HomeMy WebLinkAboutMiscellaneous - 132 BRENTWOOD CIRCLE 4/30/2018 (2) � 1�3 BRENTWOOD CIRCLE - � -_ � -
2101=pp0.0
��
��
Date. .
Of
HORTM TOWN OF NO H ANDOVER
t PERMII"' OR PLUMBING
a SSACMUS�
This certifies that . . . 1. . . . . . . . . . . . . . . . . .
. .� .
. ., r ¢, . . . .hasPermission to perform
plumbing in the buildings ofG .�c- ./. . . . . . . . . . . . . . . . . . . . . . -`s
{,
at . � -. . . r . . , North Andover, Mass.
Fee,?c;2 . `. .Lic. No,.�y A . . . . . . . . . .
r7l` Pel �B G INSPECTOR
Check At
7122
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location/3,2 1?46AI j fool-) C-AOwners Name yMeS Permit#
Amount
Type of Occupancy,
NewRenovation Replacement ® Plans Submitted Yes E] No
FIXTURES
E~
w
w
3 as A c� ° �
R4SEMrr
IX I F—
IST
>D
4M It"
5Mffi"
sM HBM
7MHDfMM
9M HDM
(Print or type) Check one: Certificate
c
Installing Company Name 1 41/®/p14/L-1 /���i��'/syG El Corp.
Address jed d®'r S-7
Partner.
I416-17e,,vle -P4 D/9 V2-
Business Telephone 97 y a y S 9 So y El Firm/Co.
Name of Licensed Plumber: ?`fa,04 S' �`�,`�02✓��
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
g,iability insurance policy 0 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
Signature Owner ❑ Agent El
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 State Plujpbing Code and Chapter 142 of the General Laws.
7.�-- � �-�--
By: Signature 01 Licensect-Piumoer
Title
Type of Plumbing License
�3-7City/Town License um er Master Journeyman
APPROVED(OFFICE USE ONLY
Date.'���. . . . . . .
HORTN TOWN OF NORTH ANDOVER zl
PERMIT FOR PLUMBING
SSACMUS�
This certifies that . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . .' . . . - ;
plumbing in thebLuildings o . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . North Andover, Mass.
f kY
I
Feel`'). . . . . .Lic. NW. f4� ! �. :. . .�.
PLv;M�$NG INSPECTOR .}
Check # 3 7f— R,
7125
MASSACHUSErIS UNUMM APPUCATON FOR PERMPT TO DO GAS FMING
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations /g� Creel' Permit#
eWAYAmount$
�'"!%�f�7ri S Owner's Name
New❑ Renovation ❑ Replacement ® Plans Submitted
U
w w ra F x a
z °� H o ° °o w H
W d F cn C4 D d
ww z z z x a W a w F w F
c� F z F z O w F, � a �
z `� z a .0t0 00 w
W O x w 3 A U a U a > ca a F O
SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . F L 0 O R
8TH . FLOOR ,f
(Print or type) n/ Check one: Certificate Installing Company
Name— �/��LO/�.4.� �GyM i�/G 11 Corp.
Address 12O J,a/r• S-7"2 El Partner.
13-f 4
Business Te ep one %7Y SBS=qs"o Firm/Co.
Name of Licensed Plumber or Gas Fitter %d/p�sf o9 S "g L ea 2.9�
INcSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. YesEl No❑
If ybu have checked}_es,please indicate the type coverage by checking the appropriate box.
Liability insurance policy ® 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 13
1 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 State Gas Code
and Chapter 142 of the General Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title ® Plumber ,?YY-?3
City/Town Gas Fitter License Number
ElMaster
APPROVED(OFFICE USE ONLY) ® Journeyman
�i Location Gcr 0 a `-'►"'
Y
No. �d S Date 9--0?3 _d
NpRTh TOWN OF NORTH ANDOVER
F w
A
i y
• i ; , Certificate of Occupancy $
;�s'�^°•Eta' Building/Frame Permit Fee $
GNUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ j U
-7
1 Check #
t
a
--� Building Inspector
i}
r'
5
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
'lei
BUELDING PERMIT NUMBER DATE ISSUED: 9`,;z
SIGNATURE:
C C
Building CommissionerlIn for of Buildings Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
l � �
> Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Diaik—t Proposed Use Lot Area s Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Rewired Provided
1.7 Water 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 D
SECTION 2-PROPERTY OWNERSBIPIAUTHORIZED AGENT N-1 10 iC liStrict: Ye.S
2.1 Ownerof Record
Q► �,� t _ ` 3 �/le.•—j waw
Name(Print) T Address for Service
CIV'
Signature Telephone
2.2 Owner of Record:
i
4
Nume Print Address for Service:
r
Signature Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Led Construction Supervisor: n 03
V` et" f License Number
Expirati Date
Signature Telephone
3.f Registered Home Improvement Contractor Not Applicable ❑
�-cJSCC-,
CoAtpany Name / / 7 7 y M
Registration Number
Adddress - /(Z.-210��
s Expiration Date
Signature Tele hone
SECTION 4-WORKERS COMPENSATION(M.G.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 all applicable)
New Construction ❑ Existing Building, ❑ Repair(s) Alterations(s) 0 Addition ❑
C
Accessory Bldg. ❑ Demolition 0 Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be `: ' OI?1FICIAI.USE ONLY
Completed by permit ap licant
1. Building . (a) Building Permit Fee
Multiplier
2 Electrical _ - (b) Estimated Total Cost of
Construction
3 PlumbingBuilding Permit fee(a)X @)
4 Mechanical HVAC f 0-9'�'"
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
Q pp � per.
I, A �7/1�i V/1'�'(� S as Owner/Authorized Agent of subject property
Hereby authorize_ j„—1" to act on
tyJN:half,in al matters relati to work authorized by this building permit application.
Signature of Owner Date r
SECTION 7b OWNFRUITTHORIZED AGENT DECLARATION f
4Y
as Owner/Authorized Agent of subject o7:,
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
runt Name
Si a tre of Owner/A ent D to
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 15 2N153
SPAN
DIMENSIONS OF SILLS '
DIMENSIONS OF POSTS ;
DIMENSIONS OF GMDERS t
HEIGHT OF FOUNDATION THICKNESS '
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Page No. of Pages
Z41 �
Tom DeFusco
23 Dutton Road
-
Home Improvement Reg. # 117756 Pelham, NH 03076 Tel 603-635-3017
Constr. Lic. #071037 Fax 603-635-3751
PRLP SUBMITTED TO PHONE DATE
O
STREET JOB NAME
�n��w clti
CITY,STATE AND ZIP CODE CQ JOB LOCATION
Z J
ARCHITECT DATE OF PLANS
JOB PHONE
L
We hereby submit specifications and estimates for:
.....................................................................................................................................................................................................
....................................................................................................................... ..
e
D L
M�...�,J....e......................................�.......... �/.............�C. ....................................5..,�_._u_Sal...C...........................................................................
.
............................. ...... _ ► _� L........... ....._............�-c�c_ ........._w �fi s ><�s
t ..............................................................................................
�-
v dv
L
��
�-c
o
L z
.............._ /...._. 5....... .._L_ -:...................._ _......_�... ..._Z.._..._...............���'
....................................................................................................................................-........................................
.
....._........................................................................................................................................................................................................................................................................................................................................................................................................................................... .
..............
( ..1
c-C
e
2_
' S G �
Ze
E FruplaSP hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
7hou �tlJ6Dc1x -ilO dollars ($ � l_d�4 ).
Pa 1 t to be m e as follows:
lr - vvicn A,1 41o, �.t) �c
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices. Any alteration or deviation from above Signature
specifications involving extra costs will be executed only upon written orders,and will become
an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be ��
accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accepted within days.
insurance. Our workers are fully covered by Workmen's Compensation Insurance. Y
rrryfitttrr of 11riaposal—The above prices, specifications
and conditions are satisfactory and hereby accepted. You are authorized to do the Signature
work as specified. Payment will be made as outlined above.
Date of Acceptance: ---T---�-- Signature
NORTH
Town of
0
Cc% = -LAKE dover, Mass.,
C
T O
I� COC NIC HE WICK V
7�S RATED OPG �5
�i BOARD OF HEALTH
PE..RMIT T D Food/Kitchen
Septic System
R bra BUILDING INSPECTOR
THISCERTIFIES THATSBA...........................................................................................................................Q`.......n..`... . Foundation
has permission to erect.... . �. ...... .. buildings on.... ....... ... K+O...................4.....✓� Rough
to be occupied as + �� � �� gqpb 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-Ljws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. t.I
l PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRU ON ST S T - ELECTRICAL INSPECTOR II
C Rough
. ...... ... ...A..�................................................................................... Service � r
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rou
Display in a Conspicuous Place on the Premises — Do Not Remove Finalh
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.
I�
p w The Commonwealth of Massachusetts
d Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
�•��•� Workers'Compensation Insurance Afdavk
Name Please Print
Name:
Location:
City Phone #
71 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
am an employer providing workers'compensation for my employees working on this job.
Company name: M 6
Address 212 L) 7L2- /L1
City: Phone# '3 3 O /
Insurance Co. n114 Policv#
Company name:
Address
City: Phone#
Insurance Co. Policv#
Failure 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
and/or one years'imprisonment_as we➢_as_civil.penaltiesin thefffim da STOP WORK.ORDER..and..a fine of.($100.00)-abay 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 hereb certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date_2/2
Print nameM ��c �c� s c'c, Phone# 06 -? C1
/
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensin
(]Check if immediate response is required Building DeptLicensing Board
p Selectman's Ofce
Contact person: Phone#. E] Health Department
Other.
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:
eJ S C
(Locatio . of Facility)
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