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HomeMy WebLinkAboutMiscellaneous - 1060 OSGOOD STREET 4/30/2018 (7) I OCco C)s d� �p�- S BUILDINU FILL i i i Date./j/��,/ . .. . . .. ,+ORTM pf �.�o 0 - o� O4 TOWN OF NORTH ANDOVER N A PERMIT FOR GAS INSTALLATION �9SS'CHUSE This certifies that . ,&"AI-X L . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . 7:-. . . . . . . . . . . in the buildings of 5�� , . . . : . . . . . . . . . . . . . . . . . at .�l��G . . �J.� 5.�.�: / �.?. . . . . . .,. , North Andover, Mass. Fee. . . . . . . . . Lic. No.,. . . . . . . . . . / GASINSPECT6R Check# 7074 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ' (Print or Type) Mass. Date ��'D ' Permit #, Building Location \OQ�Q OS°\ooc�.�� Owner's Name Type of Occupancy �()K New ❑ Renovation C3 Replacement Plans Submitted: Yesp No N Q N WN Y Z ¢ to N V N Qlu Oy m z � s Q ¢, o o 0 0 C W 0 cc J W tl } J ~ S �' tW- Y H m X a z W O ui S W < Q < < O O W a O W P o v i LL a ; o o ., o e y c d >r o SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR Y STH FLOOR 1 6TH FLOOR 7TK FLOOR STH FLOOR Installing Company NameT� � •'��� =k one: Certficate Address_\ o k �.c C�> 9 Corporation ❑. Partnership Business Telephoned : '�� , =k•— �� \ ❑ Firm/Co. Name of Licensed Plumber or.Gas Fitter c '� INSURANCE COVERAGE: ! have a current ' pity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 12 No ❑ If you have checkedrtes. please I irate the type coverage by checking the appropriate box. A liabilityinsurance is 7 Other type of indemnity❑ Bond ❑ policy OWNER'S INSURANCE WAIVER: I am aware that the licensee does not-have the insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement. C one: Owner Agent O Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 have submitted(or entered)in above application are nd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this appli on wilt be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the S, By T of license: Plumber Sig ture of Licensed Plumber or Gas atter Title itter ster License Number City/Town LJ Journeyman APPRONED(O I NL Location /6)b0 cpS a O a 4 !S�� No. &S5— Date '' h NORTH TOWN OF NORTH ANDOVER L F p ` Certificate of Occupancy $ Building/Frame Permit Fee $ 3' 2ACMUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C) `r r Check # 1 SO 6 Building Inspector TOWN OF NORTH ANDOVER WELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING TWS SeCtIUII for Official Use OnI ic tie^ �. �' ,� •L �.-�S -.�' ii��� R 4"k BUILDING PERNUT NUMBER: DATE ISSUED: z SIGNATURE: Buildi2&Commissioner r ofBuildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /UG0 0 s�oya/ - ��/a.?J—; ® 00,-7fi 1` , G/f�/.l Map Number ParceVNumber 1.3 Zoning Information: 1.4 Property Dimensions: v Zonin Distrid Proposed Use Lot Area Frontage ft 1.6 WELDING SETBACKS(ft) m Front Yard Side Yard Rear Yazd Required Provide R Provided R red Provided �� 1.7 water Supply M.Gd...C.4o. 34) 1.5. Flood Zone briormation: 1.8 Sewerage Disposal Syst— Public ❑ Private ❑ zone outside Flood Zone ❑ Muaicipal On Site Disposal System ❑ Q 2.1 Owner of Record ww► vie 1 s u�o Os" o«.✓ s�. ti�� ��� . O Name(Punt Address for Service �� �5- V1 - 25-67 rn Signature Telephone 2.2 Authorized Agent Name Print z Address for Service: r rZ O Signature Telephone o z aM 3.1 Licensed Construction Supervisor _ Not Applicable ❑ r,' Address License Number O Licensed nstruction S _ sor. i �7 C j "7 D ' 'Ar 7� ��0—�L/f Expiration Date C Signature Telephone r 3.2 Registered Home Improvement Con r Not Applicable ❑ v . Company Name Registration Number y c . � m Address f -e-4 V U �/ Expiration Date Z Signature Telephone v 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 rmit. Signed affidavit Attached Yea.......0 No.......❑ MOM �TM�r� c �r CO1�17 5.1 Registered Architect: Name: Address (�Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable 0 Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signatu*e Telephone Expiration Date w Y Not Applicable ❑ Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building Repair(s) ❑ TAlterations(s) Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: VVI-ho h N CL rL t ✓✓1 c i f 0.1 a>^ C -erLd C�4 Q ? : Lfl age, USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A-2 0 A-3 0 IA ❑ A4 ❑ A-5 0 IB 0 B Business 0 2A 0 C Educational 0 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C 0 H High Hazard ❑ 3A 0 IInstitutional ❑ 1-1 0 I-2 0 I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential ❑ R-I ❑ R-2 ❑ R-3 0 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: Mvia- BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft III am IN Independent Structural Engineering Structural Peer Review Raluired Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT P / S ,as Owner of the subject property Hereby authorize A 4 Cvr !c'*7 c i I o ) C: J6.6,11 1 CA n to act on My behalf,in all rnat6rs relative two work authorized by this building pefinit application Signature of r Date I r " NO 7D6 I\� �� "` {' 1 C ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury CA V t SA-1121 ., S Print Name Signature o Owner/Agent Date W Item Estimated Cost(Dollars)to be F Com leted b t fl licant1. Building ov Building Permit Fee Z d tom' Multiplier 2 Electrical cr (b) Estimated Total Cost of Construction from(6) 3 Plumbing ✓�� Building Permit fee (.)x(b) _] 4 Mechanical(HVAC) �� 5 Fire Protection 6 Total (1+2+3+4+5) Check Number y�:k •�,F,xl,3 a: r r ,� L,a elf 4,';,i $ a i-'<•... 4 F - s^€- „r r ` {�Sd;? -''i+°`•'kv ,'»< 6•Ft- r Leyt:%t. Sa FraiN�r:•if'' ?'*i. a.3 t}�. {u Alt � ,4 ,,J )�� ,.��' s 3f ��l�:. ^us„-4' ,. at�'r�'k�r7J:C'�•"9a�'r,r*t.+ <_.r�:R�;. NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2 D 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a. i &• -�: t r1' „„�s� „'7 p • ? 7., '• +� '."� '•+ to .. ,x 'r^ .Ar ,�- ,..,. `" ;.,e, sY =c;•^���� �,* f S� ��k-��v�•a4' c ��i�i � ^ 3 R�E c't aw. �s2Zf« r'l4Y `"d x3'� n L YA f.. , 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_�i /h,r,�, c � f y � �,,�.� c PHONE4��7/,-&J—o LOCATION: Assessor's Map Number PARCEL 00� SUBDIVISION LOT (S) STREET 1640 C/SXart;/ )', —��, -,c% ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED 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-bI 10,frv�I �S61ar RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 Jm lopThe Commonwealth of Massachusetts Department of Industrial Accidents Office of lnvesdgaftns Boston, Mass. 02111 Wafters'Compensation Insun a Affidn* S' /a?, Please Print Nacos' c4.n C Locaaon: iv L Osou.l s/ �.i�� 12,r� CRy �� I am a hamecwrrer pelformi myself. Tarn e I am a sole proprietor and have no one working in any c apedly 0 I a n an employer providing workers'compensation for my employees working on this job. Comp=mems: , Address CIM Phone it inauratce.Co. Pokv 0 Comoantf name: Address City: Phone�! Irtazanom Co. Pcicv;il Fdk,na to some caveraga a monad under Secdon 25A or MGL 152 can lead to tha kromkion d aknleat pwww=d,a flrn up to$1,5w.w andrarone yesrs'imprisarxnaru.a.YM.r.cbA.peo2WsJoao,!mdASTOP.WDRKtJROERmdeflead.(SIW M-AAWmpnk*.ms I understand that a copy of this shA nrerk be forwarded to the OMM of Inv doodons of the DIA for covarepa vwMcatlon. I do hereby underv and wry that tM IrrNMwdM provided ebaw Is bus and caned Signature r p� 20a j Prl s asv�a Panne 3 y y OffCM use only do not write In this area to be completed by dty or town oMk9al' Cky or Town O—MA �...,.�.;� ❑ Buikft Dept []Check if Immedlale reaponae Is required ❑ Lterolt Bowd ❑ Selectman's Ofte Canted person: Phone i+ ❑ HeeM Department ❑ Other 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 c 11, S 150 A. The debris will be disposed of in: e 3, J- v,,P, , Ce e �o (Location o Facility) Signature of Permit Applicant to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1 � — tna.n•r li :� i i + 1 1 j-.. ! -t , - i._-i� <- ��'� --.-... -r ._1:-- � 4-. - - � - - - - � tel:. - - —j=-^^ �— - -r--_,_,...0 _•j--- �- -- T`-�- a�J.�'.,;- :� '; ------------- AL t r ! , R �' 43 i L E 71 V ! 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I� _ ff LA , �Zip_ NORTH Town 0 4 over 0 0 No. avow over, Mass 0' 1E OCHICHE CK 0RATED 01 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT......D.A.U.I.;b..............SA...llo"...04.14.... si.MI logo S6& 4 BUILDING INSPECTOR .... .... .. . .... ...... ..... . ..... ..... .... .. ...... logo/j ... ..... .... ............ . Foundation buildinks on ..../49..40 40 4 .0.0b..... has permission to erect..../ ............................................ ..... ...... .......... Rough to be occupied as. P#+49 IPI OAJ..vS r ............................................... ... ...0 #0 Chimney .... ............................................... provided that the person accepting this permit shall in every respect conform'­t'o'41Wterms 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. /2 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S S Rough T4TOIW�� .........00-,-4- -.00A... . ................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building I GAS INSPECTOR Display in a Conspicuous Place on the Promises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 1[_SEE REVERSE SIDE _J1 Smoke Det. ti Date......... . .....—f....... ,40RTN TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SSA US This certifies that ... ....... ..................... has permission to ..................................... wiring in the building of.......,Z ................................ 'Wat. -,.j. .. .. '' ....... ...... North Andover,Mass. ...V. .. ........... ... .. ........... Lic.No. ............. ........... EIIC IRICAL INSPECTOR Check # I:-; 5725 Rough Service Final (1hP Tommunwealt4 of M1 0011c4ugetto Office use Only Department of Public Safet Permit No. : q"2_< V1 BOARD OF FIRE PREVENTION REGULA ONS 527 CMR 12:00 a� Occupancy & Fee Chemo 3/90 (leave blank) APPLICATIONworFOR �PERMITeTO Masachusetts Pwith theSERFOtRaMeELEC,527 CMR TRICAL WORK 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of G To the Inspector of Wires) The undersigned,applies for a permit to perform the electri al Work describecrbelow. Location (Street & Number) 46 Owner or Tenant V ( ` Owner's Address zz✓-ve F Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building ff�GZ�O^� ��f /Utility Authorization No. Existing Service C� ���d r-Vi ��Amps�� �``�d V01 7 Overhead 1:1 Undgrd� No.of Meters New Service(ii,,�, R �Q'�e) A'_Q Amps 2 •� u�/, Volts j� Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 3 ,( Location and Nature of Proposed Electrical Work v ✓�m r C J TOTAL No.of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above in- No.of Lighting Fixtures 1/0 Swimming Pool gmd. ❑ gmd. ❑ Generators KVA No.of Emergency Lighting No. of Receptacle Outlets "/0 No. of Oil Burners Battery Units w / No. of Switch Outlets No. of Gas Burners 7422FIRE ALARMS No. of Zones Total 0 Nx: of Ranges No.of Air Conditioners TonsI01. . No. of Detection and Initiating Devices Heat Total lotal / No. of Sounding Devices. ,No. of Disposals No. of Pumps Tons KW No.of Self Contained -4 : Detection/Sounding Devices 'No. of Dishwashers S ace/Area Heatin /�p�+ r.0 KW Municipal No. of D ersLocal❑2 Connection [--]OtherHeatin Devices KW No. of No. of Low Volta No.of Water Heaters KW Signs BallastsWirin j ��, No. Hydro Massage Tubs No. of Motors Total HP OTHER: � L t INSURANCC COVERAGE: Pursuant to the requirements Massachusttes eneral Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑NOI have submitted valid proof of same to this office. YES O NOx If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work$ A� (Expiration Date) IkQrk to Start Inspection Date Requested: Rough Final ei/, // C,C Signed under the penalties of perjury: FIRM NAME —J c7 7 LIC. NO. � Z Licensee U t O Signatur z LIC. NOZI TZ Y Address ' Bus. Tel. No.(� ZS/ Alt.Tel. No �f � 7 f� OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re 'red y Massachusetts Gene Laws, n that my as on this permit application waives this requirement.,Owner Agent (Please check one) Telephone No. \ 71)`{7S dTb1PERMIT FEE $ (Signature Owner or Agent) Rough Service Final (9O111n1DnWt81t4 Of AlBnMc4usetts Office Use Only am Department of Public Safet — � Permit No Un BOARD OF FIRE PREVENTION REGULA ONS 527 CMR 12:00 Occupancy & Fee Otecke - 3/90 (leave blank) 'APPLICATION WFOR ork to be �PERMITeTO PSERFORM ELECTRICAL WORK Electrical Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) \ Date T?rhn C City or Town of �/ �° To the Inspector of Wires) The undersigned.applies for a permit to perform the electri al ork descri elow. Location (Street & Number) CJ _ ® a/ j Owner or Tenant ( ( ' Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building a Utility Authorization No. ExistingService Qv ZC/ tti �i� .���� �►"� �Amps�J � VOverhead ❑ UndgrdJzU No. of Meters New Service(a,t(_ Pf&e) mps 2v U Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work li Ji rn C f 2 No.of Lighting Outlets TOTAL No. of Hot Tubs No. of Transformers KVA Above in- No.of Lighting Fixtures 0 Swimming Pool grnd. ❑ gmd. ❑ Generators KVA �+1 No. o Emergency Lighting r-No. of Receptacle Outlets /c.✓ No. of Oil Burners Battery Units �. No. of Switch Outlets No. of Gas Burners ota lio FIRE ALARMS No. of Zones of Ranges No. of Air Conditioners Ton QI� No. of Detection and. eat ota total Initiating Devices of Disposals No. of Pumps Tons KW No. of Sounding Devices. No. of Self Contained of Dishwashers S ce/Area-Heating ✓4p j M "'e- KW Detection/Sound Devices Municipal of Dryers Heating Devices KW Local[:]* Connection ❑Other No. of No. of- Low Volta \ of Water Heaters KW Signs Ballasts Wiring 4t C1, Hydro,Massae Tubs No. of Motors Total HP ER: -3 r All f ✓CJ�t�..�r `� w zX et P RANC COVERAGE: Pursuant to the requirements Massachusttes eneral Laws e a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O NOV I have submitted valid proof me to this office. YES U NO have checked YES, please indicate the type of coverage by checking the appropriate box. RANCE ❑ BOND ❑ OTHER❑ (Please Specify) 091 ated Value of Electrical Work s ,_ (Expiration Date) to Start Inspection Date Requested: Rough Final 4L,i under the penalties of perjury: NAME10 1111 (f iee _e1 LIC. NO. z Y f s Signatur —` LIC. NO.�Z ? t/ Bus. Tel. No. 2y OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equilvalent as ry Massachusetts 3 i Gene La s, n that my sl on this permit application waives this requirement,Owner A enc 8 (Please check( onej) '!Telephone No_ No. (Signature Owner or Agent) PERMIT FEES W Location /QU Osgood ,S lReer No. — a!t Date MORTIy TOWN OF NORTH ANDOVER 3? • OL f 9 Certificate of Occupancy $ . o, __ • . ;�s'�•• E<� Building/Frame Permit Fee $ AC Nus Foundation Permit Fee $ Other Permit Fee $ L 1.Oo TOTAL $ > Ll1 Check # 1732 Building Inspector Site Owner Applicant of Site Addr�s Size of Proposed Sign /O�O _ _ o-z How attached- a) Against the wall_( Illumination- a) Not illuminated bS Roof -� b) Internally illuminated ( ) c) Ground O c) Externally illuminated ( ) d) Other ( ) 1 �? Materials: Proposed Colors: Background_( ;e 'o h Lettering_. y Border_ . vim Required. Attachments: Note: No permanent/temporary sign shall be erected, or enlarged until Photographs of building an application on the appropriate form furnished by the Sign Officer has Material sample been filed with the Sign Officer containing such information including Color sample photographs, plans and scale drawings, as he may require, and a permit signs) for such erection, alteration, or enlargement has been issued by him. Site or Plot Plan (Required for all free-standing . g ) Such permit shall be issued only if the Sign Officer determines that the Drawings of proposed sign sign complies or will comply with all applicable provisions of the By-Law. Other, specify Wifl sign overhang any public road or walkway Yes No If Yes, Name of Agency.who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED:_ 27 ?_v� VII, revised:jrn- 8/98 SIGNATURE OF APPLICANT r 11"x120" Green B.G / Ivory Border & Letters I �I pORTH q Q �sy,lD $6 s6 OO OH Co' COCMKIftWKw � ��SSACHUS`A TOWN OF NORTH ANDOVER SIGN PERMIT DATE May 27, 2000 PERMIT # 16-2004 This is to certify that David Samuels for Simplicity Salon has permission to erect a 11" x 10 Foot Wall Sign INTERIOR ILLUMINATED SIGNS ARE PROHIBITED on / at 1060 Osgood Street Providing that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-laws relating to the sign regulations of the Town of North Andover. Any violations of the Zoning Regulations regarding Section 6 of the Zoning By-law will void this permit. Inspector of Buildings Date I . O@ WO uTH N 73 a r a +P9V^'..ywnu..ifj BCNU`-+ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number Date THIS CERTIFIES THAT THE BUILDING LOCATED ON J D 6 0 0 56-o o ID 5T- MAYBE TLMAYBE OCCUPIED AS 1^4 A n9 /cy r r- i A-d l c v r e- 4 f-IA i P- S A /0 N IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO 1)A- L)9 5 A of D � / S /0b0 0S 6, Building Inspector NORTH ® of - Andover I VA -14`yy 0a �` dower Mass*, y 8 ey 1 T O = LAK \ 1 A_ COCHICHE WICK 7� AoRATED S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........ 4V.s.............. A..N�.&V ,A........................................................................... BUILDING SPECTOR ...... .... .......... Foundation 116/`4 has permission to erect......... *000^.... buildin s on ......14PA0.0........© x+..66.0....S. .... Rough, to be occupied as '.. � .................r....... ... Chimney .a.l . ................................................................. ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final�Ojjj< _S a� o 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. %?S/a Sw O INi PLUMBING IN qRASIgR VIOLATION of the Zoning or Building Regulations Voids this Permit. R PERMIT EXP IRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START- ough - y, .... . ................ _ f BUILDING INSPECTOR ru � Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPA,�RTIWENT Until Inspected and Approved by the Building Inspector. Bumex i - 111NI ✓ N Street No. SEE REVERSE SIDE Smoke Det. 4 Location r IC1 �&),w J No. Date TOWN OF NORTH ANDOVER FL R 41 Certificate of Occupancy $ sCMUs�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `Check # 6;8 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M OTHER THAN A ONE OR TWO FAMILY DWELLING `y's:..0`<.; F _ -a ,k a„ mat s Section for Official Use Onl � .�. �. -� �;; rix '� -.� ,��.:. :� ` BUILDING PERMIT NUMBER: DATE ISSUED: Z SIGNATURE: Building Commissioner. or of Buildings Date SEC'fIa: a 16, 1.1 Property Address: J1.2 Assessors Map and Parcel Number. C� I Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Area Frontage ft 1.6 BUR DING SETBACKS(ft) m Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zane ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record 1 A - Name(Print) Address for Service m Signature e 2.2 Authorized Agent .Name Print Address for Service: Z O Signature Telephone m 3.1 Licensed Construction Supervisor Not Applicable ❑ 3 4z Address License Number O Licensed Construction Supervisor: C S o.S`�r(g(g / 72-1 Expiration Date Signature Telephone 3.2 Registered Home Improvement ContractorNot App cable fjv Company Name Registration Number M r Address r Expiration Date ^^Z Signature Telephone Y SECTION 4 WMKiB" AO- is, `tq �� r 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 Yea.......❑ No........❑ SECTIONS PRdF»SSIONAI.>t3ESIGN Affil)C #1!TST ICTION SERVICES 1�E?R EtJIiII►INCS U " S St31B E ''i`C3 CONS 1!'811JCTI©N�OIT�tUL I' AN TCI► @('1►IR t 2b�Ctl!NTAIIIN+ M! 1D 35,1 GF.O)� >�NCI1S16 D SI'A � 5.1 Registered Architect: Name: Address Signature Telephone 5.2 Regtsberetl��;ProfessienA� ri� l���` - Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature f. sF. Telephone Expiration Date ijY7N if��_a 1$�wT.1M1 ( Not Applicable ❑ Company Name: Sa � ct Responsible in Charge of Construction I a - z New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i l`P -lee 04 t C 1 �`) i�Cl �n�dZI ►�y �J/1 �� J6i1'���X �� ii �� � b�t i ff� ( �� .C/",J 1 7�� a�S V �N / /y GV.9"// Gti?P� �/tiU ✓�LYd�+�/J C.� ,N /4w- TU !✓I��P ©G9 P �CJuw ULc7a�^''. � e C2�v az17 �✓i�(Y,1w L-� //� �G++^Q USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A4 0 A-5 ❑ 1 B ❑ B Business ❑ 2A 0 C Educational 0 2B 0 F Factory 0 F-1 ❑ F-2 0 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ I-1 0 I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential 0 R-1 ❑ R-2 ❑ R-3 0 5A ❑ S Storage ❑ S-1 0 S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 1 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft ,Y w Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize to act on My be ,in all ma lative two work authorizedb3this building Permit application z 2-00/ i luref gna o r Da a I, A J,.4 S 4IMA \ / as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Ag nt Date Item Estimated Cost(Dollars)to be 0 Completed by permit applicant QMw 1. Building (a) Building Permit Fee 2 J Multiplier 2 Electrical (b) Estimated Total Cost of 741- -- Construction from(6) 3 Plumbing 4?/— Building Permit fee (a) x(b) �D 4 Mechanical(HVAC) iC�ay� 5 Fire Protection 6 Total (1+2+3+4+5) Check Number : �� s 3 ` e 31 et(.� 1r+,,,, ,(. li ✓�. r # t t.. U. 5s' Y 4�b 1t 5.M{ ... ?all WON, n t 3,5 {+.> .$a .tl-♦ itt,�Jl! S ii .�.. NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1� 2ND 3kD SPAN 1 DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHI1vINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �✓ 1. 5$dy�"`�Yy �, _..� �,y..�xY..,� t �� '2tk�. �+ s t � � `i qtr t .;M.��.m r �fi .r.�`'4W�� f� r-'ia FORM - U - LOT RELEASE FORM INSTRUCTIONS: This fora►is used.to verify that ail necessary approval/permits-from Boards and Departments having jurisdictionhave been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �ssssssssssasssrssrssaassssrsssssrsrssssssssssssss.srssrssssrsssasaassaaraas■ APPLICANT -t PHONIX7:f)77,Y �yy. ASSESSORS MAP NUMBER 3f LOT NUMBER Z 9 SUBDIVISION LOT NUMBER STREET JA STREET NUMBER ;106 U rsss�srsrs•■ rssarrsa ■sssssrrrs.■assssssasssarssasssssssssrswas aaasaaaa:saa■ OFFICIAL USE ONLY �ssarsasasa,■sasassrsssssrrassra.ssassass■usrsssssaasssass ssas.aaaasaaaaraas• . RECOWATIONS OF TOWN AGENTS Down mossasasassrsrassassrsasass�ssesass�ssss�ssarssssrsesessssssaasaaaaaaas■ DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENT s TOWN PLANNER DATE APPROVED DATE REJECTED COMIVIENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS—SEWER I WATER CONNECTIONS DRNEW Y P FIRE DEPARTMENT APPROVED DATE REJECTED CONDAENTS RECEIVED BY BUILDING INSPECTOR —. .. _. DATE 1 6. BOA�iO OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR b Number: CS 055851 Birthdate: 02/17/1568 Expires:02!17/2005 Tr.no: 8855 Restricted: 00 BRIAN A FRANCIS 18 ATLANTA ST rZ,` HAVERHILL, MA 01832 -- Administrator • s� / 0o 710 a. ( Ci G C�j f a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9� Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: city Phone # I am a homeowner performing all work myself. am a sole proprietor and have no one ymrldng in any capacity' . 1 am an em play w providing workers'compensation for my employees Working Onthis job, Company name: Address City: Insuranm.Co_ Policv# Com2M name. , Address: trCx: Pt Insurance Co. Policy:#. Failurb to secure coverage as required ender Section 25A o1MSL tS2 carkaitto the i ipo s�ian at tfirrnaR p oE; upto,31 and/or one years irnprianrMrreott �u�elams�tallOP fioe�o€ Lj asst n understand that a copy of this statemerit may berfwwarded to the office-of Instigations c!f the bixfor cm erage veruiagon. dbhwebycotrY r Me paks andpenembs ofpe#wybwfhe6ifam oomprwiidedabomitsbyeawccorred Signature [ #e Print name Phsos c rida! use only do not write in this area to be completed by city or town officiar or Tawe t?estrnt/t icerisirira .. C]Check J imrneebate respanse is-required B contact persom Phone# DH ealth Oe A Other a 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 de ris will be disposed of in: (L cation of Facility) v-� 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 NORT#q ® of 1Ly B ey T ("C' O -_ dover, Mass., Ifs COCMICMEWICK �1. DRATE D Cl V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System - BUILDING INSPECTOR THIS CERTIFIES THAT..............14 .`'..............w��.�.....1..1 r�.. .s........................................................................... Foundation has permission to erect...1.04*NM 0%.... buildin s on ...... ..6.0........©SG..oD.,U..... ........... Rough to be occupied as........'..#9 M. ~r. ..t.................�.......5.a. s N......................................................... 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 Inspe ion, Alteration and Construction of Buildings in the Town of North Andover. s/a i PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARELECTRICAL INSPECTOR Rough T � .'............ . .......... ............... 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 Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. A Date �� G o .................... yORTIi 40 TOWN OF NORTH ANDOVER 3,. p PERMIT FOR WIRING �,SSACHUS� This certifies that .....�r .......................... :r-............ .................................... has permission to perform .......:.. ........ wiring in the building of.:.- = !- -�"�-'............................................... atr'�.............. ...... ....- .........:................... ,North Andover,Mass. Fee/ � ....... Lic.No jai. / �,:... f ,.. :._x.................... /�ELECTRICALINSPECTOR Check # ' 5118 Rough Service Final �hP CnDI11p1DUUtPMjt DfINI3SML�U>SPtt>li Office use Only Department of Public Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 -oo, Occupancy Fee Checked 3/90 eave blank) APPLICATIONWFOR �PERMITeTO Masachusetts Pwith theSERFORElectricaMe ,CECT ICAL WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) _ ate City or Town of va cIWL' To the Inspector of Wiresy . The undersigned,applies for a permit to perform the electrical work described below. Location (Street & Number �U C�U fps "GG Q _P% Owner or Tenant / L ' Owner's Address N '4y oa .4*, Is this permit in conjunction with a building permit- / Yes No (Check Appropriate Box) Purpose of Building _Oxl CA � Y c�����J fie U ili Authorization No. Existing Service 616-V�Amps �� 0 /0 Volts verhead ❑ Undgrd X No.of Meters New Service Amps / Volts Overhead 1:1 Undgrd ❑ No.of Meters Number of Feeders and Ampacity nz /pwso1/ _q ca"C.w%1/ Location and Nature of Proposed Electrical Work Z TOTAL No.of Lighting Outlets No. of Hot Tubs No. of Transformers KVA A ve In- No. of Lighting Fixtures �Z � Swimmin Pool rnd. ❑ rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 3CJ No. of Oil Burners ^^ Batte Units - /� No.of Switch Outlets No. of Gas Burners ` (en J4/! li'L FIRE ALARMS No. of Zones Total No. of Detection and No. of Range.s No. of Air Conditioners Tons Initiating Devices Heat Total Tota No.of Sounding Devices. Z No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection6ounding Devices No. of Dishwashers Space/Area Heating KW Municipal No.of Dryers Heating Devices KW Local❑, Connection Other No. ot No. ot Low Voltage i No. of Water Heaters KW Signs Ballasts I Wiring 94t i44, �J- eA.A. �rPJ No. I't�dro Massage Tubs No. of Motors / Total HP OTHEI INSURAWT COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES U NOXI have submitted valid proof of same to this office. YES U NO U If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) Estimated Value of Elec rical Work $ 67Vr (Expiration Date) Work to Start J (� Inspection Date Requested: Rough ` Final Signed under the p4nalties of rjury: FIRM NAME !� !.r/.-�G LIC. NO. r Licensee S'6e�r» C Si natureG �3G ..., f LIC. NO� Address J �/ ff3o m 1 --gib-Tel. Ncf% ,17X/ Alt.Tel. No 9 `7 95 OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance co age or its substantial equivalent as required by Massachusetts GeneralLa a d t signature on this permit application waives this requirement ne Agent (Please check one) Telephone No.476) PERMIT FEE $ (Signatu a of Owne or Agent)