HomeMy WebLinkAboutBuilding Permit # 10/24/2016 BUILDING PERMIT
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received oo
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Date Issued: f u- e A U5
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building F One family
Addition U Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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Identification Please Type or Print Clearly)
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OWNER: Name: Phone:
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THIS CERTIFIES THAN ......14Y45............ ........... -r:......Finco4kc4ps
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has permission to ereU..... �. ............. buildings on .......... '........ .�.�,�. .. .. .....
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to be occupied as ........ �` ®.,....... ... ................................................. chim
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provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover.
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rougl
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PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCT N STARTS Rougl
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BUILDING INSPECTOR
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Display in a Conspicuouslace on the Premises ® Do Not Remove Final
No Lathing r Dry Wall To Be Done
Until Inspected and Approvedthe Building Inspector. Burne
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Invoice
Colonial Fireplace Date Invoice#
2261 Main Street 10'20.2016 21$5
Tewksbury, MA 01876
1
978-447-5192
customerservice@colonialfp.com
Bill To Ship To
Jim Brown
43 W. Bradstreet Rep Terms
Road
No.Andover,MA
01845
Quantity Item Code Description Price Each Amount
I H1305 Hampton HI300 Timberlane Brown Wood Insert 2,500.00 2,500.00
1 Labor Installation Labor 1,500,00 1,500.00
MA State Sales Tax 6.25% 0.00
H1300 Wood Insert
H1300 Medium Wood Insert
Model H1300
Qpbrnum Efficiency 77"/0
Emissions(gramslhr)EPA Certified 3.8 gramslhr
.Maximum BTU' 75,40.0 BTU
Maximum Log Size 18"
Firebox Slze s 2.3 cis,ft.
Flue Size 6'
BUm Time(lyjiical}" up io 6 hrs,
FL,nlglh of bum time and BTU Flange depends on type o€wood,climate conditions and
lation.
Unit With Cast Faceplate
23-Y4'
23 U�
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3av,e°
oil
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11 Q zafa A b
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�J�E F
Dimension Description 12400
Unit With Oversize Cast Faceplate Aidlacentsiaewau(teside) 117(280mm)
--------23sr4 - B Mantle(to top)"" 20"(548mm}
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.....23-1/4'. Mantle Depth(not shown}Maximum
--� ----- - C Top Facing(lo top) 12"(305mm)
f t7 Side Faaing{to side} B'(295mm)
St-11B"
77 X74 E Minimum Hearth Extension` 18'(455mm)
j F Minumim Ffaath Thickness" ; 0,5"(13mm)
71B„ G Minimum Hearth Side Extension 8"(205mm)
i7-174 ,
' _ Side and Top facing Is a maximum of 1.5"thick.
.. -a+-a14°- - s a° r Floor protection must be non-combustible,Insulating material with an R value of
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1.1 or greater.
'The Commonwealth of Massachusefts
Department of.ndustrzalAeddents
a 1 Congress street,sdite 100
d
F Boston,MA 02114-2017
www mass.gov/dra
Wovkers' Compensation Insurance Affidavit:)3u ideas/CoxttractorsMecfriciansl3.'lup bears.
TO BE I'ME)WITH THG PERM TING AUTh:ORITY.
3
A ' Iicant 7nfornnation Please Print Le 'bl
Name pusiuessibig anization/ludividual):
Ad&ess: Cd n s r a - --- -
cit r/state/zxp: _ .sbl)YPhonD 4: q`11 414 q 5)19 �-
Are you an employer?Checke appropriate box:
Type Of prajeet( ecluireci);
I fl I am a employer with employeos(full and/or part-time).* ]. p p]&W'Gpns"cfion
2.❑Iain,a sole proprietor or partnership adhavenoemployees workingforme in g. QRemodgjlffk
any capacity.[Noworkers'comp.insurance required]
3.E]I am ahomeowner doing all work myself.[No workers'comp.insurance required]t
9. ❑Demolition
10 C7 Building addition
4.❑I am a homeowner and will be hiring contractors to conductC work on my property. I will
ensure that all contractus either havo workers'compensation insurance or are sole 11.❑Elec#rical rep,4irs or additigps
pxoprietors with.no 1 npldyeas,
12,] PI=bltzg repairs or additions
5.Q I am a general contrsetpT and.I�ave hiredthe sub-contractors listed on the attached sheet, 1 Rbof repairs
These sub-contractors J "'employees and have workers'comp,insurance.
b.❑We are a corpoptiorl and its.officers have e:rercissdtheir right of exemption per MGLc. 14. other
152,§i(4),and ire have no employees.[No workers'comp.insurance required-a
*Any applicant that #I must also Till out the section below showing their workers'compensation policy information:'
t Homeowners who submit ibis affidavit indicatingfhey are doing all work pd then hire outside contractors must submit a new affidavit indicating sucks.
#Contrac#ors that check ched'sn additional sheet showing tho name of tha sub-contractors and statgwhether Or pot fhose entities have
empIoyeos. 7#the sub-coniractozs have employees,they must provide their workers'comp.policy number.
T ani an employer drat is providing-workeiv compensation insurance for my errcplayees. 'Belaav is rliepolicy and job site
information.
Iosuranco Company Name.' `� l
Polloy#or Self-ins.Me.k � � � t� Ercpiratioxt Date:. I 1
lob Site Address: '✓ � r CitylState/Zip: � i .�
Attach a copy of the workers' compensation policy declarations page(showing the policy z aAAer and exprrat-ion.date). C)
Failure to secure coverage as required under MOL G.152, §25A is a cxin7tinal violation punishable by a fa up to$1,500.00
and/or one-year imprisonment,as-well as civil penalties in the form of a SWOP WORK ORDER and a flue of up to $250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office of investigations of tho DIA for ixtsiarance
coverage verification.
Massachusetts Department of Public Safety r�/re` c„r�rrn,rcoea/11.c�'c��fi�aac/rrrsrl�,
" Board of Building Regulations and Standards
Office of Consumer Affairs&business Regulation
License: CS-105920 OME IMPROVEMENT CONTRACTOR
Construction Supervisor egistration: 181414 Type:
xpiration 4111201.7 Corporation
SCOTT M HAYES
COLONIAL FIREPLACE
6 CANTERBURY AVE
HAVERHILL MA 01838
SCOTT HAYES
474 WAIN ST
WILMINGTON,MAA 01887 Undersecretary
Expiration:
Commissioner osl1912018