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HomeMy WebLinkAboutMiscellaneous - 19 FOSS ROAD 4/30/2018 19 FOSS ROAD 210/047.0-0087-0000.0 L Date. . 40R7: ti TOWN OF NORTH ANDOVER .fir l�t� '•�OOL PERMIT FOR PLUMBING • i ! 'f► X0,,:.0^^��45 ,SSACMUSE� This certifies that Ul. . . 1 . �` '. . . . . . . . . . . . . . . . . . face. � . . . . . . . ; has permission to perform .�-f'.�:`�[x1-•'. . . . . . . . plumbing in the buildings of . Y . . . . . . . . . . . . . . . . . . . . . . . at . . . . . .. . .. . . . . . . . . . . .... . . . . . . . . . . . North-Andover, Mass. Fee. .��°. .�f.Lic. No..!�� .� .�..... � �� � . . . . . . . . . . - "PLUMBI�;KSPECTOR Check # !// UUUUUU 6 "14 9 MASSACHUSETTS UNIFORM A LICATION FOR PERMIT TO DO PLUMBIP (Type or print) NORTH ANDOVER,MASSACHUSETTS / C�S� � d U/S G 2 I°D Date L� Building Locatton / ncrs Name �4 Permit# � Amount �; i Type,�o occupancy New Renovation U Replacement Plans Submitted Yes No FIXTURES ce Cr Cr STSffiNIC B4SEMPvr RHDm y 3�II FIDQi I'i M]HIDM 4M]HIDM 5M FIDM 6M FLOM • '7III FIOQt � 6 (Print or type) ll !I 1 / 4 Check one: Certificate Installing Company Name �J ,CI j/t Y� �7 7`N [] Corp. Address �� d u D Partner. zb c✓lC a AA ? Business Telephone &16 _ f S a -3 2 Q []--Firm/Co. Name of Licensed Plumber: /`/fir6 ( U/^z Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1� 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 submitKerfolimed or entered)' above application are true and accurate to the best of my knowledge and that all plumbing work and installation un er Permit Issued for is application will be in compliance with all pertinent provisions of th;nTv4 sss a Plumbing o e and Chapter of the General Laws. BY icense umlumbing License Title City/Town 17cense Numoer Master '/ Journeyman ❑ APPROVED(OFFICE USE ONLY 1.uuu I t Date. . . .?. . . . . .. . .... .. OF ,40RTM 02 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACMUSEt . This certifies that.---/)/Y... . . . . . . u. . . . . . . . �: . . . . . . . . . 4 ,has permission for gas installation--4-1. . . . . . . . . i i'n the buildings of . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . it . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee��. . ... Lic. No.. . . . . . . . . . r.k- . . . . . . . . . . . . GAS IP. CTOR Check# G� 4818 MASSACHUSETTS UNIFORM APPUCATON R PERNHr TO DO GAS G (Type or print) Date s d y NORTH ANDOVER,MATC, ASS77o SET/TS u BuildingLocations AA </%l �� ����� Permit# G �l Amount$ 5" Owner's Name � SA 22C+'f (� New ElET Replacement ❑ Plans Submitted ❑ 94 ao I a W O U C7 W F y�� OF O D O E»A. F � U W 0 A 1.0 .4 a 0 a H 0 SUB -BA SEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3R D . F L O O R 4TH . FLOOR STH . FLOOR 6 T H . F L O O R 7TH . FLOOR 8TH . FLOOR (Print or type) 7� hec one: Certificate Installing Company Name 7 0 Corp. N U >� Address G �� ❑ Partner. A/ yv s ?K Business a ep ne d-- a 1 2 — 7 . ❑ rirm/CO. Name of Licensed Plumber or Gas Fitter C!r/ [INSURANCE COVERAGE Check one: have a current liability Insurance policy or it's substantial equivalent. Yes D No❑you have checked yes,please Indic a the type coverage by checking the appropriate box. ability 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 r entered)in above application are true and accurate to the e best of my knowledge and that all plumbing work and installations ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus S t as Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By. ❑lumber to 7 Title Cityfrown ❑ Gas Fitter License Number 19-M- aster APPROVED(OFFICE USE ONLY) ❑ Journeyman e F � Date.... I i AORTH 0 ',t .-o'•1tiO F 3? OL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that .w�� has permission to perform .. ............................................ wiring in the uildo / ................ North Andover Mass. _ ELECTRICAL INSPECTOR A Check # -5 4e'2—O r 7HECOMMONWEAL7HOFMASS4CHUSE77,.S office Use only DF.DUUME TAFPURUCS4MY [Pe—:t,.N:..BOAROOFFNEP ONRWUL ONSM MR12.0es Checked a APPLICA71ON FOR P TO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACC i RDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORTION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 55 Owner or Tenant Z_ Ut c,rC7 Owner's Address f � i Is this permit in conjunction with a building permit: Yes o n (Check Appropriate Box) i Purpose of Building f..le�/ Utility Authorization No. Existing Servicen�n� AmpsVolts Overhead Underground No.of Meters l New Service AmpsVolts Overhead 1:3 Underground No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7,,7 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total 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 Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- YES NO IhTms#rrn&dva1idpoofafsameblhe0ffi=YES CT If)mha%edrelEdYESpleaseirtdc*dcMxofoovwgeby INK ANCEE BOND OTHER (Please Specify) Esti n*dVairofE cmcal Wodc$ WodctDStat D� hrspearonDateRequesW Rtargh Fvlal qgnedun&rTrRra6mcfperjtry FIRMNAME 1'n-e4 /''&/ C��C sew r, LkffwNoL 4 Lioer>see v/ Sigtahae ItiseNo BusalessTelNa �7� �� d//6 9 o ct -k D- y4 C_V-0— I�q h- (3� �i Olga Alt Tel.No. OWNER'SINSL ANCEWA1VfR;IamawarethattheLioffwdoesmthavetheir umoeoor Woritssrbslaria gWvalartastaglmedbyM GeneralLaws a2dthatmysigrlsanecn duspem>itapplicadm waves this mqX'ernem ()Tease check one) Owner Agent Telephone No. PERMIT FEE$ Signature or Owner or Agent I Date.... e HORTM 4,a°L TOWN OF NORTH ANDOVER PERMIT FOR WIRING - ; SCHUS�t This certifies that ....1.��?.t?..�...n.?C ........5..�//d �° has permission to perform ..... �.....c . !��>.�.';!�?/1�- w%rmg m the building of.....,�.�/.N........ .......................................... r: i �U` �� ,North Andover,Mass. Fee.�'............... Lic.No.w . ...... r :.. ELECTRICAL INSPECTOR Check # Q , 5166 . THE COMMONWEALTH OFMASSACHUSETTS Office Use only/ / DEPART IEWOFPUBIICS MY Permit No. BOAROOFFIREPREVEMONREGUT4TIONS527CMR12.W Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERF: ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACH TS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Z U Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wor de bed below. Location(Street&Number) 6D5 Owner or Tenant 1-0 V A/A Ar Owner's Address G.A— Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location aeld Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round around No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Z�- Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KWInitiating Devices No.of Dishwashers Space Area Heating KW Ng.of Sounding Devices Ni`'-qt,Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local [--J Municipal Other Connections No.of Wattr Heaters KW No.of No.of I Signs Bailasis No.HydroMassage Tubs No.of Motors Total HP OTHER• ItuuartceCoveiaga Putsuanttothelegwffn ZofMassaclniset G=xalLaws IhaveawauntLmb iryh>t ar=PdtcynrkxingCompILe Coveageoritsabsmnfdegtlivalertt YES E NO Ihawabnvwdvandplaofofsametothooffim YES ' v' IfyouhavEchecloclYFS,pleaseindicaletbetypeofcoveageby g u INSURANCES BOND O H R (Please Specify) EVimlionDale EsWTWdValueofElecfacalWotk$ Wotictostart Z�l U kgxctionDate'Reguested Rough Final Signedunder eesOfpetjury: FIRMNAME c., C---( t CE LiarseNo. Al ►�-`��-� I-ioensee LM �c7 1) Signakm LiomseNo I L"7 br o BusatessTelNo. V—t Alt Tet No. 71r 3�S—v xb OWN]R'SINSURANCEWAIVE, awarethattheLicensedoesnothavetheinsutancecovmgeoritssubontialopvalentasmgmeclbyMass�CEt�Laws and that my signam on this pemrit application waives this rogtmemetlt ,/O (Please check one) Owner ® Agent _f t/ Telephone No. PERMIT FEE$�� lona ure ot Uwner or Agent The Commonwealth of Massachusetts d Department of Industrial Accidents: W Office of Investigations w Boston, Mass. 02191 Workers'Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I,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. f Company name: i Address t City: Phone#: " Insurance.Co. Policv# Company name: Address ' City: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment-as_mrell_as_civil.,penaltiesin-the formof-STOP WORK_ORDER..and_a.fine-of.(.$1D0..OD)_aday 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name 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 ❑Check if immediate response is required E] Licensing Board F-1 Selectman's Office Contact persona Phone#: Health Department Other TOWN OF NORTH ANDOVER BUHMING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUMDING OTHER THAN A ONE OR TWO FAMILY DWEMING Section for Official Use Oil BUILDING PERMIT NUMBER: DATE ISSUED: . - SIGNATURE: L �� w Building Commissioner r of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Pared Number N 7 8 � Map Number Pared Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonis District Proposed Use Lot Area Fronts CA) �i 1.6 BUILDING SETBACKS(ft) r Front Yard Side Yard Rear Yard Required Provide Required Provided Requived Provided �c I 1.7 water supply M.G.LC.40. 34) l.s. Flood zone bBermgiaa: 1.8 Sewerage Dkpoed syctear v Public ❑ Private ❑ Zeno Outside Flood zone ❑ Mmicipal On site Disposal System ❑ 2.1 Owner of Record Name(Pi.ffD Address for Service: lop 6 M l SignatureLou PS Telephone x 2.2 Authorized Agent Name Print Address for Service: Z 0 ' Signature --------------- Telephone - - 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number Licensed Construction Supervisor: Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number r r Address ---------------------- --- r Expiration Date - Z Signature Telephone G) CQ(is -�r JZ4 Zl;—' AAA U 2 ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury 1 equ%f " AJ,*7-2— Print Name Signature of Owner t Date Item Estimated Cost(Dollars)to be Completed by permit awlicant 1. Building .- g 6 7 (a) Building Permit Fee -� L / Q Multiplier 2 Electrical (b) Estimated Total Cost of 0 C) C) Construction from 6 3 Plumbing � 6a Building Permit fee (•) x(e)a 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) q - V, Check Number NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS iST 2 No 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS MENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBMINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE lbkq f w s� o��>� t©�i F re±�osl�v�►o� Eta in �>e��.., New Construction 0 ExistingBuilding Re its 0 S Pa � ) Alterations(s) Addition 0 F Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: l4 7VZ46- 4-Z 11eA4*1$Td47 d &n,o .11 om USE GROUP Check as applicable)' CONSTRUCTION TYPE ' A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 lA ❑ A4 ❑ A-5 0 113 0 '{ B Business 0 2A ❑ C Educational 0 2B 0 F Factory ❑ F-1 0 F-2 ❑ 2C 0 H High Hazard ❑ 3A 0 IInstitutional ❑ I-1 0 I-2 0 1-3 ❑ 313 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 0 R-2 ❑ R-3 0 5A ❑ S Storage .0 S-1 ❑ S-2 0 513 ❑ U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: { COMPLETE TMS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE • ExistingUse Group:P Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: b BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include F Basement levels k Floor Area per Floor s �vAA 6 Total Areas O Total Height ft Independent Structural Eng;incering Structural Peer Review.Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> ,as Owner of the subject property Hereby authorize 061e/S $ Z 1 STif!/ to act on My behalf, in all matters relative two work authorized by ttfis building permit dpplication L7 Signature of Date SECTION 4-W CIAMM' 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. Si ned affidavit Attached Yea.......❑ No.......❑ SECT1fON S P)itdF)ILSSI01'FAL ltl >[ d±t ltllilf C TSTRUCTION SBRYfC .S ;B TI�.M Ai�ID STRUC"IYTRES SUBJECT:TO GbNtSTB JGTION COI"OL iL P &'�OA1' `'TO?8�.C114R 316{CON?�l1NtNG Mt)RE THARH A CF,©F.VICLOSED*AM 5.1 Registered Architect: Name: Address Signature Telephone 5:2)Reif:te�+e�.Freieszioa� taiceKti� - Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ lame: Registration Number address signature Telephone Expiration Date lame Area of Responsibility address Registration Number ignature Telephone Expiration Date ame Area of Responsibility ddress Registration Number gnature Telephone Expiration Date 3 " ,'etr>ac'to�r Not Applicable ❑ )mpany Name: :sponsible in Charge of Construction Location l 0/ No. a Date NORTH TOWN OF NORTH ANDOVER V Certificate of Occupancy $ Building/Frame Permit Fee $ MU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /7/74),S Check # r ` a 17564 Building Inspector �1pRtk Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 �SSACHt15�< D. Robert Nicetta Building Commissioner (978) .688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE ( d JOB LOCATION SS ko Ma /lot Number' Street Address P "HOMEOWNER O / 26E 2 Name Horne Pho e_. Work Phone . • PRESENT MAILING ADDRESS � /9 �s City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings r 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) 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 farm 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 P P Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL a W The Commonwealth of Massachusetts " Department of Industrial Accidents Office of Investigations ~� Boston, Mass. 02111 . '�, ,�•"� Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I 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 City: Phone#. Insurance Co. Poli # cY Company name: Address City: Phone#. Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1700 and/or one years'imprisonment_as.well_as_civil.penaitiesin theforn d a..STOP WORK_ORDER..and_a fine.of.(.$100..00)aday 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name 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 ❑Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM i 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) 14,q o OA(7 � , Signa a of Permi icant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH '9 Town of Andover No. / o dower, Mass., / 07/0 o �. COCHICMEW1 K V 7 AERATED p` �C3 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.......A0;................ ..Z.�.�r.0.............................. .................................. BUILDING INSPECTOR Foundation has permission to nect.....�<< y..... buildings on ty � O� ...... .......... Rough .. .. ... ... to be occupied as �. ��....... ` f�.............. j Chimney V...............igIV � ..... 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 Code;Rlri relating to the Ins action, Alteration and Construction of Buildings in the Town of North Andover. 0) PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU N S T]b 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. Burner Street No. SEE REVERSE SIDE Smoke Det.