Loading...
HomeMy WebLinkAboutMiscellaneous - 191 JOHNNY CAKE STREET 4/30/2018 (2) 191 JOHNNY CAKE STREET 210/107.A-0191-0000.0 Date .�. . ! . . . a TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . t�P�. '►,tiy}. ` --t t P a ^ has permission for gas installation . . 'Q , , Aefe ,. . . . . . in the buildings of. . . . Ham, , ,,r'- ?- . . . . . . . . . . . . . . . . . . . . . . . , ,at . . �;CJ.J-_, ,, . . . . , ,North Andover, Mass. Fee . . . Lic. o.'k .. . . . . . . . GASINSPECTOR Check# 2 ?/ 8747 J° •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK h / -/ CITY - /d _ _ MA DATE( 3 n�II PERMIT# q JOBSITE ADDRESS [`ll �/d k �a, OWNER'S NAME OWNER ADDRESS s a_• ►-� TE� _ FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTI PRINT CLEARLY NEW:D RENOVATION:E] REPLACEMENT J PLANS SUBMITTED: YES[Q N 1 4 APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 �— BOILER - I I I BOOSTER CONVERSION BURNER COOK STOVE I 1 �. ) J 1. DIRECT VENT HEATER _ --..- f _. . f _. - I-- C DRYER FIREPLACE FRYOLATOR FURNACE _ JI -� -I __.J _ GENERATOR JLzj GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT �- OVEN I "" nOOL HEATER ')OM/SPACE HEATER )OF TOP UNIT 'IT HEATER T --,.4VENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES 1 NO [( IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF OVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY Ej BOND 1n OWNER'S INSURANCE WAIVER:I am aware that a licensee does not have the insurance coverage required by Chapter 142 of the 6 Massachusetts General Laws,and that my signature on this permit application waives this requirement. _T CHECK ONE ONLY: OWNER _J ENT ! SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true an rate to th est o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c nce hall Pe ' ent pro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j 42---_ PLUM BER-GASFITTER NAME�.:.;.V,.6..� od a h•. LICENSE# 5! SIGNATURE MP E1MGF 0 JP 1 JGF LPGI[]I CORPORATION Q# PARTNE SHIP©#=LLC 0# COMPANY NAME: ADDRESS CITY ,� �/•s! - STATE�ZIP�99D _ TEL 1.7 FAX CELL %$/``sa-��EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /z�/� FEE: $ PERMIT# 1 PLAN REVIEW NOTES I A; �v t The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations VV 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �i✓ -a h"� Address: r � l� led City/State/Zip�(`g rl e z� O/Mphone#: 76 / _W6 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 2 1employees(full and/or part-time).* have Hired the sub-contractors 1 am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10A, — Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL lumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12. Roof repairs insurance required.]r employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am 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'compens ion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.0 cr 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' isonment,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 v' la r. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' anc coverage verification. I do hereby certg rte pains a d penalties of perjury that the information provided above is true and correct. Si ature: Date: - 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 ofhire,• 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 Liability Companies(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 officially 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 home owner 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: The Cowaonwealth of Massachusetts Department of Industrial.Accidents Office o£Investigations 600 Washington Street Boston,MA.02111 TO.#617-727-4900 oxt 406 or 1-877,7MASSA.k'B Revised 5-26-05 Fax#617-727-7749 ww.m.ass,gov1dia Date .5� 4� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation 1�1 .01 c-,.j in the buildings of R(:�;�.(v _ at . . . . *Lic' * * .',North Andover, Mass. . I. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR check# 2_ 1 �01 8688 � 1 •f ' J "COMMONWEALTH OF MASSACHUSETTS PLUMEURS AND GASFITTERS LICENSED 113 A Jk:r URNEYMAN PLUMBER ISSUES THE ABOVE LICENSE TO: DAVID A TANNER 24 WALDEN ROAD ` t ul WAKEFIELD Mk 01880-].02 Ii j 1 24527 95/01/14 15680 o , r a I %t t� u , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK UT r 1.1-10 —1 CITY MA DATE ]PERMIT# JOBSITE ADDRESS „� y � C� _ --IOWNEKS NAME OWNER ADDRESS ._s� - TELF_ FAX ----__jj TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E] RESIDENTI� PRINT CLEARLY NEVt*U RENOVATION: REPLACEMENT:El PLANS SUBMITTED: YES[] NX APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 E.ED DIRECT VENT HEATER DRYER J FIREPLACE ) FRYOLATOR FURNACE GENERATOR GRILLE _ ] INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST _ 1_ _1 _ J= 1.�. UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER ._! _. _ _1 I--1 OTHER 1 _ . -J E=Dq all INSURANCE COVERAGE Pave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Y NO -�___I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CO GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE PO { OTHER TYPE INDEMNITY BOND �__I r 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: OWNERS]__4 NT SIGNATURE OF OWNER OR AGENT z'JI 1 hereby certify that all of the details and information I have submitted or entered regarding this application are troth r to th b t o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp lance wit I Pe ' t pro ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ) / 4v� PT"UMBER-GASFITTERNAME - ,AVL_§ LICENSE# yid ( SIGNATURE MP El MGF JP*JGF LPGI CORPORATION —1# PARTNERSHIP 0#=LLC[J# COMPANY NAME111, a A, ADDRESS CITY a rw STATE /!W ZIP 'S? TEL FAX - -- - CELL 11EMAIL 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 �� i s . The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations U1 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): / Q✓,d Address: O� ovet 1-�e City/State/Zip: A/.t e, �''t ��),/�'l� e'ing Phone#: 7L!�-) —c;> Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I ' � have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2 I am a sole proprietor or partner- listed on the attached sheet. [J Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL1KEI umbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no oof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. s Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am 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.Lic.#: 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 Sect 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 impriso ,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. e a vised that a copy of this statement may be forwarded to the Office of Investigations the DIA insurance c erag verification. I do hereby certify u r thepai andpenalties ofperjury that the information provided abo/ve is true and correct. Signature: / �-•-�� �' ��oti.�- Date: ` Phone e;�, 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#: 1; 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(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 officially 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 home owner 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 Commonwealth of Massachusetts Department of ladustriai Accidents Office o£Iuvcstigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 at 406 or 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749 www-mass,gov1dia 1 .! COMMONWEALTH OF MASSACHUSETTS y ` PLUMEf.RSAIS URNEYMAN PLUMBER LICENSED .�S A J•.. ISSUES THE ABOVE LICENSE TO: DAVID A T aNNER . 24 WALDEN ROAD i r WAKEFTELD MP. 01880-162 i i 24527 05/01/14 .15680 _ _ _ Date... .C; 5-- /7N° / r G .......................... 9 f kORTPf TOWN OF NORTH ANDOVER b~ = p PERMIT FOR WIRING VSs'RcwusE� This certifies that .::�............................ has permission to perform u.�7 . ............................................................... wiring in the building of........ ....................................................... .......... .... at..... .g1........... .... ...... .. .K . -...... Andover,Mass. lee n..... ....Lic.No. .�'......e .... ria �! Ro.... ...1,..�fin........ ' —'ELECTRICAL INSPECTOR 06/28/99I WHITE:Applicant WARY: Buildit 'Dttpt. SII} PINK:Treasurer S:\ FOR OFFICE USE.ONLY The Commonwealth of Massachusetts Permit No. /7: a Department of Public Safety Occupancy&Fee Checked PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) Ro PERMIT TO PERFORM ELECTRICAL WORD A ION FOR All work will be performed in accordance with the Massachusetts General Code.527 G�tR 2-00 . G � (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of A' tqNeV. Ue;g, — To the Inspector of Wires: The undersigned applies fora permit to perform the electrical work described below; MAP Location(Street and Number) 1 Owner or Tenant /�f�` S G�L Zo Owner's Address Is this permit in conjunction with a building permit? Yes 11 No IX (Check Appropriate Box) Purpose of Building Utility Auth rization No. Existing Service_ Amps / Volts Overhead❑ Underground❑ No.of Meters New Service Amps / Volts Overhead ❑ Underground❑ No.of Meters Number of Feeders and Ampacity t ,,.i1 ar and rnnrlPnSPr Location and Nature of Proposed Electrical Work Prnn,,�a an i n ct a 1 rii r�^o—fAr air h� 4unit and thermostat. No.of Lighting Outlets I No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd.❑In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners I No.of Emerg.Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No:of Zones No.of Ranges No.of Air Cond. Total Tons S No.of Detection'and No.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons KW No.of Sounding Devices No.of Dishwashers Space/Area Heating KW No. of Self-Contained Nd.of Dryers Heating Devices KW Detection/Sounding Devices No`�of Water Heaters KW No.of Signs No.of Ballasts I Local Q Muncioal Connection C] Other No.tof Hydro Massage Tubs No.of Motors Total HP I Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES®NO❑ I have submitted valid proof of same to this office.YES®NO❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE® BOND❑OTHER❑(Please Specify) Nnrr•rnac anA Tai vht-nn 9/09/99 - (E:piration Daft) Estimated Value of Electrical Work S 450.00N Work to Start Inspection Date Requested:Rough Final — Signed under the penalties of perjury: FIRM NAME Joseph R. Serra LIC NO. 30658E Licensee Signature LIC NO. Address Bus.Tel.No. 508-660-2538 Alt.Tel.No. OWNER'S INSURANCE WAIVER 1 am aware that the Licensee 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 his requirement. Owner❑ Agent❑ (Please check one) Telephone No. PERMIT FEE 5 �•0 Z)(Signature of Owner or Agent) 4 � , PAGE PER311T NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ; MAP 4,40. lo :2 LOT NO. 1 l�{ 2 RECORD OF OWNERSHIP —IDATE BOOK :PAGE - ZONE V I SJB DIV. LLOT_NO. LOCATION / PURPOSE OF BUILDING /J 1 .•- : _ •- °•�._'''' OWNER'S NAME 7NO. OF STORIES SIZE -•I _ OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RO BUILDER'S NAME �JG � �� Q�� A r„/' SPAN DISTANCE TO NEAREST Wilt-DING DIMENSIONS OF BILLS DISTANCE FROM STREET P03TS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS • IS BUILDIPIIG NEW SIZE Of FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOHO 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 /!� �YZ/J`- S��y�-G� •^ LAND COST SEE BOTH SIDES , EBT. QLDG. COSTJfv PAGE I 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 S ATTACHED GARAGES MOOT CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED LS /J 7 Fi BUILDING INSPB.CTOI SIGNATURE Of OWNER OR AUTHORIZED AGENT FEE •, � `OWNER TEL I PERMIT GRANTED CONTR.TEL/ CONTR.LIC.F (-J 13 ( C,1-2 � II T40RT Town of __ _ - Andover No.,..�2. mom Wrn - - _ s dover, Mass., _ Cd 19 '9AX E -CDCMICMEWICK S OqA T E D AP `G BOARD OF HEALTH Food/Kitchen i Septic System PERMIT T D THIS CERTIFIES THAT......... BUILDING INSPECTOR .��..4... ...........S1�t.���................................................................................................... 4.A.441 LFoundation has permission to erect.../Q�e...l l=.......... buildings on ...../.... ...�()... C.a../�.P........4. Rough to be occupied as......%s.- It. h......AerA.t. .Zaii,in ..'...............0...Rt.fe.c}v..1=....0.kn�Q......'�.y�.�.'��f��!.. ..�......... Chimney provided that the person accepting this permit every respect conform to the terms of the applicatioon 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR . UNLESS CONSTRUCTION ARTS Rough ..:fr... .! ... ........ ................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Rt CVT_ 1 fp 7 Street No. G it *rt L i Smoke Det. BUILDING RECORD 1 OCCUPANCY 12 — iNGIE FAMILY S:oRI S THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM Mum. FAMILYOFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- s APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a• 1 2 13 CONCRETE at K. PINE BRICK OR STONE HAROW D PIERS 'PIASTER DRY V/All UNFIN. 3 EASEMENT AREA 'FULL IN. 8'M't' AREA _ % FIN. AttIC:AREA _ NO B M-T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALtS 9 FLOORS a, CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH --1_ ASPHALT SIDING HARDI'l D ASBESTOS SIDING _ COMIAGN _ VERT. SIDING ASPH. IIIE _ STUCCO ON MASONRY _ SIL1CCO ON FRAME M ATTIC SIRS. 6 FLOOR I_ BRICK ON FRAME CONC. OR CINDER St K. STONE ON MASONRY WIRING ' STONE ON FRAME DEOUAATE (� NON AE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.1 GAM89EL MANSARD TOILET RM. 17 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER _ ROIL ROOFING MODERN FIXTURES tILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS,FURNACE FORCED HOT AIR FURN. TIMBER BMS. E.COLS. STEAM STEEL BMS. E, COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS .. - 7 NO. OF ROOMS GAS BMT 2nd _ ELECTRIC I d 13,d I NO HEATING r