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HomeMy WebLinkAboutMiscellaneous - 15 DEWEY STREET 4/30/2018 (b 6 Date....... .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU This certifies thatE�s l'ot--fli ...... .................................. ... ................................ has permission for gas installation ..................... in the buildings of....."..Are e. ................................................q.................... 0 North Andover, Mass. . ...... . ......................... ..... ........ at....../..5 ,,)... . Fee.5a:.531 Lic. No. /A5�Z... ............................................... GAS INSPECTOR Check# /636 .9080 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 2 MA DATE Z7 //q PERMIT# �� v JOBSITE ADDRESS ✓ OWNER'S NAME GOWNER ADDRESS ITElf�'7Y Y07-79'z8FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIALo PRINT CLEARLY NEW:E] RENOVATION: REPLACEMENT:Eh PLANS SUBMITTED: YES 0 N0za APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER l_ _I .- _ �-- ! _ h+ w: - _ C DRYER FIREPLACE FRYOLATOR -�z..1 I FURNACE -- - 1 - - - - -- ---� -- GENERATOR GRILLE LI �- INFRARED HEATER -- LABORATORY COCKS MAKEUP AIR UNIT I I OVEN I- - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER _ - I _. _. i- -_ �- _. I ATER HEATER OTHER - - - -- - - I Vii=-I Irr1 I - - - - - -I=-- i1111 -_-� -- _�_^ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES 40NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CO ERAGE BY CHECKING THE APPROPRIATE BOX BELOW o1 j LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY BOND Is OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER El AGENT c SIGNATURE OF OWNER OR AGENT In hereby certify that all of the details and information I have submitted or entered regarding this application are true n a o the t of my owledge and that all plumbing work and installations performed under the permit issued for this application will be in compl' e 1 P rti r 'si f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME / rlY1 _4jq: _ LICENSE# 5(ZI SI NATURE MP* MGF 0 JP® JGF LPGI CORPORATION©# PARTNERSHIP EI#l___ LLC[3# Sole COMPANY NAME] eg `tln_.JADDRESS CITY Q - _ -- STATE AZIP 4uD3 TEL FAX /CELsy�iszz L. EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ J�-/ j FEE: $ PERMIT# �7 PLAN REVIEW NOTES l L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly � f Name(Business/Organization/Individual): Address: City/State/Zip: I-VH _ Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2 I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. o workers' comp. c. 152,§1(4),and we have no y [N p 12. Roof repairs n insurance required.]t employees.[No workers' 13.2. 3. - other-94 o,6e Pl4,f� ,� L comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert u pai and al ies o erjury that the information provided above is true and correct Signature: Date: 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#: 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 of 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 the grounds 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited LiabilityCompanies p s(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 or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured 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 officidlly 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Commoawoaltl of Massa.,hmetts Department of Industrial Accidents Office of Investigations 6.00 Washington Sixeot Boston,MA.0211.1. Tel,,#617-727-4900 ext 406 or 1-877-MASSAFF, Revised 5-26-05 Fax#617-727-7749 wwwmass,gov/dia COMMONWEALTH OF MASSACHUSETTS !.�3 PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: GLENN MMCCABE :1 POORFARM ROAD j _ DERRY. NH 03038-420 I�f 13562 05/01/14 187425 : , Date. . ... . No TOWN OF NORTH ANDOVER ,. .,ao 0 c PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . : . .�' has permission top'..-.... !,!. 't- . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .-°,-^ :`'rY�`':''. . . . . . . . . . . . . . . at.� . . . . . . . ."" -1 . . . . . . . . . . , North Andover, Mass. Fee.:?�). . . . . .Lic. N s!.�f . . . `�-�-�' `yz��-: . . . . . . . . . . �� PLUMBINGiiNSPECTOR Check #�'j`3a' WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS G� Date / 2o-.z) Building Location l G �� Owners Name AWC ��C�� Permit# Zy Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES z a a ►- w H H a x �U Ln E~ H a -let t� z SLREM II�g1VIIYI' NE HIM L M FOQ2 3M HIM 4IH 1~IOCR 5MIOR 6M FI OCR 7IH HLM SIH R(XR (Print or type) b��L �L���! fi Check Corp.. Certificate Installing Company Name ❑/ `�C Address �� ! " � ❑ Partner. Business Telephone 4�-( 7 — /p Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond ❑ Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner n Agent D 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 ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State and Chapter 142 of the General Laws. By: signature ol Merismriumner Type of Plumbing License Title �. 7j'7� T _ Ci /Town License um erm =— Master ❑ Journeyman APPROVED(OFFICE USE ONLY N2 2595 Date....ze-;............. NORTH ?��'����-•°,�°o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING '� �Ss�cMusE� 'Whis certifies that .... has permission to perform � . 11 wiring in the building of.......... -�-' .............................................................. at... .................................................................... .North Andover,Mass. Fee=0' .....�....... Lic.No..... -� ��-t���....................... �/ ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer LPermitNo. Use Only BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Checked�� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 77}CMR 12:00 (Please Print in ink or type all information) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. Location(Street&Number Owner or Tenant -57—IOwner's Address /-57— Is s this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building �� I/AUtility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A No.of Lighting Outlets Total No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gr ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets. No.of Oif 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 osal No. Pumps .Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area HeatingKW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivAtypoverage NO = have submitted v id proof of same to the Office YES= NO = I u have checked YES please indicate thby checking the appropriate box. INSURANCE BOND = OTHER = (Please Specify) HR J9 Estimated Value of Electrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: �/ .� P� FIRM NAME �lfl/V/,4 �/�tf t LIC.NO.,2�,?7 Lkpnsee f !_0 4 �i-�9 /A AJ Signature - ( LIC.NO. Bus.Tel No. Address Alt Tel.NO. OWNER'S INSURANCE WAIVER: I am aware that the Licensei does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT f;EE $ �/ (Signature of Owner or Agent) Location /s— No. c Date NORTH TOWN OF NORTH ANDOVER 3? • G- 41 � s 4L I Certificate of Occupancy $ '••�°''<�'+ Buildin /Frame Permit Fee $ Sri "j ss'4cMust 9 `- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 14122 Building Inspe vo,r," TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPA15,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T € BUILDING PERMIT NUMBER. DATE ISSUED. M SIGNATURE: Ale, � 3 Building Co ssioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6/U .o -6000-© /Q Ali Map Map Num Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Diiiic­t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required 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 ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: Signa r Telephone 2.2 O of Record: '/ Name Print/ Address for Service: Sb?�y 114 eP4 m Signature Telephone SECTIQN 3-C014STRUCTION ISERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number M" Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number r Address r � ^z Expiration Date Signature Telephone G) 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) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (/' J SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be zt3 'IC ,USE ONIY Completed by permit applicant ";ss 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(e) 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 y as Owner/Authorized Agent of subject property Hereby authorize tip f [�Yl/�i S AL J ))[1 6k. to act on My behalf,in all matters relative to work authorized by this building permit application. ✓ 0%L Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Print Name Signature of Owner/A ent Date mom NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2.N D3RD 777 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 NORTH Town . of Andover No. 2m, h Z_ LA O dover, Mass., '" ggbe COCMICMEW1 I oRA'rED iPGt�S BOARD OF HEALTH PE ' T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ....... .. .................................... Foundation .................. has permission to ere building n ............... Rough to be occupied a ............................................ 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 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 UNLESS CONSTRUCTION ELECTRICAL INSPECTOR 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. Bumer Street No. SEE REVERSE SIDE Smoke Det. Town of North Andoverr►ORTH OFii4e° ,6'9gr Building Department o 27 Charles Street North Andover Massachusetts 01845 Z .^ (978) 688-9545 Fax (978) 688-9542 '9 CO-C-KM ��SSACHUS���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# C S- the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility lovation Signature o , pplicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass, 02111 Workers'Compensation Insurance Affidavit Please Print Name: 11n17 I"S / JGwc- Location: . / City ►S �W Mi( Phone (60 3) 3 8a-15kY 0 am'a homeowner performing all work myself. �l am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address C Phone#: insurance Co. Pclicy Company name: Address City Phone# Insurance Co. Policy# 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 andtor 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 herby certify;7-a pains and penalties of u that the information provided above is hue and correct. Signature il��- - Date Z v G'(? Print name Phone# ?�,5� Official use only do not write in this area to be completed by city or town official' 0 Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 013009 Birthdate: 06/20/1958 Expires: 06/20/2002 Tr.no: 27297 Restricted To: 00 DENNIS J DOUCETTE _ 231 OAKRIDGE RD PLAISTOW, NH 03865 Administrator PERM14 NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. V PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE `ZONE SUB DIV. LOT NO. I // , 7 LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME Q SPAN -- DISTANCE TO NEAREST BUILDING C DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION S�rl M ,f / e /I7Q IS BUILDING ON SOLID OR FILLED LAND tztWILL BUILDING CONFORM TO REQUI EMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED A D APPROVED BY BUILDING INSPECTOR DATE FILED / / - L�o ff O SlUILDING INSPECTOR SIGNATU F OW NE UTHORIZED AGENT FEE �-- OWNER TEL.N Z--� � G G PERMIT GRANTED CONTR.TEL.# . p 9 CONTR.LIC.# O 3 r H.I.C.# BUILDING RECORD , i OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 I3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/2 % FIN. ATTIC AREA _ N_O 8 M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\r✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MAS NRY ATTIC STRS.b FLOOR I_ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE___ HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 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'T'G UNIT HEATERS 7 NO. OF ROOMS• GAS OIL B'M'T2nd _ ELECTRIC 1st.12nd I NO HEATING Town of North Andover of NORTH OFFICE OF 3? batt 6 400E COMMUNITY DEVELOPMENT AND SERVICES p « . 146 Main Street 40 North Andover,Massachusetts 01845 WILLIAM J.SCOTT �SSACHUS Director In accordance with the provisions of MGL c40, S 54, a condition of Building Permit Number S'1-5' 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 111, S 150A. The debris will be disposed of in: C 9 o r L22 cJ,W (Location of Facility) Signature of Permit Applicant to NOTE: Demolition perrr.•.it from the Town If North Andover must be obtained for this project through the Guice of the Building Inspector. RD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 e- I �� II C DBPARPi�NP Oa �/u°�� � �' •aelRUCfrOn SUPgR�CLIC SApgpP I CS CBNS , e1 X889 BrPlres. B Restricted Ao. 86/18/1998 Birthdate. 88 86/18 /1958 PUNTS J I 131 0AIRIDCg UCBppB PLASpOa RD Ny 88865 r x S ' e �Juh i �i Tovvn of �.. S 4 ®ver 0 - '....:a..�. No. . F dower, Mass., I 19 0 . COCLIFIEWICK `S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System FOR BUILDING INSPEC F THIS CERTIFIES THAT . 4 �. ............. . Y Foundation has pdrmission to erect..........:............... ..............buildings oiii. ..........i.��........�.. W..rl - ...�3_7.r.................... Rough - t tobe i;yCupied 8s..................................................... �.....�............................:......................................... Chimney provided that the person.accepting this,4wrmit shall in every respect conform to the ternis of the applicat�lon on file in ,�. this office, and to the provisions of the Codes and By-Laws ttdating to the inspection, Alteration and Construction of `'nal Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this R)rmit. Rough Final PERMIT EXPIRES N. 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T Rough ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR .Display in a Conspicuous Place on the Premises — Do Not Remove Rough FinNo lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det.