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HomeMy WebLinkAboutMiscellaneous - 11 MONTEIRO WAY 4/30/2018 (2) 11 MONTEIRO WAY J� 210/060.0-0130-0000.0r I I I I i ' I i 1111��14. Date. . . ..... .. - . NORTH TOWN OF NORTH ANDOVER O � P • PERMIT FOR GAS INSTALLATION �9SSAC HUSE�Ay This certifies that . . . . . . . . . . . : . . . . has permission for gas installatiori�/. �� . !�tr�lf� / .r.', . . . . - i�!/j r! in the buildings of . . . r. - �. . . . . . . . . . . . . . . . . . . . . . . . . . . at /.�`:,1 �.��� lJ . . . . . . , North Andover, Mass. Fee. . Lic. No.. . ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 � GAS INSPECTOR Check# i 4683 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) VANy e 2 Mass. Date I to 2004 7 Permit # Building Location Oner's Name 'I "MOS O /n �ype of Occupancy S t �� N c 2New p Renovation ❑ Repl e / Plans Submitted: Yes❑ No❑ N Q W 0 N (A t1 z S 0 N Q Q z N h Y S h W J N. W Ch V m h S Il VCC Z O .WCC 0 t ¢ Q f W < 01 N h y W C a C r h Q W z V W = W < CCo ry W h J < Z Q Q Q W ~ rrr •h' = h z < W J < C r r N Q >_ 0 h U, 0 IN SUB—BSMT. BASEMENT ' 1ST FLOOR TND FLOOR I 3RD FLOOR ATH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR BTHFLOOR InstallingCompany Name STARK&CRONK PLUMBING&HEATING Cteck one: Certificate Address 308 MAIN STREET,GROVELAND MA. ®/ 2486 C Corporation 0. Partnership Business Telephone 978 372-6981 0 Firm/Co. Name of Licensed Plumber or.Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes O No ❑' If you have checked Yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy ❑ Other type of indemnity❑ Bond 0 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. Check one: Signature of Owner or Owner's Agent Owner❑ Agent C1 I hereby certify that all of the details and information I have submitted(or entered)in above application are a nd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit' for this applicatio 'll be in compliance with au pertinent provrsrons of the Massachusetts State Gas Code and Chapter 142 of the n WS. By T of License: Plumber gnature sed lumber or as atter True fitter 11027 er License Number City/Town Joumeyman APFFCVED(O I S N 1 BELOW FOR OFFICE USE ONLY PROySS INS�PECTONS FINE L !%SSP 'C TIMNS SKS s- .,_....,��..._., .,..._. FEE - - -- ' NO. APPLICATION FOR PERMIT TO DO PLUMBING . NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE - 19,..._._ PLUMBING INSPECTOR Date. �f . . . . R ".OR':��o TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING �,SSACHUSE� This certifies that 4, . . . . . . . . . . . . has permission to perform . ./�.!. f.!_f.1.. . . . . . . . . . . plumbing in the buildings of . . . . at . / . . Y /. -!: �. . . .i �l. 4-�� J North Andover, Mass. ,If 1 . Fee. . ...:/. . . . .Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . / PLUMBING INSPECTOR Check .N �( �� t 5 ; 4 � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO.DO PLUMBING (Print or Type) N �W Loy e(Z _ . Mass. Date 3'/1- ,zo04 Permit Building l.ocatlon ` th 04et's Narm��J9, k G tv eiz..� w S4 r `hype of Occupancy ±E= S —P_s�, . vc e New p Renovation ❑ epha4cem4 plans Submitted: Yes❑ No O FI)CTAES z _ a o, z97 Ui - OW r<- W ¢ S ¢ a Z O 2 2 q a 2 .J to a a t V lu ¢ Y < 40o. d }' v ¢ m a Cr o < — < 3 x = O O C < .� 2 < W O < a = ¢ d ¢ O tL � Z = Y 0. O r- < Y < >L u. Y W < = Y 1- O a a 2 q F' Z O O as = z .W O V 2 < < S < < O < ¢ ¢ ¢ < O < F- x -+ m w o a 3 = r q. v n < 3 c m o Sun—BsMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR . 6TH FLOOR 7TH FLOOR 8TH FLOOR STARK&CRONK PLUMBING&HEATING Installing Company Namcl Check one:. Certificate Address 308 MAIN STREET,GROVELAND MA. OC'oiporation 2486 C ❑ Partnership Business Te)ephone 978 372-6981 ❑ FumIco. Name of Licensed Plumber " >i 7 G va, INSURANCE COVERAGE: • 1 have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 141 Yes ❑ No D If you have checked yes, please indicate the type coverage by checking the appropriate box i A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licenses 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 Check one:. S+gnature of Owner of Owner's Agent Owner ❑ Agent❑ 1 hereby certify that WI of the details and information I have� fitted(or entered)in ve application are true and accurate to the best of my knowledge and that all plumbing worts and installations under the perm• � moved for this application will be in compliance with all Pertinent provisions of the Massachusetts State Plumbi a and Crapter a General taws_ BY gnature of sensed lumber TrUe Type of License:Masse Journeyman❑ City/Town 11027 APPROVED(0 NC USc ONL Ucense Number t BELOW FOR OFFICE USE ONLY PROGRE``S 114SPEC�5 FINAL INSPECTIONS SKI:T�t1lE$. ... - FEB APPLICATION FOR PERMIT TO DO PLUMBING NAME i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER P"-RMIT GRANTED DATE • �PLUMBINO 111SPECTOR Location No. -5 Daten �O�TM TOWN OF NORTH ANDOVER a • • ; . Certificate of Occupancy $ ss�cNUsEt� Building/Frame Permit Fee $ Y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #� G "Building Inspector/ i U TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE IS SIGNATURE: Building Comtnissioner/12g=tor of Buildings Date SECTION 1-SITE INFORMATION I O1.1 Property Address: 1.2 Assessors Map and Parcel Number: G ro L✓a L4L�-/,Q CSD Map Number Parcel Number O 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 v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record 14 14 le a L1, ma H �_e 1 t � f Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: I v 1c7 l-i.. q I file 14 �:e� ry �Q O Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Fce,Lc, ,,4 L. 6'(r 1eS Licensed Construction Supervisor: 6 /? O License Number oZ�a / ,�ivr S7� n , ov�J— Address q - /0 Expiration Date Signature Telephone 3.2 Registered Home Improvement tractor Not Applicable ❑ v I\, a karrd J. Gi .t Company Name /QQ, M r� t-f 0 Registration Number r Iv' Address Expiration D[P at /1 Signature Telephone V N SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 256(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 buildin permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: c � In r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Q60 p d Multiplier 2 Electrical (b) Estimated Total Cost of 6-0 b 0 Construction 3 Plumbing p d p ® Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 5'© Q O Check Number SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT u h c as Owner/Authorized Agent of subject property Hereby authorize R1 p�61 rzA &I rs to act on My b is f;in all ma s relative to work authorized by this building permit application. Si ature of 04ner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, S 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 S,gt2LEY F'u�4 Print 1jame Signature of 0-kneWA14 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1 sr2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS 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 NORTH t F Town of R over 0 kSOO 4 _ o - dower, Mass. ' �rlol� COCMICHEW9 V oRA TE D p'9 C) `7 H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �' Foundation ......... .......... .........�............................... has permission to ere ........ ..... b d' gs on.//......... .. ... . �.....�.... Rough to be occupied as.... .. 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION SyaT0 ELECTRICAL INSPECTOR ............... Rough ......................... Service BUILDING INSPECTOR Fina( Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 62111 WonTers'Compensation Insurance Affidavit Please Print Name: f`t G�Ct V-4( Location: // AD 4 t Y'0 Wo L4 City /Vn , Ahv-ev, Phone'yl*) am a homeowner performing all work myself. �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 Cites Phone#. Insurance Co. Policy# Company name: Address City: Phone# Insurance Co. Policy# FQilure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under�pains and penalties of r].0 that the information provided above is true and correct. Signature Date Print name tt a �'� �. lot l Phone# f Official use only do not write in this area to be completed by city or town official' F-1 Building Dept ❑check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person:_ Phone#- r-1 Health Department Other FORM WORKMAN'S COMPENSATION Town of North Andover o� �o DT#1 a, Building Department o 27 Charles Street # _ North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 40"""""al'" R�TlD pP 5 9SS�CHU`��� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the 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/at: qr/C ,5 C1e4r7r� SerULC F cility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. �, '`.! ✓�� �`Jammn�zrueu��t of�ll����uael�i ? , BOARD OF BUILDING REGULATIONS AA License: CONSTRUCTION SUPERVISOR Number. CS 034317 Birthdate: 04/16/1952 1 `i Expires: 04/16/2002 Tr.no: 22064 Restricted To: 00 RICHARD L GILES 240 ANDOVER ST ..... N ANDOVER, MA 01845 Administrator 3 1 j� j i 1 3 r I I —--- 269 1601 361 511 722 _ 98, 74 a — -- 24' 101 16 �� W 6L W2436 W2436 36R , 36R CATHERDRAL CEILING ;DISH. 24; B3D21 ; BR33634 171X 8- \ g,,!' / 10 4 1 12 ( .mow i� =� - - ,-�-. i✓ CEILING HEIGHT-90 3/4�� �. 61 D' ' � � 903 HAN GING HEIGHT-89" 90 ' i ' _ SOFFIT-3" SCRIBE MOULDING 27D , WITH 3/4" CROWN MOULDING N CO TR , 34 C H D BROOKHAVEN it CABINETS F 41RFIELD DOOR STYLE B1 D; , 3DX COLOR—COUNTRY ON M LE S 27 5 1 it DOOR COLOR—CIDER ON MAP E �/ 13 �B_ _ WOS PULLS—NONE—FINGER GRIPS N-DOOP& , - - - - - - ' f C�DUNTERTOPS TO BE DETERMINED 413 •"5—L gi D;I�i it 1 :SPACE FOR SUB-ZER r.ln-rF-M��n A �tit"T " - " 12:48" KANUt 34 36" WIDE WALL FILLER HEREyJ. 84" HIGH BEST HOOD ABOVE ( - -- - - DOOR PANELS BY O T H_lS ~ ' 5:2-ROLLOUTS , 61 D; 13:TRAYS j 1174 31F .t 1174 u:2-ROLLOUTS PIGEON40LE ABOVE 34 �2-EXISTING MICROWAVE ON SH.ELF 241/2., W; 1�` `71 j 14:0PEN SHI:L t= CABINET - - - - , 18" D_ r' . ._4ZY SUSAN fq!f": t" L t `•4 s . 1 Date. JU � s NORTH TOWN OF NORTH ANDOVER 1-?Obe..ip ,e,ti Op PERMIT FOR GAS INSTALLATION ,SSACHUSES This certifies that . . . . . . . . . .. . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . i has permission for gas installation . . . . . . . . . . . . . . . `in the buildings of . . . .m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . //. . . . . . . . . . . �'`�� 1�: . . . . . ., North Andover, Mass. Lic. N . . . . . . . y�9d GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MAP u v W PARCEL MASSACHUSETTS UNIFORM APPUCATON FOR P DO GAS FITTING ,•,A� Sveb (Type or print) Date 3 `'-n 19 00 NORTH ANDOVER,MASSACHUSETTS Building Locations �� m©� R� W Y Permit# Amount$ Owner's Name S4 C, New❑ Renovation Replacement ❑ Plans Submitted ❑ � w z c QF a z = o z 9 m m F a O O O w H U W = Z F O O w Z Q > d F C d O O O w O F e a m o m 3 c 0 u cc > c a F o SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 1 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 51t H . FLOOR 6TH . FLOOR 7TH . FLOOR b H . FLOOR (Print or type) one: Certificate Installing Company Name `f AEZ lC -k CR c>NtG Corp. ! 3 '� C Address X,N S ❑ Partner. l?`IOV�' LIaN� I� Business Telephone C�-2 ,3 7 A 6 rer/ ❑ Firm/Co. j Name of Licensed Plumber or Gas Fitter �eiruho L� 1'1(o d 3 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q..— Nor—] If you have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S to Gas Code and Chapter 142 of the General Laws. s By: Signature of LicenPlumber Or Gas Fitter Title ❑ Plumber //aa City/Town ❑ Gas Fitter License Numoer ©.. Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date....2 /- u A/ 40 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...... 61 ................................................ has permission to perform ...... ..........') . . ............................................... M wiring in the building of..... 0.`.:!..`.j.............................................................. -,-N6rh Andovk �ws.at........ . ... ........ ......... .... 11 Fee...... o. Lic.No...... . .. ... .. . .............�z :ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts lQt�h��4/J1 0 Pewit Xo: Department of Public Safety = Occupancy d Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code. 527 CMR 12:00 C (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of A lone t/ To the Inspector of Wires: The undersigned applies for a permit to perform the 4lectrical work described below. Location (Street & Number) LL// l r/ /uo ly l�lf./ /�Q I-V 4 Owner or Tenant `7/�'�y ,C-� A0 Owner's Address `' Is this permit in conjunction with a building permit: Yes 3� No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization NO. _ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity l Location and Nature of Proposed Electrical Work j Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Abode❑ In- ❑ grnd. grnd. Generators KVA No. of Receptacle OutletsNo. of Oil Burners A No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heat Total Total Pumps Tons KW No, of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices A Municipal No. of Dryers Heating Devices KW Local❑ Connect ion❑Other No. of Water Heaters KW No, of No. o Low Voltage Signs Ballasts Wiring C No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES E5-1 NO ❑ I have submitted valid proof of same to this office. YES[ —NO ❑ If you have checked YES,-please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) T9�"7` �a !S ( —0C Expiration Date Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME ' /1 LIC. NO. 7 Licensee ' T Signature ` � LIC. NO. Address �01 WOPOC/,� lam® �/0�(/, Bus. Tel. No. ' Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit app l ation waives this/requirement. Owner Age (Please check one)) /} /S �60(k `v d/ ' TelephonnNo� Y' /�(�Q C'7 v_ PERMIT FEE S �✓ Signature of Owner or Agent Do Not Write In Here CA For Electrical Inspector Only 00 m r- m M Street and No. ............................................. > z Name ........................................................... Electrician .................................................... PermitNo. .................................................... Comments .................................................... ...................................................................... Location Z/ No. 0 Date woRTM TOWN OF NORTH ANDOVER 41 Certificate of Occupancy $ Building/Frame Permit Fee $ ^F sACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # pa 3671 / Building Ins6ector s TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: Q ic SIGNATURE: d1n Commissioner/1r of Buildings Date SECTION 1-SITT INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: CSC 0 ()1,30 Map Number Parcel Number IV- &Jauv r .0,6 � I-/3" O 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 W&ter Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record h"r(- y Gnf e i 'ltv i4- W Name(Print) Address for Service: 4-y - a31 0, Signature Telephone 2,.2 Owner of Record: Name Print Address for Service: O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: /6/! 6 8 License Number mn Address 6 — (3 Y— ® O Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 16kour C OV10 , Co -'vtc . /� � 6�a Company Name M �fW{m �� 0,3 Registration Number r Address y 60 , "O`1 Cj— 0 0 60 r 6— 0 z Expiration Date ` ^ Si nature Telephone U/ 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.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s)�as Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ' Brief Description of Proposed�Wo*- ,t Si o F - U 1,10 A C ou Fad cc2,,e r r>Q,a e ` , N--fw SECTION 6-ESTIMATED CONSTRUCTION COSTS Item � Estimated Cost(Dollar)to be OFFICIAL USE ONLY eZ5 000 .5 d Completed b permit applicant 1. Building (a) Building Permit Fee ';�Si o a 0 '0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 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 19 -7 to act on My be�i!i' ergr uthorized by this building permit application. Signature of Owner Date j SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �/�1(� �� I�/ {�1/Yl D4 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 rk : ) ple � Print Name -rr�n �' . �a Q Si ature o Owner ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR Tl1VMERS 1 2 ND 3 RD SPAN DIN ENSIGNS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of Aindover 0 No. 0Q 0_ LA e dover, Mass., CHICHEWIC IT 0'�ATED P9 BOARD OF HEALTH Food/Kitchen PE T .T D Septic System THIS CERTIFIES THABUILDING INSPECTOR 9 Foundation has permission to ore ... ..... ............. ............ uildings on ....&........... ... .... .. . ... . ... GV ... . ..................... Rough tobe occupied as . ......... ..... ... ... 'k*s*'h*'a I res .....................................I........................ ..... ...... Chimney provided that the person accept' his per conform to the-terms of..the,application vdflewin� this office, and to-the provision the Codes and By-Laws rel In to the Inspection, Alteration and Construction of Final 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 Rough ................................................................................................................. Service BUILDING 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. s F N� !MPRO ElIENT SON R TOR%, z ;s Re iiiiation .101687` ETXPePRIVATE. CORPORATION ON oa ,UnVOO :BROOKS CONST. CO.'! i?iCC Qf LA # Mak OiRral ���.M. BROACitRY'STC i �, • 1-800-427-0260 508-686 0260 603-8 94-4488 e rnk4 to n t;f gnp- nzs�?s l"f4c.v -C�hiriev-�ung 685-2-310 job-1 I Pylonteirc k/YaY Ncl;h Ando -, M-A 011 845 ----------- -- ------ PROPOSAL All home improvement coi-!CtO(s and subcontractors angaged in home-I- anprpvsr-nient contracting,Unfess spec ifitally exprnpi I I rcr,,ti�qistmtiorl by Prov!sjoris o,Chapter 142A ofthe genera!laws,must t�repiticred,,i h Onwea rnm ith 01 Nta j inquiries about rogiatr.Ition and status Should be made to the Director,Home improvement Place,ROOM 1301,Bo ton MA 02108 (617)727-8598 Contract Registration,One A Silbuft'Dri A SPECIFICATIONS Apply V Z 1�6 j ov&r L-Iji ra id areae hnu_c to be=104d undef vinyl Typs of 1n,,:,u! tiOtl VhVI J Champ;to be nsl-all�d Aroufl-d a"wirdows and doors. Govor LAI! WO nw Ol,".o c'Pcov.red nwhiii-atlim.; Lim- it , ---k, 4 r LL .-I-- L, Ilan-lys not covered Or Installed: als I VAndows--ramo-si for VJ fz :3 Inside 2>Vindow Si'l,; -1Trim $hulors Q/&onql ;1:1--Cows '_j Pool Wwk J, a w,JJll 1LI"'QIi- �j, A�Ic­-1,:- f in,"xT,1�.,l -61,191�rc,lr�, jj� C:T 6QO��Q--330 �t .a! V 6xi A, %�h Propose t-erciw to lurn-h-, ll and 1;abol cof-p,eie in accccrflance at,44--sflecd--ations.Ine ifle,;Un:al A SERVICE CRARGE OF 17 OF THE UFAIeriD BALANCE PER PUM WU BE AMD TO BALMICE IF NOT PAID-ACONIM.-TO-1E1Mff OffRACT-DR-MR-EETIM-]OF�CSR 49— Windows-Doors 25a N-Broadway-Breckenridge Mail 16 el Salem,NIK 03079 (603)894-4488 o-De Of"vat W-20*'th.s ont:act, ;SUd a ALF D--Dj---P-RJ[flA.— --R-JE d, 01'PpLi�!r'�Clal A=2-414 13t�'e 10 Orde-,�ML0' W"IM dal: by wnj,;�,r_ (I o Acceptance of Propose! - -Im tll* inat ttwr Fq,: -;, V� ,is tr.1lisactinn at any time prior to midnight of the third business day after the date yoti,ttjf�t auy,��r,q ,iay cancel In this iransaction,Cancellation,must be done in Writing. 00 NOT SIGN THIS CONTRACT IF THERE ARE Af4t BLANY SPACES. O-Y-1 ---Ell 1714FORMATiON 0,14 BACK�- + I �.��R ;`!I, ! A�:' CE ..'.: Dare+N" r :... _.... .,.aRaccclv.l .. n2 1i,aQ � T)�))S CERTIFICATE IS MUM R hIRTTEfi OF INFORM ATtON "f^ ONLY AND CONFE=RS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,F-XTENO OR j Davis b Moody ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. { •.I 4ii 125 COMPANIES AFFORDING COVERAGE ;-:Ikr.,tow NH 03865-°° COM?ANY A Merchants Mutual �a,c, 603__382 9354 F�cHo� 1603-3. 2-7786 _. ----• �_..__._ — .. IGONAPANY 'COMP/AY C Firooks CoagtyvestieTa Co. , lne' j 1 -- 2SA North Hroadway J~ANY Salem Nil 03079 ! D TION Of ANY CONTRACT OR OTHER DOCt1 MNX TN RESPECT TO WHICH HIS -NIS is T O.NOTWTHHt T THE 3 ANY L� [�TEEM OR COT�4 POLICIES DE5 INSURED NAdtt:C1 ABOVE FOR THE POLIO PERICO TJI PACNES<,'. Tals Is 7O CERT THAT THE POi.IC'18S OF iNSv1tANCE Lls'rED gF4OW HAVE BEEN ISSUED To Ili (,E Fr KATE MMAY Be ISSUED OR MAY PERTAIN.TNI"INSURANCE AFFOROEQ!!Y TFIS POLI CRMEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ARIDCONOTROi't6 OFSUCH POUdES.LI M ITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAMS" _... ' POUCY EFFECTIVE T"OLiCY F,(pIRAT1ON I-MRS TYPE OF INSURANCE POLICY NUMBEh DATE 0AMA7DJYI'1 DA i Ea(MMNDNYI CE-NC-AAL AGGR_E*ATE s 2000009--- . t:I+,lra AAL LIA69 rtY UCTS-COM n<I 28 99 Q4/28J00 PRODP/DPAGrb S Q004000 - -= I. X _a_nMMEaC4+LCI[;NER.ALUAWTY GCp6145521 ( , PERSONAL4 AflV1NA/RY S 1400000 �- .) �._._ ... OCCUR(LAarsMAOE + EACH OCCURRENCE $10000 I.._.., OwNER'SaCQNTRACTOR'sPROTi] DAtaACtEEN+rensnn) s 50002 { .. _...�.---• { IAt1J 6xF(Aeyare penan) i 5008 =+UrOn oettLE LIAOILIT( CCMSINEO SINGLE LIMIT $ }ANY AUTO �4 4y AIL OWNED AUTOS g�pemn)rFY = j (Per person) r. CHFOULED AUTOS HRED AUTOS J BCDELY 9 Y i {)p4DN•OwNEO AUTOS I PROPERTY DAMAGE S AVTOONLY•EAAGCMeNr i CARACE UAWLITY {ANY AUTO ` OTHER THAN AUTO ONT.Y: - CACH ACCIDENT $ i AGTlREGA16 f y MESS LIABILITY EACMOCCURRENGE $ AGGREGATE S UM(4RELLA FORM - I = y�ATMER YHAN UD48RELLA FORM � _ X 'DTA S O�. wORRERS COMPENSAMN AND It�i " F�IPLOYERSLMBtRY FLCACHACCIDENT $10000_0 �H[:aRI+IR>EIOW X tNCi R14SS19 ' 05/15/99 05/15/00 ELOISEASE-PoLivruNitr $500000 '" 'rgahlC�2Slr=%6CUfeVE OFFICERS ARE: MML EL DISEAVE•EA EMAPLOYEE s 100000 I i Nim"�ICNOFOPFJtAYiOfV6ILOOAtIf7N8tHEHiCLESKPem aIrTEIAS ' 1 �';:_?.l1FttiA?T�,F'tOi.{)i*R :s'3.,:. ` .a;-, .�..: .` . ... t`,rf��(�•��;l'IQN�.. .. . .., i.'.. .... " �-�. . � . . AROCO O 1 SHOULD ANY OF THE ABOVE DGWRr6E0 POUCIES BE CANCELLED BEFORE TME EXPIRATION DATE Tt•IEREOF,THE W%HNG COMPANY WILL ENDEAVOR TO MAIL PRESW I n RTITSN NOME TO TME CERRFICATE HOLDER NAMED TO TRE LEFT. MI rl' L A LL"M TD AR sur>t Nl7RCE 8.4ALL POSE NO COL.IC30 MOA LOAM 50 ALBZON STRUT i METHUEN MA-01044 ANY KIND ANY, S I A Nth TIO $ P 'GC3 ',C ORLt A D R ..rE.v r:3J::•� •J... R 1. C 25-.SS't . { MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print r Type) _ fir, Mass. Date 9^� _ tuilding Location S e Permit # 7b � . 7-7O ers N e o �- 41 • Y • New ' Renovation �J Replacement Plans Submitted D FIXTUREC rn . � W N _ ¢ as v a t¢-• � H ¢ N ¢ .p = .0 = �• us us m ua v m x to o ulG1d tII N N 9 tZ O O tu O W t. W_ 1tt M CL 4 to W Z ol C3 V tu of W ac ¢ G y> x Ul W0 as „s a tz ¢ a ¢ w W U c� W ¢ w a 7 � Z d W J < Cc �' y- t/! Cn O 2 O N S > C W 0 2 4 G d C O O W — O W L— SU&—BSTMT. t BASEMEMT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR 8TH FLOOR (Print or Type) Check ne: Certificate Installing Company Name ANDOVER PLG. & HTG. CO. INC. Corp. 1051 Address 5732 SO. UNION STREET Partner. LAWRENCE MA. 01843 Firm/Co. Business Telephone: 508-685-8383 Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the 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 coverages. Signature of owner/agent of property Owner u Agent 0 1 hereby certify that all of the deLids and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that iL1 plumbing Worst and installations performed under Permit issued for this application will be in compliance with all neat provisions of the Massachusetts Slate Cas Code and Chapter 142 of the General Laws. By TYPE LICENSE: Z I Plumber Title Gasfitter Signature of Lice ed City/Town: Master Plumber or Gasfitter Journeyman 6739 APPROVED (OFFICE USE ONLY) License Number lDate. /... ........ 1776 ' HORTM TOWN OF NORTH ANDOVER i pf ..ao ,e 1ti o? ' PERMIT FOR GAS INSTALLATION` i • ,SSACMUSE� 7 1 f r� This certifies that �'.'. . . . . . . . . . . . ... .: . . . . . . . . . . . . . . .. . has permission for gas installation . . 1-i . . . . . . . . . . . . . . . . . . .M. 9 in the buildings of . . .l i, , . . . . . . . . . . . . . . . . at !/. . . . .. . . . . . . . . . . . ` . . . . . . . . . ., North Andover, Mass. Fee. .4- —. . Lic. No.i! .�. ,. . . . . t GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File