HomeMy WebLinkAboutMiscellaneous - 2192 TURNPIKE STREET 4/30/2018o M
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577,v"
Date .... !2 ....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......... le ...........5 ....
has permission to perform....... SW227� .........
wiring in the building of ..................
at ..... ., z rtn .... 57,-
........-
............ North Andover, Mass.
Lic. No.
Fee ... 777� '4
............. g'�M' NS�ECMW
Check#
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
a Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52� CMR 12.00
(PLEASE PRINT K OR TYPE ALL INFORMATION) Date: O )L4 09
City o Tow of: f�A—A ()K66Ve r To the Inspector of Wires:
By this applicatio dersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street &Number) -)-,I —L TU'llnvl_K�
Owner or Tenant
j'`l (-4hiILYd (Jf-YJ r
Owner's Address
5j12,ri-1.L
Is this permit in conjunction
with a building permit?
Purpose of Building
Swimming Pool Above ❑ In- ❑
rnd. rnd.
Existing Service
Amps / Volts
New Service
Amps / Volts
Telephone No. % /D'–
Yes ❑ No x BLDG PERMIT #
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install low voltage security system at above location
Completion of the following table may be waived by the Inspector of YYires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. rnd.
o. ot Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
of
No. In Detection and
InDetection
Devices
No. of Ranges
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
Heat Pump
Number
Tons
KWNo.
of Self -Contained
No. of Waste Disposers
Totals:
.... ...
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ElMunicipal Other
No. of Dryers Dr
y
Heating Appliances KW
urity Systems:* 1
No. of Devices or Equivalent
No. of Water
KW
No. of No. of
in ;
Heaters
Signs Ballasts
No. o eve uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: / (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Brinks Home Security LIC. NO.:
Licensee: John Holmes Signature �,� perLIC. NO.: 749C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-657-0443
Address: 155 West Street, Suite 6 Wilmington, MA 01887 Alt. Tel. No.:
*Per M.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" License LIC. NO.: SSCO 001163
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by ]aw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ® owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ 4b
Date . '......
NoarM
&ORT TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACMUS� � � �!
This certifies that:. .. .
...... .
has permission to perform ............. .......... .
plumbing in the buildings of . ................ .
ai ........... ....... //,North Andover, Mass.
Fe
PLUMBING � TOR
Check #� 11�
7878
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
't
of
New ri Renovation Replacement
FIXTURES
Date 1G' tel ®�
I Permit # ��7 8q
�S Amount �D
Plans Submitted Yes No
(Print or type) Check one:
Installing Company Name�0 /b Dqy TV 6 � h ElCo
Certificate
. ( rP.
Address 'Q �� Partner.
Naak -R ti AAA—O-tycq 11
usmess Telephone 0 O Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑
I hereby certify that all of the details and information I have submitted (or entered
best of my knowledge and that all plumbing wor tallations performed un
compliance with all pertinent provisions of assa X Statelun. bing Co
By: icens um er
Title
Type of Plumbing License City/Town .
rcense um er Master
APPROVED (OFFICE USE ONLY
Agent ❑
in above application are true and accurate to the
- Permit Issued for this application will be in
and Chapter 142 of the General Laws.
ElJourneyman (/��
Location
No. --�) 5 / Date
MORTIy TOWN OF NORTH ANDOVER
6OL
F 9
+4L Certificate of Occupancy $ _
Building/Frame Permit Fee $
sgCHU
f Foundation Permit Fee $
Other Permit Fee $
z
b TOTAL $
Check`! � o c
l
15140
5 1 /j O � A&f-(2-��
Building Inspector
TOWN OFN T ANDOVER
BUILDING DEPARTMENT
PPLICATION.TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY -DWELLING
Map Number Parcel Number
UILDING PERMIT NUMBER: DATE ISSUED:
1.3 Zoning Information:
1.4 Property Dimensions:
:GNATURE:
Building Commissioner for of Buildin2 Date
i BUII:DING SETBACKS ft
;CTION 1- SITE INFORMATION j
1.1 Property Address:
1.2 . Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
ning District Proposed Use '
Lot Area , Frontage 8
i BUII:DING SETBACKS ft
Q, 01
Front Yard
Side Yard
Aear Yard
Required Provide
Required Provided
Required Provided
Water Supply MG.LC.40. 54) � `.� 4`A
1.5. Flood Zone Information:
t'�..� --• ..
`
1.8 Sewerage Disposal System: - .
dic 0 Private 0
Zone Outside Flood Zone ❑
Municipal 0 On Site Disposal System 0
;CTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Owner of Record
;
r
me (Print)
Address for Service
nature
Telephone
Owner of Recor :
arae Print
Address for Service:
nature
Telephone
CTION 3 - CONSTRUCTION SERVICES
Licensed Construction Supervisor: Not Applicable ❑
:nsed Construct`on Supervisor:
License Number
cess
Expiration Date
ature Telephone
tegistered Home Improvement Contractor
pany Name
I 'ess
tture
Not Applicable ❑
Registration Number
Expiration Date
p
SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the- building rmit.
Signed affidavit Attached Yes .......❑ . No ....... 0
SECTION 5 Description of Pra osed' Work check alt a livable
New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition D
4, {. z ,
Accessory Bldg. ❑ Demolition ❑ t` °Other ❑ Specify `
Brief Description of Proposed Work:
PSECTION 6 - ESTIMATED CONSTRUCTION COSTS 1
Item
Estimated Cost (Dollar) to be
Completed by permit applicantIr
:s10f, 04'
a k
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
-Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical (HVAC)
5 Fire Protection .
6 Total 1+2+3+4+5:
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
o W- NERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
eby authorize to act on
behalf, in all matters relative to work authorized by this building permit application.
'—Signature of Owner Date
v SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true.and accurate, to the best of my knowledge
and belief
'Print N
AQ.
of Owner/Agent Date
MATERIAL OF CFMVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
_ FORM U - LOT RELEASE FORM I fu s� a � 1
a - S qo rk-q-Q
INSTRUCTIONS: 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 C. A /tee%/' Ccs ti r U
WP
/� HONE
LOCATION: Assessor's Map Number a PARCEL_
SUBDIVISION LOT (S)
STREET ST. NUMBERR 19 Q,
*****************************************OFFICIAL USE
ONLY***********************************
RA"ENDATIQNIkOF TOWN AGENTS:
ATION ADMINISTRATOR
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMM
DATE APPROV15D
DATE REJECTED
RM -14
1,
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9197 Jim
DATE
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Locationt—
No. Q0 Date
_. Nom,_ TOWN OF NORTH ANDOVER
o
s ; , Certificate of Occupancy $
�'�s'•CHUS Building/Frame Permit Fee $
30—
� s+cMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 3
Check# 06-
1
16006 /SAA
Building Inspector:
y
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMrrOLISH A ONE OR TWO FAMILY DWELLING
77i
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
2 �Vr ; IQ, �%-
1.2 Assessors Map and Parcel Number:
G +
Map Number Parcel Number
V n A
,C �V
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
9�h�-eeh co/) zo t
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Cgnstruction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2Re istered Home Improvement Contractor
S
Not Applicable El
/ 3
13743
Company me
Registration Number
Expiration Date
Si nature Telephone
MU
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X
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90
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M
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0
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... ❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑
Existing Building 0
Repair(s)
0
Alterations(s) ❑
Addition 0
Accessory Bldg. 0
Demolition ❑
Other 0 Specify
Brief Description of Proposed Work:
£A(Z-0�'�
SECTION 6 - ESTIMATED CONSTRUCTION
COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
(}FFICIAL
iISE QIYLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
Q .moi
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
0 0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, 1?' GL ZO" as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
I me
Si ure of Owner/A ent
Date
NO. OF STORIES
SIZE i
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST2ND
3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
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: t� tt
(Location of Facility)
0W- --O�L
Signature of Permit Applicant
0*7
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
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.
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.
2 n , e- I _ I!, S
Address 2 7 FigrK :54
Company name:
Address
City Phone #:
Insurance Co. Policy #
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_well_as.civil_penaltiesinshe%rmrda_STOP WORK ORDER.,and_a.fine_of.(.$1110.DD).-tlay.againstme.
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
L
I do hereby certify un er the pains and pen:;Z
f perjury that the information provided above is true and correct.
Signature d/ 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 j] Licensing Board
p Selectman's Office
Contact person: Phone #. E] Health Department
Ei Other
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Location_-_ 14 7
S-
No.
Date
%5
HCRTp TOWN OF NORTH ANDOVER
F „ Certificate of Occupancy
$
` _ Building/Frame Permit Fee $
Foundation Permit Fee
$
cMuSE`
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
r�
Building
Inspector
_ 07M i3 94 j4 24.00 PAID
k' 74.43
Div. Public
Works
PERMIT NO. Z�
4�--
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
iRIAP +40. I
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION/�, Q Z_ `ru rLw F, kE- S -l ---y
PURPOSE OF BUILDING ��0 (/ts% 5'�.41A)cr
OWNER'S NAME
NO. OF*STORIES SIZE y
OWNER'S ADDRESS 2! -1� 7 � •� •.
L
BASEMENT OR SLAB
GYM
ARCHITECT'S NAME ;•:
SIZE OF FLOOR TIMBERS 1'BcT7
2ND 3RD
BUILDER'S NAME C ty
-�
SPAN -
DISTANCE TO NEAREST BUILDING -
DIMENSIONS OF SILLS
POSTS -
DISTANCE FROM STREET
DISTANCE FROM LOT LINES — SIDES REAR
' GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW L` y O�
i!'G
SIZE OF FOOTING X
IS BUILDING ADDITION i
MATER:AL 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 NCU
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 APPRROVVVE�DB`Y BUILDING INSPECTOR
F,I
DATE LEp �� Z S / )
SIGNATURE OF OWNER OR AUTHORIZED AGENT
FEE C
PERMIT GRANTED OWNER TEL.
CONTR. TEL. #
19 CONTR. LIC. �#Z
3 PROPERTY INFORMATION
LAND COST
_W. BLDG. COST ./ y 000, G 7-V
i
EST. BLDG. COST PER SQ. FT.
EST. BLDG. -COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
_ 77-T_ mom*
BUILDING RECORD
1 OCCUPANCY 12 t S
SINGLE FAMILY 5 oRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA -
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
.l c�
CONSTRUCTION
2 FOUNDATION
CONCRETE
—I
—{
8 INTERIOR
FINISH
PINE
HARDW D
3
2 13
I —
CONCRETE BL K.
BRICK OR STONE
PIERSPLASTER
DRY WALL—
UNFIN.
—
3 BASEMENT
AREA FULL
FIN. B M AREA
1/1 1/7 '/
FIN. ATTIC AREA
_
NO B M T
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS
CONCRETE
EARTH
B
_
1
2 3
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DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
H—AR-0111D
COM/ACN
ASPH. TILE
STUCCO ON MASONRY
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_
BRICK ON MASONRY
BRICK ON FRAME
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WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE I NONE
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ASPHALT SHINGLES
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_
WOOD SHINGES
KITCHEN SINK
SLATE
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_
TAR & GRAVEL
STALL SHOWER
_
_
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
_
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STEAM
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HOT W'T'R OR VAPOR
WOOD RAFTERS
_
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_
RADIANT H'T'G
UNIT HEATERS
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OFFICES OF: ;
APPEALS ;tx,y; NORTH ANDOVER
BUILDING t'+.:y4r
CONSERVATION DIVISION OF
HEALTH
PLANNINGPLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
12o Main Street
North Andover.
Massachusetts O 1845
(617)6853.775 .
r %.
In accordance with the provisions of MGL e 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 e 111, S
150A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
7 - (-s-- F�
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(P'_ease print)
DAT7,
JCB LOCATION
Numcer Street Address Section or town
—A
Nampa
SEC... 1.7 l?Y 7T ING ADDRESS
K-
C- / Lo.Yn
Home 'Phone Work ".:one
tate
Lip coca
The current exempti„on for homeowners„ was extended to include owner
-ccc oiEd d!:fellinzs of six units or less and to allow such homeowners to
en,__c-E an individual for hire who does not possess a license, provided
thatJtie owner acts as supervisor. (State Building Code, Section 109.1.1;
DEF =:v 1: l0iv OF EiCMEO I :
Persons) who owns a parcel of land on which he/she resides or inLanus L U
r EslCe. on which there is, or is intended to. be, a one to six fami'_-,� dwe _-
ir,c,, a" -ached or detached structures accessory to such use and/or farm
struc—.:ras A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner” shall sucmi�
to the Building Official, on a form acceptable to the Bulling Ufficial,
C1E /she shall be responsible for all such wor'.<. performed undar the
bu_-di:,g permit. (pec tion 109.1.1)
_ha =icersignEc
_c 3ui_cin
t"homecwner" assumes responsibility for compiianCa
'Ode and other applicable codes, by-laws, rules a^.0
Iit 11- If _
Ce_ tha
:vc_ _.. :::;lover 3u__cing Deoart;,;ent minimum
hE/sh,e w_' 1 comply
_aC"-:,_a7 E-tS!.
t he/she understands the To.:tt o
inspection procedures and
with said procedurEE anti
�L0 Cl, ear Or lar_Er.
ion 107.0. Cons
308 b
TOWN OF NORTH ANDOVER
A
PERMIT FOR GAS INSTALLATION
S
This certifies that ... �''�-�....::........ '".......
��^.
has permission for gas -installation .... • .
in the buildings of `' ... ./..... .....................
;�-, ?: ti
at . r!: r' j ,North dover, Iss:
Fr ... -:-n . Lic. No j..... .. : {...... .
/fes+GAS INSPECTOR
WHITE: Applicant CANARY: Building ' Zt. PINK: Treasurer
• MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
�\1 19 I l
d
Mass. Date
City, Town Permit # (!?o
Building Owner's ,,(
AT: Location Name (�. u ��-
.l
1 11-1-
a S Type of Occupancy:6--03—i
GNen�b Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
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OR MEMNON
Qui■��■■i���■�■1■t■■■���v��H�
W4�19]0;201[ LOIN
MORMON
8TH FLOOR
(Print or Type)
0-3 -Check One: Certificate
Installing Company Name EaS�n�C�t�e 'Corp.
Address Partnership
C[ Pj 3 ❑ Firm/company—
Business Telephone Name of Licensed Plumber or Gasfitter
3 ,Ken
1 hereby certify, that ail. 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 ail plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Cas Code and Chapter 142 of the General Laws. .
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE: Q/Y�'��
Plumber
Gasfitter Signature of Licensed
Master Pixlnbg- or Gasfitter
Journeyman �(
License Number
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3076
Date
NORTH TOWN OF NORTH ANDOVER
0,4. ,,ao ,e1tiOL A
p PERMIT FOR GAS INSTALLATION
b - •''fa L c�
�SSwruuSE't
This certifies that .. C-'��............... ....... • – • . • �
has permission for gas installation .:.:....:� : -: .
in the buildings of .:... 9 4 ... • • • • • • • • • • • • . .
77
at `
North Andover, Mals.
Fee ..... . Lic. No.22 ...... ....
GAS INSPECTOR
WHITE: Applicant CANARY: Building De101. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
K
Mass. ate -' 19
City, Town ermit #
Building Owner'
AT: Location Name
Type of Occupancy :. (CYC —
G
New ❑ Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
LN
m
e
f
0
(Print or Type)
Installing Company Name ECCS-;P_rn
Address
'T)fu� vers
Check One: Certificate
aCorp .
Partnership
❑ Firm/Company
Business Telephone Name of Licensed Plumber or Gasfitter
1 hereby certify that all of the details and information I have submitted (or entered) in above application_ are true and accurate to the bat of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
Provisions of the Massachusetts State Gas Code -and Chapter 142 of the General laws.
TYPE LICENSE: �
Plumber
Gasfitter Signature of Licensed
Master P1 b Gasfitter
Journeyman
License ;imber
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
��i■11■■1111■111111111■1111■1
MEMO
(Print or Type)
Installing Company Name ECCS-;P_rn
Address
'T)fu� vers
Check One: Certificate
aCorp .
Partnership
❑ Firm/Company
Business Telephone Name of Licensed Plumber or Gasfitter
1 hereby certify that all of the details and information I have submitted (or entered) in above application_ are true and accurate to the bat of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
Provisions of the Massachusetts State Gas Code -and Chapter 142 of the General laws.
TYPE LICENSE: �
Plumber
Gasfitter Signature of Licensed
Master P1 b Gasfitter
Journeyman
License ;imber
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
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Location
v
No. ?J S Date
NaRTM TOWN OF NORTH ANDOVER
b y
+ ; ; Certificate of Occupancy $
'S3 14US Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 30
Check # t S
1689 Building Inspector
4)
a. y/ •' i
L V
SIGNATURE: \�
Building Commi oner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
2.11OOwner `of Record /j n
Name (Print) Address for Service
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
SECTION 3 - CONSTRUCTION SERVICES
Front Yard
Side Yard
Not Applicable ❑
Rear Yard
Required Provide
Re4qWred Provided
Required
Provided
Company Name
f
Registration Number
Address
Expiration Date
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes No
2.11OOwner `of Record /j n
Name (Print) Address for Service
Signature Telephone
2.2 CKner of Record:
Namc=Print Address for Service:
A
Si re Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
f
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (1VLG.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check all app
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
,Y /24
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed
Com leted b ermit applicant
� CIA
USE IND,
1. Building
00
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire ProtectionAIM
6 Total(1+2+3+4+5)
2 52Dr c'
Check Number �' S
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize % GO 24-5- to act on
My be n eY e to work authorized by this building permit application.
II /Z D
Sigiiature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION,
I, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Own"nt Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TINMERS 1 2 3
SPAN
DlIvIENSIONS OF SILLS
DIlvIENSIONS OF POSTS
DMIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OY CHRV1tgEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
/030 t 7W
4:5 r.14zer-.-�
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
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
c 11, S 150 A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
O c '1
Town of North Andover
Building Department•,'S
27 Charles Street
�SSACHUSEt�
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE //12, /U
n
JOB LOCATION
Number Street Address Section of To
"HOMEOWNER
Number Home Phone Work Phoi
PRESENT MAILING ADDRESS �% f �y�P�% f 5;`
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of 1 or 2 units 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 of two
there is, or is intended to be, a one family dwelling, attached or detached structures
accessory to such use and 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,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 108.3.5.1)
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 No. Andover
Building Department mini
comply with said procedu
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING O
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
Revised 4.30.03
Home owner Exemptions Form
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
"S C USEt
This certifies that
.................. .......
has permission for gas installation -40::x'.. ...
in the buildings f ... ..........
at 'q 9-. 7—
............. North Andover, Mass.
Fee : -r ..... Lic. No... % ... ........
GAS INSPECTOR
Check #
4971
..:
MASSACHUSETTS UNIFORM APPLICA
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
FOR PERNM TO DO GAS FITTING
Date 12/15/04
Building Locations Permit # - �1-17/
Richard Conroy Ovrls NameAmount
978 975 891
New ❑ Renovation Replacement ❑ Plans Submitted ❑
(Print or type) Eastern Propane Gas Ch one: Certificate Installing Company
Name ff Corp.
Address 131 Water St.
❑ Partner.
?fan vers MA lel 2P4
Business Telephone,,00 7,pp ❑ Fimr/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check
I have a cun-ent liability Insurance policy or it's substantial equivalent. Yes M No❑
Ifyou have checked Yes, please indicate the type coverage by checking the appropriate box
Liability insurance policy F 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 ❑
.. �j ..v ...a. 4.. V1 At; %, I a„u,,.n,,,auixr 1 f,ave suvrmuea kor enrerea) in above app ication are true and accurate to the
M best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
- --compliance with all pertinent provisions of the Massachusetts State Gas Code ano Qhapter 142 of je General Laws.
ICity/Town
APPROVED (OFFICE USE ONLY)
Signature of Licens Plumber Or Gas F1'tt n 2
Plumber L P / J
Gas Fitter E 7—e 777 um 5 e
❑ Master
❑ Journeyman