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Home My WebLink AboutBuilding Permit #424-14 - 11 SAUNDERS STREET 11/12/2013 (3) O�NO oT 6 q� �- BUILDING PERMIT 0 r TOWN OF NORTH ANDOVER ° }� -1 �1 APPLICATION FOR PLAN EXAMINATION 4` Permit NO:-7,K.7 Date Received Date Issued: 1 i "SSacHus��y IMPORTANT:Applicant must complete all items on this page LOCATION /l 69ox<(ei�S S — �r`t 7lt PROPERTY OWNER / Print MAP NO: ' PARCEL:&Z2-ZONING DISTRICT: Historic District yesCno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial �eration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer r / L h )P1t,4) ef biae)�&_ &9(41� "t)ey Aect) Lve(2n�� 1e, c 5 _ r/e-I a i o A w — Identification Please Type or Print Clearly) OWNER: Name. � ((,Q�Q / � Phone: 97Y-b6q'� Address: CONTRACTOR Name:4T9 ui aPhone: 66q, � � Address: 10`cC,Jeir- N4 leer . (16W Supervisor's Construction License, Exp. Date: LS 83723 6- 7- IDIS Home Improvement License: ExpDate: 1 7�9 Zz . ,,76- �o�y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ 6-R6y Q 0 Check No.: �(�b'Z Receipt No.: on NOTE: Persons contracting with unregistered contractors do not have access tot lel guaranty f nd Si Agent/Owner of Signature A �` nature of contractor< 9 9 �� 9 � i� � � � '� �� c�-c� 1J ��V Z/�Q/� � `� ��1� V"--, YNA"_ m MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY�� 0,110 Z/ '' / MA DATE PERMIT# JOBSITE ADDRESS /% S v/w=' �r'� r! OWNER'S NAME 11r.4 4640 OWNER ADDRESS GL�� TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT 4 CLEARLY NEW:❑ RENOVATION:REPLACEMENT: ' PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR— 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER C DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN " INTERCEPTOR(INTERIOR) 4 KITCHEN SINK LAVATORY / ROOF DRAIN 1 SHOWER STALL SERVICE 1 MOP SINK TOILET ;7— URINAL t WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING Z� OTHER i 1 INSURANCE COVERAGE: I have a current IiabilitV insurance policy or its substantial equivalent which meets the requirements of MGI,Ch,142. YESE3--NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [L}''�n 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER El AGENT [I51GNATURE 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 my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpliance r all Perone ovision of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME1,1D�c� / LICENSE SIGNATURE MP Z3'- JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ADDRESS l-41 ::�7Z/0 CITY L STATE/J� ZIP ✓ TEL `l7e tJ _ FAX CELL`lEMAIL psSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MA DATE 1= Z / PERMIT# l � 9— JOBSITE ADDRESS ,.,� OWNER'S NAME OWNER ADDRESS TEL FAX PRINT OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL❑ RESIDENTIAL CLEARLY NEW:❑f RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES❑__I NO APPLIANCES-1 - FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ ._ .. ... _ .- DRYER — ... _ _ _r.. .. FIREPLACE ( ❑❑ _ �-( �___( - __— —� -- - �I _ _. I = __I s FRYOLATOR FURNACE GENERATOR � GRILLE INFRARED HEATER ^ LABORATORY COCKS ❑�_ L1 ._ .- ��_--I --._I _.._. C �I � 1 _ MAKEUP AIR UNIT - -OVEN � la_ z� I L POOL HEATER ,ROOM/SPACE HEATER - 1ROOF TOP UNIT _ TEST ( ..�.. -l _____�_{ _ C-.J —_ I UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER 25 T ! f fOTHER ... - _ -=--- I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES y 0 ❑ 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: OAAfNER ❑ 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 my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli ce with alt� Tfinnt pro ' ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTE R NAME LICENSE#f//.I, SIGNATURE MP MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION[:]I, PARTNERSHIP❑# LLC❑# COMPANY NAME ADDRESS 4� CITY STATE ZIP TEL _"� s✓- r FAX — CELL tel'?.if' -4f12/ EMAIL