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HomeMy WebLinkAboutMiscellaneous - 16 SAUNDERS STREET 4/30/2018 (2) SFJ SAUY1pERS ST1�C-EY r"AP 0'2 q Dat/ .- Of,�pRTM,�' TOWN OF N'?RTHANDOVER PERMIT FOR PLUMBING i ,SSACMUS� This certifies that . .. . . . . .. .. .. . . J .. . . . . . . . . . . has permission to perform � . . plumbing in the buildings of . . . . . .. . ..`. .. . .. . . . . . . . . . . at/l. ./ . 'c" /" . . . , North Andover, Mass. 11� Fee. .' . . . . .Lic. No . . .�. . CPLUMBING fSPECTOR Check 7 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date `3 d Building Location IG—CC Owners Name O,6 M P4-I Q— N .. Amount �3�a), S" Type of Occupancy New ri Renovation Replacement "� Plans Submitted Yes ❑ No FIXTURES wrtO O rA � C7 a O O U ,.a W A A �SRQVIi: FT 1SE FIQQ2 � M ijaR 3M K-0Qt 41HRaR SM FLaR 6M)Hl-" - 7M Hf= M FLOOR ' (Print or type) Check one: Certificate Installing Company Name ' El Corp. Address X C L-0(—erl Partner. JaLWY Mk 61160 u�m�Telepho e Finn/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. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three ' rance i ature 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 Massachygptts Stat PI bing Code and Chapter 142 of the General Laws. By: igna u oi LicenseciMUMDer nL 3Type of Plumbing License Title el � 3 City/Town icense um er Master ❑ Journeyman APPROVED(OFFICE USE ONLY Date. ./. .7� ".F;<<3.. ..... ,�ORTM I f 1 ���`' 6 �� TOWN OF NORTH ANDOVER O _ A • . PERMIT FOR GAS INSTALLATION �1S SACH S This certifies that,? --! -���'=' has permission for gas installation- . . . . . . . . . . . . . in the buildings of j, . . . . .; -Qel.. .... . . . . . . . . . . at fj � a- -�- ��'-�. : "• • North Andover, Mass. Fee . . Lic. No.7r(.3 GAS INSP96 OR Check# 63 14 MASSACHUSETTS UNIFORM APPLICATON FOR PERM TO DO GAS FITTING (Type or print) Date ,C/ 30 l O NORTH ANDOVER,MASSACHUSETTS Building Locations ��/ `S4, Permit# _ h 3 4 Amount$ ''j Owner's Name PACU Pit-,%Kjq�(Pri Aaj New Renovation ® Replacement Plans Submitted U a cli 0 u GG ' I o a F F m C C z96 O Z F W4C V w F C o C > W w m � C x eG a z Qw d C .�. F" w m > Z O w w x o x 3 0 ° z > c w F o SUB -BASEM ENT BASEM ENT 1ST. FLOOR f 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) 'r Name Check one: Certificate Installing Company Corp. Address C� Lo Lt t I ,S Partner. mess a ep one _p L(( Firm/Co. Name of Licensed Plumber'or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes If you have checked Yes,please indicate the type coverage by checking the appropriate box. No� Liability insurance policy 1:1 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.Genera(LAV,and that my signature on this permit application waives this requirement. Check one: Signature ofwn s gent Owner 13 Agent 13 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: Sig ture of Licensed Plumber Or Gas ' Fitter Title Er Plumber 9 6 3�3 City/Town, E] Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ® Journeyman Date/. ��.. .� • NORTh TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION +•ro•' Sy SACHUSEt rte This certifies that �r'` . . . . .���`'. . ! `— 1 n �S has permission for gas installation . . . . .�. . . . . . . . . . . . . . . . . in the buildings ofs . . . . • • • . at . Ar4 . . . . !` .�. . . -:�. ., North Andover, Mass. �. . . Fee. �. Lic. No. ,f GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS (Type or print) Date ct NORTH ANDOVER,, SSA USETTS Building Locations Permit# Amount$ //I i Ile Owner's Name New Renovation Replacement Plans Submitted x w O F M F Z a v, x w w F a a e 0 Iw- z 1- e x w w w a d a = F > om z o F �' '' z w > w z ` o vF, x 9 x O x R � 3 0 � a 0 00 > o a0, H O SUB-BASEM ENT IF BASEM ENT 1ST. FLOOR I J- 2 FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or typ © `� �,/�/„ / Check one: Certificate Installing Company Name (� �"4 /�/ Corp. Address Partner. S-- Business TelEphone Finn/Co. Name of Licensed Plumber'or Gas Fitter 1'7c /AS 7 INSURANCE COVERAGE o e:I have a current liability Insurance'policy or it's substantial equivalent. ��Chsec ­No If you have checked yes,please' dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnityD Bond D l 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 13 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 installation der Pe for this application will be in compliance with all pertinent provisions of the Massachusetts tate Code and al ter 142 oft General Laws. By: Signaturesed Plumber Or Gas Fitt r Title Plumber City/Town'. Gas Fitter License Number Master _ APPROVED(OFFICE USE ONLY) 0 Journeyman Date. . / ��`. . . .; .... . HORTM w� Of „ao ,°Ati0 3j a° TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION SACHUSEt� This certifies that . . . . . . . . .`" .. . has permission for gas installation .? . . r. . . . . . !. ``:�' in the buildings of_. .. \./!`. . . . . . . . . .,. �f--r^'. . . . . . . . . . s . atNorth Andover, Mass. Fee/."? . .. Lic. No2� /—<S— --`�' !;-' . . . . . . . . GAS INSPECTOR Check# ��� 6296 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS G (Type or print) Date l Q NORTH ANDOVER,MASS IiUSETTS Building Locations � > 5 Permit# � Owner's Name Amount$ 7 New Renovation Replacement Plans Submitted � a x c7 v w x �, z F n a a > d F z H d x w a w °�' ,W w° E~ x a z W > w a .H. �" �� uVi a m Z O F W Z o x °� .da a a F o SUB -BASEMENT 0 ° z > BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type Check one: Certificate Installing Com Name C �/ �'` g pang 3 � D Co Address/ D Partner. usiness a ep one D Firm/Co. Name of Licensed Plumber'or Gas Fitter Q' INSURANCE COVERAGE Check on . I have a current liability Insurance,policy or it's substantial equivalent. Yes Lj No� e If you have checked yes,pleasindicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond 13 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 13 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 St as Code a Ch ter 1 of the General Laws. By: Signature o nsed Plumber Or Gas Fitter Title Plumber X az City/Town,. D Gas Fitter (cense Number Master _ APPROVED(OFFICE USE ONLY) 19 Journeyman Location /�o So�tic�F r s S� No. / Date O RT No M TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ CMIi1i Building/Frame Permit Fee $ as 3�I Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S' Check # / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING -... s .: .w _af BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of BuildinE Date SECTION 1-SITE INFORMATION A 1.1 Property Address: 1.2 Assessors Map and Parcel Number: SOW Yid ev-s s-� d� 3 Map Number Parcel Number \ 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G1-C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 3' Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT n 2.1 Owner of Record ��111�e� yry�e✓r Allip s f e 'n Address for Service: _ I 2�& Signature V Telephone Q� 2.2 Owner of Record: \ A 1 l )0i`ler N e ri Address for Service: r ri Si nature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C License Number Address Expiration Date Signature `�' Telephone r 1 3.2 Registerel Home Improvement Contractor Not Applicable ❑ Company Name n Registration Number r r Address m:= 2 Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(nG.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 Work check all apphcable New Construction m/ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J N GReim) r 11 Y Re,'Pk61Y115 �4e P/,JtVf 4a U ��cJS� 2 filar `f fir✓fa L)i d Cd de, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be '" Completed b t a licantkz 1. Building (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 Or 6 Total 1+2+3+4+5) %Odd Check Number SECTION 7a OWNER AumogyzRbON 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/AUTHORIZED AGENT DECLARATION I, �h l (/� i i/ " el/' ,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 Ailif Pra e L� VatJe Si er/Aature f Ownent NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TAMERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS D-v1ENSIONS OF POSTS' DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F'k U1- ai3 Wall 23 :k3Q� t rALAN f T 10m C' Int PEG r f I- Sow ,so'* S o l h Sim .3 i PU p SES ONLY• Tt t Tp P1fc U9ED FAR MpRTA06 (i SLIRYEYI AN01ti ( 4T All IN 9T MFI,Y S. s PLAN Lg aASEn ON A TAPE SURVEY[N OLD NOT BE USED TO ESTAgLLSII PiIOPEftTY LINE HI9 St10 � T OFFSETI m SHC�VJN 'INEREFOFiE.T1lE LAND Ss�X COUNTY PLAN OFLA u , PLAN REFERENCE: r' I DEF-0 REFERENC t1-r10• 03.9 PL. BK CERT•NO. approximately as l ox at the existing building Is located appr t PFIEPAaEn FOR: ! that o o G e I time i haret3Y t: a N �f�i.1 Shawn and was not In violation4��oceledli ab food i�azIN Area. h. 4P A�ti�G� M t V iii Construction.This huilding e HAZARD COMMUNITY NO. 25Uo9$ y� FLQOD EFFEGT1VE.�3sta93 �i I i3oUNDARY MAP N0. 3e- I �+ SCALE: I MI y 4-Q FEET i'64QMAS • t A1LLIE A COMPANY �• CIVIL ENGINEERS &LAND SURVEYORS BStLI.,iE >~,-r Kp.88�32 .1:3AQMA 018137 fl44-27$7 (617} i. RE 15[ERE4 LAND SURVVO -j 4. DATE: �! cgs=—o The Commonwealth of Massachusetts Department of Industrial Accidents • a f d Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit I 97h, SV0 'k Name Please Print Name Location ! c� L�/ �P✓� �r� Citvor Phone I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity aI am an employer,providing workers'compensation for my employees working on this job. Company name: 0 Address Ci : Phone#: Insurance Co Policv# Company name: Address I City Phone#: 1 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 asxrel_as.civiLpenaltiesln-thelnrmjofa-STOP WORK-ORUER and-a.fine.of-(.$1-00.-00)-a-dayagainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify,under thepains and pe ' s of perjury that the information provided above is true and correct. Sign re Date re 6 �a I Print name 1 �� 1 j er Phone . Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept r ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: phone#: ❑ Health Department ❑ Other ... ...... v. —v.uss r9jIVVr61 Building Department ' 27 Charles Street # North Andover, MA. 01845 D. Robert Nicetta 'ss��►�,S s{g Building Commissioner (978) 688-9545 .,..;(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print l DATE / JOB LOCATION Number Street Address Map/lot "HOMEOWNER 1 0 al yVrr / Name ome P one Work Phone PRESENT MAILING ADDRESS / Ala City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of 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 j DEFINITION OF HOMEWOWNER: 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 dwelling, attached or detached structures ac- cessory to such use and/or fans structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance 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 No.Andover Building Department minimum inspection procedures and requiremepts and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Town of North Andover Building Department ' .� y, o 27 Charles Street North Andover, Massachusetts 01 845 978 688-9545 Fax 978 688-9 °�4 + ; ( ) ( ) 542 NTeo SSACHUS���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit-# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 56a. The debris will be disposed of in/at: Facility location Signatu of Applicant ate NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. V40RTH Town of 0 Andover VIA No. -A 07- 5 "-0700/ cocHic I dover, Mass., ORATED P' H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT...................... .#........... ............................................................................. ........... Foundation * 40 0 10% has permission to P........................ buildin s on ... Rough to be occupied as...Pro /-S* 1 2 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. Redw 8&o RAS Is 0-3 .%,o St 4 ov% s, 7-A 1 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL 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 Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE A u L._.L L._L 1 I 111 �: kx ` lyi ry` a 1111 i � I jg� 1 h', a� �1 r • r I rp li�'ll..'7'yl�I,I'+M k✓Fh*���I 4�'� ;� P I � �a�it °^ ISA i' �; . 4,1hdlNl rFl ' a h41lll uI !1 , ! s ull III h 1 v,I j 1 i ��p N�� �r . �.,,,,•., ,,... a., � I r INi ,1 In! G t a �flll 'r� � i I 7 , W 1 x I r v L L L s ,.� I I I ��✓h ' � ' M it � I�"�' jlp t' r qY lll h � W I IIS �Ij�IN� j � I t t old OOJIO 4 I I .C. 'I y (' ' 11 '� ML Ipf.1 r II� "•" � ' 6 e r �,, t I � r� tl�I�I � �' 1 �'��h�i �''�- µ �'• � '.F �'-•—•+•,� , f O IMP 1 Mi I �� 4hlll I I! u �1 :• 1_ P ry p I b Ih1 I n:hl!. I '4141 I �h I4 �, y n"pl ... a .r. .... • , .la" :.-...a- alwl'�c�1.,., ` ��u,1r r1+4 - ,.' ., '��.�'� _ • .e ,:I �, IW * I MR , ^„s .. � t w:.i III w « •