Loading...
HomeMy WebLinkAboutMiscellaneous - 1424 SALEM STREET 4/30/2018 1424 SALEM STREET 210/106.A-0022-0000.0 Liberty V 1.Lutual, Liberty Mutual Insurance r� New England Region Central Property Unit INSURANCE 75 sylvan street Danvers,MA 01923 Tel:(800)566-0323 February 19,2016 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address:1424 Salem St,North Andover, Ma 01845 Policy Number: H3221804866640 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number:031838674-0001 Date of Loss:3/18/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, �99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A &B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws,Ch. 111,5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 j. t;. Date. ,! . :?.' �J� �. ... .. r l HORTM TOWN OF NORTH ANDOVER A� PERMIT FOR GAS INSTALLATION •.i 9SSACMUSEt This certifies that . . t !.r 9:.% . . . . .�. . . . . . . . . . . . . . . . . . . . . . . . x' rA has permission for gas installation . . .Dfil Y. . . . . . . . . . . . . . . . . . in the buildingsof . . . .0 M . / lL • • • . . . . • . . • . • • . • . _ . • • 2 at . . .Y. . . . :'ev.lie: . . . North Andover, Mass. Fee. 3A~. . Lic. No../?Pv ?. . . . S IN1,SPECTs 1. . . . . . : Check# i 5224 E { MASSACHUSEM UNIFORMAPFUCATONFORPERN UrTO DO GAS FPIT NG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations �'7 27 �al �I 57 Permit# g L L y } Amount$ 30— r IAC) n kA---A v Owner's Name J New❑ Renovation Replacement Plans Submitted ❑ I oC x F a z O F o ] W C7 F �j F o o 0 ts, a 3 A C�7 a U g > 0 a F O q SUB -BASEM ENT r " B A S E M ENT 1ST. FLOOR A 2ND . FLOOR 3RD . FLOOR 4TH . F',LOOR 5TH . FLOOR 6TH . FILOOR 7TH . FLOOR 8TH . FLOOR (Print or type ` C ec one: Certificate Installing Company Name � 121,m &Jim Li Corp. Address «�'� �T' ❑ Partner. i er k f usess a ep oneFirm/Co. m I Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Yes,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 ❑ 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 ail 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 `fid 42 City/Town ❑ Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) ❑ Journeyman i Date. .. .? . ...a Of "o :1hc TOW OF NORTH ANDOVER µ PERMIT FOR PLUMBING SS�ICHUS� This certifies that . . . U_. Y.cr- . . . �/ . . . . . . . . . . . . . . . . . . has permission to perform . . A.e .0.. .I-tA =. . . . . . . . . . . . . .. plumbing in the buildings of . . . . ),FA .. . . . . . . . . . . . . . . . . . . . . . . . at . . 1.2 `!: . r . : .". . . . . . . . . ... . . . . .. North Andover, Mass. C Fee. 7. Lic. No.�� r'?. �. . . � r PLUMBING INSR CTOR Check # f 4 6595 .,T MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J Date Building Location 1' v2 5( 5a)elli 5;r7 Owners Name Jd {� � C Permit#--&zq J ^ Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES 73 Ur Cf, Ur SLRBM t R4SEW l' 1SlC)EItOQt 3V)t iHIDQt M H OM 4M H" nja nax 6MHEM 7MRCM 91H HDCR (Print or type) Check one: Certificate Installing Company Name/ 22�? Corp. Address 6,-'? L�lC a Partner. vii- O1 3 usmess Telephone _S�-pl6 Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate._ e type of insurance coverage by checking the appropriate box: Liability'insurance policy . Other type of indemnity a 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 above application are true and accurate to the best of my knowledge and that all plumbing work and ins ions �rlormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass uset S bing Code and Chapter 142 of the General Laws. By: i o is nse um Type of Plumbing License Title L 1 Too?—'o City/Town is n e um Master Journeyman ❑ APPROVED(OFFICE USE ONLY 5.�.. ^hr'�>--�^.,A...�'��.,#.�°a'..,:r..-` ...__:. ,�"�-G-�.,;�.^^P,. "r�'r-. �-'�r+�•p if,�".`.'z.a.,�....X.�..,'�?�, 6185 Date.��.J............... ...... ,F, NORTIi 3?pe',r``o+�`ehOpL TOWN OF NORTH ANDOVER I,: # PERMIT FOR WIRING Sg^CMUS� I 'f This certifies that . has permission to performr....... J wiring in the building ov.... } at a.y. ..-. ------ ..... ........... . North Andover,Mass. �X A... F{ Fee Lic.N . .... ............ .. . . . . s ELECTRICAL INSPECTOR P Check # �� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. G Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME�),527 SMR 12.00 (PLEASE PRINT IN INK OR TYPE LL IN ORMATION) Date: Moll 7 QS City or Town of: AMw6e. To the Inspector of Wires: By this application the undersigned gives notice of his or er'intention to perform the electrical work described below. Location(Street&Number) 141 M ew�, S--fte4— Owner or Tenant p,h Telephone No. �� 3 oclJ 7 Owner's Address ScAme— Is this permit in conjunction 'th a buikli,ng permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service (ad Amps /alCj /02.yo Volts Overhead[� ndgrd❑ No.of Meters 1 New Service -WO Amps Id-C//a1V0 Volts Overhead ndgrd❑ No.of Meters Number of Feeders and Ampacity / I Location and Nature of Proposed Electrical Work: Completion of the folibwin table ma be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o mergency ig ng rnd. rnd. Bette Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones of Detection and No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices a Tons g No.of Waste Disposers Heat Pump Number Tons K o.o -Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElConnectio Municipal [IOther No.of Dryers Heating Appliances KW Security Systems: No.of-nevi s or Equivalent No.of Wit—er KW No.o o.o Data Wiring: Heaters S' ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E BOND ❑ OTHER ❑ (Specify.) (Expiration Date) Estimated Value of Electrical Work: (�`3`�J— (When required by municipal policy.) Work to Start:IC)/CA Q Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify,under th erns an penalties of perjury,that the information on this application is true and completes FIRM NAME: e LIC.NO.:-1600YA Licensee: Signatu LIC.NO.: (If applicable,enter "exempt"in a license number line.) Bus.Tel.No.- Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: 1 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. 1 am the(check one)❑ owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. � .-`-- I Official Use Only _ Permit No. Department of Fire Services j Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank) ' r. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 C�flk 12.00 (PLEASE PRINT IN INK OR TYPTION)E LL IN ORMADate: �O�, '� a's City or Town of: To the Inspector of Wares: A By this application the undersigned gives notice of his orTer intention to perform the electrical work described below. Location(Street&Number) rsat, P.Wt Svpzp� Owner or Tenant -1 hon 14aU Telephone No. A;� aCoC3 tat / Owner's Address Is this permit in conjunction w't6 a bu' mit? Yes No P, 1 g pe ❑ (Check Appropriate'Box) Purpose of Building_ + Utility Authorization No. Existing Service (60 Amps lolQ / yC) Volts Overhead " -Undgrd❑ No.of Meters New Service -200 Ampso2yo Volts Overhead[ Undgrd❑ No.of Meters —L Number of Feeders and Ampacity / t Location and Nature of Proposed Electrical Work: <,G V Completion of the ollost, table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans No.o f Total Transformers KVA 4 No.of Lighting Outlets No.of Not Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above -d. ❑ rnd. ❑ o.o Emergency Lighting Batte Units i No.of Receptacle Outlets No.of OR Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Neat Pump Number Tons KW o.o - onta ed Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Connech'aon ❑ Other No.of Dryers Heating Appliances KW unty ystems: No.of Devices or Equivalent No.o aterKW Si ns Ballasts No.of Deo.oNO-70-r— Data Wiring Heaters vices or E uivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Telecommunications Winng: No.of Devices or Equivalent OTHER: Attach additional detail il'desired,or as twquired by the Inspector oJ'Wires. 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 cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: LNSURA NCE [y BOND [IOTHER EJ (Specify-.) (Expiration Date) Estimated Value of Ele cal Work: ( `�7 (When required by municipal policy.) Work to Start: JU/A 77' Inspections to be requested in accordance with MEC Rule 10 and u n com leti po p on. 1 curd;fy,under th ains am penalties of perjury,that the information on this application is true and complete. FIRM NAME: .7 c LIC. NO.: ��QO Licensee: Signatu --% LIC.NO.: (Inapplicable,enter "exempt"in ie license number line) Bus.Tel.No.: Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my sigpature below,1 hereby waive this requirement. 1 am the(check one)❑ owner ❑owner's,agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Commonwealth of Massachusetts Official Use Wy Department of Fire Services Permit No. 4,C) Occupancy and Fee Checked BOARD OF FIRE,PREVENTION REGULATIONS [Rev. 1`,1/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordanoe with the Massachusetts Electrical Code(ME ),527 CMR 12.00 I _ II (PLEASE PRINT IN INK OR TYPE ALL INFRMATION) Date: 9 oZ�IC1S City or Town of 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) ILlOZy 4E0,J Q9A ST k6w,= Owner or Tenant :1:!h(\ v6d 1 Telephone No.'191-aa3— Stl Owner's Address SCA Is this permit in conjunctionv���it_h"a building permit? Yes ®, No ❑ (Check Appropriate Box) Purpose of Building .Rest 7�i Mill Authorization No. Existing Service J 0 Amps /aV/ a t{G 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: x VI n MVI l M Completion of the folAbogwin table ME be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Tr o Total Transformers KVA `No.of Lighting Outlets I No.of Hot Tubs Generators KVA No.of Lighting Fixtures N Swimming Pool d Above ❑ rnd. ❑ B. U ft �e ry r ting, No.of Receptacle Outlets I No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches S No.of Gas Burners No.o Detection and Initiating Devices No.of Ranges N1 No.of Air Cond. Tons No.of Alerting Devices {� No.of Waste Disposers Heat Pump Number Tons KW No.o - ontamed Totals:. Detection/Alertin Devices No.of Dishwashers I Space/Area Heating KW Local ElCouncectton ❑ Other No.of DryersHeating Appliances KW unty ystems: No.of Devices or Equivalent No.of Water _ KW o.of No.of Data Wiring: Heaters signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or Equimatent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 co7fage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE LVJ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of.Electrical Work: M&_00 (When required by municipal policy.) Work to Start: 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the painand penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee. l vt 13 LIC.NO.: (If applicable,enter"exempt"in the : nse n tuber line.) Bus.TeL No.:Q28' Mfg 'Eat'i ' Address: 011C Alt.Tel.No.: _ I OWNER'S INSURAN E W VER: I am aware that the Licensee does not have the liability insurance coverage normally /' '--- required by law. By my signature below,l hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent �_ L✓ Signature Telephone No. PERMIT FEE:$ " 60, 1 � Date.................................. ' ° <•``°;°�"° TOWN -OF NORTH ANDOVER -3 PERMIT FOR WIRING ,ssACMUSEt N ; This certifies that ....... ,....... ............. ..... ..................................... ` ..has permission to perform �-..� �. ... ... .... ... ' ..` wiring in the building of... at:... �!. �- ....f . •„-% .. ........... North Andover,Mass. Fee-3 ............. Lic.No.��A��. .! ��'pp �. . ELECTRICAL INSPECTd©K .. 6heck.#. 7 '-„ter ��x-�""..>s.�+'"`s3�,�` rx^^�^��?;p"`�*�:a+w:���,.cr w-k.yr.+th�-. F+4r�' ;�C; •�K�'�. Commonwealth of Massachusetts Official Use Only g Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEf),527 CMR 12.00 (PLEASE PRINT IN INK OR TVA- kid-wep— INF RMATION) Date: 91az)0s City or Town of: To the Inspector of Wires:, By this application the undersigned gives notice of his or her intentU19 form the electrical work described below. Location(Street&Number) ILIGLI �I W S AAAMMOk Owner or Tenant 611 Telephone No. P -/�;Ra3-a7S9 Owner's Address SC� Is this permit in conjunction Zith bu mg permit? Yes No ❑ (Check Appropriate Box) Purpose of Building :PAPS.; T W Utili Authorization No. Existing Service ICO Amps /at)l 61 t10 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: –Ax Li In n fA@Lrm , 1 w44& Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total I Transformers KVA No.of Lighting Outlets ' No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ 0.0 mergency ig g IV rnd. rnd. Batte Units No.of Receptacle Outlets ' No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches j No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges ��� No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of elf-Contained Totals:_ Detection/Alerting Devices No.of DishwashersSpace/Area Heating KW Local E] ElMunicipal Other I Connection No.of DryersHeating Appliances KW Security Systems: //A No.of Devices or Equivalent No.o Water KW No.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: I Attach additional detail if desired,or as required by the Inspector of Wires. 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 co age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify.) , ' Estimated Value of Electrical Work: '��'GO (When required by municipal policy.) (Expiration Date) Work to Start: 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,underthe pi do and penalties of perjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: / Licensee: �t t� V Signatu LIC.NO.: ' (If applicable,enter "exempt"in theAnse number line.) mus.Tel.No.. Address: �l E S� /$IiCS Alt.Tel.No.: OWNER'S INSURANCE W VER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,l hereby waive this requirement. 1 am the(check one)❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $_ 21— i x Location No. Date i ;N E HORTq TOWN OF NORTH ANDOVER 3? 0 SOL Certificate of Occupancy $ E<�' Building/Frame Permit Fee $ 4 ncwus ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ fC3_ Check # - 19457 Building.inspMor TOWN OF NORTH ANDOVER 4 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4y W d Nm� r,_ - �,✓.,. ..cz .�•it �+- �sys"+ ^� .�, t r t" '�s"rs '' n.� • �;,�;a ac�.4?�'" ,��3 BUILDING PERMIT NUMBER. DATE ISSUED: �,n SIGNATURE: Building Commissionerff for of Buildings (Date , , SECTION 1-SITE„INFORMATION),,,,_, �_Nl � - .,>,a�I� "l-1 J i ~j„tom�J.J� ��►.J � T 0 1.1 Property Address'.-/ ` 1.2 Assessors Map and Parcel Number: 7� 1•� Map Number”�+''v �ti.J��,r Parcel Number 3 ,/ -•J 1.3 -Zoning Information: 11.4 Property Dimensions: Zoning Di;_Uic_t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS(ft) �- Front Yard Side Yard Rear Yard Required Provide Required Provided Provided 1.5. Flood Zone Information: 1.8' Sew e 1 System:1.7 Water Supply M GL.C.40. 54) �sP� ys Public ❑ Private ❑ ` Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT Historic District: Yes No `M 2.1 Owner of Record r-y-I 1 I AJ Name(Print) Address for Service: CQ1/ Signature Telephone 152.2 Owner of Record: Name Print Address for Service: p��qy 1�1 Signature Telephone _ SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name - Registration Number M Address 0 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 I appUcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0t` Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIALUSE ONLY 4� Completed by permit applicant ate:-°�. e .. "�'�°c;.` " _��� �`•���s �.n 1. Building (a) Building Permit Fee ✓ _-S .r tJ v 0 Multiplier 2 Electrical (b) Estimated Total Cost of 5 Construction 3 Plumbin —7 c>Z5-Z) Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 L/ ; Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR-APPLIESYOR BUILDING PERMIT t I>�;► '=--� I�CJ��C as Owner/Authorized Agent of subject property Hereby authorize to act on • My behalf in all er el tive work orized by this building permit application. r Si ature o er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare tha ateinents and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name ' Si nature of Owner/A ent Dat NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i A0RTh TOWN OF NORTH ANDOVER Of OFFICE OF p BUILDING DEPARTMENT �0 ; 400 Osgood Street North Andover, Massachusetts 01845 ,ss^CHUSt1 D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Pleaseyrint DATE: 4/ U} JOB LOCATION: C)as Number Street Address Map/Lot HOMEOWNER 17 c4 16 7 Y 220 r a 73-1/ Namd Home Phone Work Phone PRESENT MAILING ADDRESS )LrX W j ' Sfi T 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 BOARD OF APPEALS 698-9541 CONSY'RV ATION 698-9530 HEALTH 699-9540 PLANNING 688--9535 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 at: S±- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11 S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris ns will be disposed of in: Illy (Location of Facility) Signature of Permit Applicant Fire Department Sign off Dumpster Permit Date i i I I i I � � � j ; � � � i '� N ��,.�� ' �J i �� ' , j ,. i �pr� � i >Z��5 � l� ® \V C / �--� 9 3 i 1 .�-----�. 2�r . � ' � j � i � I i ' � s ; � i i � f � � � � 1 � � � � � � � I I i � � ' � I � A i i � � l f � � i � � �� � 1 i I � � � ! 1 i � � i I NORTH T Ovo ®ver m f No. I, =. _ _ QC dIF 0 LA 0 dover, Mass.. COCHI CHEWICK RATED BOARD OF HEALTH Food/Kitchen PE 'RMIT T D Septic System 09W BUILDING INSPECTOR THISCERTIFIES THAT................. ......... ............................................. ............................................ Foundation _1 Rough has permission to erect buildings . ....... A. Chimney to be occupied as --1W*VW_W"WW.... --6-77r7�.....' r.Wshall In every respect Final provided that the"poeormson accepting this pe' 1 lontf �Mm to the terms of the application on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough ......................... Service BUILDING 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. SEE REVERSE SIDE Smoke Det. 0000, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO O GASFITTING (Print or Type) yu,,, A'n U e/ . Mass. Date / l0 1.9 �1 Permit BuIlding LcCatlOn yy Owner's Name_.Y`1, j�•�ri�r, - �V," Fol[_4e4/ • 11/ /7 O Type of Occupancyy tri » Now p Renovation p Replacement 0 Plans Submitted: Yes(p No ni O f N S} Y rk N Atte w w ¢ O ul Z H J N W 0 V m f' x vl Z w r Z Z 0 �, C a O O W y_ A} C m H N W W O a C �s ►- ,{ aU W O ry j7+1'r W W N J Z < = C W W C W `- W N W O O U rN• W W > a W z. < IX < < o ow a oc 'z o x w 3. o o J v ¢ > o d O Sue—BSMT. { � g. .BASEMENT 1ST FLOOR ; 2ND FLOOR � 3RDFLOOR 4TH FLOOR ' 6TH FLOOR eTH FLOOR 7TH FLOOR H4 6TH FLOOR 'z In"" Name The Plumbing Co. , Inc. Y� Check one: Certificate # Address— P 0 Box 16071 Corporation 1219C fi Wakefield Ma 01880 p Partnership t y,b Business Telephone 617-246-0019 ❑ Firm/Co. .' Name of Ucensed Plumber or Gas Fitter Clifford H. Giles INSURANCE COVERAGE: 1 have a current habil Insurance nY policy or its substantial equivalent which meets the requirements of.M(3l Ch. 142. Yes Q No ❑ N you have checked Y—es. please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 9 Other type of Indemnity❑ Bond p OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by s fr Mega. 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ? �y ature'o(Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my ext, krtowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compifanos with aM Pmt Provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge ei I Laws. ^' Te of license: —k-1,Ax Plumber Signat ltcon Mumber or Gas Fitter To Gaslitter Master license Number 8701 Journeyman `.; FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. i PERMIT GRANTED DATE _198 GAS INSPECTOR 2775 Date ... ...... HpRTH TOWN OF NORTH ANDOVER A pf ,oto � ,e1tip O ` PERMIT FOR GAS INSTALLATIO f � A #• � s o �a �9SSACMUSEt . / _ Y This certifies that P. <.�y..11.�r�. -.G�, . . . . . . . . . . .... . has permission for gas installation .N. . . . . . . . . . . . . . . . in the buildings of . .C.'. 13.13J.cA.). . . . . . . . . . . . . . . . . . . . . . . .. . at J d1, I. . .SA.lk—., Ste. . . . . . . . ., North Andover, Mass. Fee., .,�, . . Lic. No..S7U/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer