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HomeMy WebLinkAboutBuilding Permit #1 - 579 CHICKERING ROAD 7/1/2009 BUILDING PERMITo�"°oT b qti TOWN OF NORTH ANDOVER c� '� »`*` o° APPLICATION FOR PLAN EXAMINATION 7D Permit NO: Date Received 4 4 �9SSACHUS� Date Issued: ^C) IMPORTANT:Applicant must complete all items on this page LOCATION 57q, 'Cl U � PROPERTY OWNE 4 2Q70evye1 F14"--ii P JSP Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Ind ial Alteration No. of units: Commercia Repair, replacement Assessory Bldg Others: emoln Other Septic __ Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 0-046 A Identification Please Type or Print Clearly) -70 OWNER: Name: D)N 11D Phone:CF—LL � G 1-7 Address: -1 L 7—'-f�0/L CC)u 2-r, G9A:k C)�b aC) � f - O i g 55- CONTRACTOR 5-CONTRACTOR Name: A� fit , r. Phone Address: - Co 4K. C _ t A&A upervisor's Construction License: C, , Exp. Dater ' 01 o Home Improvement License: ' - Exp. 'Date Zt� 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: $ 2 FEE: $ 19D Check No.: ':�? r�� - Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the aranty Fun R Signature of Agent/Own„ r Signature of contractor Location e ct No. Date TOWN OF NORTH ANDOVER 3? OL f 9 • 1 Certificate of Occupancy $ ssACMUst�� Building/Frame Permit Fee $ 0 Foundation Permit Fee $ Other Permit Fee $ ._ TOTAL $ Check 22 � v � Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL v Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING.SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT r COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street -----{ FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Do( Fire Department signature/date COMMENTS Doc:INSPECTIONA - Revised 2.2008 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) t i ❑ Notified for pickup - Date .........._......._................__._.........__......._......._._......_........_.._.........................................................._...........---._.._...._..........----......................................................-- ..__.._.............._......._...._.......................................................................... -------- Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit DO New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 v LCOmMENTS���������� - - - NORTH ovm of Andover . NO. dover, Mass.,- LAK OC HICHEWICK 0RATED BOARD OF HEALTH Food/Kitchen S PERM, IT T D eptic System THIS CERTIFIES THAT....... (.....er..;.rtt....er.jo..�160WW F��A BUILDING INSPECTOR .......... '.10 BUILD has permission I to erect....... buildings on .................91.1.......C...(41.409......oltal undation Rough to be occupied as..... ......0%.6..........f\t.%.00tA.............................memo................ ................... Chimney ...... .... . ...... ... ... ......... ........... ......... provided that,the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 300 PEPdvff EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S T T, Rough ............... . ...................................... BUILDING Service Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. L t' The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations x 600 Washington Street `- Boston,MA 02111 T- = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelzibly Name (Business/Organization/Individual): Address: City/State/Zip: k__�� _4 / Phone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I _ employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.L✓.J I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance P� required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required 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. I do hereby cer e"der the pains and penalt' s ofp rjury that the information provided above is true and correct. Sio I ti Date: Phone Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: The Commonwealth of Massachusetts s ! Department of Industrial Accidents t' Off ce of Investigations 600 Mrashington Street Boston, MA 02111 �r z Workers' Compensation www nuus gov/dia . Insurance Affidavit: Builders/Contractors/Electricians/Plumbers klapficant Information Please Print Le.,bl Nene(Business/Orpnization/Individual): Address: City/State/Zip: "J Phone#: . Are you an employer?Check the appropriate box: 1.0 I am a employer with 4. M am a general contractor and IF7. M ject(regnir�: employees(full and/or part-time).* have hired the sub-contractorsconstruction 2•❑ I am.a.sole proprietor or partner- listed on the attached sheet t deling ship and have no employees These sub-contractors have lition working forme itt arty capacity; workers' comp.insurance.[No workers com . insurance 5. ng addition P ❑ We arc a corporation and itsrequired.] officers have exercised their cal repairs or additions 3.Q J am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself»[No-workers'comp. C. 152, §1(4),and we have no insurance required.]t 12.Q Roof repairs -employees.[No workers' COMP. insurance required.] 13 Other 'Any applicant that checks bolF I must also fit!out the section below showing their workers'oompetasation policy information. t Homeowners who submit this affidavit indicating they are daring all work end than hire outside contractors must submit n new affidavit indi 4Cortnactors that check this box mustatt-bed an addiional shear,showing the name of the sub-cortuactom and tieeir wmtcets'cec„�. ..ti ..Cintas such r F•••;,srfomcstion. I am an eMPlayer that is psovidurg:workers'compensation insurance for my eniPhyees: Below is the policy and job site information Insurance Company Name: ' Policy#or Self-ins.Lic.#: £xpirstion Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required 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 tts civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 Covera v .6 cation. I do herebytYY er the airs of pe /rat the information Provided above is true and correct Si Date: lP 3 a Phone#: _ G) 2— O}, JcW use only. Do not write las tris area,m be completed by city or town official City or Town Permit/License# Issuing Authority(circle one): L Board of Healtb 2 Building Department 3.Ci*Trewn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Restricted to: 1 G 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid wit l ut signature - -D Date.... ......`.,-J�.........�... a ,%0R7N °ft"'°:•1"° TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ;,SSACHUSEt This certifies that �.. ..` '?^G'................... has permission to perform ..�......' ... ................................................................... wiring in the building of f- - �� �^- �' © ............................................. ......... ............... J .......... ........ ........................ ..... ........... ,North Andover,Mass. Fee.4 ... Lic.No.0/..... ..... ...................................................r!)k.2"y. ELECTRICAL INSPECTOR Check # lO i 8064 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. x Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant (�pdt ,9 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes L No ❑ (Check Appropriate Box) Purpose of Building n�rnnC '/ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps ! Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets l2 No.of Hot Tubs Generators KVA No.of Luminaires l Z Swimming Pool Above El In- El o Emergency Lighting 2 nd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches �� No.of Gas Burners No.of Detection and InitiatingDevices Tons g No.of Ranges No.of Air Cond. Total No.of Alerting Devices � No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent 2- OTHER:OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� r (When required by municipal policy.) Work to Start: 3 9 0 Inspec ions to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the pe�t".I's. g office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER �(Specify:) W C�L I certify,under the pains and penalties of perjury,that the information on this application is nd complete. FIRM NAME: /YID s_ ��-�r•.-L S"G. LIC. Licensee: 94y,,�a 11174 Alw— Signature r LIC.NO.: (If applicable, enter"exempt"in th license number line.) Bus.Tel.No.•'? 7 0�Op Address: 3 ];�jjC./Z-& /a� /'l2¢ Cl IT 7-/ Alt.Tel.No.9 X336-6,c Z-4 *Per M.G.L c. 147,s. 57-61,security work requires Departmen of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent ,s, Signature Telephone No. PERMIT FEE: $ ;� P 7 The Commonwealth of Massachusetts ki ! Department of Industrial Accidents .. •VIA Office of Investigations i°�'" 600 Washington Street tl Ht� �• Boston, MA 02111 www.nwss.gov1dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �Please Print Legibly Namie(Business/Organization/individual): �� 1 ' 1e v�o� = �' 't ,� -��•{ Address: ��/� , - City/State/Zip: /Cr/`f CSW Phone#: . � Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_tit _ 4, ❑ 1 am a general contractor and I 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2.(] I am a sole proprietor or partner- listed on the attached sheet.t 7• [J- Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for mein any capacity, workers' comp.insurance. 9, Q ,Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.[] 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself,[No workers'comp. c. 1.52, §1(4),and we have no 12.[] Roof repairs insurance required.]t employees, [No workers' comp. insurance required_] 13.[]Other 'Any applicant that checks botf#I must also fill out the section below showing their workers'compensation policy information, I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is.providing workers'compensation insurance for ray employees. Below is the policy and job site information. ' Insurance Company Name: Policy#or Self-ins.Lie. Expiration Date: a ' r Job Site Address:_ City/State/Zip: Y Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required 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. I do hereby certify unnd, r pains and penalties of perjury that the information provided above is true and correct Signature: / Date: / D Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# • Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other i Contact Person: Phone#: No►N w CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 514 Date: May 7 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON Elements - 579 Chickering Road MAY BE OCCUPIED AS Commercial Tenant Fit Un—Theraautic Massage IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Cheryl Arbis 579 Chickering Road North Andover MA 01845 .00� Building In or Town of _ . Andover . _ .: ::J: .py. to No. l� �O o dover, Mass., ���� I. T' COC HIC HEWICK ,_ ADRATE D P' �y . S V BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT............ .................. ........................................................... ........................... Foundation `=� / 1j has permission to erect........................................ buildings on .. ......................... ..... ........................ .... ... E ¢....... Rough to be occupied as........... ....... . . . ........�,.�.�.. .... . . .................................................................................................... _ .. Ch' provided that the person accepting this permit shall i very respect conform to the terms of the application on file in Fin 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. LUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS 90 ELEC ICAL IN PECTOR UNLESS CONSTRUCTION STARTS Rough ' Service BUILDING INSPECTOR c9/ --/ _GAY Fina Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. '- CONSTRUCTION CONTROL AFFIDAVIT Re: Elements Therapeutic Massage- Shawsheen Plaza-Andover, MA In accordance with section 116.0 of the Massachusetts State Building Code. 780 CMR 6th Edition, I, Steven Petitpas Registration no. 8391, certify that I am a Massachusetts Registered Professional Architect. I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ARCHITECTURAL: X for the above named project and to the best on my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code 6th Edition, all acceptable engineering practices and all laws and ordinances for the proposed used and occupancy. I or my authorized agent have performed the necessary professional services in accordance with my Contract with my client, and was on site on a regular and periodic basis to determine that the work has proceeded in accordance the documents approved for the building permit and have been responsible for the following as specified in Section 116.0. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permits, and approval for conformance to the design concept. 2. Review and approval of the quality procedures for all required control materials. 3. Special architectural components requiring controlled materials for construction specified in the acceptable architectural practice standards listed in appendix B of the Massachusetts State Building Code. THIS AFFIDAVIT SERVES AS A FINAL REPORT THAT TO THE BEST OF OUR OBSERVATION AND BELIEF THE ABOVE PROJECT IS SATISFACTORILY COMPLETE, IS IN ACCORDANCE WITH THE SUBMITTED P T DOCUMENTS,AND IS READY FOR THE INTENDED USE AND OCCUPANCY. G�S�rR JOPRp FTi rFc� <v -o o y N0.8391 p BOSTON J �?y MASS. Signature F9�lN Of 0A Subscribed and sworn to before me this day of /�1�1 9206) John J. Greeley My commission expires: October 3, 2008 NotaV Public My Commission Expires Date. .'. s� TOWN OF NORTH ANDOVER PERMIT FOR PL J'MBING ,SSACMUSE� ,cam This certifies that . !. . . . . . . . has permission to perform �. . ... . ... . . . . .-` ` r~- .. . . . . . . .�/ - - plumbing in the buildings of---. . ;v . .--•. .`J; . :r.:-a-�,: at A . North Andover, Mass. FeeLie. Nd 2-/qm r� < ^7'1. !,. . . . . . . . . . . . . . / PLUM$ING INSPECTOR Check # 7677 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS �'A`l-4 1 Date C I 3 � v Building Location 1 -I/l(5� �(�,� � Owners Name J�e;�� D l/� Permit# G I Amount T pe of Occupancy 6AN1W1 ((1k New rl Renovation Replacement Plans Submitted Yes No FIXTURES �a oLC con za. � o � o a w A a a a a a Q o A B4SMEST ISS PLOCR 2 L 2 I M FLOCK MFLOCR 4MRD t 51HR-OCR 61HROOt - SII3IHTA(Yt (Print or type) `—`— Check one: Certificate Installing Co pany Name I WkV✓1X() �LM�WAJ,I \✓� Corp. `� r Address ( W l U ❑ Pier. Business Telephone rl Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond rl 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 ac !!/ Plumbin Code and Chapter 142 of the General Laws. By: Type of Plumbing License Title ���4 C� City/Town icense Numuer Master ElJourneyman APPROVED(OFFICE USE ONLY NORTH 0-T%-r 0 619"1 s 2 � _ M` a O C � I o" O COCNit IWKM V1 �9sRN Arso SACHUS TOWN OF NORTH ANDOVER Sign Permit Date: March 25. 2008 Permit Number: 030-2008 THIS CERTIFIES THAT, David Gorham - Elements Therapeutic MAssage Has permission to erect a 12'x2' Non illuminated Wall Sign On 579 Chickering Road provided-'that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign.Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit Internally Illuminated Signs are Prohibited AIA Inspector of Bufngs -t' .<..I,.Q� �y r� If,Location 5 ! / r _ No. - ' 'l3 Date 3� fl �} + NORTq TOWN OF NORTH ANDOVER 1 F P Certificate of Occupancy $ 1'�s'••°•tt�' Building/Frame Permit Fee $ swCHUS Foundation Permit Fee $ Other Permit Fee TOTAL Check # 2 1 0 ' Building Inspector SIGN PERMIT APPLICATION 1600 Osgood Street–Building 20, Suite 2-36 i TOWN OF NORTH ANDOVER Site Owner �/ fr�.J A)4 Applicant Glqlny l / 12141 S Tel PQ Site Address �� ('ilii/ G`l C�C/�{/ �v�/Gro Size of Proposed Sign hoz X l Map Parcel INTERNALLY ILLUMINATED SIGN PROHIBITED How attached: a) Against the wall X Illumination: ONot illuminated b) Roof b) Externally illuminated c) Ground >> / d) Other Materials:'&2C4&/ ,L" � ,V Z/ Proposed Colors: Background C / �—: Lettering V �1 Border / / /TG/ G1Y ��(/� 119 7' Required Attachments: Note: No permanent/temporary sign shall be erected, or enlarged until an Photographs of building application on the appropriate form furnished by the Sign Office has been Material sample filed with the Sign Officer containing such information including Color sample photographs,plans and scale drawings, as he may require, and a permit Site or Plot Plan (Required for all free-standing signs) for such erection, alteration, or enlargement has been issued by him. Drawings of proposed sign Such permit shall be issued only of the Sign Officer determines that the Other, specify, sign complies or will comply with all applicable provisions of the By- Law. /y Will sign overhang any public road or walkway Yes ( ) No 0 If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: SIGNA URE OF APPLICANT 144" i � 4 t t 24" - .� thera peutic massage 3n tnerapeutic 4MAM■T S11114MM Company: Elements File: NorthAndover 24 Spencer Street Stoneham, Ma Address: This Drawing is the Property of Gamit Signs (781)438-5280 FAX (781)438-8823 and can not be reproduced without the Date: 3/06/08 Permission of Gamit Signs.