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HomeMy WebLinkAboutMiscellaneous - 133 CHADWICK STREET 4/30/2018 133 CHADWICK STREET 210/074.0-0008-0000.0 r 7L �1r f Date....`......&......r....2— NORTH °�t"`°;•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� - This certifies thatt ................................................'� ....... has permission to perform ...,!.:....................................................................... wiring in the building of.'` --... . ...................... ............................ �- ,North Andover,Mass. at.........--.......... . ...�. .................... Fee.......:............ Lic.No:�:"l"..0 .. .... .Yk ....r .................... 'ELECTRICAL I CTOR Check # �� Official Use Only Permit No. 2 21!1- .. .. %,040--e Prime S46 0 Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:0000 C (Please Print in ink or type all information) Date 5 < To the Inspe r of Wi es: Town of North Andover The undersigned applies for a permit to perform the electrical work d cribed below. Of Location(Street&Number � �" Owner or Tenant VW Owner's Address Is this permit in conjunction 'th a building permit Yes ❑ No (Check Appropriate Box) Purpose of Building �Welt v 4 e{ Utility Authorization No. EAsting Servicey Amps ZO v Voits Overhead /�� Undgrnd ❑ No.of Meters New Service Amps l?Pj 20�doits Overhead 1/1 Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i Total No.of Li Ling Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting Wo.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone —. Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers S ce/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heatinn Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Winn No.H ro Massa a Tuds No.of Motors Total HP OTHER: D 2 �• � �� INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES//NO = have submittegTlid proof of same to the Office YES= NO — If yo ve chec �S pleabe in di te��oyCov�ge by checking the appropriate box INSURANCErBOND = OTHER = (Please Specify) y�eri C CO �� (Expirbtion Date) Estimated Valueo EI ctrica Work$ M-a� Work to Start_ _ '�/6 z Inspection Date Resquested Rough Final Signed under the Ifenalti6s of perjury: LIC.NO. FIRM NAME AZ 'a L Licensee !r�• Signature LIC.NO.AA J? �/7 kl / )Bus.Tel No. 74- Addres,2, !�� s yN J 7/f/ f'.SCJ/� [,� �i� Att Tel.No. ^ OWNER'S INSURANCE WAIVER: I am aware thaf the Licenses doot have the insurance,overage or substantial equivlint as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) � lV all, Telephone No. PERMITTEE $ �( (Signature of Owner or Agent) Location 133 6,4 0&1(1� S No. Date NORTh TOWN OF NORTH ANDOVER f � A Certificate of Occupancy $ CNUS<� Building/Frame Permit Fee $ 3`�) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ "- Check # 5 3� Building Inspector I TOWN OF NORTH ANDOVER �. BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � ��' •:,��is Se�tii�:fbc BUILDING PERMIT NUMBER: DATE ISSUED: r1 �0 O i C ; SIGNATURE: Building Commissioner/I for of Buildin Date SECTION 1-SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 \ Re red Provide ReqWred Provided R red Provided 1.7 Water S .G.L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: ��`.t Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 � SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r 2.1 Owner of Record O Name(Print) Address for Service: w 79V- YM-7 Si ature Telephone O 2.2 Owner of Record: Name Print Address for Service:. C n Signature Telephone A SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: C License Number Z Address F� 70--(If Expiration Date / g ature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 CCC ,err e- C Company Name Registration Number r 7 !✓ Address Expiration Da ^ Signa re Telephone Y/ i i . ii -� SECTION 4-WORKERS COMPENSATION(ALG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will j in the denial of the issuance of the building emit. Signed affidavit Attached Yes........0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition ❑ I ( Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify �11/�,c /j G�Q� Brief Description of Proposed Work: I 1 I I � 1 tt I f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Dollar " ( ,x Completed by Ermit a 1. Building (a) Building Permit Fee C� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 3Q(' 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 /[> r%/'/✓`O-� p/Ii ,�i�li7�' to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,q� 1, �✓ d/2�'� r%gr �i � 'xV f ,as Owner/Authorized Agent of subject property I ( Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T11VMERS iST2ND 3KU SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF Cl-MV1NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 11/09/2000 10:38 978_597-3149 INTERNET INSURANCE PAGE 01 — A: M. CERTIFICATE OF LIABILITY INSURANCE 11/08/2000 PRODuceR TM15 CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ILmR1'1>GT XNBVRA'ECS At78>r1CY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 CH=CIDIItING ROAD HOLDER.THIS CERTIFICATE DOES NOT AMEND,(EXTEND OR ALTER THE COVERAGE AFFORDED 8Y T14E POLICIES BELOW, NORTH MWOVZR, DBA 01845 INSURERS AFFORDING COVERAGE tNSURlD INSURER A: SAVVW MPBRTT AND CASMTY YINSURIINCI ALL VmZR ON& AOOP/PZ8T Iii FLAG INSURERS: 70 JZVTZRA014 STFtZZT INSURER C: INSURER D. NORTH ANDOVZR DMO 01645— INSURER f: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SVCM POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAWS. IN TYPE OP INSURANCE POLICY NUM®ER POLICY EFi6 E UCY iRl► UNITS GENERAL LMOIUTY EACHOCCURRENCE $ COMMERCUILGENERAL LIASIL)TY FIRE ALWE UUonasre i CMS MARE Ll2 OCCUR MED EXP Artorp wn t ❑ ___ PERSONAL S ADV INJURY S _ _ GENERAL AGGREGATE $ GEVLAOGREOATE LIMIT APPLIES PER:1 PRODUCTS•COMP,OP AGG i POLICYPRO- rLOC AUTOMOSALE LIABILITY j COMBINED SINOLE LIMIT i= ANY AUTO (E, A 2009M) ALL OWNED AUTOS A �i—BODILY_"JURY = SCHEDULED AUT08 Tw P~) HIRED AUTOS BODILY INJURY $ NON-CWHED AUTOS (Per"dftM) PROPeRTYDAMAGE i 09 (Per awftri) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC 1 AUTO ONLY: AGG i Excess LIA601 ITY E-ACHOCCVRKNGE i 01 OCCUR EQ,CLAIMS MACi AGGREGATE a DEDUCTIBLE i I) tJ RETENTION i f WORKERS COMPENSATION AND EMPLOYERS LIABILITY LIMITr J► ARO000776 11/09/2000 11/09/2001 E.L.EACH ACCIDENT 4 100,000 E.L.DISEASE.EA EWLOVEJ S 100,000 OTMRR E.L.DISEASE•POLICYLIMIT is 500,000 DESCRIPTION OF OPERAIWNIULACATIONSNEHICLCVP.XCLUS10N$ADDED EN INDORSENENTISPICIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED•INSURERLETMR, CANCELLATION $HOULD ANY OP THE ABOVE 099=590 POLICIES BE CANCELLED BEFORE 71HE EXPIRATION DATE THEREOF,TME ISSUING INSURER WALL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO YH!Le",BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON LIABILITY OF ANY RIND UPON THE INSURER,IT$AGENTS OR REPRESENTATIVE()+ AUTHOR TATIVE A" ACORD 26,3(7187) 9ACORD CORPORATION 1936 0 � A Licensed& Ins � Insured Roof Leak Experts (978) 794-3883 • 1-800-WAIT-4-US Fropoial Submitted To Phone Date Street J, 1KOF1 Job Name City,State&Zip Code Job Location Job Phone We Propose thereby to furnish and labor in accordance with specifications below, for the sum of: Dollars All material is guaranteed to be as specified. All work to be completed in a workmanlike maer according to standard practices.Any alteration or deviation from specifications Authorizedbe- nnlow involving extra costs will be executed only upon written orders,and will become an Signature: extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control, Owner to carry fire,tornado and other necessary insurance. NOTE:This proposal e Our workers are fully covered by Workmen's Compensation Insurance, withdrawn by us if not accepted within__ days. We hereby submit specifications and estimates for: I NORTIy Town of Eover o,J� c0c."I dover, Mass., / DRATED S H E BOARD OF HEALTH 1PERMIT T D . Food/Kitchen Septic System C BUILDING INSPECTOR 1 THIS CERTIFIES THAT........U R... I.........S..m. ...C. ...�.. ...��..�.....�.......................................... Foundation has permission to erect....�?Q.o......h........ buildings on .....kd.3.....C ,.,.. C. ......s. ... Rough to be occupied as......0.. - IQ.......:.I.........4.14..y.. ./' ..................................................................................... 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 Insion, Alteration and Construction of Buildings in the Town of North Andover. 19/78 �pe tavol 400� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR C 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 RoughFinal 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. r Location tA— No. / .' Date G G e2i ` MORTM TOWN OF NORTH ANDOVER F 9 ` Certificate of Occupancy $ �'�s''••'•Eta Building/Frame Permit Fee $ s�►CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '� Check # -� i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT Arr PLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /�� DATE ISSUED. l ! e &tA_� SIGNATURE: ` BuildingComms o isner/Ip/0 3ector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /,33 C halt s-� a-7y a-7 0008 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: - Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS fit Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water Supply M.G.L.�.40. .54) ?i Public 0 Private'a ❑ �i. Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ i SECTION 2-PROPER'TY,OWNERSHWIAUTHORIZED AGENT n 2.1 Owner of Record 7z: n Name(Print) Address for Service.: Signature Telephone 2.2 Owner of Record: C Name Print Address for Service: ^^� C, Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C License Number Address Expiration Date am Signature Telephone r 3.2 Registered Home Improvement Cornctor Not Applicable ❑ C)C) Company Nata Abe ! �\ i Vl ry,� l Registration Number A ess ` �J` Q L,31 _66 V 7 ,_ �� Expiration ate nature 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 buildingpermit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other pecify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ` n: a ,Completed by permit applicant 1. Building oC (a) Building Permit Fee 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 to act on My behalf,in all matters relative to work authorized by this building permit application. signature of Owner Date SECTION 7b OWNER/AUTHORIZEDA'.GiENT DECLARATION 1 ��UV'l[�'l ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the for going application are true and accurate,to the best of my knowledge and belief c��1C 2Priaef Owner/A ent Dat NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS I ST 2ND 3 RD SPAN DITVMNSIONS OF SILLS DM ENSIONS OF POSTS DRv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I y 4 � IBPROQEfIEN1.CDNTRA6TOR �pe: Prilmate Corporatio _—_--gaState Roo'6trtg; it ey Se'n Mahon Si. . /tbMlNISTRATO�O. READING. na a>.a5a - k NORTH °f<<``°;• '"o TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS� This certifies that ....... `.,. : ^ .�t-s.... ;:/................................. has permission to perform ............fir. .• .. ............ l.. . ......................... t wiring in the building of................................................ �9........... r ....................... at.........:-.......r...r.! ,: �. '�.....................'` ....... ,North Andover,Mass. J Feet,-4-.A....`....... Lic.No..... 1..c ........... '?....f.....' 'tu.. J ... ELECTRICAL INSPECTOR 6 Check # 5642 11M Luly1Ly1VlV YI'EA"n yr AVIV At'nU.wi 1 ("�.•�j--����/� DEPARTMENTOFPUBIICSAMY Permit No. BOARDOFFIREP ON REAVX0NS527a1Rn-00 Occupancy&Fees Checked APPLICA77ONFOR P TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDAN E WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ` (PLEASE PRINT IN INK OR TYPE ALL INFORMA ON) Date U?il 1g Town of North Andover To the Inspector of Wires: The undersigned applies for a permit too rform the electrical work described below. Location(Street&Number) 2j 64,� ," l� Owner or Tenant 0,-,ar.e r kt T- iu t. ,ff le k o v t'C Owner's Address Is this permit in conjunction with a building permit: Yes No EJ (Check Appropriate Box) Purpose of Building 11 1'4c k e-4, G'Q wt o do Utility Authorization No. Existing Service /00 AmpsVolts Overhead M Underground a No.of Meters t New Service Amps� Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 77-f J 7 P7 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total Z KVA No.of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA round ground No.of Receptacle Outlets �3 No.of Oil Burners No.of Emergency Lighting Battery Units t No.of switch outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones i Q� Tons No.of Disposals No.of Heat Total Tote! No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Devices KW Local Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• ]rtsitrataeCoveraagz..Arts>antbttetagtmanats�GalaalI.avvs IhaNcaamaYLiabiityhmaanc>Fb yittct&gComple>e scoveworilssk9adwagivalfft YES NO Ihave&ftAWdvatidptoofofsa=loftO!lice YES r—T lfyvuhaveched®dYES,plea9 niicaftth peefwvwWby INSURANCE boot BOND Mm (Please*cdy) Estff l VallleofE1Xft alWdk$ WO&IDStat hpecfimD,*R0We*d FX* Final signeduncirTrFtlal mofpaw FIRMNAME Lioe WNa Lit== Sigrtaaae Liomllb Busk=Td Na AkTdNa OWNER'SINSURANCEWAIVER Iamawaetha drLmwdoumthmftmm=eovw*crits&&l:XM givalataste4tedbyMas�GffnWLaws and that my sgr�ue cn�appliratial waives tliS tecltrieanaY (Please ch Owner Agent Telephone No. PERMIT FEE$ tgna ure oi Owner or Agent r Date.. ./ . ...... . Of HORTM ,41 F� °` °p TOWN OF NORTH ANDOVER 41 ' PERMIT FOR GAS INSTALLATION Ac HUgE< This certifies that . . ~U . . . �. +-4..:�- � . . . . . . . . . . . . . has permission for gas in the buildings of at . . ,-: : , North Andover, Mass. r Fee?4,. . . . . . Lic. ... . . . . . . . . ` GAS IN$PECTOR Check { r �, MASSACHUSETTS UNIFORM APPUCATON FOR PEIMr TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS B 'ldi g Locations �1 �3 CkpaVhictc Jr- Permit# Amount$ c Owner's Name U�t SITYey1(rj New❑ Renovation Replacement ❑ Plans Submitted ❑ �a H c o a ° w 04 HUG 0 z z O Z U a.a FF O a SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) r Che k one: Certificate Installing Company , Name V , G e!Z 4-r 0 1- Corp. t Address Z j&-r,—V,N L,,i , A ❑ Partner. Business Telephone A=7'37'-0 _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter -2 rL -cam J INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes,please• dicate 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 ❑ 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 Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Date .. . .J." HORT: a TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACHUSE� / This certifies that . . . .» . .. . . .. ..,... . . . . . . . . . . . . . . . . has permission to perform _. -!� ��,�., . . . . . . . . . . . . . . . . . . . plumbing in the buildings of .-: -.`;r�r'. ?e-- -•:- ! . . . . . . . . . . at . ./.,',�. . North Andover, Mass. Fee '7 `5�'. .Lic. No. . . . . . . 1 � �� . . . . . . . . . . . PLUMBING INSPECTOR Check # 6370 MASSACHUSETTS UNIFORM PLICATION FOR PERMIT TO DO PLUMBING (Type or print) 1 NORTH ANDOVER,MASSACHUSETTS r l Building Location l�3 !'1 9J C'/j��0(/1 C' e ate. #_ ` M W C ( Own Name Amount 37"S o Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES H E~ w c a E* F* —SLR BM I1��Iv>avr' M HIM 3M FLOOR 41H FLOOR 51H HIM 61H MOOR t 71HHDM SIH MOOR (Print or type) Check one: Certificate Installing Company Name V , !� -(.AL1. Corp. Address 2 J t h>�j i N GM. /�/P:tnf�'�iN l�A Q 2."1 El Partner. Business Telephone 17 (2-3 S--,m Firm/Co. Name of Licensed Plumber: V. ��'-rL NF-c o 4j - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy J4 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 I hereby certify that all of the details and information I have submitted(or entered)in abov a I lic ion a true and accurate to the best of my knowledge and that all plumbing work and installations performed under Pe I ed or is application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code an a e of the General Laws. By Signature or Licenseaum er Type of Plumbing License Title ..f- 12- 21 City/Town icense INUMDer Master Journeyman ❑ APPROVED(OFFICE USE ONLY 133 n/�o ,��, Location — + No. Z/v a;z, Date NORTIy TOWN OF NORTH ANDOVER 3? •. • O > ; ; Certificate of Occupancy $ . °, ._mss:.. ,' • / ,-I s�CHu9 tom Buildin /Frame Permit Fee $ / 6 y sst Foundation Permit Fee $ Other Permit Fee $ J TOTAL $ Check # 0�101J 17 .1014 J' 40 r"L'x�� Building Inspector f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4 $0000 tow -a- ; rn BUELDING PERMIT NUMBER. DATE ISSUED: 1-3 - 4,,? ,-3r SIGNATURE: Building Commissioner/Inspector of Buildings Date z SECTION 1-SITE INFORMATION 1 O 1.1 Properly Address: 1.2 Assessors Map and Parcel Number: 7Zv. .06 6l l Lo p Map Number Parcel Number ` 1.3 Zoning Information: 1.4 Property Dimensions: e� Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired Provided ReqWred Provided v 1.7 Water SupplyM.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Seweraga Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ' ��.tii(t: liSt(!Ct: YC P,Jp M 2.1 Owner of Record of_' o0v[C' Name(fin Address for Service Slgnature Telephone 2.2 Owner of Record: 1 0 Name Print Address for Service: z I M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl — Licensed Construction Supervisor: 0 License Number 11 Address Expiration Date E Signature Telephone r r 3.2 Registered Home Improvement Contractor Not Applicable ❑ t Company Name M Registration Number r Address r z Expiration Date /ate Signature Telephone Y� 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.......0 No.......0 SECTION 5 Description of Proposed Workcheckall a acable New Construction ❑ Existing Building 2' Repair(s) ❑ Alterations(s) T7 ition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / ��O i/Q �4 e d� oI/WO �� ^�o wU � � s e cn pe s"ctt.e/ �/e eel' iusol4el/ leew LV/t/rO� WO rvk /aee �rJ1`S, d -19nl412 dfloor L l"A dleC,Omr"�Ve G'OHCZ'"'e 1"DJ4e ) e lrQ'Oye 0,Qf'n /h she// hit ry ea 9;t ,e/r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building l� (a) Building Permit Fee 12 DD. 0 . Multiplier 2 Electrical 2 ©�D (b) Estimated Total Cost of Construction 3 Plumbing 2 000 Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 16. G1oo Check Number SECTION 7a OWNER AuTHordZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Y4r, 0'"t Kc 4 /_0 V ,,a lj as Owner/Authorized Agent of subject property Hereby authorize_ aQ r Y w04,Wq e to act on My behalf, rs rel ativelto work authorized by this building permit application. / ' � Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Yu F` 0,,cee- �3 ui P_`'t 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 Vu rt yrcl� �a � Print Name m i/o3 /zmv y Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I' 2' 3 RD SPAN DIMENSIONS OF SILLS DIIv1ENSIONS OF POSTS DIMENSIONS OF GIRDERS i 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 of NO oTN 1 TOWN OF NORTH ANDOVER OFFICE OF 4 too A BUILDING DEPARTMENT 400 Osgood Street �'*s*Argo r US t1� North Andover, Massachusetts 01 845 SgGH D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: ��O e%ri c Number Street Address Map/Lot HOMEOWNER_ Yr: &4e ve A llov,•C 4 <:570 94? 219 Name Home Phone Work Phone PRESENT MAILING ADDRESS /.33 0/c�a( `L4 0-4 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL HOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • 1 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) 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 NoRT#i Town of And Q ,,,c,. 7Q No. 4yoZ ` /_ � _ s G v _= o�� '� dower, Mass., COCMICK!WICK �,45 RATEo I co BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System I, • S BUILDING INSPECTOR THIS CERTIFIES THAT....q4.A.�............. ... `� ..........jr ..V. . ...... ..................... ...................... Foundation has permission to erect....�M.trA..�.. uildings on ...... .... ......CA o4dw<< Rough ................................... ............ t0 be Occupied 8s M IAO �� w♦ �/� Chimney 1 �....... . ............... ...................... ............... ......... .................�...... . ...... 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 relaJou to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or BuildingRegulations Voids this rmit. Rough PERMIT EXPIRES IN 6 MONTHS Final NAR UNLESS CONSTR.0.... . ........ EL E CTRICAL 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 RoughFinal 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.