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HomeMy WebLinkAboutMiscellaneous - 114 PHILLIPS COMMON 4/30/2018 �` 114 PHILLIPS COMMON 4 210/058.0-0048-0000.0 f -J / I I Date.�&................ 4ORT", - - ;.. o TOWN OF NORTH ANDOVER o o PERMIT FOR WIRING �ate:',: • �, `SQACHUSE This certifies that ......... .....:. . . .. .. 0..................................................... I has permission to performs`1...........:............................... . �a wiring in the building of.....:......... `? `�CA"'' at ..................................I' ...n North Andover,Mass. Fee'l...............Lic.No. ................. ...................... ..............................:::............................ ELECTRICALINSPECTOR /Z Check# �) Commonwealth of Massachusetts Official Use On y Permit No. Department of Fire Services ' � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL.INFORMATION) Date: oZ / /tQ City or Town of: NORTH ANDOVER To the In pe oc r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street &Numb0er) y fVj 11 5 Telephone No. 97 � ^ OwnerorTenantyI&4b ?- `EYY7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No R (Check Appropriate Box) Purpose of Building W)"Dne h(,Q Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters l:r New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: &( i1PYGL �t`G�V �/ C vtere 4 D� y Completion of the following table maybe waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Cell: TranSusp.(Paddle)Fans s Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ap 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices Heat Pump Number Tons KW No.of Self-contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal F] Other No.of Dishwashers Space/Area Heating KW Local ElConnection No.of Dryers Heating Appliances KW Security Devices s Y No.of Devices or Equivalent (� No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent [OTHER, _ Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o Electrical Work: O, 00 (When required by municipal policy.) Work to Start:,2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O RAGE: 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 cov ge 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: r affupTc LLL LIC.NO.: / S Licensee: gyp, . / Signature t LIC.NO.:19,2/ _ (If applicable,enter "exempt"in the license number line) Bus.Tel.No.:�pU Address: 7 7 W 1156NI 0( i->SU ,IM 4 nO)O SI Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Depa Mint of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent fP.E mu FEE:$ 3�p Signature __ Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an ; electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence','during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: ., Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass[a Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass❑' Failed Re-Inspection Required($.) ❑ 1" Inspectors Comments: . Inspectors Signature: Date: FINAL INSP TION: Pass M Failed '❑ Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com r�l w The Commonwealth of Massachusetts Department of IndustrialAccidents �� d I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lehi �n Name(Business/Organization/Individual): 6) C L 6C �� ��� L L�-- Address: 27 (ZcA 50 n P (-22 City/State/Zip: Phone#: Zj—70 5---gl 5 Er Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.'b" am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F]Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workerscomp.insurance.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. Other 152,§1(4),and we have no.employees.[No workers'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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-cofi6ctors have employees,they must provide their workers'comp.policy number. f am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1'do hereby ce if under the ains and penalties of perjury that the information provided above its true and correct. Si ature: Date: �CQ Phone#: 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#: r. e` 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 o 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 theo gr ands 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 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 ' if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-ih'sur6d 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia r j ��{ ,COMMONWEALTH OF MA55A"ETTS t? ELECTRICIANS , ISSUES THE FOLLOWING L``ICENS.E x # y AS l REQ JOURNEYMAN ELECTRIC I� mow"% .gig. S JASON CHARETTE 4 B BALCOM''Sl 5�,- j;� dz R SHUX" 03060 3761 . 1 B 0 1 16:: _ J , . °COMMONWEH<O. ALTF MA55ACHUSETiTS .`.. :f BQAR fl ! E�ECTRTC I ANS fSSUES THE. EOL`LOWT . LI1Cf JSE�AS A R', RED MASTER: 'ELECT CAM x JONF'R CHARETTE I i .4 B BALC'Ohf ST i .,APS MA:; NH 03060- 211; 3060 3761 21 153 A 07/311`6 8z3z8 Date......�.. ..... poRTll °fs TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,WqI $A US This certifies that ................................................-�---" ....:....................................... has permission to perform_—, �...... .............- .I . ......................... wiring in the building of.......:...........:.................. .:. r ?............................. 7 � - ` 1 at........1/4' � .... .. ..�--�.. ,North Andover,Mass. r Fee .......... Lic.No'A�/ 'p('......... ............... r. ELECTRICAL INSPE R Check # 8689 r Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC/,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: r City or Town of. NORTH ANDOVER To the Inspector of Wires.- By this application the undersigned gives oticef of his or her tention to perform the electrical work described below. Location(Street&Nupiper) L� �,j 16 (l Owner or Tenant Telephone No.-(grs— al Owner's Address Clow 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: LMLUrnacel Completion o the ollowin table maybe waived b the Inspector of Wires. p 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 zg mg I rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of RangesNo.of Air Cond. Tons l No.of Alerting Devices ! Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: ............................"'.. Detection/Alerting Devices r No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: a _ 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 cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER F1 (Specify:) I certify,under pains a d pe hies of per' ry,that the information on this application is true and complete. FIRM NA LIC.NO.: Licensee: Signature( LIC.NO.: , 3� (If applicable, ter "e empt"in thq lice se ber li)fe.)// Bus.Tel.No.: LTJ? Address: 1!-tlA �ls�z"�l ( J/ Alt.Tel.No.: 5 / *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑owner's agent. Owner/Agentp v Signature Telephone No. PERMIT FEE. S p o �f Date. . . . .. .t1. . 9.0�.. '{ OE.HOFTH 3= TOWN OF NORTH ANDOVER O 10", - 9 • - PERMIT FOR GA NSTALLATION �f9SSAC NUSEtSh V This certifies that . . . . . . . . . . . . . . . has permission for gas installation in the buildings-of -�_=-� : . . . - . . : . . . . . . . . . . at � . . . ..�=: . . . . . . . .' `Nort`fi-wndover, Mass. Fee . . . . . . Lic. No.. . . . . . . . . . ��'`' �. . . . . . . . . GAS INSPCTOR Check# 5.81 p A . Y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) A/ Mass. Date ! .o v go Permit r� -, cam! - Building Location Type of Occupancy New ❑ Renovation ❑ �. Replacement,® Plans Submitted: Yes❑ NO ❑ AN N W N ]C Z ¢ V7 N N U 2 W W ¢ O U N. z a W d ¢ ¢ o Q z W W O W Q = = F- N Q ] W N ¢ W Z U W N W d ¢ H Q W W 0 J d = ¢ ¢ a ¢ W lit f- = h ¢ C7 F Z J f. = W W O > LL F- U _! W Z W - d C r r y 0 m Z O z W O 1A _ d W > ¢ W = Z. d ¢ d d O O W O tiJ F- ¢ _ Q U x LL o d U ¢ > c a H o sua=as MT. BASEMENT 1 ST .FLOOR 2ND FLOOR I 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR "". 7TH FLOOR CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Check one: Certificate Installing 5 South Summer Street Address Bradford, MA 01835 '_Corporation 9.78-372-9999 (phone) Partnership 978-372-0882 (fax) Business Telephone Lic. Plumber: T�G.ti "?� �3��tt = Firm/Co. Name or Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance a ce policy or its substantial .equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy 91 Other type of indemnity ❑ Bond p' 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: OwnerEl Agent ❑ Signature of Owner or Owner's Agent I hereby certity that all of the details and information I have.submitted (or entered) in above application are true and accurate to the test of nno '.knowledge and that.all plumbing work and installations performed under the permit issued for. this application will be in compLanoa'.vith all pertinent provisions of the Massachusetts State Gas Code and Chapter.142 oftKeGeneral Laws. By Tie of ocense /Js � Plumber gnature oUcensed ?lu fbgr or as Fitter Title 1Gas fitter Master. License.Number City/T own burne;�nan A pRROI F� (OFFICE USE ONLY( - 4 Date.�e o',"'�T:14, TO OF N TH ANDOVER PE M OR PLUMBING SACMUS This certifies that . . . -~ i. . . ��`' . . . . . . has permission to perform --"'."``� --`' plumbing in-the buildings of '" :�� r �. . . . . . . . . . . . . . . . at��f! .�_. : . . . Q.. . . . : . . . . . . . . . . . . . . . North Andover, Mass. Fee�r�. . . . . . .Lic. No..�� ��). . v�� . . . . . . , PLLMB�IGV3INSPECTOR 1 Check # o/d 7187 a; _tt'.. A F tGi O r r t 0 l F rr ,. � R F llf ��r Ile ._ `t _..>....--.. _..,....... E . f._ ;.,� r ,-.___ -......,_...__ _ .......�.__�..._.... .........: u _ _ aE P lRyjf .. , G e l :U BS T. m ISTFLOO� 2ND FLOon 3FYtI FLOOR 4T94 6'L000R 1 13TH FLOOR CLIMATE DESIGN HEATING and CONDITIONING Installing Company Name err y 5 South Summer Street , LLC Address Bradford,MA 01835 Check one: Lertrficate 978-372-9999 hone 1/C 978-372-0882(fax) orporation -=-�= ' Business Telephone Lic. PlPartnership umber: ;J Name of Licensed Plumber i It"S.URANCE COVERAGE: -._._. have a cure ent liability insurance Policy or Its subst?nYes Zf No ❑ t� equle�lert which meets tile requirements nts of PAGL CSE- 142. l9 YOU have checked ,es. please M,,czte the type coverage by ctieck4ing the appropri�-4e fix. .���clliabili y insurance policy � tither type of indemnity ® Bond.t E t.�soY¢`Y�l`t`7 e�iW Si<as�a5�sC6 WAIVER: ,6 - b7�rc�.f ❑ LZjj�7onature E ' � R a lVER: l am ew-dre uzat the licensee does riot have' g p"" . off the Mass. GeDeeral Laves, and tlmt ri1 I nature on th—Is ermlt applle�tit�n�aive ce overage re�ufr�d by f MY e R s this requirement. Check one: or Cwrter or- Iner's 6c�ent Owner ❑ agent ❑ I hereby G'erj,314li:t 1l of 411"�� i no��odge and Umt&11 Plumbing work aro ins 11a, l s rgmve rrSubmitted�e<rth�4 permit a wcsdelor 4his Partnent P(misions of the or his uta trua and 3mirate to thr�b-st of Eny hus�Ets SEs to€lu�r rig do�n' application vrili bk in cz�rnpiiar: with SSI _ t 142 of tf f� en�rel �ws. Title nature of LErensed,?iurnber TjW Jf l Ec ns-na: Mast k)urnem an (� bmnse.FIumber / l Location /a7 No. V Date i NORTH TOWN OF NORTH ANDOVER 3? G 0 x. Certificate of Occupancy $ 2-- *, Building/Frame Permit Fee $ � � o ,ssACNUSEt� Foundation Permit Fee $P 44 �J A." 7- _ Other Permit Fee $ 1 'o?AwOl Sewer Connection Fee $ `��_'s f 9 4 � 2a Water Connection Fee $ rf f � TOTAL ®. ` . Building Inspector Div. Public Works /n7 b- /l Y/ / Location � No. 41 Date 2-11L-19— TOWN -111%2—TOWN OF NORTH ANDOVER p Certificate of Occupancy $ �a • # Building/Frame Permit Fee �sS� uSE� Foundation Permit Fee CH $ l .,n Other Pernfli WPM PAYMENT--- R Sewer Connect Wet Water Connection Fee 5 TOTAL N0. Andover Co#eG 46ii Building I spector M / Div. Public Works Location �' � !/I,�z� 5!✓J/y'fi�.,J No. `7 v Date Ot �►64D TOWN' OF NORTH ANDOVER',r�a �a'�.yO p Certificate of cupancy $ 0 Building/Frae mmit Fee $ Fo�AdatioiQe s�CHuse x� rme $ Othe13 rmit f $ J'7 Sewer nectr e&% $ ,.61f)� I45water Co tion ee $ /b I(-0 00 TOTAL L $ 'p-00C) A (VI)/'} L /6 Building Inspector ��'�� Div. Public Works �ryc"stir No, _ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �� 41 AGI. 1 Mto'. -40. LOT NO. 2 RECORD OF OWNERSHIP FDATE BOOK 'PAGE Y NE I SUB DIV. LOT NO. R I — LOCATION PURPOSE OF BUILDING I OWNER'S NAME lX•e m 4 I NO. OF STORIES /2 SIZE OWNER'S ADDRESS ^ ,3f I 1I�` --� ` 1. I B SEMEN OR SLAB "v{i ARCHITECT'S NAME '7 Y7C i_/ �/�(,J� SIZE OF FLOOR TIMBERS IS ' !© 2ND k 3RD BUILDER'S NAMESPAN I(,[ .� r ` DISTANCE TO NEAREST BUILDING le DIMENSIONS OF SILLS DISTANCE FROM STREET wn/ " POSTS � II DISTANCE FROM LOT LINES–SIDES /►„ ( REAR �'J`6 t � GIRDERS v . / 2 AREA OF LOT (�i�O [�!Z(� FRONTAGE ••�G�n 1- HEIGHT OF FOUNDATION (�. l /` ( (— THICKNESS/O IS BUILDING NEW JV(� �S - SIZE OF FOOTING ( X X IS BUILDING ADDITION p ,.y MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING SOLID FILLED LAND - WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /l IS BUILDING CONNECTED TO TOWN WATER I/�� BOARD OF APPEALS ACTION. IF ANY (moiMIA IS BUILDING CONNECTED TO TOWN SEWER - i es IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS r,Lf MllT FOR FRAME/BUiIDING 3 PROPERTY NFORMATION s LAND COST SEE BOTH SIDES EST. BLDG. COST J lEE MID- PAGE I ILL OUT SECTIONS I - 3 MX j=jjUjjUW EST. BLDG. COST PER SQ. FT. N Q�A sI PA�� 11A.&Q D.6 EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 �o�er 8/� nevem 't J. Gl N SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 1 _ S . APPROVED BY 1. ATTACHED GARAGES MUST CONFORM TO STATE FIRE R tTIONS�+►b FEE pAl��'�md�a PLANS MUST BE FILED AND PPROVED BY BUILDING INSPECTOR DATE FILED .. �. BOARD OF HEALTH SIGNATU OF HORIZED AG FEE �] ) 7Q� OWNER TEL,N-6 ! �( !Z 1 PLANNING BOARD PERMIT GRANTED CONTR.TEL.#60, sG-�r-�y t9 9� CONTR.LIC.#-(CYC.3Sz-7 BOARD OF SELECTMEN Ft BLDG. PERW EEE emn O4 19 +I' . LESS FDA FES -�� d {4 . !7� BUILDI�L��NG�INSP�M6C DUE FRAME PERMS SUILDiNG r)EP/-\i;Tr r' t � 4.., j 1T 1 BUILDING RECORD 1 OCCUPANCY;•• 12 SINGLE FAMILY I STORIES- -THIS SECTION MUST SHOW-EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY MICES = 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 1 ?_I3 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL , UNFIN. 3 BASEMENT:_ AREA FULL FIN. B'M-T' AREA '! '/p °/. FIN. ATTIC AREA NO B M-T FIRE PLACES HEAD ROOM MODERN KITCHEN AL i 4 WALLS I '•9 `. FLOORS CLAPBOARDS '•„ B 1 2 3 , DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING - HARD\N'D _ ASBESTOS SIDING _ COMMON _ '`yr` oil'%I" C•�'L VERT. SIDING ASPH.TILE "•+u• 1�3t+ �.7.�tr"$ ' STUCCO ON MASONRY. STUCCO ON'FRAME 't _ BRICK ON MASONRY ATTIC STRS. & FLOOR _ �rt� BRICK ON,FRAME P CONC. OR CINDER`BLK. �'� ` pal TOM STONE ON MASO,NRY._ i, WIRING ,,' jjR STONE ON FRAME SUPERIOR I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING `\ \� �1t f Tl `�°1 +T• GABLE HIP BATH Q FIX.) _ t GAMBREj_d MANSARD TOILET RM. (2 FIX.) , 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 I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H' 'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B' T 2nd ELECTRIC y 4 f M• 1st �j 13rd I NO HEATING � p• a.ny i:l' :e s. 7". FORM T/ T QT yam'np Ry A �E INSTRUCTIONS: This form is used to verify that all necess approvals/pests from Boards and Departments havin dry have been obtained. This does not landowner from compliance wrelieve the applicantiand/or on any applicable local regulations or requirements.ith aor state law, Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Subdivision n nn► Lot(s) Street ^ M St. Number ************************Official Use Only************************ a RECOMMENDATIONS OF TOWN AGENTS: Conser4ation Admin' Date Approved is trator Date Rejected Comments To n4anner Date Approved Date Rejected Comments o Health Agent Date Approved Comments �I/� Date Rejected V� �� I Public Works - sewer/water connections 1A driveway permit MCC Fire DepartmentTT rReceived by Building Inspector �' S L, � 5 Date UUP SEP o L'AIa VING ANAL CONSERVATION R FINAL SEWER/WATER FINAL X40H 1"ly own oAndover 6 OL hro No. 1 ® w� r``1lu1 f 3�' DRIVEWAY ENTRY PERMITS 7Z er, Mass., �. l+ - 19 G H HEWICK A0R Pte\ 1 BOARD OF HEALTH r PERMI LD �1494 •................... THIS CERTIFIES THAT... ��,4� ..41PMKOVs?..3x�••••••••••••• . BUILDING INSPECTOR w �i+l �� .�..�i�T...I.iT, !!Td� Rough -. has permission to erect ..4!.l.�Q.�.,�....... buildings on .... � Y tobe occupied as.................... •••• •••• ... F inaI provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,AlKOT � �� �NLY Rough Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-S. B.C. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. FEE PAID4100 PERMIT EXPIRES IN 6 M O N T� F ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION START Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. (rL.-� . Building Inspector PL•A.NN1NQ, . :. _. ANAL CONSERVATIO .-M FINAL SEWER/WATER T.. FINAL own of 6 ?� ndover �K y W 4y1rj�Y� I •"_ No. DRIVEWAY ENTRY PERMIT - -3=- l 9 ------ � 1`■,q'�{,KAOILD ver, Mass., + _ 19 z C SI M,c ME WICK 9q 01 O. ; � BOARD OF HEALTH PERMI THIS CERTIFIES THAT..... l�, 4rs....44?MO .. .!�'... .��. .•................... ``' BUILDING INSPECTOR has permission to erect ..4!.?. MP IE t....... buildings on Rough T l Chimney to be occupied as......... �.! '!-ti... �L ....!..� � ¢..` ..Jt..!.... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,AItIRMT ��k �NLY Rough Andover. REGULATED BY PARA. 114.8-S. B.C. Buildings m the Town of North Final VIOLATION of the Zoning or Building Regulations Voids this Permit. I Q� S YFEE PAID PERMIT EXPIRES IN 6 M O N T�I" ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough � service 7 0 PERMIT FOR FRAMUBUILDING Final .� BUILDING INSPECTOR GAS INSPECTOR TE. FEE PAIDA "Leo"o Rough DA Occupancy Permit Required to Occupy Building Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. lad, ,�_,&A— Building Inspector • °{ rig''; f { �{'p � (Y SEP 2 8 1992 :!` I • ........... l �q¢ 3� ' ..................................................................... Ld 7- /2.S40s•F =0.287TN AC FO✓,ipaYio�l N r 30 � i3S ,e i 5 00 x=8.73' • �o TE ;�o�....Z>s-rioa/ S //c PEBY CE.f7X"Y TO TyE T/TLE /,US(/PO P AND R` or TQ Ti/E BAN.Y T,ygT T,yE OwELLGuG /S LOCATED ON Tfi/E GST qS S//0/YN ANO Tf/i0T/T DOES CO1/FOPiYI �N ,PV17W Tf/E ZpN/.vG .PEGA PD/NG SETBACA'S LOT L/✓ES. /Ute. �NIXj YE2 J'9 SS`s "r 121e7We-,e CEPT/FY T//,vT T s�/s OIrEGL/N6 /S NOT / L/7447EO /N T//E FEOEPAG FLODO ff4ZAPp APE 4. 14 e,4 -V SHawN oit/ FE.N���4 Mt/N/Ty /O�,v�L 'k • � � 250099G�SB �/✓/GL/P,S �Oi�irj ,QE✓CLaP/r/E'.e/T 93 Co es? SEPT./ /9 9,E OA 7t5 �v - i Ti%/S PLAit/ p RV Pv,PPo9ES-if/OT FD,P . Bovvo.Ps� oma' ..v. Bo�,vo.ves�iv.�o.P,�- /NE.P.P/�J.9G� E.vGidEE,Pic/G SE.PI�/lEs AT/O•(/ TAKES/ F,PoiY! EX/ST/(/G PELo,POS, (oto �q,P,Y ,ST,PEET A.t/ODIiE.P, �1ASS.4C//vSETTS O/8/O i tFIC�►TE OF USE & OCCUPANCY Building Penult (dumber 'x! Date oz THIS CERTIFIES THAT THE BUILDING LOCATED ONo MAY BE OCCUPIED AS S l /IJ 6�L Z /f-/1/y !AJ J L L /uG IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 01 pORT1{ , CERTIFICATE ISSUED TO P1 L L i P-( "-: ADDRESSYJ r' rI' S T' � x g7 3A_S e B dink Inspector I