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HomeMy WebLinkAboutMiscellaneous - 228 Forest Street (3) - f - - - - - \ � 1 /' 4 �� i i `\ Location No. Z 3 Date A TOWN OF NORTH ANDOVEW Certificate of Occupancy $ 4A 1i •; Building/Frame Permit Fee $ ,c c "o►+unth Foundation Permit Fee $ s� 5e iE Other Permit Fee bt-X40 $ �I Sewer Connection Fee $ i r Water Connection Fee $ TOTAL $ LL k 7/ Build nspector 9822 c� V 2 2 Div. Public Works t f PER.mrr NO. 2�3 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE : MAP h40. LOT NO. 2 RECORD OF OWNERSHIP (DATES BOOK ;PAGE I ( — ' ZONE ( SUB DIV. LOT NO. � LOCATION ., PURPOSE OF BUILDING 9WNER'S NAME NO. OF STORIES SIZE g AA Ap .. v/y,.NER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAMESIZE "",,�� SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME 1 �A I-�(�'I,�- SPAN - DISTANCE TO NEAREST BUILDING �c. 7 ,v DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES �b /V✓ O - -L T. BLDG. C O PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED JAND APPROVED BY BUILDING INSPECTOR DATE FILE r (� BUILDING INGr%d or j Q SIGNATURE OF OWNER OR AUTHORIZED AGENT `+ F E E SO OWNER TEL# PERMIT GRANTED CONTR.TEL# 3 1. 19 CONTR.LIC.# H.I.C.# X3971 BUILDING RECORD 1 OCCUPANCY 12 NGLE FAMILY S.-CRIES SITHIS 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. CONSTRUCTION 2 FOUNDATION B INTERIOR FINISH CONCRETE a' 1 2 I3 CONCRETE BL'K. --II PINE BRICK OR STONE p0 7L PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. BM'T' AREA _ ./. 1/1 '/ FIN. ATTIC AREA NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 3 FLOOR BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR 1. 1 NONE ADEQUATE 5 ROOF 10 PLUMBING GABLE 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 q TILE FLOOR "D TILE DADO • 6 FRAMING I i l_ HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS - 7 NO. OF ROOMS OIL ` 2nd _ ELECTRIC .r. ,: ,.... . B'M T' Ist 13rd NO HEATING t NOft F own of over O �., ;`�^ `'�•it ,',,�:�t-.� � 70 o_r�_ �l rt dover, Mass.,�t a,%k 3 199 C0C1i'C__":' %ADRATED pP�'4% 5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT IAWPOM.4...�y ........................................................................................... Foundation has permission to emM......V>C% .v............ buildings on .... Rough W-11 lIS.......................... �� �L.M.0p .....I... .� � .......................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the 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 Final ELECTRICAL INSPECTOR Rough 1............................................ ........... ....................... Service BUILDING INSPECTOR Final GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal Dan FIRE DEPARTMENT -- r. Burner Street No. Smoke Det. _ OFFICES OF: �~ - -TOW - Of 20 main Sii6et APPE ALS •g ay; NORTH ANDOVER - -rror:h Andover. BUILDING t�,e Massacs7usetts o t 845 CONSERVATION DINT SiON OF HF_-kLTH - - F't1i.N'ING PLANNING & COMMUNITY DEVELOPMENT KARE_`HP_`ELSO`, DIRECTOR In 1rt:ance with tiesic C c; .IG:. S :� d of Building ov it cor, itica S Number 27i s :hct *^.e �c ~.T 'is resulting from this work shall be disnomi ofin s prcnerl, .,. rte: sc(id xasie ^sc. :c_.. ._:...d 5y 12G it c 111, S The debris'will be disposed cf it+. -_ Lam.:C:iiCn ci :CiiIi-;1 �e-\ Jles3tt:re of ecrina Applicant D to :TOTE: Demolition permit from the Tow3 of North Andover must be obtained for ~ this project through the Office of the Building Inspector. KAREN H.P.NELSON ' • ,1° Town of Director 120 Main Street, 01845 BUILDING NORTH ANDOVER (508) 682-6483 CONSERVATION °" °` DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT DEMOLITION OF BUILDING AFFIDAVIT DATE A I /a OWNER'S NAME & ADDRESS ESSJJU A b -A 6r ' p LOCATION OF PROPERTY TO DEMOLISH 228 DESCRIPTION CONTRACTOR'S NAME & ADDRESS vc s T '__0 havr!Fa DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS - WATER: gZ� 5-00-?G SEWER: -T:Z-Cc) GAS ELECTRIC TELEPH D3/ G CABLE �3 f TARE CES (t/!` lir O 6 ��✓va S 1 Get l v� Gft/�c�li/�J FIRE 'ASvu7 he W d GF JE,,&4,T/6✓/ - p. i EXTERMINATOR �r c vl e DUMPSTER - ON/OFF STREET al E �1- DIG SAFE NUMBERZ') .fylZ DATE REC'D s�3 f /Flo BLDG. INSPECTOR �, Location No. Date pe HART" TOWN OF NORTH ANDOVER ae tip • pp Certificate of Occupancy $ 41 Building/Frame Permit Fee $ s�cMus t� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ w Water Connection Fee $ 1: TOTAL $ ` Building Inspector 07/43/96 . 049 8 7 99199,©p PAID Div. Public Works Location No. Date 01 TOWN OF NORTH ANDOVER - F „ Certificate of Occupancy $ . Building/Frame Permit Fee $ o �M�st� Foundation Permit Fee $ 4- Other Permit Fee $ s a Sewer Connection Fee $ j Water Connection Fee $ TOTAL $ Building Inspector (°06/27/%-11:5498411f.00 PAID Div. Public Works Location�2.A Fowzr- P T No. 2 Date 'V $r TOWN OF NORTH ANDOVER = p Certificate of Occupancy $ * Building/Frame Permit Fee $ �' b��ns►�" N t Found tion Permit Fee $ Ss,CMUstl �er It Fee $ I Sewer Connection Fee $ r Water Connection Fee $ TOTAL 2r 1V 'Off, t * (� Z g3 _ Building Inspector � � .3 y" Div. Public Works I• PER-11T NO. I Q ® APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE : MAP 1i0. //0/ r! pT tr_ r- - 2 RECORD OF OWNERSHIP DATE BOOK :PAGE ZONE SiJB DIV. LOT NO. LOCATION PURPOSE OF BUILDING�— ' OWHER'S NAME L'`Q'�• I�... ` NO. OF ST 1 SIZE C JIB Q� '-) - OWNER'S AOORESS/� D /��, CF� D SII �J Dm BASEMENT OR BLAB r ARCHITECT'S NAME /'>�:+^,^--L-J��� /T JJ C` SIZE OF FLOOR TIMBERS •19T�� BUILDER'S NAME \�1_ I/� )A SIA)A SPAN 3I LJ DISTANCE TO NEAREST BUILDING C�/ l DIMENSIONS OF HILLS DISTANCE FROM STREET— Z6,10 *1 - . POSTS X le OISTANCE FROM LOT LINES -/SIDES REAR / '�1! -9 Z ©� - GIRDERS AREA OF LOT r�/terO� FRONTAGE ��� HEIGHT OF FOUNDATION �/ THICKNESS �fdF IS BUILDIIIIG NEW e� L�� - SIZE OF FOCTING v �/ `1 _ C 18 BUILDING ADDITION MATERIAL OF CHIMNEY !: 19 BUILDING ALTERATION + IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,L^� 18 BUILDING CONNECTED TO TOWN WATER V 6'�11J BOARD OF APPEALS ACTION. IF ANY GG IS BUILDING CONNECTED TO TOWN SEWER �J IB BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS a PROPERTY INFORMATION LAND GOVT SEE BOTH HIDES .. .. _ EBT. BLDG. COST cdj t PAGE 1 FILL OUT SECTIONS 1 - 2 r/ EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM � Jc✓ ELECTRIC METEpB MUt'T BE ON OUTSIDE Of BUILDING SEPTIC PERMIT NO. � ATTACHED GARAGES MUST"CONFORM TO STATE FIRE REGULATIONS 4 APPROVED BY PLANE MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ` r DATE FILED ■UILDINO INtPtCTp/ •IGNATURE O OWNER OR AUTHORIZED AGENT 1 y F E E OWNERTELI 9 d-- PERMIT GRANTED 96 mQ T ,�,.,,..rw CONTR.TEL 1I0 R . i >;' E CONTR.LIC. i DUE FRAME PERMIT $ H.LC.r o• t•-_. -�� ._fir - 1; er . BUILDING RECORD ' 1 OCCUPANCY 12 INGIE FAMILY JPI^ sroRIES ITHIS 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. CONSTRUCTION i 2 FOUNDATION 8 INTERIOR FINISH CONCRETE CONCRETE 81 K. PINE BRICK OR STONE HARDW D PIERSPIASTER !+` _ r .DRY WAtt UNfIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA /1 1/1 FIN. ATTIC:AREA - NO a M'T FIRE PLACES • i HEAD ROOM _ MODERN KITCHEN Y. 4 WAttS I 9 FLOORS CLAPBOARDS 1 2 DROP SIDING CONCRETE WOOD WOOD SHINGLES EARTH ASPHALT SIDING HARDIWO ASBESTOS SIDING COMJACN I_ VERT. SIDING ASP". TILE STUCCO ON MASONRY STUCCO ON FRAME Mr-UP MASONRY ATTIC STR5, b FLOOR BRICK ON FRAME - CONC. OR CINDER BLK. l STONE ON MASONRY WIRING STONE ON FRAME SUPERIORPOOR _ - ADEQUATE I� NONE i g ROOF 10 PLUMBING E GABLE HIP BATH 13 FIX.1 GAMBREL MANSARD TOILET RM. 12 Fix.1 FLAT I SHED WATER CLOSET II ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING ' TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOCR TILE DADO g FRAMING 11 HEATING WOOD JOISTFIPE F8R'tTACEr, ,. ~ 1 - "► - . - _.FORCED HOT AIR FURN i TIMBER BMS. b COlS. 31Er ._ y STEEL 8M5. 3 Cots. HOT W'T'R OR VAPORF�' a i WOOD RAFTERS A'IRtC3NDH•NONJMG ` _Y ".?;�t 7.+ RADIANT H'T G UNIT HEATERS NO. Of ROOMS 7 z . _ OIL ' lft 12nd _ ELECTRIC I 3rd I NO HEATING 1. w FORM U - LOT RELEASE FORM x INSTRUCTIONS: This form is used to verify hat 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 local or state law, regulations or requirements. ****************Applic nt fills out -this section***************** APPLICANT: - �. Phone LOCATION• ksw�r' Map Number fd Parcel �7`3162, Subdivision Lot(s) ;i Street kaea IS-1 St. Number Z. GEENTS: icial Use Only************************ RECOMMEDATIONS OF T Date Approved Conservati Administ ator Date Rejected Comments 41D ll�� Q Date Approved (2. Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connectionsIr - driveway permit Fire Deq ment ,Received by Building Inspector Date L Town of W Main Street, 01845 DirectorNORTH ANDOVER BUILDING CONSERVATION ,99ACNUSa4 DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT DATE ;b PERMIT # (.. LOCATIONZ2 e `-e-e 7— OWNER'S NAME. BUILDER'S NAME�� MASON'S NAME ( /�� �1Q/� MASON'S ADDRESS �ti,% SA� / r MASON'S TELEPHONE MATERIAL OF CHIMNEY6 /`-% 1N'iERiOR CHIMNEY 6—&.A`A t-EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES L - THICKNESS OF HEARTH Will chimney or fireplace conform to recr'uirementA s of -he- code and have rules and regulations been received- DATE ..w •. ,.-.SIGI�#ATTJ2E O-Fs>wldl�°SO.N CONTR.:.uLSC -E5' .--Coi,,TSTRUCTION COST/CONTRACT PRICE _ -- PERMIT GRANTED ' d•(� r'1 FEEF ,?,S— l V•0.)R3 Y ROBERT NICETTA, BUILDING INSPECTORJ/ n INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES �v � 28 - s Growth Management Bylaw Exemption Statement Town of North Andover Building Department ' This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit(below) Address of Property for Permit(below) Map and Parcel /Jv1/4 Purpose ofApplication (check below) Pb.one Number of Applicant: Single Family _Two Family 7-a162 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law,provided that no additional residential unit is created. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning B la This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density,(buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an a jacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other perm4,s from al!other boards and comniissionc k,ave_been received and the project.is incompliance with those permits),.-and the De,4elonment Schedule. . _ does not accommodate issuing a building permit in that Year,one buiiding permit will be issuer:pel Year per Development until such time as:t„a Developn.;• nt S,hF! s:-accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply,whether done to my knowleda2 or not, is I ds for refusal by the Building Department to issue a Buildin Perm'2 Q _� �� . 7& Signatu a of Owner or A thorized Agent who signed the Attached Building Permit ate This form must be attached to the Building Permit upon application for such permit f n ` T 7r niC °StriCLeC TOt raP4!t RossesE z nrren ROBERT Ka,szchusetts State Buil _1D , coee , NESSIkA is cause for reVocatlor! of tC�s 7:" ANDOVER, HA e ElO • ORTFy o over zoo w o _ At,L. aov96 er� Mass., Z - 19 �A COC-CMEWIC K\` s. GRATED PP F SF BOARD OF HEALTH Food/Kitchen PERMIT T 0, Septic System e BUILDING INSPECTOR THIS CERTIFIES THAT......................M.0.-S A ?4...........Lg;�o...........lc.0.......... ......... .; .. ............. � �'ti'. Foundation pp has permission to erect..s.6.. .. ..0 ...... building on ....... ......... - ......`.. :•,•l• •�••••• Rough tobe occupied as................................................... /..1 (7.,�. ................ ..... .. ..�'?�..f........�/ j.....:.... Chimney provided that the person accepting this permit shall in every respect conform to the terms of tre application or; file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construe#ion of. Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARS,: 1;14:; •S. B.C. Rough PERMIT EXPIRES IN 6 MOI\ S PAID Final T I ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS �- . .... Rough Service WING IIa1$PECTOR Final Occupancy Permit Required to Occupy uildingh`'r GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Rercor e. Rough �, Finaf' , No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building inspector: FIRE DEPARTMENT p p Burner Street No. Smoke Det. a } CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 288 Date sammgn 13; 199h THIS CERTIFIES THAT THE BUILDING LOCATED ON 328 FOREST STREET MAY BE OCCUPIED AS SINGLE FAMILY W/2 CAR GARAGE UNDERIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Hon7M CERTIFICATE ISSUED TO Messina Dev.. Co. , Inc. 44 Great P n Dr ADDRESS Boxf o LisE Bui ing Inspector e NORTH F 0 00 L over VIA �rt . dower 1lilass., "� 19 COC MI C Ii E MCK V ADRATED PP� C BOARD OF HEALTH La AMIT T D PEI"Ow Food/Kitchen �"""4`� Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...................... .: x./.11 . ......... . � .......:_........ .................D...,..... ........ Foundation has permission to erect.. .6.. ..: .. �....... building on ..... .........-0.9�'�..-.�F3.:-7............. .7 ...... to be occupied as ..................................................�/I/ ..6.1_0................ ../....(... ........ .. .... ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of application on file in inat 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. PERMIT FOR FOUNDATION ONLY PLUMBING REGULATED BY PARS;. NSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 114.8-S. B.C.B.C. it Rou PERMIT EXPIRES IN 6 MOT�,i j S PAID �_. .na UNLESS CONS T RUCTION S TS ELECTRICAL INSPECTOR Rough' �.�l� Service ` LDING INSPECTOR Fina Cl;l"Id� Occupancy Permit Required to Occupy uilding GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough61/9 Final No Lathing or Dry Wall To Be Done FIRED ARTMENT Until Inspected and Approved by the Building Inspector. � i �..- Burner Street No. /,� Smoke Det. ( L rn.,��sa�.rlu5tI IS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN,G (Print or Type) NORTH ANDOVER , Maas. Date4-/-, 2D Building — Z tit" Location Z lip; 2 /"O r t Permit # 5 l l� � �. r Owner'sG�� / Name New Renovation O Replacement Cp Pians Submitted:. Yea O No [p • n n a s co; at F- a 0 0 tl N Z M h C C Z tl IC A d V r M A Q h z -' F _ as b h e: w ;0 0 p o M� w i 'S 00 d 7G S oJ e°1 a°e s p a° 1- o :ue—aoMT. • • •ASEMENT i 1ST FLOOR 2N0.FLOOR I SAD FLOOR 4TH FLOOR 6TH FLOOR STH FLOOR t 7TH FLOOR t STH FLOOR Check one: Certificate Instaliing Company Name ] Corp. Address 7 d t Partnership ❑ Flrm/Co. Business Telephone Z 2 3 Z/ y Name of Licensed Plumber or Gas Fitter_ ct,An e INSURANCE COVERAGE: Check�o 1 have a current liability Insurance pollcy or its substantial equivalent. ' Yes [[Y No 0 If you have checked Vis, please Indicate the type coverage by checking the appropriate box. A Ilatrpity insurance policy O Other type of indemnfty O Bond O 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 permft application waives this requirement. Check one: nature o Owner or Owner's Vgonl Owner ❑ Agent O I 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 an plumbing work and installations performed under the permR Issued for lhl appilcalion will be c compliance with all pertinent provisions of the Massachusetts State oas Code and Chapter 142 oT the K Issued Tof Ucense: F— m 'lumtumber This Pler na urs nae um r as or as Ucense Number Z 3 7 '�0M^ umeyman AF'rTOWD(OFFICE USE ONLY) .y ?� 2285 Date. . . NaR,M TOWN OF NORTH ANDOVER Of� 9 ti o� PERMIT FOR GAS INSTALLATION i s $A US 9 This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iF V has permission for gas installation .� .!.%'�. . . . . E in the buildingsof . . A. . . . . . . . . . . I JJ at . .2. . . . • . . . . . . . . . . . .. North Andover, Mass. Fee?a. Lic. No o2 �� -� . . . . . . . . . . . . . . . . . ... . . . . . . . $ r y GAS INSPECTOR WHITE:Applicant "'CANARY: Building Dept. PINK:Treasurer GOLD:File