HomeMy WebLinkAboutMiscellaneous - 25 CONCORD STREET 4/30/2018li N
i..
Date. �.A/...J
TOWN OF NORTH ANDOVER
°oma
p PERMIT FOR PLUMBING
This certifies that '..........................
has permission to perform .... AL. ' : ..'
...............
plumbing in the buildings of . .f ................... .
at .. ..'.... ........... , North Andover, Mass.
Fee. b L..... Lic. No—1.1 .1 ....... .................
PLUMBING INSPECTOR
Check # r
i� JJ.I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print) G'
NORTH ANDOVER, MASSACHUSETTS
Date /0-/7 -a 5'
Building Location S, % G/`/C a�� S34vners Name Wi LG /.4 /%
Amount
Type of Occupancy
New Renovation ®/ Replacement Plans Submitted Yes ❑ No
FIXTURES
(Print or type)
Installing Company Name
Address N `
Check one: Certificate
❑ Corp.
Partner.
Frnt/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 13-- Other type of indemnity El 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 11 Agent 0
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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code a ha ter 142 of the General Laws.
;
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing license
License Master Journeyman (�
R
Location ,�O- ri %
No. r_%` // Date I' '
MORT1y TOWN OF NORTH ANDOVER
FMMw
s
Certificate of Occupancy $
,;Us t�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #
Building Inspectbr
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
e+et�ios for oft -W Use tilai[
BUILDING PERMIT NUMBER:l�
DATE ISSUED: ���
04 a
2
�/
SIGNATURE:
Building_Commissioner/I or of BuildingsDate
SECTION 1- SITF. INFn1 mA rrniv
1.1 Property Address: v v _ _ `vl `
1.2 Assessors Map and Parcel Number:
O , �/1 I n I) o f J r ,(�
v F I `
Map Number
Parcel Nu b�
1.3 Zoning tf`lormak/tion:
1.4 Property Dimensions:
Zonin District Pr posed Use
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide R 'red
Provided
R red Provided
1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Informatiion:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ ZODe Outside Flood Zone ❑
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
W!LLI #M E0R-1 Cht7- 1l
P Coke S
C Ar
Name (Print) Address for Service:
D0 Vex
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Signature Telephone
Expiration Date
3.2 Registered Home Improvement Contractor.
Not Applicable ❑
Company Name
To�1 �S u�'�i�T , Stuff .2 �L
Registration Number
Expiration Date
i nature Tele hone
T
M
Z
O
11
SECTION 4 - WORKERS COMPENSATION (M.G.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 ....... ❑
SECTION 5 Description of Proposed Work checkall applicable)
New Construction ❑ 1 Existing Building e I Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ I Demolition ❑ ' Other ❑ Specify
Brief Description of Proposed Work:
s t RERooF
I SECTION 6 - ESTIMATRD CnNCTRTTrTInN CncTc 1
Item
Estimated Cost (Dollar) to be
CqWpleted by permit applicant
OFFICIAL USE ONLY
1. Building
Tq q h -'
O V
(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical (HVAC)
5 Fire Protection
1<
6 Total (1+2+3+4+5
Check Number
3Eq; i lUiv is U W tvr,x AU 1HUKJ_LA 11Uf4 1 U lip: C OMYLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
11 M I T CA S Tk t C DA2 E 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
C
of Owner/Agent Date
5r
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
(MIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHAVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
r
a
w
�o¢
o
v
y
�
Q
m
16- o
U
w
a
Or flt
iw
a
W
c+
w
a
ro
w
w
w
rA
z
cn
o
cn
O
H
f E
a
x
H
cc
W
G3
C4FE
�o
m�
�o
o
: O y
C
V V
C C
MM
�t O
O i
m
Ea
� C
ID
0 0.
Cos
CD "r
14 $
cmm
N �
mm
o Z' 3
:
a�
m
C
W
LL
� m
W 'p
y A
V!
ID
CL13 .Z
LOS O O
� O Q
a�
0 Of
ca
�Z
91
U
0
O
4-j
co
O
c■
L
O
03
Z p.
O H
D c
Ia) QM
w ca O -0
W -
CO) O O
m m
CD CD
� Z
CL �■+
= O.a
CD
O Cl i
CL
� O d
Cc
�Q
c
c
CO) ZCL
�
v y
O c
—
c -
'- c
cc
C.
H
LLI
U)
W
W
C9
W
U)
C L O
m
CL
co O C
m
16- o
s
Go
O
Or flt
�y
O
"_ O
C
r
Ecm0
m
CL
A
L. y •Om
�a=
91
U
0
O
4-j
co
O
c■
L
O
03
Z p.
O H
D c
Ia) QM
w ca O -0
W -
CO) O O
m m
CD CD
� Z
CL �■+
= O.a
CD
O Cl i
CL
� O d
Cc
�Q
c
c
CO) ZCL
�
v y
O c
—
c -
'- c
cc
C.
H
LLI
U)
W
W
C9
W
U)
e
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
at: 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.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
/-1,4-5 =[�C / CWCzkD ST
Fire Department Sign off.
Dumpster Permit
(Location of F'j_j
aci
Signature of Permit Applicant
Az Lo
J ---
Date
,per T� -����� �✓t���r�
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104569
EXPIMIOM 7/1412006
Type: Private Corporation
DAVID CASTRICONF ROOFING, SIDING &
David Castricone
7 Hillside Road
Boxford, MA 01921 Administrator
tl