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Home My WebLink AboutMiscellaneous - 19 MEADOW LANE 4/30/2018 19 MEADOW LANE 210/045.G-0047-0000.0 Date...........�.................................... OF NORTH o�' •' °°� TOWN OF NORTH ANDOVER " q"= PERMIT FOR GAS INSTALLATION � 88gCMUg� This certifies thaU.�-�..�.......................................�-J , has permission for gas installation .lnz,....^:. G..� in the buildings of.. . — ............................. ................... ............................ at.....�......1..........Y.Y.1.Pa&Q\!--........L t-j................... North Andover, Mass. Fee.. G 3 .......... ? ................ Lic. No. .!?........ .M.GAS................................................... �( GAS INSPECTOR Check# t ;1 2 , -CN- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYN.Andover MA DATE 5/15/2014 PERMIT# JOBSITE ADDRESS 119 Meadow Ln OWNER'S NAME -o AXY-1 —� GOWNER ADDRESS I Same �TE IFAX — TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 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 DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER -VA--TER HEATER OTHER Replace 1 Gas Meter x INSURANCE COVERAGE I have a current liability-insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® BOND 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 ❑ AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE#F736 ' SIG ATURE MPEDMGF❑ JP❑ JGF® LPG ® CORPORATION❑# 3285CJ PARTNHIP❑# LLC®#0 COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501TEL (508 832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAIL JMarinoRRHWhite.com 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ v � FEE: $ PERMIT# PLAN REVIEW NOTES ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �ViMO�IVifV(I=AL.T H OF MASSr!iG:l� 1 '-PLUf�Ij[BERS AND G - ,. ASFiTT RS' ;, ICk`IUSED AS'A..MAA TER F!.�IJM CR- s ISUESTHB`4BQUENS "LIG E70;"="=:• - _ - -_ MAR I N-0 T �.. "`iiJ6RCE$7`�12 ' MA 0a ;` I(} _`, t.. . ^ 1)5/01/14 0- C. OF€UiASS/A.C'1=�US:E'I�S' _ �. "PL 1711113ERS AND GASFIT E--"' Li'CFNSED AS A JOU.RNE M'''U'�f?I.Ut4 THE ABOVE LICENSE T0:-= '�JbIG 'S? R mA 05/01114 ri4f GJ//014 1-1:rJ4 �CJi303L0(tel ICH Wr-Il I G I�UIV5 1 ICUI,I I-"HUt t'JL/t7L AC ® DATE(MM/DD/YYYYI ��- CERTIFICATE OF LIABILITY INSURANCE page 1 of z 08/29/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the POROY(ies)must be endorsed. If SU 13ROGATION is WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willia of Massmchusette, Inc. PHONE c/o 26 cot"ry Blvd. -NO•_F�: 877-945•-7378 FAX�NO): 888-467-2378 P. 0. Box 305191 -MAIL Nftmhville, TN 37230-3101 D�Ii>;5fi CQ�CG�f1C8teJ9(�Wj1� 9_gOt[1 INSURERS AFFORDING COVERAGE NATO th INSURED INSURERA: The Charter Oak rife 7:aeuranCg Company 25675-001 R. H. White Construction Company, Inc. INSURER B:Trava7gre Property Caevall;y Company of Am 25674-003 41 0. BoxZ Street INSURER C:NatiOnal Union Piro Ineuranca Ccmpauy o£ 7,9445-001 P. 0. Boa 257 Auburn, MA 01501. INSURER 1);Travelers Ind&=n ty Company 25658-001 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 16SUGD TO THE INSURED NAMED,ABOVE FOR THE POLICY PERIOD INDICA7ED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IJZEL NSR TYpE4pM3URANCE DD' SUE P POLICYEFF POLICY EXP vuvn POLICY NUMBER LIMITS A GENERAL LIABILITY VTC20C0 977X9948-13 9/1./2013 '9/1/2014 EACHOCCVRRECE s 2 000 QQQ X COMMERCIAL GENERAL LIABILITY EW TF,pemancrl _ 30tl_QO0 CLAIMS-MADE OCCUR e ereon $ 1Q 000 JV INJURY S 2 QDO,000 EGATE $ 4000 000 GEN'LAGGREGATFLIMITAPPLIESPER: P/OPAGG $ �QOO OOO POLIGY PRO LOC B AUTOMOBILE LIABILITY VT.TC.AP 977R955A-13 9/1/2013 9/1/20nj 14 NN $ �acoldeDSINGLF.LIMIT S 2,000,000 X ANYAUTO BODILY INJURY(Perpereon) AIJALIT08 NED gUTOSULED BODILY INJURY(Peraccltlen!) ;S X HIREDAUTOS X NON-OWNED eraccldnCoDefl AUTOl $ X Cv11 Deg C uMBRELLALIAS X OCCUR BE8766140 /1/2013 9/1/2014 EACH OCCURRENCE $ 5,000,000 X EXCESS LIA6 CLAIMS-MADE AGGREGATE 9,000,000 DED $ RETENTIONS ],0.000 $ jj WORKER9CORVIIJATION VTRKUB 820SAIO5-13 9/1/2073 9/1/261,A X O - ANDEMPLOYERS'LIABILITY y�N TlJRY,U. D ANYPROPRIEToR(PARTNFRIEXECUTIVE N NIA VTC2XUB 8203,A71A-13 9/3./2013 9/1/2014 E.L.FACHACCIDENT $ 1,000,000 OFFICERWEMBFREXCLUDED? L`J Mandato�In NN) E.L.DISEASE-EAEMPI,OYFE S 1,000,000 U�ts KIII-11UN u�iiPI.RATIONS helew E,L,DISEASE•POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach Acord 101.Addltonel Remark-Schedvin,I!more epee-Is r aqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THr=ABOVE DESCRIBED POLICIES BE CANCEI.LED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of InguZance AUTHORIZED REPRESENTATIVE Coll:4197604 Tpl:1694012 Cert:20267680 ®1988-2010ACORD CORPORATION.All rights reserved. 4CORD 25(2010105) The ACORD name and Ingo are registered marks of ACORD Location_ _ // No. - ! Date �1 _54/�/ 14aR7►, TOWN OF NORTH ANDOVER 3?O�,t``D •,ho�t S Certificate of Occupancy $ + Building/Frame Permit Fee $ c14u,Et Foundation Permit Fee $ A Other Permit Fee Sewer Connection Fee $ Water Connection Fee $ t L1 Building Inspector Div. Public Works PER311T NO,.. fia APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1� MAP+40. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK "PAGE .ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING , m J�,/��J ) ��'Y) f ( (�Yy 1 (�,/ OWNER'S NAME q NO. OF STORIES SIZE OWNER'S ADDRESS �j JS V BASEMENT OR SLAB - v /' ARCHITECT'S NAME /V C_ SIZE OF FLOOR TIMBERS IST 2ND 3RD \ BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING 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 ✓ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS 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. COS /1 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 1 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 PJCANS MUST BE FILED�A}ND APPROVED BY BUILDING INSPECTOR �///DAT LED !/ BOARD OF HEALTH URE OF OWNER Olf A H IZED AGENT FEE ( _ 11-- PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 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- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ d 1 2 I3 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/ 1/1 '/ FIN. ATTIC AREA _ NO BM'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 HARDW D _ ASBESTOS SIDING COMIACN VERT. SIDING M ASPH. TILE —{I_ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY&__ ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE I NONE rj ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 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'T 2nd _ ELECTRIC 1st 3rdNONO HEATING i Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE 9 JOB LOCATION 0C,�=12 Number Street Address Section of town "HOMEOWNER" �i9�l�O�/c �oyv��,,�� 6�3 5 6 r 50f= ///// _51111 Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six 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 109 . 1 . 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 to six family dwell- ing , attached or detached structures accessory 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. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the r ;building permit . (Section 109 . 1 . 1) 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 ... ,North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements . -HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL 'Note : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0, Construction Control . p �. V� % 4i{p��i SLC S P �1�E n 0 tr�� r1 O-R TFi.._ F tl tl 11 A , AL awn No. 165 ° y - {'ly 1991 _�. BOARD OF HEALTH s THIS CERTIFIES THAT........ . ... BUILDING INSPECTOR P AV has permissio" 'Idings on ...... ...... .. Rou h 9 Chimney to be occupied as..... . Ch' ey .�..... .. .....�.... ... .............. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTIQA STARTS Service Final BUILDING INSP CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by SME TNO. moke D . Building Inspector