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Home My WebLink AboutMiscellaneous - 108 HIGH STREET 4/30/2018 (2) / 108 HIGH STREET U-1 1 210/053.0-0023-0001.0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIN� s (Print or Type) NORTH ANDOVER Mass. DateY/0,11 143uilding Locati n /Q �� <,4 - Permit # I �� Owners Name 04 - New -7 R novation 1E] Replacement T3---Plans Submitted FIXTURES H to t5 z x 0 fA Q vt CC .0 o) _ ttt j Cs t' O V CO t 2 trs z F. c «- o o w < to rn m Ul o Q a us r `z � z o Qo srt as o 1 w t�' CC o h- z Wus > k Uj -Az d m e a o a N ao aaa .4 0 t. 7 0 W y zoto Sull—asmT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name / s/�/e!� � �•��(f/Q Corp. Address Do.k r=O/_ _ - S ( Partner. Firm/Co. Business Telephone: (0 0 / // ' Name of Licensed Plumber or Gas Fitter Y,S k 5*4 01�c --Ae— Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q 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 coverages. Signature of owner/agent of property Owner 17 Agent M I hereby ccrtiry that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under"Permit isseed foz this application will-be in compliance with elf pettlnent provisions of the Massachusetts State Gas Code and Chaptes 142 of the Cental Laws By TYPE LICENSE: lumber Title F,..a sfitter Sig ature of -Licensed City/Town: ster Plumber or Gasfitter ourneyman J,* rV 3 P APPROVED (OFFICE use ONLY) License Number ,-. To Date...... .. / ..... _ 798 A NORTH TOWN OF NORTH ANDOVER Of �.to ,e 1tiQ o PERMIT FOR GAS INSTALLATIONS cu« ,SSACMUbc Y7 This certifies that . . . . X has permission for gas Inst lation . . . . . . . . . . . . . . . . ti. Q in the buildings of . . . . . . . . . . . . . . . . at . . . ,�r ./ L , North Andover, Mass. Feel2,•. --,.-Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WHITE:ApplicP / 3/G GAS INSPECTOR WHITE:Applica CANARY:!'BBuildin ept. PINK:Treasurer GOLD:File Location / 14 S-r— No. Date �oRTM TOWN OF NORTH ANDOVER f • O� 9 Certificate of Occupancy $ #1 'Argo�� JSA stt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # U 15163 1" Building Inspector TOWN GP NORTH ANDOVER BUILDING DEPARTMENT PPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING UILDING PERMIT NUMBER: Cp DATE ISSUED: / r C [GNATURE: AA (Vln� Building Cominissionerfl for of Buildings Date z GCTION i-SITE INFORMATION 1.1 Property Address: 1.2. Assessors Map and Parcel Number: Map Number Parcel Number � `t 1.3 Zoning Information: 1.4 Property Dimensions: nin Distrid Proposed Use Lot Area Frontage fl S BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired. Provided Required Provided } Water Supply M.G.LC.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System .lic ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ ..i ;CTION 2-PROPERTY'OWNERSE[IP/AUTHORIZED AGENT �7 -Owner of Record me(print) n Address for Servi 7` Deo naKre Telephone Owner oirRecord. ame Print Address for Service: iature Tele hone MON 3-CONSTRUCTION SERVICES Licensed Construction Superviso : Not Applicable 0 V. rased Construction Sypervisor: D License Number ress Ji 0 /�W, T r Az q '76 &6 1-7l 0(aExpiratin J at� atu Telephone 2egistered Home Improvement Co75" for Not Applicable ❑ �n -�� ,�4 2�� 6, pany Name g Registration Number 13n' "ess mamm Expiration Efaie ttur Telephone 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.......0 No.......0 SECTION 5 Description of Proposed Work check aN a licable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be .,E ,> , Completed by permit applicant 1. Building /bbb (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee(a)x 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 j Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION /�- i I, G�: ,IJ ! ,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 eve � Print N kL I — 1-1Av--101 Signal of Oent Date will NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvlBERS 1ST 2ND 3 SPAN DIMENSIONS OF SILLS DR\4ENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION 41 THICKNESS SIZE OF FOOTING J 2. L_ X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND i IS BUILDING CONNECTED TO NATURAL GAS LINE FF rQ� 108-110 High Street North Andover,, Massachusetts Buyer: Kevin and Jill Smith Jay and Judith Farrow Scale: 1" = 40' February 25,1982 h fes,- A, O.r, 7; flew *_3W6 aAll. 1110 >� �t Y NOTE: This is not a survey and is to be used for mortgage purposes only. N.8.- Do not use offsets for establishing lot lines for the erection of fences, walls, hedges, etc. I hereby certify that th bu11&1 on this property is located ,as shown on plan and compli with the zoning set back requirements of the o North Andover when I constructed. I further certify that the above property �� r .q i�C� is not' located in a Flood Plain Zone. CYR ENGINEERING SERVICES, INC. 300 CANAL STREET LAWRENCE, MASSACHUSETTS ;rx''' r pt �� r 23 Pot€ - S lint Al Qh T'b'�� co� NORTH Town of over 01' No. of 7 ........ ...... .. -_ C" O� CoCHIC L dover, Mass., ADRA-rED p•PG,`�5 S H BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........ `e.v.l.a.......... c+ ?..v±'Zl................................................................................................. Foundation has permission to efeet....F`e.�p �A .`.`..... buildings on ...... ......�.....�"�.....��...!�!.........�.�`....................... Rough to be occupied as.......L►. . .. ......... mNC.. ... V. ..... ....... .0.' ................. 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-Lawsrel ting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �-3��3 S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION SjARSELECTRICAL 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 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.