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HomeMy WebLinkAboutMiscellaneous - 1058 JOHNSON STREET 4/30/2018 (2) 1058 JOHNSON STREET / 210/107.A-0066-0000.0 i i li I I Location N S 0 a� S4 No. a Date o"T: TOWN OF NORTH ANDOVER a Certificate of Occupancy $ _ + , , Building/Frame Permit Fee $ Foundation Permit Fee $ Ss�cNust Other Permit FF`e $ Fel n Fee $ Water Connection Fee $ _ TOTAL $ .5i 4/ MAO OR Building Inspector Div. Public Works 1 I'RMIT NO. a y3 APPLICATION FOR PERMIT TO BUILD* ******NORTII ANDOVER, MA AI 11'NO. LO'1'.NO.� 2. RLCURD OF O11'NlRSII11' BOOK PAGE ZONE SUB I)h'. LO F NO. (� I LOCA IION %o S 1'l1RFOSEIN BllIIDIN(i ( d �C J NcJo RQ 'ACvr'\ OWNER'S NAME l NO.OF S'HN(IES SIZE ()WNER'S ADDRESS BASEMEar OR SLAB 16 ST ND RD V I�LScS AR('I IITECI'S NAME SIZE OF FLOOR I IMBERS 1 2 3 BI III DER'S NAME SPAN DISTANCETONEARESI BUILDING DIMENSIONS OFSILLS DIS VANCE FROM STREET DIMENSIONS(N:POS IS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDEWS AREA OF LOT Y /1.„� FRONTAGE �e` �� IIEIGIFT OF FCAINDATI(NJ TI IICKNESS ISBIJILDIN(iNEW 4YiJ� O -'SIZE OF_I((MING - e X IS BUILDING ADDI II(N) MAIERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR"TILLED LAND WILL BUILDING CONFORM TO REQX)IREMEN'I S OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CCNdNECI ED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS!.INE INSIIICTIONS 3. PROPER"!'1NFORNIATION LANDCOST ESI'. BL.D(i.COST PAGE I FII.I.O(TT SECTIONS 1-3 EST..BI.DG.COST PER SQ.FT. ESI. BLDG.COSIPER ROOM EI EC-TRIC METERS MlIS1'BE ON OUTSIDE OF BUILDING S01 IC PERMIT NO. AI-I ACI IED GARAGES MUST CONFORMTo STATE FIRE REGtWATIONS 4. APPI(()N'ED BY: C i. PLANS MUST BE FILED AND APPROVED BY DOILDING INSPECTOR BUI!.DING INSPECTOR ITnft (' OWNERS'IE11l. DATE FILED E ( .r C(NJTRAULII � ` MAY 2 8 11 � j C(NJTR.I.I(YI { _ SIGN.VI1RIi OI t)14'NIiR OR Al I'H kN21Z1[U AOI:NT r7 7ry '" ' ';S .. I'll RMIT t IRAN 11:1) � ) 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 TC-k;g- PHONE g7,s(p8,- ono LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) J 4 STREET ST. NUMBER .)oS-6 OFFICIAL USE ONLY***"* o� Poo RECOMMENDATIONS OF TOWN AGENTS: . ... CONSERVATION ADMINISTRATOR DATE APPROVED ^ IDATE.REJECTED COMMENTS (y UV-e4-[k%AJ TOWN PLANNER DATE APPROVED r1� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 1 05/ 3/99 11:49 F 617 395 3420 AC&B, ATTORNEYS 0 001 94•!5 t /I���`�.ry„� ' _ _ /`I/"•"'moi/ �� � - N eou�� T'o rx 4yer (oCr.F.onl t - L.. •'V _ mat e .F 4 Z'jr 2.7r ` $ # X srtpest*vi 36e Road bwwomm Rate mw 7W M*rWW ins7rAW04 plan is for mor*ge �©y*ea�� Con+ln++n+lY-PRntl Number Pum Only Q is rot an Wrument Mortgage* G�Number77 f�fmm 4 is not to be used to sata=8h prop" ; di7Les,fences,drt�pam hedges,etc.,or to be used Inspection d wd _fir has been conductcd for any P-*peace outer than io ortgbW Plan G r d 16 ti�a,bbeet of sou interpmWioa thio erty .�. �loeeEed u++l`hin the flood zone. Aw its r ftraMV an.this Am fs appr+atsamratak located on Ow Qramd an shouna, and it orn{fprme to aha C11POb1ANC0 N �e+le:t in +� [R baui �—��: 1 Whm and to ;•itsMORTGAGE INSPE6"i (WS INC. • � B1:.8O7I9RVfLtE MX98. m Ln CS) m \ r tD ' lD w r W I r M L EryLd UlU En��?oyd V e," 1- RR C !y C oIOM rjiP8uOi` dM�ng R gqu.�dt pRS E�,7t'P,ATa Ods One Ashburton Place -� Room 1301 ns 5-ar;�+ �y 3�b � a� 3 80st0n . Massachusetts 02.1O8 HOME IMPROVE=MENT CONfRAC'TOR Reg3�;►._ratit;n 1�g�.5A Expi ation 0-4!1y!!;1 Type - PARTNERSHIP ," HOME IMPROVEMENT (Oii1RACTOR Registration 128358 z ABOVEGROUND POOL..:, & CON Type - PARTI�RSHEP z BRIAN J . I-AWNICK.I Expi�atiee 03!24IN 200 BEDFORD RD APT 28-6 W06UP.N MA 0-1801 kitABOVE GROUND POOLS & COM BRIAN J. LAIIAKKI • L ,�,� " BEDFORD RD APT 28-9 ADWeSMATMRN IFA OE801 i v M : m r NORTH Town oOF ®Ver No. tp2&12 C, c r_Q dover, Mass.,4 C 0RATED P? I S SE BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System L BUILDING INSPECTOR ... THIS CERTIFIES THAT............... ............ .......... ......*­.............. Foundation has permission to erect... buildings on ...........14 *V614 A........... — Rough to be occupied as..... .......A.4.jole.......6•4N ............................ Chimney . ................../SII ...................................... 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 "? *C 0* 1 " (a PERMIT EXPIRES IN 6 MONTHS Final Pr) 10qA UNLESS CONSTRUC 01, ST ELECTRICAL INSPECTOR 'C Rough ...... .... .. ....... ... .... ....... Service BUILDING INSPECTOR :41-_000000004 Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. Date.e 7n..�-?- 0-,�..... H°RTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� r r This certifies that . ,. �� "�1 k' ................ ............................................. ........................... C e, has permission to perform ....r.�.�'.��........................................................................ wiring in the building of. ........................................ !� at /...�..... .......... ............... ,NorthAjndover,Mass. �.... Lic.No.,�r�....... ............... .. ..ri C_�a.-��............. ELECTRICAL INSPECTOR Check # 4167 ./ r 9 THECOMMONWF.ALTHOFAWSACHUSETTS Office Use only DEPARTNIEIVTOFPUBLTCS9FL7Y Permit No. BOARD OFFIREPREVEVH0NREGUTATIONS527CAM 12:(XI Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date g 's 3 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 R A Ole Owner's Address-15,4 m tt, Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building A"0 y Utilit Authorization No. Existing Service Amps Ito/A q y Volts Overhead © Underground No.of Meters New Service Amps / Volts Overhead r--J Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work =GILL — /3,CDR�nWI S No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices TVH.of Dryers Heating Devices KW Local Municipal � Other _ Connections No.of Water Heaters KW No.of No.of Signs Bailasis I` No.Hydro Massage Tubs No.of Motors Total HP OTHER SV r1 /�An/C L tom? "O FGooR o? Sf40WC,,--, - o? Fi9r✓s htstlranceCovelar-Rnalanttothe legmenuzofMassxlnlsetlsGanalLaws lbaNcaomWL2abiWhnrmmPbhqmhding(AxT!212LffahonsODmnWeritabsmrtWegrmiat YES NO IbavembnttltadvalidproofofsametDdrOliim YES IfywhavedrdmdYES,pkw--rdirafi-,thetArofmverageby dwldngthebox Li INSURANCE BOND OMER (PleaaeSpecfy) 4104 a Date *10S FFstnn&dVahteofl tlWolk$ Sigr>v�l under Wokvurxi t Ins i*mDateReyuested Rough final tie t�talties of peljtuy: FIRM NAME 7 LrmseNo. J7DD A A Lim . Sf�/��i SigrtablleC�c'�"� LioemNo .SAA BusirmTel.No. 2&/,ti��30 Arlrhr ec �D L30X 47/ ACAOir11I q ^9 n t S Ir"7 5:5// Alt Tel No. 2'1 ff � T&S7 a) OWNER'SINSURANCEWAIVER;lam aware thattheLic wdoesnothavethemarmxcc) iagecritsssubstantialegmvalattasleWWbyMassadn>sHtsGmedLaws and that my signahne on this pmat application waives this lequa M=L (Please check one) Owner Agentd1' Telephone No. PERMIT FEE$ �- Igna ure ot Uwner or Agent N Date:'-: �-. V, N° << << J9 ot NOFTM •�4,o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i i a ,ss" us� This certifies that '. . . . . ., ."- . . . . :.: . . h / �� has permission to perform/. fi`. .: . . .` '-?' . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . `:!-kL. ' Q/. . . . . i . . . . . . . . . . at/. .,-) . .'. . ., . . :'-•-�-'�^.�-�� . . . ., North Andover, Mass. �1 Fee..�. . . . . .Lie. No.';�m.k . . . . . . ... . `. . . .r. . . . j PLM411 (G INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �j j� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT T ADO PLUMBING U(Type or print) NORTH ANDO MASSACHUSE G%c� Date Building Locati Owners Nam Permit# r� 9 jL�'✓ O � Amount Type of Occupancy New Renovation Replacement 13 Plans Submitted Yes No FIXTURES rn w a >4 x a a x � aCq a d w 04 w A = Z Z SOHM RASMM ]SE FLOCK 14 M FLOCK 3M FLOCR 4IH FLOOR 5MR aR M RLOCR 7IH FLOCK M FLOOR (Print or type) 01 Ch-JG� Certificate ���� Corp. Installing Comp y Address Partner. usiness Telephone Firm/Co. Name of Licensed Plumber. Insurance Coverage: irate a type of insurance 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 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' llations performed der Permit Issued for this application will be in compliance with all pertinent provisions of th assac efts State Plum C d Chapte 2 of the General Laws. By: a tcens r Type of Plumbing License Title City/Town License um e�- Master Journeyman APPROVED(OFFICE USE ONLY Location No, Date ~ORTh TOWN OF NORTH ANDOVER o ►O.? • • y Certificate of Occupancy s i � Building/Frame Permit Fee $ 'SJ,cMuSEt Foundation Permit Fee Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ S I JI Building Inspector 12 i, c,0 1/99 (*048 25.00 PAID Div. Public Works PERMIT NO. © APPLICATION FOR PERMIT TO BUILD****** *NORTH ANDOVER, MA hi%I,No. V A. 1.01'.NO. / 2. R!C(IRI)OF ON'NLRJIIIP DATE BOOK PAGE ZONE SUB DIV. 1.0 F No . (Q �1 LOCA TION / S ^ V C� N S d /`J PURPOSE 11F Will DING voto 2 X p S e W,l(0,0 j�t� -7-0 4,6q tee OWNER'S NAME �, NO.CN=SI(N(IES SIZE. )! A�� 6 OWNER'S ADDRESS BASEMENT OR SLAB ST ND RD AR('I III EC'I''S NAME SIZE OF FLOOR TIMBERS I 2 3 111111 DL•R'S NAME SPAN DISIANCETONEARESTBUILDING t DIMENSIONS OFSILLS DIS FANCE FROM S TREI:'I' DINIENSI(NJS(lF POSI S DISTANCE FROM LOT LINES-SIDES Al REAR �� DIAIENSI(NNS OF GIRDERS AREA OF LOT S/ , FRONTAGE IIEIGI IT OF FCAINDATI(NJ THICKNESS IS BOILDING NEW A/0 A10 -'SIZE OF.1(X7TING a X IS BUILDING ADDI II(Nl �Y 0 MAIERIAL OF CIIIMNEY 15 BUILDING ALTERATION es IS BUILDING ON SOLID(ITTII.LED LAND WILL.BUILDING CONFORM TOREQXIIREMENI'S OFCODE � IS BUILDING CONNECT ED-1OTOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO"TOWN SEWER 15 BUILDING CONNECTED TO NATURAL GAS LINE (' INSFUCTIONS 3. PROPER TI' INFORMATION LAND COSI' EST. BLDG.COSF PAGE I FILL CX IT SECTIONS 1-3 EST. BLDG.COS T PER So.FT. ESI I. BLIXi.COS I I'ER ROOM EI ECTRIC AIEI'ERS MUST BE ON(N)TSIDE OF BUILDING S6,1 1C PERMIT NO. ATIACIIEDGARAGESMOST C(NJFORMTOSTATEFIRERE(H)LA'II(N S 4. .l,PPROVED BY: PLANS MUST BE FILED AND APPROVE=D BY BUILDING INSPECT(Nl BUILDING INSPECTOR DATE FILED �j OWNERS I"El4� C( 1l. C(Ndl R.11-1 C(NJIR.LICYI S(INA I I ME(N=OWNER Nf iR OR Al I F1 10121 Zlil)A(;I?NI- r TLIi 1'I HMIT GRAN 1) 19 -- •LED Ai Town ofdover �o ti r + 0%No. � '� ��r R' � "Q dower, Mass. 9' %AORATED p,?9- (GJ A H' � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........i��r C a all ' Foundation has permission to erect....?M��/....... buildings on ............1.. .5 ...... � I�404WV Rough to be occupied as.... &.*N 4rV f -but ....'�v...,,to-44er, 'Nov��+ 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 1 P .MI�T" EXPIRES IN 6 M0NTTJS Final EF� UNLESS CONSTRUC - 1 �-�- r S ELECTRICAL INSPECTOR a y Rough .... .......... ........................ ........... ....................... Service BUILDING INSPECTOR Final 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 Dane FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. AORTH �O'et��.v ,e�tiO Town Of North Andover o `A Plan BuildingDepartment Review p ...:.::�... , * &uJJff )old rfiuer 90 508-688-9545 ��SSACH �y Site: 1058 Jchism St. 146 Main St. Town Hall Annex Peter CardMo APPLICANT-1058 �St- DATE: February 20, 1997 Zoning Distrtc-f: ' R-2 Use Code : Title of Plans and Documents: Revised Cardillo Hse. Renovations & Additions rec'd: 2-19-97 Request : Building Permit (Plan Review denied on 2-12-97) Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By-Law Use requires permits prior to Building Permit Other Other Remed for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copyof Recorded Variance Information indicating Non-conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure X 3 Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details X 13 Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal her ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled'Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new building permit application form and or request for plan review to receive approval. 1 c,e 2=19-97 2-20-97 Building Department Official Signature Information Received Denied Ac nj , 2p_ 1 99 7 If Faxed Denial Sent ._ . If you require assistance please call the above number and we will be Yale to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. I t AORTPI 1 �O•,,`�o ,e' ti O Town Of North Andover ;� Plan Building DepartmentReview 508-688-9545 �'° °"' DamId MillerSSACHUS� Site: 1058 Jchison St. 146 Main St. Town Hall Annex Peter Cardillo APPLICANT:100558�Jdysm St- DATE: February 20, 1997 Zoning Dist nc�f: ' R-2 Use Code : Title of Plans and Documents: Revised Cardillo Hse. Renovations & Additions rec'd: 2-19-97 Request : Building Permit (Plan Review denied on 2-12-97) Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By-Law Use requires permits prior to Building Permit Other Other Remed for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copy of Recorded Variance Information indicating Non-conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure X 3 Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details X Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. # I I # Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled`Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new building permit application form and or request for plan review to receive approval. 2=19-977 Building Department Official Signature Information Received Denied fc'nj f y9 7 If Faxed Denial Sent , r16 6'iere PCR'b If you.require assistance please call the above number and we will be a le to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. .t .. � - � � ^�►. d ' r+ Plan Review Narrative The following narrative is provided to further explain the reasons for denial for.ithe building permit and or request for plan review for the property indicated on the reverse side: ' H" �ug I � M bt� al Wt ARTICLE 1 SECTION 113.8 INDEPENDENT STRUCTUAL ENGINEERING REVIEW Referral recommended : Fire Health Police Zoning Board Conservation Department of Public Works Historic Commission Planning Other Other 7 N t NORTH 1 20ett�i° "0 Town Of North Andover Plan Building Department Review Dam Id°A,.,° ld I�].1er 508-688-9545 �SSACHU5Site: 1058 Jdmscnl St. 146 Main St. Town Hall Annex Petr CardUlo APPLICANT:1r058 JAS- DATE: February 20, 1997 Zoning Distrlc ' R-2 Use Code Title of Plans and Documents: Revised Cardillo Hse. Renovations & Additions rec'd: 2-19-97 Request : Building Permit (Plan Review denied on 2-12-97) Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By-Law Use requires permits prior to Building Permit Other Other Remed for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copy of Recorded Variance Information indicating Non-conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies 1.Information Is not provided,2.Requires additional information,3. Information requires more clarification, 4. Information is incorrect. 5.All of the above. # # Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure X 3 Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footin q Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. # Water Fee State Builders License Sewer Fee Workman's Compensation Buildin Permit Fee Homeowners Improvement Registration BuildingPermit Application Homeowners Exemption Form MI m Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new building permit application form and or request for plan review to receive approval. 1 'Z—A2-19-97 9-90-97 Building Department Official Signature Information Received Denied , 2p 97 If Faxed Denial Sent Io 0-, D ILL If you require assistance please call the above number and we will be Wile to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. Plan Review Narrative The following narrative is provided to further explain the reasons for denial forithe building permit . and or request for plan review for the property indicated on the reverse side: ` a:_. :: ! ,�x�..r i �a.:;,-a�;ts. it �a5 Hl1'}tr;•.i C �' �r,., r ��l it! i�nrMilli, ... ,Y ,,, % is ARTICLE 1 SECTION 113.8 INDEPENDENT STRUCTUAL ENGINEERING REVIEW Referral recommended : Fire Health Police Zoning Board Conservation Department of Public Works Historic Commission Planning Other Other PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. �- PAGE 1 MAP K.10. .10? LOT NO. .10?- 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE I SUB DIV. LOT N . _ LOCATION O PURPOI SE OF BUILDING _ OWNER'S NAME . C f. , NO. OF STORIES I SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECTS NAME 512E OF FLOOR TIMBERS IST SND 3RD ` BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING nO� DIMENSIONS OF SILLS _ DISTANCE FROM STREET DISTANCE FROM LOT LINES — SIDES `� �,y O/REAR GIRDERS AREA OF LOT T�//K/ LIT T� 9 FRONTAGE/�p�/ HEIGHT OF FOUNDATION �JCJ THICKNESS IS BUILDING NEW NQ SIZE OF FOOTING X IS BUILDING ADDITION Nd MATERIAL OF CHIMNEY IS BUILDING ALTERATION VESIS BUILDING ON SOLID OR FILLED LAND ' WILL BUILDING CONFORM TO REQUIREMENT F CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE II INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH,SIDES LAND COOT + EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 _ EST. BLDG. COST PER Q. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM BEI-TIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING - 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILE" s''� /Z- SIGNATURE OF OWNER OR AUTHORIZED AGENT ■UILDING INSPECTOR FE E OWNER TEL.A �9C3aa ,O PERMIT GRANTED CONTR.TEL.N 19 CONTR.LIC.k H.I.C.# a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM . MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS d I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 8 t 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ r _ DRY VJALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M T AREA _ 1/4 1/1 % FIN. ATTIC AREA N_O B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARWN'D ASBESTOS SIDING COMRACN _ VERT. SIDING ASPH.711E _ t STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR I_ - BRICK ON GAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR 11 ADEQUATE NONE ' 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FL _ AT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK - SLATE NO PLUMBING _ TAR 3 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING i l HEATING _ WOOD JOIST PIPELESS FURNACE FORCED_ HOT AIR FURN. 'I TIMBER BMS. IS,COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 1 7 NO. OF ROOMS GAS OIL - B'M'T 2nd _ ELECTRIC ltt 13rd 11 NO HEATING • -- ,:,,,sem»:.•:, �..,.. .,�.,...-,..� No.: Date 7 -7 NORTF� TOWN OF NORTH ANDOVER p BUILDING DEPARTMENT Building/Frame Permit Fee 9 p'ATD SSACHUS� M (-- Foundation Permit Fee Other Permit Fee $ 0 uil ing Inspector f Q rfOR'r Town of dover L No. * . dover, Mass., 199 '9 -00 CMICNEw ICK iY + 9_t1 Oq'�T E o v �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........................ BUILDING INSPECTOR .......... (rte ................. ... -3.1..l (o...................................................... / Foundation has permission to erect-....4--LTEif0.......... buildings on ......1..>.5.. .......... ..........,S..rl......... Rough to be occupied-as.........................................O. ..lY.!`?'/.................... ..l..If7..�1./...G.......................................................... Chimney provided thatfthe person accepting this permft 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS Rough ' ............ Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove . Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Town of North Andover N°RTN OFFICE OF 3?°4,,to ..,4,, COMMUNITY DEVELOPMENT AND SERVICES ° . p 146 Maio Street North Andover, Massachusetts 01845 i.LIAM J.SCOTT 9SSACHUS Director In accordance with the provisions of MGL c40, 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 c 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant bate NOTE: Demolition permit from the Town cVf North Andover must be obtained for this project through the Office of the Bui!ding Inspector. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 I Location No. Date �pRTM TOWN OF NORTH ANDOVER a s Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 7 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. / DATE ISSUED: �P ic SIGNATURE: •••� Building Commissioner/12,wfor of Buildings Date Z SECTION 1-SITE INFORMATION O LI Property Address: 1.2 Assessors Map and Parcel Number: o N lea � 0 6 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 39 NmUt -3c>/ 3'0 "Co CA 3 o N42- C—L, 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public A, Private ❑ Zone Outside Flood Zone Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record h00a-t)0QD-zl - oo-64 4,0001,-) N e(Print) Address for-Service: Signature Telephone �. 0 % L-- (�t� �ba-vzotn 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 'ei' ��_ Licensed Const tion Supervisor: O License Number r mn Address _a,T-W.".�* , �'7�? ".3 .� S Expiration Date re Telephone icr 3.2 Registered Home Improvement Contractor Not Applicable ❑ v `vhcIcrR sry is c tCompany Name 3� ,� M Registration Number 32-3 li,. Address r t4l;7,f �'73 23 S- Expiration Date z Si t Telephone Y SECTION 4-WORKERS COMPENSATION(NLG.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 Pmposed Work(check all appUcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 'P aJU s-A em 16,4i 7— SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFTCIAL;USE ONLY Completed by permit applicant 1. Building r 00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) f 4 Mechanical HVAC 5 Fire Protection 6Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ' as Owner/Authorized Agent of subject property Hereby authorize Tf PY J to act on My behalf,in< atters v o work authorized by this building permit application. oy�tpg�c�d /3 p�23 ' Signature of Owner Date SECTION -b OW ER/AUT`HORIZED AGENT DECLARATION I, Q- �SLL1 �� d�--� as Owner/Authorized Agent of subject property Hereby decla7thathe statements and information on the foregoing application are true and accurate,to the best of my knowledge and� o r�c�0 OL Printto,,- me Si ature of O er/A t Date RON NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NIF 7•iav�wSoN : A/ AooRZ 94•05' •.� - RIF WT G 9.4,oo� SF Ci 0% ° J 0 POOL- h� ��WooD Eq TOHNSoV S7— AMERICAN SURVEYING COMPANY OF BOSTON, INC. J"-S. WFETAN 1264 MAIN STREET •ALTHAM, NAM. 0E461 PHONE (781) 699-6477 FAX (761) 893-7091 A REGISTERED LAND SURVEYOR, PREPARED FOR INTEGRATED MORTGAGE SERVICES, INC. DO HEREBY CERTIFY THAT THE r ' 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 alQN,4SOIZZ) (��70' PHONE ' LOCATION: Assessor's Map Number�/'r PARCELj„o SUBDIVISION LOT(S) STREET S°•y ZST. NUMBER ************************************OFFICIAL USE ON y**************, ************* **** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED t� COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD IjVSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED (o DATE REJECTED COMMENTSAZ Q PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9\97 im • 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 Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector U r The Commonwealth of Massachusetts Department of Industrial Accidents . Office of investigations Boston, Mass. 02191 e Workers'Compensation Insurance Affidavit Sv Name Please Print Name: i w,o h{ V C-0 rt iru---7 iD rl k S: V i cxf s Location: 323 XC<.% h 67— city A I # keaJt /• Phone # !7'7,6 97,3 3 I am a homeo r performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. Policy# Company name: Address City: Phone#: Insurance Co. Policv# 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$1,5oo.00 and/or one years'imprisonment.as v+tell_as_chdi4 enattiesin2helmn-d aSTOP w9RK ORDER-and_a.fi.ne._of.($1D.o.OD)-ariay.againstm-_ 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y /do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name .� h e Phone.# 1,79X73 X73 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina Building Dept ❑Check if immediate response is required n licensing Board E] Selectman's Office Contact person: Phone#: E] Health Department Ei Other BOARD OF BUILDING REGULATIONS Incense: CONSTRUCTION SUPERVISOR NumbirCS 081 Birthdate. 1011811971 ' Expires; 1011612€05 Tr.no: 81133 Restricted: ICI JEFFREY A Tlh+tONEY 323 MAIN ST N READING, MA 01864 Administrator I 1 i ®\ Itciarci c:t ttaxiltling Regulatimis asiiai. taaatlaii°) License or registration tiatlicl for 1aaliviclul use ttuly HUME IMPROVEMENT CONTRACTOR before the expiration date. It I'ituud return (u. Registration. 10£31357 Iloa it of Iluilditig li€'indations and Standards, Expiration. 5121/2005 Clue Ashburtou Place Rm 1301 Ilustuit,Ncht 0?1011 Type: (SSA TINIt:1NEY CONSTRUCTION SERVICES JEFFREY TIMONFY $ :323 41AIN ST, 2 t: . � � 3,a. / N,REW)ING,MA 01854 Ulminisiratai` ' r lvailid vvithuut sigiiart4 el0of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address:/ _'•�.�f �„► S'T Owner: Date of Inspection: rT BICE VlbrUJAL,YJTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 10 feet. Locate where public water supply enters the building. J f 4 t � Ito- (No 1 y Aly¢ f A A.. �'"�' '�I6 h�s;`��'�`ytit�i�s?�"�%�ti"�+S•�Ki!rkt±�!k?.h�k�i1#��'�? � Aw+ae'�'. oe ZE, ` ^' \ �r div. i. / V J QD ow t t, IX7 AwXvY 74m 6 6 W , 0 �9 a Ch 2 -�- ^wt€�h+c!"W4'�trWh�ig4#SaM#oeZ�e:�g,L�d 'tireiS�kcat:::N i"w�i3tll?K':.r@r't';'.<e�«L•!k,si;.al8anke:'�*�K#a"",';.',I�P.�reAa:i�u'��w(tia,K�1:'-_'�".:.,.. ".i`.6a'"kd :t3��c"1"Y ')�T'a't�r?�'t ... �'� x 8 �;1�;m. ;»sof '- S� �.�,s+tk,^z_�rw�• t�Ae&�.aux`r'aa4$#sr.:mw,5cs,+�n..t�, e��*c�a.+iwama,+ ��r E de } 3 { y 1 / r � � Wt 5 A , ql � S �tc�Sut4o� SS (�1V - r a J ore Sohv, 5e%,, sT &crr k i c t f { +C3vP c.7 S�'..,�- �► ,kms AOteV Qe i t t a y 2 S u 1 l . I 0 ' 'f �� 1 t ti .SQL b Xe-') Re-6 a e � �s PMM Ay RAM, fozu�Not its, ts F� t -700 IV low -V�t ,- ' _ /"ev-9 JS to o34 40C $_S O( "Viol 1.5*"; NORTfy Town 0E dover Owl C0 No. °� coc.,C dover, Mass., AERATED P?�\,`'`� S H � BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT41(4....... .............dN.�..eS d. .............................................. •••• Foundation has permission to erect....3AP....t1. ....... buildings on ......I.O..15.8..... A. N..�O.N.........S Rough R11111"Ar-r- 5 I*GA "Do"W"w- � .�� � �� I Chimney tobe occupied as................................................................................................. C. �. ...................................... 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. ' R PLUMBING INSPECTOR 0 /50 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS ARTS ELECTRICAL INSPECTOR Rough ................................................ ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Dat(.. . .. . . . . . . . . . AORTPI 04"'t TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING ,SSACHUS This certifies that . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . has permission to perform . . . . . . plumbing in the buildings of . . . . . . . . . . . . . at . . . . . . . . ... . . North Andover, Mass. Fee Lic. No. . . . . . . . . . . . . . . . . . . INSPECTOR Check # Y &0 5685 MASSACHUSETTS UNIFORM APPLICATION'FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS � Date / Building Location 11 •Owners Name Permit# Amount Ziv. --o Type of Occupancy New Renovation Replacement ❑ Plans Submitted Yes No FIXTURES z W H � PP SLIMM R4s vE,w M FLOOR 2N]HIM 3MFUM M FLOOR MR" 6M BLOM r 7MROM SIH FIOM Y (Print'or type) 1 - Check one: Certificate Installing Company Name '7 Corp. Address `' " Partner. Business Telephone j G El Firm/Co. Name of Licensed Plumber: ` Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ja Other type of indemnity El 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 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 perfo der Permit Issued for this application will be in compliance with all pertinent provisions of the Mas achu S e mbi a and ha ter 142 of the General Laws. By: Signature of Licenseaum er Type of Plumbing License Title ;/ G� City/Town License um erMaster�_� Journeyman APPROVED(OFFICE USE ONLY �\