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HomeMy WebLinkAboutMiscellaneous - 10 KITTREDGE ROAD 4/30/201841 Date. . 8967 T TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... .. ............ has permission to perform .... ................. plumbing in the buildings of ...... tee. 0 ................. at., ... /0.. ........ North Andover, Mass. 14.q.7. W. . Lic'. No -F 7.7 .. ...... PLUMBING WSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING /V City/Town: Dt%� �- ©v l"�IIIA. Date: ��" d 3 i ( Permit# 4y Y Building Location: I0 /t it , �' � Owners Name: �vC�r-t 'AIa O Type of Occupancy: Commercial ❑ Educational [j Industrial ❑ Institutional ❑ Residential el- 0 1 SU- BASEMENT 1� F OOL R 2ND FLOOR 3" FLOOR 4T" FLOOR ST" FLOOR OR 6T" FLOOR 7TH FLDDR 3T" FLOOR New: LJ Alteration:E] Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name: _ —T✓rL Address: 4y A'^ / City/Town:40,,,ell Stater Business Tel: ---f')'?— L,is' 40gQ Fax Name of Licensed Plumber: JA- , - a f C Check One Only Certificate # 9-150rporation ❑ Partnership ❑ Firm/Company IINSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 9'No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. U/ 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 Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ i hereby certify that alt of the details and information t have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all p{u„rb;ng 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 License: Tiffe ❑ Plumber Signat of Licensed Plumber City/Town Rllaster APPROVED (OFFICE USE ONLY) ❑Journeyman License Number: FIXTURES DEDICATED rr H Z SYSTEMS W X zLn y W Z d in Z la - C' Y Z H Q to to z Q U Q f" W (7LU Ln 0 Z to O z F- N Vaf W C W LL. g_ 0 C 3 W S ° ° W t/f W J Lrjj Z ►+. Q Q G7 to 0 ~ H 0 0 a Z Z VJ N F W of y FW - a Co m° o LL x° g s o° y N 3 3 3 0 ° a �, W aLn 0 31 Installing Company Name: _ —T✓rL Address: 4y A'^ / City/Town:40,,,ell Stater Business Tel: ---f')'?— L,is' 40gQ Fax Name of Licensed Plumber: JA- , - a f C Check One Only Certificate # 9-150rporation ❑ Partnership ❑ Firm/Company IINSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 9'No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. U/ 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 Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ i hereby certify that alt of the details and information t have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all p{u„rb;ng 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 License: Tiffe ❑ Plumber Signat of Licensed Plumber City/Town Rllaster APPROVED (OFFICE USE ONLY) ❑Journeyman License Number: Date. ............ ,oRTH 0 TOWN OF N TH ANDOVER *.f( PLUMI 7Z PERM FOR PLUMBING This certifies that L has permission to perform ......... plumbing in the buildings of .................................. at. . ��I .......... I North Andover, Mass. Fee -O--.). Lic. No.q ....... ...... 1. , ...... .............. PLUMBINGKSPECTOR Check # 2 6 Y I 14 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, NIASSACHUSETTS Building Location O `/) Date 9 Owners Name / Vye- 17oO Permit ff /�,6 Type of Occupancy Amount New Renovation Replacement Plans Submitted Yes ❑ No lii`lTi1nL o i ":X1 IMM. ..............' .. • • . KV DIVA 001 MKIM v0�� MM���I 1 ... MOM .�.-.--. IM r i " ................�.' 1 .......-�� ...-...1 1 ...EEEMMW ..... ..MM���1 (Print or type) Installing Company Name / Check one Certificate Corp. / Partner. Firm/Co. Name of Licensed Plumber: �_ C � r e o i2 hisurance Coverage: Indicate the type nsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ 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 tgnature Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have Submitted (or entered) in above;application are true and accurate to the i;est of my knowledge and that all plumbing work and installations performed under Permit Issued liar this ;application will he in ,_.ompli:incc with ;all pertinent provi ;ion; of the 1v'1assachL1.SCttS,,We Plumbing CodcChapter 142 of the General Laws. B y: Title City Town APPROVED (:OFFICE USE ONLY 31g11 -' C Gr LICUISeli 1 un']- 1�C Type of Plumbing License _12 U .L- lch nse um er Master ff�—Tournzyman M I" a Date.... r -,�..Lwx 0 TOWN OF NORTH ANDOVER 0 - PERMIT FOR WIRING This certifies that ............ J..�. ... ...... 4en!�� ............................ has permission to perform .......... ........................... ... .................................. wiring in the building of ........ .7.�� n-� . . ...................................................... at ........... P.. k� ...................... . North Andovei, Mass. �, e -- P.Q Fee ....... ............. Lic. No. ...... ........... .......... ...... Check # C;ZCM�CAL IN*S* P*ECTOi 9016 -� 5 PeankNo. 9 , BOARD OF FIRE PREVENTION REGULATIONS and F Omupmiw Omm� APPUCATION FOR PERMIT TO PERFORM ELECTRICAL WORK M werko bapedoaaed iaa000tdaooewidttbe Bled ccae @An =tit lz oo (PLEdPMff NINKORTPPEAU NF0DU 0 Datm V- �//, SE Cit! or Towa of A r�A AA a9o-I To the I rof mimes: By this appuod m the mr&W and Sivas nonce of m or ha i on to p 1 11 " me docuiad v ire ibed uelotiv. Lo oo m (Sbvd dt Ownwwleaamt Owner's Address Tdepbome Na Is this peri' > tg►P Yes (.J No U (APPr'aP Purpose of &eS , , J� 2 ✓l C � Uf�y AmttoftW9m Na Bxbft service Amps _ ! Vets Ombead ❑ UzOgrd ❑ Nm serer Amps _/ VoW Ovacbeed ❑ Undgrd ❑ Number of Fadms aid Aupadty Locatiwt and ofPtvpased BteWrial Worft Le - 0 le, oemPt"� I/U ofRecmWLumbWhW of I.atsiNS&O Otrfids Of LuaimaQ+es ofRmgft leOmHds of Switdtes ofRamws of WembeDispoom OfWabwm&m Na of Doom � 0. KW Na Hydroma Malts of Fu of Mt Tabs Tift Pool ADM d. ❑ td. ❑ ofoii Bm'meis of Certs Berwers Tom of" Can& 'r— cdArea Ham KW fiftAppy HW of 106 Of Sims Berets of ANobn Tow lip No. of Metma Na of lets ❑ [' ❑ outer .4Mwh a rwl detail tJ'drabrg arcs rwr*edby the bsspecW ofWires Estimdod Value Biodricd Wore (Wbm by pob'y ) Work m Start: o p m be in umtdaacs with MM Rule lq gad Spat mmphtion. n�rs�ANcg Co cs: tkdms waived by the owner, no pa�it far tba padoemaaoe efeledtical work may issue unless the Umume provides proof of liabt'lity hmmm ' eovWV a its mbftnM equivalent. The imders4ped c>ati5a thatsuch is in facce, and bas proofofs=eWthe paeanisuiog oboe. SON& DWRANM BOND ❑ ofBM [I ftccifr-) 214 ri C h k► S qYO ICE Ieffto,autawdtapaims ofPAoWAAWd* I I isa. m, —'coxwkft IBW NAIL: m e o D i.IcNo_-. 3 E-/ 9 7 LIC NO- _ (Ifs seer aoesrPr" br til v Atom nw9ber J(� 144 :�� rC' L!1 Bus TCL NG7 f�' - �P 5 ss Addre1f / Alti TOL Now - TS71/. *Per ALGJ- c. 147, s. 57-61, securit9 work requires DapftlmraeofPnbliic Safety "r 11 &am Liallo. OWNBR'S MSURANCK WAN IM I am aware dW doLicensm does teethe 8le liily iosfnatboe eoVely mq*W by iow. By my sWoAse below. I bereby waive: this requaemeat I am the amowner��'sQwwdnt a` Tdgio"Noa PESMITFFM- $ ,OR 0 0 Aft 41 S C14US Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ' 6 ... / 1/ .5 ................... This certifies that I�t ... has permission to perform ... 13 ............................ plumbing in the buildings of A- .................... .... J't. at .... North Andover, Mass. Fee. . Lic. No../ . ....... q� . "-4 ......... KUMBING INSPkT6R Check # L14i j�� 0 j"/ 11 ,d MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS /1 Date Building Location/ U // l /�7%�eC! eV �ners Name �� i ,OO Permit # / Amount Type of Occupancy Renovation Replacement New 01 to Plans Submitted Yes No a (Print or type) Check one: Certificate Installing Company Name Corp. Addres yo .Partner. Business Telephone Firm/Co. Name of Licensed Plumber: l�Ci Insurance Coverage: Indicate the type f insurance coverage by checking the appropriate box: Liability insurance policy 1 Other type of indemnity Bond 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 -to 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 un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseqq Stai Plumbing de and Chapter 1 of the General Laws. By: Mignature o ice , u er T eJPmg License T e Title City/Town License lumber Master e , Journeyman . PROVED (OFFICE USE ONLY 1 '1 J • .i (Print or type) Check one: Certificate Installing Company Name Corp. Addres yo .Partner. Business Telephone Firm/Co. Name of Licensed Plumber: l�Ci Insurance Coverage: Indicate the type f insurance coverage by checking the appropriate box: Liability insurance policy 1 Other type of indemnity Bond 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 -to 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 un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseqq Stai Plumbing de and Chapter 1 of the General Laws. By: Mignature o ice , u er T eJPmg License T e Title City/Town License lumber Master e , Journeyman . PROVED (OFFICE USE ONLY .e" Location C�� - eg,�- � �N o. A Date '?, // ins - ; 4 Check # 1-19�4 -1,4 10 1.76 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Ins6fctor a- 1.1 1.1 Property Address: l a /K-t'f�-�o��le "JmUIIV 1J1J111UU Tey IVO 1.2 Assessors Map and Parcel Map Number Number: Parcel Number tgnatrtre 1 Telephone 1.3 Zoning Information: Zoning DiAt c ­t Proposed Use 2.2 Owner of Record: Name Print 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft SECTION 3 - CONSTRUCTION SERVICES Front Yard Side Yard Telephone Rear Yard R red Provide Required Provided Required Provided Not Applicable ❑ Company Name 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ 5EU11UN2-PRUPEKYYOWNERSHIP/AUTHORIZEDAGENT "JmUIIV 1J1J111UU Tey IVO 2.1 Owner of Record rt�c �: Name (Print f I1 D 1 6 -9 Address for Service ` C> a tgnatrtre 1 Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Li�ansed Construction Supervisor: Ad&Fss Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 rn X ic z O rn 0! .. • 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 applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building�v v (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 3 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My b2lf, iall �rrss re`lati ork authorized by this building permit application. iature of Owner U D Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 N of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TB /HERS 1 ST2 ND 3 RD 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 w In J y u U) v C/)w a a O CL x rx v U x a a x rs' w a a w x o rx c w" CL � � ID x o r� -cao rj. a o z cn v cn In J y a F- LJU h _ Wt W O CL C: W ti L.I W O O 'dNl u Q E CL � � ID o a Q` w O O F=4 z = O d a F- LJU h _ Wt W O CL C: W ti z = O d C tai m 00 1! m C O N L.I O 'dNl m E CL � � ID o a m � � = $c.=wm' O N t9 U O 0 W Y/ U) W W W N L7 0� L911., .,A CA O v v P4 . -4 � c cm CO) ME h O O CD 0 CD H Z = O� 0 Cc o a cm< co z� cc CL c O C z m CL C3 CO) O C C c CO)CL 0 U) 19 W W 19 W N a a a a w acti cn cd w x U ii w a '�c w w W c� w w 0 w w Qo 0 z cn O cn L911., .,A CA O v v P4 . -4 � c cm CO) ME h O O CD 0 CD H Z = O� 0 Cc o a cm< co z� cc CL c O C z m CL C3 CO) O C C c CO)CL 0 U) 19 W W 19 W N Y, (C) FORM U - LOT RELEASE FORM A°' -2 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from 01 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 61 LOCATION: Assessoes Map Number CIS SUBDIVISION TION TOWN PLANNER ( �tf P) COMMENTS OFFICIAL USE ONLY PHONE ?,7f -)2f_'_0 22 -2 -- PARCEL LOT (S) ST. NUMBER/G) TOR DATE APPROVED ``(�iV(� DATE REJECTED IL DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS. DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm -U . I�Z V 9� O k