HomeMy WebLinkAboutMiscellaneous - 25 LEXINGTON STREET 4/30/2018l
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) '•' 1.
North Andover Mass. Date 12/2 19 97 Permit # J3� 3�
Building Location 34 Lexington St Owner's Name Bonanno
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement N Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg . &P1g. Co. Inc: Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 617-438-7776 n Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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:
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 installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Piu i Code nd Chapter 42 of the General Laws.
By
ignature o Licensed Plumber
Title
Type of License: Master [X Journeyman ❑
City/Town 8 3 2 2
APPROVED OFFICE USE ONL License Number
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Installing Company Name Heritage Htg . &P1g. Co. Inc: Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 617-438-7776 n Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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:
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 installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Piu i Code nd Chapter 42 of the General Laws.
By
ignature o Licensed Plumber
Title
Type of License: Master [X Journeyman ❑
City/Town 8 3 2 2
APPROVED OFFICE USE ONL License Number
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3555
Date.
TOWN OF NORTH ANDOVER
y PERMIT FOR PLUMBING
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This certifies that . AA .. N. �.............. .
has permission to perform .... .u-- ./? ....................... o
plumbing in the buildings of ... 13-ok .............. OR~
at 3Y ...kc.x. /s-5./4 �i... . r-IVorth Andover, Mass.0
Fee Lic. No. X31. L............. PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Locations
No. Date
�14
OR7h TOWN OF NORTH ANDOVER
i • O0.
Certificate of Occupancy $
S'•••�' Eta Building/Frame Permit Fee $
SACMUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
r
lz /
f f - Building Inspe of
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: CPR 7 pry 5- DATE ISSUED:
G
SIGNATURE: Ax
Building Commissioner/Ingwaor of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
L, - 96' , Gw
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Areas 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:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone 0
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
ame (Pnnt Address for Service
ignature Telephone
2.2 Owner of Record:
Name Print Address for Service:
1
rr
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
tea/ v1E /
�-
Licensed Construction Supervisor:
evo
� �
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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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 checker a licabie
New Construction ❑ 1 Existing Building e I Repair(s) ❑ 1 Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify
Brief Description of Proposed Work:
Le �- '0 ( L-'� )e1
1411° W ry ,c J �� C--Aa.[H C �� �_ Mr2
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost (Dollar) to be
Completed by permit applicant
UFI+`) CIAL USE ONLY
1. Building
(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
� 10 .000W5
0,
4 Mechanical (HVAC)
Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZAIRON TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, r A14M `JA- as Owner/Authorized Agent of subject property
Hereby authorize ��V%�( (, to act on
My bell imI m rs relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject I
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 Owner/A en t Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TIMBERS 1ST 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHDvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
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In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at:
Facility location
ff. L��
Signature of Applicant
4112-6/ 2 -
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 000505
Birthdate: 09/27/1935
Expires: 09/27/2001 Tr. no: 4337
Restricted To: 00
EDWARD E VIEL
55 PORTLAND ST
LAWRENCE, MA 01843
Administrator
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Location_ Iu6 Y-6 -PJ
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ =��Q
Building/Frame Permit Fee $
Foundation Permit Fee $�
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $ 1'
TOTAL
0
Building Inspector o
Div. Public Works
PERMIT NO. 1
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP
LOT NO. �'Lli_� _ �
2 RECORD OF OWNERSHIP jDATE
BOOK 'PAGE
ZONE C
SUB DIV. LOT NO.
LOCATION "i < - A l .. % /' K. s. 1
-kA
PURPOSE OF BUILDING
�Z
OWNER'S NAME NA 1/1 ��y'/7"!L(�LUCiZHU'Y�N � k(AIR
NO. OF STORIES SIZE
OWNER'S ADDRESS ,�LZ
hL•• J12
BASEMENT OR SLAB
ARCHITECT'S NAME
_
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME ;� ��_�(�'
SPAN
DISTANCE TO NEAREST BUILDING
--
DIMENSIONS OF SILLS
'" POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES — SIDES%'7 :A ��1� REAR
JJ�'i(/��� 1`,
"" '" GIRDERS
AREA OF LOT + /0 — r/ � FRONTAGE
li (fl �O
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION C r^
k✓ (,J
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
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 FILEDAND APPROVED BY BUILDING INSPECTOR
DATE FILED
SIGNATURE OF OWNER AUTHORIZED AGENT
4 F E E
PERMIT GRANTED ^
19 �G1y
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
OWNER TEL. #
CONTR. TEL. N
CONTR. LIC. #
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I
I STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
__
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
B 1 2 13
PINE
CONCRETE
CONCRETE 8L K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
'/ 1/2 '/,
FIN. B'M'TAREA
FIN. ATTIC AREA
_
_
N_O 8 M T
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS
B
1
22 f 3
_
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
_
HARDIWD
COMI,AON
ASPH. TILE
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
_
BRICK ON MASONRY
ATTIC STRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR _
ADEQUATE NONE
ADEQUATE
10 PLUMBING
5 ROOF
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 6 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. b 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
GAS
OIL
ELECTRIC
NO HEATING
B'M'T 2nd _
i.r 13rd
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
Lot "(1 3 2
160'
160 Lot 131
N
of 161 Lot 1 3 0
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Lot 128
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