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HomeMy WebLinkAboutMiscellaneous - 115 ANDOVER STREET 4/30/2018 1 DOVER ST 210/059.0-00140000.0 I i I II I f ,i I SII h i i i I I V I it I y 5 / 2 Date..�l' !5.�, D .... NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTAL TION ACHUSEt h This certifies that All 4?"4f.4,* �O has permission for gas installation . lig!IUA. . ! . . . .. . . . in the buildings of . . .� � ?,!�+5. . . . . . . . . .. . . . . . .. .. . .. . at J-6. . .�f�!!i1vll� tr' `- �y!(: North Andover, Mass. I Fee. Lic. No.. . �? , 10 .. . . . GASINSPECTO�00r Check# "YIASSACHUSEM UNUDRtiIAPPUCATONFOR PERtAWTO DO GAS FMING (Type or print) Date 9 NORTH ANDOVER,MASSACHUSETTS Building Locations �,�J !/L�n l� t`/�" L Permit# Amount$ Owner's Name � � New❑ Renovation ❑ Replacement Plans Submitted U MH 1 a O U as x 9 O a O IN� tW7 H H C4 W OF A H a c'1 0a 04 r'n SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4T 11. FLOOR ( 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR •a 8TH. FLOOR (Print or type) D ,�/ Check one: Certificate Installing Company Name. It �ig/ d�J �� !7 Corp. Address k r 4t�!'� Cl/t Partner,. Business Telephone 710 ) 77 Firm/Co.- ,Name irm/Co:Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. yes 1:3— No 0 If you have checked yes,please indicate the type coverage by checking the appropriate.box. ❑ Liability insurance policy �/ Other type of indemnity Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1.12 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 1:3 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• hest of my knowledge and that all plumbing work and inst tions i foi'niecl un<ler Pcsrnit issued for this application will be in compliance with all pertinent provisions of the Massae s.6s St: .. ;as Code a d Chap r 143 of t 'encral Laws. i gy. Signature of Licensed Plumber Or Gas Fitter I Title Plumber Cityr Town Cas Fitter Ic ense i um Taster 1PPROVED(OFFICE USE GNLY) Journeyman NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SSA U This certifies that ........ ...... ...................... . ......... ... ....... .... ... ..................... ev has permission to perform ...........Z-0.............................. .................................... wiring in the building of................AA.............L.Aj-...e70.1V.E.5.9.e- ........ ... ........ ........ ..... .... .. .. ...... 15- W4"401/6F)z - at.....................................................................5.... .r. North Andover,Mass. Fee..................... Lic.NA. . .w. l . . ...............--4 . ..... . ... ..... P. ELECTRICAL NS le . ...... Check # 7909 CFr ' � Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. UVOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. t/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: , ZI Z 7*07 City or Town of: NORTH ANDOVER To the Inspector of Wires By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) I (3 — ( 15- A VL An t 1-e� Owner or Tenant—Ty p j f K In A r e l L 4 7p u A e559! Telephone No. Owner's Address G Is this permit in conjunction with a building permit? Yes ❑ 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 Location and Nature of Proposed Electrical Work: 'RE— FEE p DEC Completioln of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners N-07 0j, Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Sel- onuined __ ....._........_...........__...... _. Totals: ." ...... ..... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Monne cioln El Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent No.o WaterNo.KW o.of No.of Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirmg: No.of Devices or E uivalent OTHER: It Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE --BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Iva rot/oh<2-- e-c,- !pic d t LIC.NO.-.Jj U 6 qJ Licensee: Signature LIC.NO.:N1 (If applicable enter'exempt-in the license numb r line.) �7—u ��7 �� S�Y`eP Bus.Tel.No. Address: (O d W t rir I�C'.S Alt.Tel.No.: Fll— r 0 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by lave-. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ j ,5.�, p i �� 4 I uN \�, AWN OF NORTH ANDOVER NpRTh APPLICATION FOR PLAN EXAMINATION 1 � pf�.��� •;'�e Perm N0: . + Date Received �'�� +► +� Datlegsu �.J �.�ss"+n• . IMPORTANT:Applicant must complete all items on this page CN �� hf[oy�✓ �.� Print RO TY OWNER Print MA. NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑ �/addition rwo or more'family ❑Industrial Alteration No.of units: Repair,replacement ❑Assessory Bldg ❑Commercial YDemolition ❑Moving relocation ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED �L +JL� IMO� t,d� �Ll�if re. t Identification Please Type or Print Clearly) OWNER: Name: ! I rK 5��r S o I�y S��yG�;o� Phone: 16' ��7��-1W X 66f Address: — IS CONTRACTOR Name: L .,`5 L Phone: q 7�-—3 7S--057� Address: � 7d ES r, -iL f3, /S —I5 3 D Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 1*4 ARCHITECTIENGINEER ',J �Y �� *ame: Phone: r Address: Z � Reg. No. V,f3 FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.005F THE TOTAL ESTIMATED COST BA D 0Yv$�1 ZS.00 PER S F. Total Project Cost :$ , 0 FEE:$ Check No.: /3 Receipt No.: Page W4 4 i TYPE OF SEWERAGE DISPOS L Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/OwnerSignature of contractor Plans Submitted F1 Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ ❑ I COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT -Temp Dumpster on sit yes l no Fire Department signatureldate I COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water& Sewer Connection/Signature&Date Driveway Permit I P� Beg.Na Name Address Meter Na Size Type Date when Installed DATE REMOVED REMOVED BY CAUSE OF REMOVAL DATE RETURNED 148" _ i 24" - 30" 3O" ' - 30" :" ir0i To 36 335i i Ts , 18" �� � — i 3 ;' 30" - — o W3030 W3018 M W3030 W3315 i N N N p \I ? . 1r-T� O B18LST B30ST 3A-REFJ 0)J - 2"—fes- 28"— i cV M f IN 0�0 _ co N N � I I� O C, I M T � r m All dimensions size designations given are Q This is an original design subject to verification on job site and ZO 0C gn and must not be Designed: 8/7/2006 J TECHNOLOGIES) released or copied unless applicable fee has Printed: 1/24/2007 adjustment to fit job conditions. been paid or job order placed. • e D i i MCD07RIM net total: $2,151.69 Quote total: $2,151.69 Quote net total: $2,151.69 Other information Volume: 118.75 Weight: 708.00 I I Print date: 1/24/2007 Page 4/4 NOTICE NOTICE TO TO EMPLOYEES / EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900-http://www.mass.gov/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30,this will give you notice that I(we)have provided for payment to our injured employees under the above-mentioned chapter by insuring with: i LSCC NAME OF INSURANCE COMPANY 10 New England Business Center,Suite 303 Andover,MA 01810-1024 ADDRESS OF INSURANCE COMPANY WC 000148-07 0 1/0 1/2007 to 01/01/2008 POLICY NUMBER EFFECTIVE DATES Brewer&Lord LLC 600 Longwater Drive Norwell,MA 02061-9146 (781)792-3200 NAME OF INSURANCE AGENT ADDRESS PHONE# Trustees of Reservations 572 Essex Street Beverly,MA 01915-1530 EMPLOYER ADDRESS EMPLOYER'S WORKERS'COMPENSATION OFFICER(1F ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers'Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hosptial attention,employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER . I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street t Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Leizibly Name(Business/Organization/Individual): %�,c -/k� Address: E 7oL F 55.E 4 le ieer/X As Ole,l5 i S3C1 City/State/Zip: 01,11's Phone.#: q 7k �t d l- /y�y X !4-6 f Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 1 SO Spo 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g. ©Demolition working for me in any capacity. employees and have workers' o workers'co co insurance.$ 9. E]Building addition [N mp.insurance comp. required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself.[No workers'co right of exemption per MGL �• 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1 s l Policy#or Self-ins. Lic.#: WG 0001 y4r O 7 Expiration Date: Job Site Address: 1-13-4"oho-rr" Srf' City/State/Zip: IV6, ti 4h610 Ac%� O 14s1O Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern y under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: l d Y o Phone#: q75. - q d/- Iq S"f Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants j Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. I The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. j i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext.406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia 3.1 - • of �G„ lu I j z i I a , 117 , i I I i 1 ( { K c ,__� Dcor -6 -nGiz�v.�z civ.._ _ -eA•••• • _a Long Hill 572 Essex Street Beverly.MA 01915-1530 W 978.921.1944 fax 978. 1.1948 www.thetrustees.org i Mr.Brian teathe Town of North Andover 97 b88-9542 Local Inspector Fax{ Mr.Gerald Brown Town of North Andover Commissioner Town of North Andover 1600 psgcod Street North Andover.MA 01845 Re: Brick House Kitchen Renovation The Trustees of Reservations mes Younger.AIA Affidavit of Architect MA License#8433 January 29,2007 Dear Mr.Leathe: As per our phone conversation this am,this letter describes my roll as project architect for the Trustees rofit 541 3 land conservation organization,that of Reservations. The Trustees of Reservations is a non-I am the suff p j � maintains properties across the State of Massachusetts.ed Architectural anarchitect Professional allting Professional responsibilities as described in 780 CMR 116.0 Register services—Construction Control. s The kitchen .enovaticm at 137 Andover Street the brick duplex.;s non-structural and will be completed 1 using Trustees of R¢servation staff covered under workman�s compensation and general liability. Project is non-structural.and does not require the protections of understand that the kitchen renovation pro 1ith this project I Construction Control,but as a C nreChamp'on�%peeler bilTrustsees1of Reservations,as work 1 be reviewing construction with progresses. Thank you for your attention to this matter, Regards' Lr t V, # 's r/ james Y ger,AIA r';. ",•; 7 ' fM �Freaa-h+�'y yi V � � I I I i f l Building Setback( Front Yard Side Yazd Rear Yard Required Provided Required Provides Required Provided / 1 Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA— or department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Created JMC.hn.2006 6 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing,Siding,Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations(If Applicable) ❑ Mass check Energy Compliance Report(If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned)to Include Sprinkler Plan And Hydraulic Calculations(If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL,SERVICES DEPARTMENT:81'FORM03 i Page 4 of 4 Date. .. .. .. i NORTH o� TOWN OF NORTH ANDOVER W. PERMIT FOR GAS INSTALLATION i 's 'lf � ..eo•'� '(y �SSACHUSEt This certifies that . . ;/! . . f . .� '� . . . . . . . • • • • • • f has permission for gas installation .11!� �� . . ��t lr:. �• in the buildings of . .!��� `. . .l? . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. . Lic. No.. . . . . . . . GAS`INSPECTOR Check# 5� �.i6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) lJ0 i2TIN UDO,/6i2 , Mass. Date Permit # J Building Location_ /I� X15 �P /1��k Owner's Name_ gasTr_-ts L:�l �C�-e 42;/ 6007 ,Jck Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Pians Submitted: Yes❑ No ❑ y N � , W N,. N (Jf OC N O z y r= H 0 J Q W O r� Z S Z i.. Q Z Z O } Q m rn F �Q o ° a r- y O W < _. _ z �- s l'- X Q W W V) N W y U W N W Q CC O' Q W L 0 f✓ Z J F- X F. W W O O > LL }- V J W z Q w Q a r H m Z 0 Z Q O H X Q W > W W O Z, Q D: Q0 0 W0� -.S O 0 S LL :5D d J U C^ > p d r O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR It 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARS TON STREET U Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone q 7 b-6 87-- 110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked Vis, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity❑ Bond O i OWNER'S INSURANCE WAIVER: 1 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: Owner❑ Agent El of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accurAte to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will b0n,c6mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ Te of License: Plumber Title 4Gasfitter Signature of Licensed Plumber or Gas albo Master License Number 374-5 y Cit /Town — APPROVED O FICE SE ONLY) Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE _19 GAS INSPECTOR Location el c 'No. _ Date t NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ . L[� •�> _ � ' Building/Frame Permit Fee $ A UEta Foundation Permit Fee $ ` SAGMS Other Permit ie $ Sewer Conr!ct o,Fee $ Water Connione $ TOTAL '� $ 99 �� 4Mullding Inspector iN15 Div.Public Works PER111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. C/3 I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE LOT NO. ZONE ✓'1 SUB DIV. — LOCATION PURPOSE OF BUILDING ort brAL AA OWNER'S NAME #e� ,p ,pro ois NO. OF STORIES 1 'SIZE ®tf A OWNER'S ADDRESS 57 7- o d `l twPBASEMENT OR SLAB Lab ARCHITECT'S NAME -45 /' NJ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME a �5 � n� SPAN DISTANCE TO NEAREST BUILDINGy� DIMENSIONS OF SILLS DISTANCE FROM STREET 12�w ,FTS "' SF. POSTS 1 l DISTANCE FROM LOT LINES—SIDES fah.cWREAR ? !�" GIRDERS AREA OF LOT i . FRONTAGE HEIGHT OF FOUNDATION QttQ1 1_..,E THICKNESS IS BUILDING NEW SIZE OF FOOTING X �— IS BUILDING ADDITION MATER:AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON OLI R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER V-60ARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EBT. BLDG. COST 6 1 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG.COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING Q APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ✓/PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 22-5- 9 w7A S��O fA.V (b& BUILDING INSPtCTOR SIGNATURE 15F OWNER OR AUTHOR ZED AG NT FEE �`� OWNER TEL.+Y ('gar) st 6- yis f PERMIT GRANTED �j CONTR.TEL.# It 2 19 T' CONTR.LIC. H.I.C.# 1 I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B t 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN 3 BASEMENT 11 AREA FULL FIN. B M AREA '/1 y, l/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN I 4 WALLS I 9 FLOORS CLAPBOARDS B � 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDAIJ D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORPOOR r ADEQUATE 1--1NONE $ ROOF 10 PLUMBING GABLE HIP BATH(3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) 1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING ✓ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE li FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 3 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 3rd I NO HEATING NORTFy F own of 0 d 0V.0 No6 19 , . odover, Mass., �� cOcCnE viCK ADRATED PPa,C�CC� 5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ,p r ) j BUILDING INSPECTOR THIS CERTIFIES THAT.......................... ...� S4. •F...b........... , �✓�.•.`i•"•••'••". _. Foundation has permission to erect.........�.ss� l `t�.... Wiidl<ag"n .......r./.. ...-.1../.5....... . ..Nfl.�..��f'�............... Rough tobe occupied as....................................................... /6.. v-0.................. .............................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on fife 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 CONSTRUCTIOWBUI ELECTRICAL INSPECTOR Rough .......................................... Service LDING 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. Smoke Det. NORTH ANDOVER HISTORIC DISTRICT COMMISSION Certificate of Appropriateness This certificate of Appropriateness is issued this 28th day of August, 1996 to Trustees of the Reservation for 113-115 Andover Street in accordance with Chapter 40C of the General Laws of the Commonwealth of Massachusetts as amended and the by-laws of the North Andover Historic District Commission. This will allow a lean-to shed addition on North Side of Existing Barn. George H. Schruender,Jr. Chairman Ka yska Rob rt Stevens Martha Larson Leslie Ho kips cy— a Aznoian Mary Cham si,Alternate Patricia Hayward,Alternate i J7te -eo01'4KZ ' � 47) ;HOME IMPROVEMENT CONTRACTORS REGISTRATION :Board of Building Regulations and Standard._ One Ashburton Place -- Room 1301 Boston , Massachusetts 02108 HOME :IMPROVEMENT CONTRACTOR _ Registration 117802 Expiration 11/27/96 Type — INDIVIDUAL -0fie �aanai:axu cal!/r,o���aaule/r wcl(a HOME IMPROVEMENT CONTRACTOR Registration 117802 WAYNE N MITTON Type - INDIVIDUAL WAYNE N . MITTON Expiration 11/27/96 8 PATTI RD � BEVERLY MA 01915 WAYNE N MITTON WAYNE N. MITTON 2,P/ATTI RD ' ADMINISTRATOR BEVERLY MA 01915 a Or/it -6-;7gn1 lowasealf� o�✓l a iuellt F� Restricted To: 00 G 8'12 0 3' - DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None Number; Expires: Birthdate: 1A - Masonry only CS 031387 07105/1997 0710511944• 1G - 1 & 2 Family Homes Restricted To: 00 Failure to possess a current edition of the Massachusetts State Buiildiny Code WAYNE N MITTON is cause for revocation of this license. Oyu,/ 8 PATTI RD BEVERLY, MA 01915 I � i � - 3a.p I , jp ..... 1 ,.-... , • r ..... .... «. .... A :. :.. .. , __ .-_. ....... ; ; L. I t � t �f :_ .... , , I I q , I i i r.... ff c s .................... ............. .......... ........... 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