in shelves and a small storage area in the unused north side crawl space. Specifications: a. Walls will be insulated with 3 1/2 insulation(R13) in 2x4 walls,.5 %2 insulation(R19) in 2x6 walls, and 9" insulation(R30) in 2x10 floors and walls. b. Siding — vinyl to match existing c. Shutters — vinyl to match existing d. Windows — vinyl to match existing e. Roof — 30 year asphalt shingle, color and style to match existing f. Interior woodwork — 5 %2 colonial speed base with 2 %2 colonial casing on window and door openings. All interior doors to be solid core masonite doors. Closet doors to be hollow core masonite doors. All new exterior doors to be insulated steel doors. g. Smoke detectors — per town requirements and will be determined by the fire department. h. Flooring — $18.00 per square yard including installation (carpet and vinyl) through builder's supplier: Remco Flooring of Chelmsford. i. Hardwood (Oak flooring red or white) to be installed on the first and second floor units in the foyers, living rooms, and the dining rooms. j. Appliances- builders choice of range, range hood, and dishwasher k. Cabinets- builders choice of cabinets. Cabinet to be an all -wood cabinet with good quality (Armstrong cabinets Tiara series). Counters to be Formica. Upgrades to granite or corian can be discussed as an upgrade. 1. Plumbing- design built in compliance with state and local building codes. All fixtures are American Standard or equivalent in white or off-white. All faucets are Delta or equivalent. Hot water to be supplied with 40 - gallon hot water heaters. All plumbing shall be new from the water main. Builder is not responsible for the water main or any plumbing or sewer that exists outside the dwelling. in. Electrical- circuit breakered service. Outlets, switches, and lighting provisions are design built to comply with local and state building codes. Electrical allowance is $800.00 per floor in lighting equipment. n. Heating- to be supplied with a gas fired boiler forced hot water system. Each floor to receive an individual zone. o. Fireplace- zero clearance gas p. Walls and ceilings- skim coat plaster finished with atrium white flat latex paint. Because of the nature of plaster, there may be some color variations in plaster ceilings. q. Cable and phone- three of each on each finished floor of the dwelling r. Bath accessories- soap dishes, towel racks, medicine cabinets, mirrors, ect. Will not be supplied by the builder. s. Landscape- any disturbed areas will be loamed and seeded. t. Deck- Pressure treated frame, decking and railings per building code Total Investment ........................................... $340,W. 00 Three Hundred and Forty Acceptance bate o! 0 I ERS * A o u w chi v a c w aG g U x w w x w u c a z o 0 a A x cn v o cn r0 gyp= C L y O •aC �. ��L)te Mg A eo a :cc 2 ? E a 46 m 0 y C E o= ' cm fti CD C y Cos NJ = c� � 3 C C m : CLL) m y m w O cmr�•p C p Q � C-0 = : / d C L m •; m p V y ' Z V� p moo o' O. C N r ca Ww m.y C-2 .E V � V � Ci O W a m p 'fl = cGO o � 0 M CODO O 6 O y H .E L- CD c O v cc r7 CO2 O CO) O cc C !O CO2 L O v CD CLy c CD CM c c 0.— CD•— � c CD co ev � 3 .o co O L- CL C' d Q C J O O O Z cs CD C. h C Date. =?`.� .. / A 417G NOR,N TOWN OF NORTH ANDOVER '• O PERMIT FOR PLUMBING �SS�cMusf� This certifies that .!! ..�>; .'�' �...A! I has permission to perform .... ......!.. . /� ' .......... plumbing in the buildings at ...,. `.�... . f.'sc !,c t r, < r c f ............ .North Andover, Mass. Fee.Lie. No........... ............f....-.r..:� :...... . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FORPERMIT TO O PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Fern Date 2 G Building Location is f ern t�cd S'� Owners NameU�l/� �C��� � Permit # �U Amount Type of Occupancy FAA& j,� 14ucc New Renovation 0 Replacement [D- Plans Submitted Yes 0 No 0 FIXTURES i i ( (Print or type)Check one: Installing Company Name 1 4,1111.4J Kee cL Pf f( 11 Corp. Address 1? F I ai.-c 1(- 12 da -.r h vA JJ If 02W 11 Partner Business Telephone 1 6 6 3 Firm/Co. Name of Licensed Plumber: v," S L, -A, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 11 Other type of indemnity ❑ 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 i su ce 1;ighdture 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 sued for this application will be in compliance with all pertinent provisions of the MassachusetAs, 3 e Plumbing Code aprC pter 142 of the General Laws. ��v,-v-v vv . By gna io kens um er ,411 Type of Plumbing License Title 2 I M City/Town License Number Master Journeyman Er APPROVED (OFFICE USE ONLY MMM ................m-.--. (Print or type)Check one: Installing Company Name 1 4,1111.4J Kee cL Pf f( 11 Corp. Address 1? F I ai.-c 1(- 12 da -.r h vA JJ If 02W 11 Partner Business Telephone 1 6 6 3 Firm/Co. Name of Licensed Plumber: v," S L, -A, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 11 Other type of indemnity ❑ 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 i su ce 1;ighdture 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 sued for this application will be in compliance with all pertinent provisions of the MassachusetAs, 3 e Plumbing Code aprC pter 142 of the General Laws. ��v,-v-v vv . By gna io kens um er ,411 Type of Plumbing License Title 2 I M City/Town License Number Master Journeyman Er APPROVED (OFFICE USE ONLY 3 2 L J Date..r, ...�...`..�.... i P „oR.N TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION A This certifies that ..: *� ...............% ..:..............`... . has permission for gas installation ..... ............ in the buildings of .:................................ at ......... .... ..................... , North Andover, Mass. Fee......... Lic. No........... ...... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP 4ASSAC ICATON FOR PERMIT TO DO GAS FITMG or print) tvvrcIH ANDOVER, MASSACHUSETTS Date ©-- , 6 19 9'� Building Locations lo Permit # ✓ Z ?,3 t Amount S Owner's Name 1� V1 New ❑ Renovation ❑ Replacement ®' Plans Submitted ❑ (Print or type) �+ Check one: Certificate Installing Company Name IR Ktc Int pt -H ❑ Corp. Address ��i IGwtg /1j1V VP- A)A /'%30XZ❑ Partner. Business Telephone G 0 3 A? 2 3 S29 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter am 4c /< C c 1—t INSURANCE COVERAGE Check o : I have a current liability, Insurance olicy or it's substantial equivalent. Yes No❑ If you have checked ves, please i icate the type coverage by checking the appropriate box. 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 neralaws fan that m� signature on this permit application waives this requirement. �--- Check one: S 1 Lmarur(Y Owner or wner's Agent Owner ❑ Agent hereby rtify 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 i,Iassachusetts Gas Code and Cha 2 of the General Laws. '�cam. ,�.ter �,� Bv: tie "Town D (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Q Plumber . 0, 1 996 ❑ Gas Fitter License Number ❑ Master ❑ Journeyman • i• i (Print or type) �+ Check one: Certificate Installing Company Name IR Ktc Int pt -H ❑ Corp. Address ��i IGwtg /1j1V VP- A)A /'%30XZ❑ Partner. Business Telephone G 0 3 A? 2 3 S29 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter am 4c /< C c 1—t INSURANCE COVERAGE Check o : I have a current liability, Insurance olicy or it's substantial equivalent. Yes No❑ If you have checked ves, please i icate the type coverage by checking the appropriate box. 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 neralaws fan that m� signature on this permit application waives this requirement. �--- Check one: S 1 Lmarur(Y Owner or wner's Agent Owner ❑ Agent hereby rtify 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 i,Iassachusetts Gas Code and Cha 2 of the General Laws. '�cam. ,�.ter �,� Bv: tie "Town D (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Q Plumber . 0, 1 996 ❑ Gas Fitter License Number ❑ Master ❑ Journeyman 8!.�Date.. ] o ... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... r4 has permission for gas installation ...l....a ............... in the buildings of .... .0 A A`.. ..................... at ...�14!.v? ©cy ........ , North Andover, Mass. Fee . ,5.8 .. Lic. No.. J / ,�D y . 4�T.D .t 0 ?21 .�. (k A4 GAS INSPECTOR Check # c2 93 E MASSACHUSETTS UNUDRM APPUCATQN FOR PERMIT TO DO GAS FfrMG (Type or print) NORTH ANDOVER, MASSA Building Locations jU — s Name V New ❑ Renovation ET"'� Replacement El Date (� — 7-0 C.( f,.D3Permit # Amount $ 10"O o f kn4-1 k 4- N%' do ,A,.L Y Plans Submitted E (Print or type nn Check one: Certificate Installing Company Name Corp. Address ..r (-aj so Partner. Oro 0� Business Ti p o - Firm/Co. Name of Licensed Plumber or Gas Fitter I INSURANCE COVERAGE Check one: I have a current liability Insurance polic r it's substantial equivalent. yes13 No 1-1 If you have checked yes, please ind' a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnitff�y 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 13 Agent 1 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and f apter-l4; of the General Laws__ I 1By: OVER (OFFICE USE ONLY) cure of Licensed Plumber Or Gas Fitter El Plumber 4�c > 9 HGFitter License um er Master Journeyman iSUB -BA SEM ENT 'IST. FLOOR 0019 FLOOR (Print or type nn Check one: Certificate Installing Company Name Corp. Address ..r (-aj so Partner. Oro 0� Business Ti p o - Firm/Co. Name of Licensed Plumber or Gas Fitter I INSURANCE COVERAGE Check one: I have a current liability Insurance polic r it's substantial equivalent. yes13 No 1-1 If you have checked yes, please ind' a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnitff�y 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 13 Agent 1 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and f apter-l4; of the General Laws__ I 1By: OVER (OFFICE USE ONLY) cure of Licensed Plumber Or Gas Fitter El Plumber 4�c > 9 HGFitter License um er Master Journeyman S Date. .45 ).1. 1. P.? TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....l .'4 FT has permission to perform ... v.�I ......e t A.`�............. . plumbing in the buildings of ... C vA d `e. at . ! D 7.1,3 North ndover, Mass. t Fee. iL'. [ . S.. Lic. No..I ,5, PLUMBING IN PECTOR ' Check # 6133 8 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 10— ! /'Pr, of OccAvalcy d? C New Renovatio Replacement FIXTURES CATION FOR PERMIT TO DO PLUMBIN Date Permit # 712 t1.1v4-,—1 Amount OT Plans Submitted Yes ❑ No ❑ (Print or type)�� _ Check o Certificate Installing Company Namr7J ;" P4 -/4- 'r pt L Corp. Address Qn n ri Partner. usiness 'Ibleptione Firm/Co. Name of Licensed Plumber:> loZ/ Insurance Coverage: Indicate the t insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 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 MasSach etts St e Plumb apter �142of -al Laws. BY Oignaiuie uiiDcensea rrumoer Type of Plumbing License Title 5- City/Town License INUMDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY L_I Date ..... .. y, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... /� �- . ...... has permission to perform ..P% .............................. wiring in the building of qev=' ......................... at . ............ . North Andover, Mass. Fee4&2.. 0 ..... Lic. No.��'�/t('...... ........ ......................... 'ELECTRICAL INSPECTOR Check # 54-17 THECOMMONWEALTHOFMASSACHUSEM Office Use only DFPAleTMEVlOFPIIBIICSAFMY Permit No. T BOARDOFFIREPREVEMO=4r R7CM120 Occupancy & Fees Checked APPLICATIONFOR PERAff ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHI SSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date a31,41- 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) Owner or Tenant C Z5 Owner's Address Is this permit in conjunction with a building permit: Yes []3 No (Check Appropriate Box) Purpose of Building R<'l'1/I Utility Authorization No. Existing Service Amps�a5� Volts Overh O- Underground No. of Meters 77 New Service DU Amps D 12WVolts Overhead ® Underground No. of Meters Number of Feeders and Ampacity f7/J .,/, Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total �— ' KVA No. of Lighting Fixtures ZIASwimming Pool Above Elground Below Generators KVA round No. of Receptacle Outlets / (� No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch 6k1W No. of Gas Burners FIRE ALARMS No. of Zones No. of Ran es No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total — Pumps � Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/SoundingDevices Local nicipal Other No. of Dryers Heating Devices KW i LEr Connections tl�.l a No. of Water Heaters KW No. of No. of _^ - r Signs Bailasis f, ©� No. Hydro Massage Tubs No. of Motors Total HP oLt D Gl/ / OTHER• 1M==CGMaW RVM tlD &Mgtt¢erre &dMassadm ltsGat sW1, ws C.a Itmeaom tLiabibtyha==Pbhyirr�AgVIM m CoveWorgsaftmWepvdn YES [ NO UvewWiWdvafdp00f0fS3WlDdeOffi= YES EI ffyouhawdrdWYEsPimmudtc*detypecfmwWby INSURANCE LZr BOND MIER �) Eti .4-� Z— WakoaStat U �3 e) r 1WecfimDE1eFzWeslutl urtder of Lm,p G6 :Na_ / � 7 1' /'T vwivric auvaUivu� wtuvrlr;itarraw-duu utx iicamu Snll[nmif)eIIl&=U or&,gibstiM anddArMsgr>ahneondlispemtappbcmmwarpsthicmgx'ertlent. � �byM el�Ga>eralLaws (Please check one) Owner M Agent Telephone No. PERMIT FEE $ Signature o caner or gen )37