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HomeMy WebLinkAboutMiscellaneous - 208 SUMMER STREET 4/30/20181 75 Date./. .Z/? .L// P ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,SgACMUSEt This certifies that ... s... ! ... '. .............. . has permission for gas installation ez y.:< ............... . in the buildings of .....4_.� ...................... at J7 ........ , North Andover, Mass. Fee.?.)...... Lic. No . Sd. �.(.. G�:�'-'NS-P-EC--TO�R- Check # _% '� < < �v 4 HASSACHESEMLTI'- FORctilAPPUCATONFORPE IMTO DO GAS FTITIlYG (Type or print) Date a /10 NORTH ANDOVER, MASSACHUSETTS Building Locations V4d �'lJJy Permit # Amount..$ 016. Owner's Name New Renovation Replacement Plans Submitted (Print or Name of Licensed Plumber or Gas Fitter /�1 �, , &J 1 N �0- .&WITR..P Chec ne: Certificate Installing Company Corp. 12&0?A Partner., E]Firm/Co: INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes, please a cate the type coverage by checking the appropriate box. Liability insurance policy -121 Other type of indemnity 1313 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 0 Agent 0 77 11GLCUy a►y Ln;., WI v1 LIM uu.aus anu mtormauon -t nave summitted (or entered) in above application are true and accurate to the• best of m} knowledge and that tilt plumbing work and installations performed under Permit Issued for this application will be in compliance with.ail pertinent provisions of the Massachusetts StaWjas Code and Chester 1410 thriencral Laws. By: Title City,Town APPROVED (OFFICE USE ONLY) ,nature of Plumber Gas Fitter Master Journeyman sed Plumber Or Gas Fitter O(8 [cense: lNumBer ,2ND. FLOOR (Print or Name of Licensed Plumber or Gas Fitter /�1 �, , &J 1 N �0- .&WITR..P Chec ne: Certificate Installing Company Corp. 12&0?A Partner., E]Firm/Co: INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes, please a cate the type coverage by checking the appropriate box. Liability insurance policy -121 Other type of indemnity 1313 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 0 Agent 0 77 11GLCUy a►y Ln;., WI v1 LIM uu.aus anu mtormauon -t nave summitted (or entered) in above application are true and accurate to the• best of m} knowledge and that tilt plumbing work and installations performed under Permit Issued for this application will be in compliance with.ail pertinent provisions of the Massachusetts StaWjas Code and Chester 1410 thriencral Laws. By: Title City,Town APPROVED (OFFICE USE ONLY) ,nature of Plumber Gas Fitter Master Journeyman sed Plumber Or Gas Fitter O(8 [cense: lNumBer 'Fj,qr;i0-) %r7:)_9JW%?f1A�v9s#g ns 600 Washkngton Boston, JIM 02111 Tf, 4i!:Jr4x11 jPiP;P.mass.gqv1dk � In #7,V1j1 Yjilr -inni -IJI11C -,o Workers!,Compensati6fi Insuran'e Affidavit: ctiltiafis/Phimbers In Applicant, forma on MR's .4 Name (Business/Or ani 4V V, � - &--� zati Address:' ;;eo P: 'fie City/State/Zi 9!9��O " ?..Pholi6#"y.�/' J' ..7Q �S="' }'rFrit� xLr Are -y u an enioloyerT Clieckitie appropriate box:i,, �jp, 4�11 Fr Type of pl�oject (�e ­, .qpired 171'arn a 1�61f,(,pjjQ,4, #T,a general contractor and 1', emp oyees (fU N6w construction %'tL'1G'1j:.1�tA I"""" Il t, have hired' &s'ub-contractors, 2. 1 am a sole proprietor or partner- listed on & ;iached sh��L I �4�jv rz r, In, i 1:i In ship and have no'employees-=:-_�, These subcontractors have =:_�. ElPerriolition Y� working for mein any capacity. workers'"` 9. []Building addition (No.workers' insurance comp. insurance. t - ?aril , 5 required 3 -;❑W' ifea. corporation and its bX; I pectrical repairs or additions 3. El I am a homeowner %Vner dbi nj all *W" rjkl v' of f icers! bave� exercised ised their.� r, , r 561u��in' g re airs or additions myself. [No workers comp- 1 .1 right Of exiiipfibfi per, MGL,",,-, t irsli insurance required] `b.45233 1 (4), and we have no n-, j ba -P. 10 employieS."(No%idrk-ers'.",�.,L' N f.-corrip insurance required.] ;Any applicant that L section beloiv shojving err;;6*cis' compensation policy infidnnation.,c zjj) this indicating eyare oingail work- I and then him outside contractors must submit a new affidavit indicatingsuch�, :Contrartor; that ch9ck this b-ok in6it attached an additioilal Weet showing the name of the sub-cantiactors-and state wheLher or not tt;6ic­e_n`ut'tcs` have ' cr#qye�.. If the sub -contractors have employees, they must provide Their workers' comp. pon ' -'cy num-ber. - " " - — -` . . L,- " Z, j 4 k I , (, 7: ': i � v " I -, •" -11,41 i I airan employer that is providing workers' compensation insurance for MY CHIP 0yees. IS e ? *c -y,,, andIbb"ifti, information. c 1* Insurance CoTpV,n f'(';S .4. 4 - 1 6 1 .73�" ULD, . UY fj 1 '0 r -ins. c.� .31." 4, P-- -Expiration Date: Policy # or Self f�l C,#:,; ) {IT. -I U.-. T, 0 13:2 .- . fl�, Job Site Address:— Attach a copy of the,work-eAl compensation Polley L declaration page (sho*iiig the lio0yn umbif and'dxpiration date): ppnalties'of a Failure to secure covera-52canleadto eimpositi6fioferiniiiial coverage as requk6d'�tifider Section 25A of MG c. I fine up to $1,500.00 and/oi one-yearimpfig6&hen� as well iis civilpenalties in f a e orm. o STOP -WORK ORDER and afine of up to $250.00 a day against the violator. `Be advised that a 660y of this st'ititriiiit rirfaY be forivarded to the Office. of= investigations of-theLDIA for insurance .cove.rage,lvefific.afion.., 1.doherebycertiffun :thepains and penalties ofperjury that the information provided above is true ond.cornxt.._: Signature: % I , - a 1bus. rU . mr1offIriff'O 3.,-T Official use only. Do not write In this area, to bd6iApkiid bj,7a&`or to-WiofficiaL City or Town: t t f (T) Permit/License # Issuing Authority (circle one) - *T : 1. Board of Health 2. Building De'oiirtmint''3.'City/T6wn,Clerk WEIL;dn'ical Inspector 5. Plumbing Inspector 6. Other W.7 P, 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 mora of the Foregoing engaged in a joint enterprise, and including the legal representatives aeceased employees'oy Howeverlttle receiver or trustee of an individual, partnership, association or other legal entity, 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, constructionusemployment be deemed to be an employer."house or on the grounds or building appurtenant thereto shall not because of s MGL chapter 152, §25C(6) also.states that "every state or:local licensing agency shall withhold the issuance or renewaof a license or permit to operate a business or to construct buildings in .the commonwealth for any l' applicant lvho has not produced acceptable evidence of compliance w� with the nor insurance uof its politicalsubdivisionsshall Additionally,,MGL chapter 152, §25C(7) states Neither the common e Y enter into any contract for,tlie performance of public wort: until acceptable evidence of Po with the insurance requirements of this chapter have been presented to the -contracting authority." Applicants it completely, by checking the boxes that apply to your situation and, if Please rill out the workers' compensation affidavit 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 ired to cavy workers' compensation insurance. if an LLC or LLP does have members or partners, are not requ 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 number listed below. Self insu ed companies ng'he law or if you are.requir6d to t should en er their compensation policy, please call the Department rs at thea num 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 Use 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 gor iven year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address the applicant should write "all locations in ( tY 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 burn.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 Commonwealth of Massachusetts 'Department of Industrial Accidents:. office of Investigations 600 Washington Street Boston, MA 02111 Tel.: # 617-727=4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Date .l : ' . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ' ifr� :lF . ,( . k ...................... has permission to perform .... w .... ...................... . plumbing in the buildings of ....................... at .. c') .0 . , ............ , North Andover, Mass. r Fee. .1.... Lic. No. ?. 7 ... ....... L ^` .`:"-....... PLUMBING INSPECTOR Check # (FIVIAbSACHUSETTS UNIFORM APPLICATION FOR rio or Ty e) R PERMIT TO DO PLUMBING ass. Date C/./,* (moi n„ 6 isiness Telephone2 0 Partnership ime of Licensed Plumber or Gas FitterTr Firm/Co. "OUMAM,t I-UVhKAGE: have a current li bllity insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes 1No 0 f you have checked rtes, please indicate the type of coverage by checking the appropriate box. , liability Insurance policy '11"_ Other type of Indemnity 0 Bond ❑ iWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. ignature of Owner or Owner's Agent Check bne: Owner 0 Agent ❑ reby certify that all of the details and information I have submitted for entered) In above application are true and accurate to the best of cnowledge and that all plumbing work and installations performed u r the permit Issued for tLallc2tlon will be In compliance with ertlnent provlslona of the Massachusetts State Plumbing Code and h to 42 of e G oral L By Signa re of Licensed Plum er City/Town 4PPROVEb(OFFICE USE ONLY) Type of License: F].ster _ OJourneyma:n License Numbeda3 a v r 310 w s go s 3 I O 9 a a z a A o z M 310 w go s 't p 0 e 0 O I O 9 a a z a A o z M MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO D (Punt or Type) O GASFITTING 1 YO' �N00VjIiZ , Mass. Date �/19 9 Permit # Z 75 ow - h —L_ / Building Location_�0 rR `S7• Owner's Name Type of Occupancy Rc�� I I,� I I i 1 A d New (� Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No n .b Installing Company Nam t-PA (n Address Check one: Certificate '� � M q R5 ; � .® Corporation G LA /tl R Ec�J r -1A r, i R4 f ❑ Partnership Business Telephone 5 (� - - (� � n 5 Name of Licensed Plumber or Gas Fitter ❑ Firm/Co. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policyOther type of indemnity ❑ Bond ❑ f 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 ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and axurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws• T e of Ucense: TiUe Plumber Signature of lJcensed Plumber or Gas Fitter Gasfitter City/Town Master License Number APPROVED O IC O L Journeyman ■���MEN����n��t�tiut������■ IFIAMME ��ONE 0 ��n�����1l�■ Installing Company Nam t-PA (n Address Check one: Certificate '� � M q R5 ; � .® Corporation G LA /tl R Ec�J r -1A r, i R4 f ❑ Partnership Business Telephone 5 (� - - (� � n 5 Name of Licensed Plumber or Gas Fitter ❑ Firm/Co. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policyOther type of indemnity ❑ Bond ❑ f 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 ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and axurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws• T e of Ucense: TiUe Plumber Signature of lJcensed Plumber or Gas Fitter Gasfitter City/Town Master License Number APPROVED O IC O L Journeyman f z C9 F d z J W IL a IL O N t - N n J W ~ IL {t ° O z O er W N J a U C3 O a . a z O O G W N O 7 1- W. W �- U i ¢ LL O O z a a cc O O W W Z O O of W F im _V J ' a a a w W LL. f LL M z ° F d U J W IL a IL O N 2 N n J W ~ Q {t ° O z LL M F d J IL IL O N n W ~ {t ° O O er W W � _ a U C3 O a . r 14 �`` Location � � �-���� � p Nb. "-?If Date NaRT� TOWN OF NORTH ANDOVER �?0�`•D ,•,MOL t a Certificate of Occupancy $ Building/Frame Permit Fee $ ��b'•••°''c�' SS�cMuso Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Q/ tjl Building inspeRor 12 7410411 08:35 117.00 PAID Div. Public Works Location fA0. r, Date ,.ORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ ` Building/Frame Permit Fee $ •�° • Eck' Foundation Permit Fee $ SAC MUS Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works n N LJ � z :t v 6. LW Iv V •r � ;J Z ^ 3 3 s y CZ M � 'a z N X } r w w J Vf X X X W — •:1 � ' L.1 U U Z w w W Z Z .'� ,, .J 5 K K a - _ Zz C — _ _ Z a = y � •` � z z Q W Z W W J w N - . T :(, 0400 ^� Z � w 1� w z Z Z Z z L) LLI � < WLW Z d w L6 N W NLU Ln CA f'i y Lnc 3 r UV < Q _ w5-7 r z N n w U W w W < ``" A � DEPARTMENT OF PUBLIC SAFETY CONS TRUbAl\SUPERVISOR LICENSE Narb Expires: Birthdate: 40 VW4 1/19/1999 1111911970 00 tm-� V7,KtAyu uty"TINE RD HAVERHILL, HA 01830 174359 Restricted 1o: 00 t 00 - 35,000 cf enclosed space (MGL C.112 SAL) lA - Masonry only 1G - 1 & 2 Wily Hoes t. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. t Department of Industrial Accidents Off/ceOf/nyestigalmffs � 600 Washinry bton Street ' y Boston Mass. 02111 r Workers' Compensation Insurance Affidavit Ifeant In .ormf att0rul .l-1 * 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 official use only do not write in this area to be completed by city or town official city or town: permittlicense N OBuilding Department check if immediate response is required Licensing BoardOSelectmen's Office Health Department contact person: phone #; 00ther ARAUANCUICAMAE Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 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, 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. � % � '-✓'� %>k '�',v � .fir ./i , i�t'�' �/ J/ / y�//i'cf„ai � ,ls//i�!li .nr/ w «1�%Y`�R1921 �i '�� 'a?•, ' ;' �,�/! "/ Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may besubmitted 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. ,.��n,. .,�.�.�ri .��sa.✓a 0sz�a%sx��•_��'.'may� ,11*0a<1" ,.,�,uX t�/ ��ri ,.....,,��i ✓�u ��� a r r;,g sf �' q :�'�r:„ City r H or Towns 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 penniUliuense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. �� ��.” '�;;'��"a �� � 7:"ea 68y 6,"�. ,�f .v �,riv�,�t°^s'a 'yrHu � ,.,g .',y fi4 .�.u,✓s,�; T^�x` pts The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 )Vashington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 est. 406, 409 or 375 MOM mmmmmm MEM M=m on: mm®� mm�j ,mmm (mmm' B6m ®6® Bmf mmm mom mom mmmm6 mmm Immo mmm mmm mmm mmm Amon ®mmm 'mmm��mmm� mm� mm� mmm !mmm Imam mmm � mmm Immml mmm 'mmol mmm mowl mmm Tm0 Mm� mmol mm�, I,mmm mmm mmm mmm' mmm (m6m mmm mom, MI mB� CC3 x N ti O DOYLE LUMBER DOYLE LUMBER 19 Aug 19989:45 am 43 RIVER RD, ANDOVER, MA. 01810- (978)688-4099 FASTBeam@ Engineering Analysis ©1996,1997 Georgia-Pacific Corporation Version: 2.0(95/NT) Project : Information : Mark #: Tetreault Desc : Roof Header Usage : Beam(R000 Repetitive : No Spacing (in.) : 0.0 Max Defl: LL = U240 TL = U180 Composite Action : No Slope : 0/12 3.5", 565 psi u 3.5", 565 psi 151011 LOADS Project Design Loads: Roof. Live=45 psf, Dead= 15 pst,� Live+Dead WIT) Live Ld(L) LDF Location* # Shape @Start c@ End @Start @End Span# Starts Ends Additional Info 1 Span Carried(pso 60 45 115% 0 a a, is a, 8' 0" S.C. - Uniform(plf) 5 0 0 0 is a, Self Weight *Dimensions measured from left end when span# is 0, otherwise, from left end of the specified span. SUPPORTS(lbs) Max Wn 1841 1841 Min R'n 491 491 DL R'n 491 491 Min Brg(in.) 1.86 1.86 [Based on bearing stress below] Brg Str(psi) 565 565 DESIGN Value Span x Group Allow LDF Ratio V(lbs) 1562 1 13 10" 31 4540 115% 0.34 M(ft4bs) 6902 1 76, 31 11247 115% 0.61 LtRn(lbs) 1841 0 0' a' 31 3461 100% 0.53 RtRn(lbs) 1841 0 16 d' 31 3461 100% 0.53 LLDefl(in.) 0.43 1 T 6' 31 _ _0.75 U414 T_LDefl(in.). 0.59-- 1 76, 31 1.00 U304 USE. GPLAM 2.0E 1.75x11.88" 1 Ply Grade selected by User G -P LAM tm GEORGIA -PACIFIC CORP.' NOTES: 1. Designed in accordance with National Design Specifications for Wood Construction and applicable Approvals or Research Reports. 2. Provide lateral support at the bearing location nearest each end of the member. Continuous lateral support required for compression edge. 3. Loads have been input by the user and have not been verified by Georgia-Pacific Engineered Lumber Technical Services. 4. Design valid for dry use only. 5. Bearing length based on design material; support material capacity shall be verified (by others). 6. Roof Usage: Install with minimum 1/4:12 slope for adequate drainage. 7. When required by the building code, a registered design professional or building official should verify the input loads and product application. 8. This engineered lumber product has been sized for residential use. A concentrated load check, per the building code, must be performed for commercial uses. 9. Max4i in reactions are based on the applicable load combinations outlined in the notes. Summation of max/min reactions for various DOL may not match total max/min reaction. 10. Company, product or brand names referenced are trademarks or registered trademarks of their respective owners. 11. For explanation of GROUP, change to expanded printout Page 1 of 1 I 401. 00 kn 0 N M 0 U c� rA 20: O� 21 u U O 'd Cd 3 N IL W15 w x 44 A lz O z z u Uad 0.4 w a z w w A p CA cn a A ,K', o c , a, cdp' w x° w � U w- O w co G ti w a rsa cn O w E IE w N O N C n m C" c m O CM C •C N CD t O Z 0 8 CD5 r a y O .y co CLL O C O CD v CL CO) O V .7:= CO) O C d H C Location-- No. Date 4 NpRTFTOWN OF NORTH ANDOVER pp Certificate of Occupancy $ Building/Frame Permit Fee $ ;�s "••°''cam Foundation Permit Fee $ sA�NUSE Other Permit Fee $ ` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ I�O Building Inspector r'-- 126G12667 ! Div. Public Works Location Div. Public Works No. Date "ORT" TOWN OF NORTH ANDOVER ,•,hOOs O?O•�",O 41 A Certificate of Occupancy $ Building/Frame Permit Fee $ CHusE Foundation Permit Fee $ Other Permit Fee $ ' Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 1 Building Inspector F I - Div. Public Works Q N u z - C Z C� I 0 � -K )c 1 Y Y N NZ QC% 1c lcz� 3 v k G 0: "e n z 0 Z Z = - — 2ii X x i = h — C — ¢ Z__ u z z a y i1 ye v Z ZZ Y _? - — C 5 Y Vwy� Z Q < =j L 6 N Q y N Q Q ` u � WW � `.�r w .. W cr a Z Z Z w w * N I: u w L6 a X W O N Z — Ji W _C W 1' ¢ LL_ .�..._ �"1 7C L s — _� N m F ¢ ww 'A W W LL Z wG 0 LU NLUc w s Z Q Z y C w L m Z N N W C LL w J ` Z < Z w L Z Z W M v Z Y ( ^ ate iDant�ftaiatu� �Jda�c��rir en M1Mk l"' 'q„y DEPARTIIENTYOF PUBIIG,SREEIY��'" ,;f HNSTRUGTIO�}SU�ERV130R fl : Resited t y d ti •� METHUEN, M0 E1844 y 69 *MZMV KCTOR� .Registration '112106 Type.-' PRIVATE CORPORATION_.:'' ' ` Expiration 03/02/99 DUPUIS SERVICES, INC. DOM,INIC F. OUPUIS, 716 LOWELL ST UEN MA 01844 ADMINISTRATOR C 4�- PM I,-ui �W Q MA } Jnnr 0 0 LjJ Qh h J K i i r 0 1l11,, 7 h `1J o Q U,! h W v Au O o� v ko, a . A � een/ Jnnr - W �, zpro LIJ Lt, W FORM U - LOT RELEASE FORM -7CKB ® �e G/ pha0INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION********** APPLICANT �.I�t PHONE5- P. Iii LOCATION: Assessor's Map Number b3� SUBDIVISION ----- STREETr,�l t� _S u m m A I( - PARCEL _(- LOT (S) /Of -rt Y3/7t j ST. NUMBER V61 *,*4******** ***********'"'""OFFICIAL USE ONLY***********"**'' TIONS OFT CONSERVATION ADMINISTRAT COMMENTS AGENTS: L V - DATE APPROVED DATE REJECTED TOWN PLANNER DATE gPROVED j� DATE REJECTED COMMENTS FOOD INSPEC R -HEALTH DATE APPROVED DATE REJECTED EALTH COMMENTS DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE uj am xa ° o � O N C VV ac eo ev m c x z ' o g ch a v 04 w m o � bio w A w w z uj am 91 V 0 0 N ff 2 0 a� O CD O O V Z O CL O CO) co cm p C I C C O•— co p C ,y m m coOw 3� O p i � O d CL y C.O V C� z CO) C C C !D CO) o � O N C VV ac eo ev m c = o cc ' o CF m o z s o n c E.N o 0 V ;c W c E 0. Vf 1 m � H a t O cQ N C J � m /y H O .E N m O_ � o .: o o CLU cm W CA m m :t= O C: OI CO d C t m O C-) m O Z O O O w Of m C �O C �C i- : y m C 4D N CL C, CD CO) cc 'VO O C O cc �LU E Me v ti Z oQ U a "00-0 a y• J O = � eyv c L con 91 V 0 0 N ff 2 0 a� O CD O O V Z O CL O CO) co cm p C I C C O•— co p C ,y m m coOw 3� O p i � O d CL y C.O V C� z CO) C C C !D CO) Location CSS S14 �►'i !,'1 � 7 "No. / ! Date �aRTM TOWN OF NORTH ANDOVER �?Oi tt�•o ! 0 Certificate of Occupancy $ • r Building/Frame Permit Fee $ Z A Foundation Permit Fee $ s1CMu5E Other Permit Fee $ S Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 0 9745 Div. Public Works PERMIT NO.,` � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP d-40. 3� LOT NO. I'7 I 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. F i LOCATION2 PURPOSE OF BUILDING NaMC' OWNER'S NAME KAKL BOKN NO. OF STORIES 'L SIZE OWNER'S ADDRESS 20$ SUMhtIQ S r BASEMENT OR SLAB 5L; ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 7 A I0 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS fix DISTANCE FROM STREET a9 DISTANCE FROM LOT LINES - SIDES ) ti f J- REAR J� Q�.� 1''�� i I " " GIRDERS 21010 3� L V AREA OF LOT (R:F�. FRONTAGE I y Z HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING 4 0 I/ X /01/ IS BUILDING ADDITION �\ MATERIAL OF CHIMNEY - IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND pup u WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yo r IS BUILDING CONNECTED TO TOWN WATER 000 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER g'O IS BUILDING CONNECTED TO NATURAL GAS LINE L, INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 4-2� K7 SIGNATUItE OF OW ERQOR AUTHORIZED AGENT 7. O - FEE i.i PERMIT GRANTED 19� 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSP[dTCR OWNER TEL. q CONTR. TEL. N CONTR. LIC. # i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR"FI'NISH d PINE P PLASTER LASTER DRY WALL UNFIN. 1 2 .13 CONCRETE CONCRETE BL K. BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL I FIN. B'M'TAREA _ 1/4 1/l 3/, ' FIN. ATTIC AREA _ NO B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B t 2 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARWVD COMMCN VERT. SIDING STUCCO ON MASONRY _ ASPH. TILE STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME - -ATTIC STRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR II POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 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 11 HEATING WOOD JOIST PIPELESS fURNArE 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 GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ 3rd ELECTRIC NO HEATING t st THIS SECTION MUST SHOW EXACT DIMENSIONS OKLOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.'" ' F 4 7 F 4 Froin. MOR`T'GAGx E PUP.PoSCS •--5A Wv. VSE oNI x tb&.S e Q UPnu PUPA c REManot ,A Un MA r%0 Lh-is P%" %r a Ciu►N cN ADDRESS MO R�'GAGG�R SOUR,Gp Jam(' �! E ��� P � PJ • a,'= Yi ,0 i k �+ 40 r h . N �/{/ — .. .: I • • � ofPATV. x (0 (1p I ./ �' ' , � ; ' • • .» o OWNER(S)N4 A, 64. CERTIFICATE REGISTRY;EX 6S�Tµ _ I C$RTIFY that the Lot shorn hereon DEED: BK %Wl—pp—.Bi–. ahl'D that the , "�D WSl.L USX= shown PLAN 0`5 to 5cg .• --' CERT. OF TITLE: — MTlA -r4e present Zoningll (_�.,6,y�/ NOTE:______ of the_oo,� of MLJQ 12.T6( D0MEL : The premises do 1 not lie within 7 a designated ,Q4,,..�.� , s,y.1H Of Flood Hazard14 n • ' IJo''. r^ •� �,�. Lone .CoM ROBERT r't,�a .� ��' ROBERT G, - GOODWIN , R. L . S. - 2 Soo" - ob ld'� � % R(.;1;.1 ;' i " I + GILLETT 1 T � 4a !� Cit.:it ''• '-' GOGGWtI� vr� 62 -CENTRAL 'STREET �5, 8$r/• �// Gut�,lwtn �a d7S J ANDOVER,' MASS: • t`! 1SrE?`� `� a =I FL(D to 1 C 8 0 0 (D 1: - 1 i V V OD 00 C-4 i iii iii iii i FL(D to 1 C 8 0 0 (D 1: - 1 i V V OD 00 C-4 I SW 5IR a = - E 4 . . 6rn . I ir 0 = 14 - IC CD CA eca 10 = =t CL D 8 C', cc F CL Co CD 0 z CD =r maim 03 C042 .-I- CD C42 CD a _p C2 OCD Ir 9! :: -1 0C41 CD to C.) C2 C2 CD Z CL a �" 0 cg CL co VJ CD Co CD CD :n Ce C=3 fD Go =3 cr �.+ _ C.CD cot CD: co C3 C/) CO) CD CD: o o -,To Q 0. 0 cn 0 C/) V)47 AN D 0 CD -4 r T C2 Pa. N YZ, COD R\ CD C =r go Cl) 4Y liC2 tM tz, = C _1 i! S 0. cn 5 1= t27 rz ti -PA 171,Cn :1 0 0 :Tl Z �:, CD -1 :5 n Wmmm� am mmUSE r)O CO) 71 cp A. Z-0 CO2 wo ommme 0 CL r- C) wo CL a. � CD ccl CL C=D CD 0 CD w t= 9 C CD CO2. CD CO2 am co CD B7 CA yO CD M I SW 5IR a = - E 4 . . 6rn . I ir 0 = 14 - IC CD CA eca 10 = =t CL D 8 C', cc F CL Co CD 0 z CD =r maim 03 C042 .-I- CD C42 CD a _p C2 OCD Ir 9! :: -1 0C41 CD to C.) C2 C2 CD Z CL a �" 0 cg CL co VJ CD Co CD CD :n Ce C=3 fD Go =3 cr �.+ _ C.CD cot CD: co C3 C/) CO) CD CD: o o -,To Q 0. 0 cn 0 C/) V)47 AN D 0 CD -4 r T C2 Pa. N YZ, COD R\ CD C =r go Cl) 4Y liC2 tM tz, = C _1 i! S 0. cn 5 cn " (D t27 rz ti -PA 171,Cn :1 0 0 :Tl Z �:, CD -1 :5 n tai �x r)O :7 71 cp A. SS -PA �x r)O :7 cp A. SS -PA Date` " 3805 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that%��?.f�h.!,U, has permission to perform ...�. �?f {..................... . plumbing in the buildings of ...�� ...................... at. , , . ,North Andover, Mass. Fee ..%? r "`.. Lic. No. 0.a . PLUMBING INS CTOR 09/02/98 09:24 15 00 • PAID WHITE: Applicant CANARY: B44ng Dept. PINK: Treasurer ACHMETTS UNIFORM APPLICATON FOR PERMIT TO DO GASG or print) Date �. 19 IAVKIH ANDOVER, MASSACHUSETTS Building Locations 20 Permit # 3 Amount $ Owner's Name NewW"_� Rion ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Address Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ 1 Uwner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Miss. General Laws, and that my signature on this permit application waives this requirement. Check one: [:1Signature of Owner or Owner's Agent 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 install s ormed unde e t Issu for this application will be in compliance with all pertinent provisions of the Massachu s St ode an apter e ral Laws. (Title City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber �� f Gas Fitter License Number Master ® Journeyman m O w C FF a z z w p > w z x U c7 Q w .a d E~ E. w p z w I✓ F x 0 SIJ B -BA SEM E BASEM ENT 1S . FLOG 2ND FL R 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOG R 7TH. FLOOR 8TH. FLOOR (Print or type) Address Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ 1 Uwner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Miss. General Laws, and that my signature on this permit application waives this requirement. Check one: [:1Signature of Owner or Owner's Agent 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 install s ormed unde e t Issu for this application will be in compliance with all pertinent provisions of the Massachu s St ode an apter e ral Laws. (Title City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber �� f Gas Fitter License Number Master ® Journeyman