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Home My WebLink AboutMiscellaneous - 121 BERKELEY ROAD 4/30/2018 (2) X121 BERKELEY ROAD 210/047.0-0061-0000.0 Date. .4 . : 'N° 4 (0) 00 :�tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S3AC04US� This certifies that . .`f '=:`� ��i—'. . . . . . . . . . . . . . . . . . . . . has permission to perform %y? :'. .'v. . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . at. h?". . `'`.f° . . . . . . . . . . . . . . . . . . North Andover, Mass. 7p � Fee! !� . . . . .Lic. No.. . . . . . .. . . . . ;elNSPECTOR . . . . . . . . . . . . .PLU Check # �n� � WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date �p� Building Location e t Owners Name tj Permit ff -S 8 Amount ,(��'✓ Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES a W W Q, A c A Q � �n 9 3D RO R 4MR J $� 6M FLOOR 7MMM (Print or type) �� Check one: Certificate Installing Company Name_ (Jj'�') � Corp: Address F1 Partner. CWBusiness Telephone � 3�/ Fitrn/Co. Name ofLicensed Plumber. Insurance Coveraee: Indicate the f 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 y f k Signature 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 an ins ons ormed rPermit ued f this application will be in compliance with all pertinent provisions of the Mas a s S mb' g C e 1 of the General Laws_ By: ature ot.Ljc&ASjq&Wo Title Type ofPlumbing L nse , Cityao` nicense um eS't -- Master Ioumeyman APPROVED OFFICE USE ONLY D Location ` No. �� Date �-� NOR7M TOWN OF NORTH ANDOVER O ,� o 3?��•, •' 00 +74 Certificate of Occupancy $ �'�a",ry°•'��' Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check # 13,16 17223 G/ - ,,---- Building Inspector/f` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING HIM BUILDING PERMIT NUMBER: / / DATE ISSUED: j�� M lO - 6 SIGNATURE: lr 3 B771—ding Commissioner/I or of Buildings Date - Z SECTION 1-SITE INFORMATION IO 1.1 ,Property Address: 1.2 Assessors Map and Parcel Number: /11 BERG EY ED, Map Number Parcel Number 1.3 Zoning Information: L• 1.4 Property Dimensions: Zonin District Proposed Use Lot Areas Fronto fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide RegWred Provided red Provided 1.7 Water Supply M.GL.C.40. 34) 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/AUTHORIZEDAGENT Historic District: Yes No M 2.1 Owner of Record R o A) LoM�X t B � .��F y D;o Name(Print) Address for Service al- 96 v` Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Z M Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Iaicensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 D U L 1) r.A S TR1Cz A2F KFC-. )) `� f/ Company Name L b ` ��(o M J-00 � uTTD h� Registration Number r i Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(KG.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.......❑ SECTION 5 Description of Proposed Work check au a Ucable New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: U1,Ny L S i D IIJ 6, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QFFiGIAL USE QNLY { Co leted by permit applicant 1. Building (a) Building Permit Fee g Multi Tier 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 as Owner/Authorized Agent of subject property Hereby authorize to act on 1. My behalf,in all matters relative to work authorized by this building permit application. i Signature of(honer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, DA-V 1 D `/AA s'f 2.1 tD 61 E as Owner/Authorized Agent of subject j property Hereby declare that the statements and information on the foregoing application are trite and accurate,to the best of my knowledge and belief Prin a 6 Ce, Si nature of Owner/Agent Date NO.OF STORIES SIZE 13ASEMENT OR SLAB SI7_E OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMFNSIONS OF GIRDERS I II i(iI IT OF FOUNDATION THICKNESS til/E OI• LOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i Board of Building Regulations and Standards 4 HOME IMPROVEMENT CONTRACTOR j Registration: 104569 ; Expiration: 711412004 T Pe; Prwate Corporation X . DAVID CASTRICONE ROOFINGS mow,✓avid�as'tricone 7 Hillside Road Administrator = Boxford,M,A 01921 - '' The Commonwealth of Massachusetts y Department of Industrial Accidents ! — SAW i1J S Ali 600 Washington Street `ds -Boston,Mass. 02111 Workers'Com ensation Insurance Affidavit:BuildingfPlumbin lectrical Contractors aiiaaiiaaaaaiiaiaiiaiiii name: A) LA DAY address �/J a cit,• Wil)b, /?V J P b u G K state: /"r.✓f ziy: phone# work site location(full address): _0_I am a homeowner-performing all work myself. Project Type: ❑New Construction ORemodel I am a sole pro/rietor and have no one working in any capacity ❑Buildin%/%%%/%%% %%/%:%%% Addition%%% %%%/%%/% %%%%%%%%%%% %%%%%%%j/%%%%%%%% %/%%%%%%/O%%%%%%%%%/%%%%%% �%�%'%/%%%%%%%%/%%%%%%%///%/ I am an employer providing workers'compensation for my employees working on this job. company name: DAV I P C'ASTRIUAIL RtzaFLVG f s/D4li &—, _rAX, address: 910- cS(kT T b A) S77 (k/n A.)—C city phone#• insurance co. olic # _I=am-a-sole proprietor--gener-al contr-aster;or--homeowner=(c-ir_d-e-one)-andbave-hired the-contr-actors listed below-who have the following workers'compensation polices: —comnany-name• _ ' --address: city phone#• Insurance co. Dolig# company name: address: city: phone#• insurance,co. lis # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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 hereby cern y unde_t a p�insstnd penalties of perjury that the information provided above is true and correct t � Signature Print name�!T�� 1 r 9 1e- T/X Phone#?7 gT L a a }��„ -= .,.- . - .:. ..-> . .- :. .-.� mss... �..�_�...•,e,�, - W.w_- --..;h official use only do not write in this area to be completed by city or town official city or town; permit/license# El Building Department ❑Licensing Board Elchockif'lmmediate response is required ❑Selectmen's Office ( Health Department g contact person: phone#; []Other (revised Sept 2003) r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) SI-LSEM s f � � Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I xAORTH Town of 6 Andover 0 LAKE z= o dover, MASS., Al-C7 6-o�od COCMICKEW" 1• oj'ATE0 0, C, 7 BOARD OF HEALTH Food/Kitchen R M Septic System E T D e THIS CERTIFIES THAT.........!.1...,..,•, BALDING INSPECTOR .... Foundation has permission to erect... ::....... .. .. uildings on...� v.......,t5gi A- -0----f Rough tobe occupied as.,.. .. .......................................................................................................................................... Chimney provided that the p son accept' g this permit shall in every respect conform to the terms of the application on file in this office, and to the provision of the Codes and By-Laves relating 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 PEi\1V111 EX MES IN 6 MONTHS Final UNLESS CONSTRUCTION' °T S Rou hECTRICAL INSPECTOR i4 g .............................................................Vr............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and.. Approved by the Building Inspector. FIRE DEPARTMENT A Burner Street No. • SEE REVERSE SIDE Smoke Det. I r VAORTI-,. . Tovm Of JJLL Andover Y OS LAKE { over,er, Mass., I �(0-00dV COCNIC NE WICK �' �.9RATED P'? C 5 \ 7 BOARD OF.HEALTH Food/Kitchen PERM . T D Septic System THIS CERTIFIES THAT.........!�..�..... . ..... ...... BUILDING INSPECTOR ... .................................................... Foundation has permission to erect... ......... uildings on l;v......... Rough to be occupied.as.... .. ....................................................................... chimney provided that the p son accept' g this permit shall in every respect conform to the terms of the application on file in this office, and to the provision of the Codes and By-Laws relating 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 MONTHS Final ELECTRICAL INSPECTORUNLESS CONSyRUCAIOA, wS Rough ... A . ........ ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building ' GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry (Nall To Be Done Final Until Inspected and.,. Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SID" Smoke Det.