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HomeMy WebLinkAboutMiscellaneous - 25 WOOD AVENUE 4/30/2018N 09948 Date.��`�.I�.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ! ..'.'. c1Y�n `fps `� A � nom. has permission to perform °-� , V G. e-2 , , , , , , plumbing in the buildings of . ��! .(�.� .►................ at ....r�, .. oc-,)j... &Q ............. North Andover, Mass. Fee ..�-�t�7. Lie. No. 2-!4. .."................. .. . PLUMBING INSPECTOR Check # I C1 C S �L MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY NORTH ANDOVER MA DATE j/`��� PERMIT # JOBSITE ADDRESS o25- Gr/OOD OWNER'S NAMFe///T//,-%4 OWNER ADDRESS 5;,l 1q � TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ,, _ EDUCATIONAL RESIDENTIAL )C PRINT CLEARLY NEW: ,,:_ RENOVATION:: REPLACEMENT: PLANS SUBMITTED: YES NO'S: FIXTURES Z FLOOR— 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URIIAL WASHING MACHINE CONNECTION WA R HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE. I have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES x NO , IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CKECKONE ONLY- OVMER `;; AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /� PLUMBER'S NAME THOMAS HALLORAN LICENSE # 24833 SIGNATURE MP _ , JP CORPORATION .._4 PARTNERSHIP:; _ ; # LLC COMPANY NAME HALLORAN PLUMBING ADDRESS 826 DALE ST. CITY NORTH ANDOVER STATE MA Zip 01845 TEL 978.685.9504 FAX CELL EMAIL ff- C f.. ,) MUA C S �L Tlie Commonwealth ofMassacliusetis Department of Industrial Accidents 1 ' Office of Investigations i 600 Washington Street y Boston AM 02111 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I,eeibly Na1ne (Business/Organization/Individual):_ AXzza rii,,v Address: tY_ _ P %i�/�a�/'�- Ci /State/Zi : /i/,� Phone Are you an employer? Check the appropriate box: 1. ❑ lam a employer with 4• ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2Y I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for the in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t employees and have workers' comp. insurance.T 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill outihe section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subfnit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the.sub-contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of peijcuy that the information provided above is true and correct. 1:�/.s/� Phone #: %1Y_ f� '' Official use only. Do not write in this area, to be completed by city or town offrcial. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #' t Date. . . S.ptit,xta��.• TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...'.. 'C.W....C�5 2 � has permission for g installation . c'L v ...'"` ..... ......... in the buildings of . UVB ............................... . at ........ � ......................... , North Andover, Mass. Fee 20.— Lic. No24 .. ................... ... GASINSPECTOR Check #� 3 �� Ilk" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY CITY NORTH ANDOVER MA DATE 5-/211-7 PERMIT # OIU�� lT•' JOBSITE ADDRESS a JAf®O© ,4!1,e- OWNER'S NAMEC'�irij'�<� 01-7-4 ADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL LX - NEW: 0 RENOVATION: [ REPLACEMENT: rLi?] PLANS SUBMITTED: YES LI NO E APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ENO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EW, OTHER TYPE INDEMNITY Q BOND < OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER (] AGENT L SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # 24833 SIGNATURE MP F� MGF E] JP I� JGF 0 LPGI CORPORATION [j# PARTNERSHIP 0# LLC [ZA COMPANY NAME:T.HALLORAN PLUMBING ADDRESS 826 DALE ST. CITY NORTH ANDOVER STATE MA ZIP01843 TEL 978-685-9504 FAX CELL J-4-7-9S2'y EMAIL pf� 4 !'n n i a s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 �4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _/7�LC�.PAi+/ �L//M (� / y Address: X026, JAttP <`r /State/Zip: ItIldf/�X /%j/,I- Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2Y I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t employees and have workers' comp. insurance? 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13_❑ Other *Any applicant that checks box ##1 must also 611 out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Phone #:%Y' Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #' Of 'A0 TIy t 9SSACMUSE, Date ..3/�G oq `i....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...WA G:(A.e !7 ..../. `/�............... has permission for gas installation .4!� .~t .............. in the buildings of ..7°Z' /`� �!yh.:........................ at ............. North Andover, Mass. Fee 42i ..... Lic. No. yy 13.. ASINSPECTOR' Check # ? 16, 6729 A MASSACHUSEWS UNIFORMAPPLICATON FOR PERAUr TO DO GAS HUNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations C9- J ,���� ���/ Permit# 7 L G�yvT�i:� O TT�9yi�9 ar Amount $ Owner's Name L)" New ❑ Renovation ❑ Replacement ® Plans Submitted ❑ Ub Namt or C one: Certificate Installing Company type) Name -77E -614 L 1014 .✓ e04 I/ U Corp. Address 1" d i3 d X S 7,Z ❑ Partner. e,4w4 eev « 14*q C S/Z Business Telephone 7-71 6 S(5-- 9 So Y ❑ FimVCo. Name of Licensed Plumber or Gas Fitter As J/4 //d /?,q INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked M please indicate the type coverage by checking the appropriate box Bond Liability insurance policy ® Other type of indemnity 1:1 ❑ 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 I 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code anti Chapter 142 ofthe General Laws. )wn ,OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber a Y � 3.3 ❑ Gas FittericL ense Number ❑ Master ® Journeyman FIM �����1♦���1�����5������� Namt or C one: Certificate Installing Company type) Name -77E -614 L 1014 .✓ e04 I/ U Corp. Address 1" d i3 d X S 7,Z ❑ Partner. e,4w4 eev « 14*q C S/Z Business Telephone 7-71 6 S(5-- 9 So Y ❑ FimVCo. Name of Licensed Plumber or Gas Fitter As J/4 //d /?,q INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked M please indicate the type coverage by checking the appropriate box Bond Liability insurance policy ® Other type of indemnity 1:1 ❑ 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 I 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code anti Chapter 142 ofthe General Laws. )wn ,OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber a Y � 3.3 ❑ Gas FittericL ense Number ❑ Master ® Journeyman 4. a., ..,. ..V:1. �.� .t. A Date. -3110.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ��SS�cMusE� This certifies that ae .� ` / /� has permission to perform ...... ................... plumbing in the buildings of ..0. .777til !9N ................... at. S.... 9.U..t. ........ North Andover, Mass. Fee Lic. No!?.�/G 3.-? . ..... PLUMBING INSPECTOR Check # n MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Q n Date Building Location ,t � aj40D 4tle Owners Name �N�,r i &17 1� V1/o 1A -J1 Permit #� 0 Amount Type of Occupancy ,(D&j 6-L L M16 New rj Renovation Replacement [@ Plans Submitted Yes E] No FIXTURES (Print type) �y Check❑one: Certificate Installing Company Name 64LG o RAN NyM 9iA1 Address ed, GyA I- 57- 0 Partner.' ItIal? T/ A14ael% Business Telephone 97& 6� Firm/CO. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy fa Other type of indemnity 11 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 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 previsions of the Massachusetts a PI b e and Chapter 142 of the General Laws. By: rgna or Lrcenseo Ylum er Type of Plumbing License Ti r2 3IX33 City/Town rcease um er Master Journeyman APPROVED (OFFICE USE ONLY [� Location ��/ r No. — J ,.y ("', Date 6 ,.pRTp TOWN OF NORTH ANDOVER f � � 9 • : Certificate Occupancy $ ; of s"KMus t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check # n '1 6339 Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMj�OLIISHH A ONE FAMILY DWELLING �ORjTWO BUILDING PERMIT NUMBER: i DATE ISSUED: 7 SIGNATURE: Buildin Commissioner/In ctor of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number Or O tJfit t—_L�!LL �/ 1.3 Zoning biformatiom 1.4 Property Dimensions: Zoning District Proposed Use Lot Area sf Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re aired Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. I Owner of Record (Punt) Address for Service ZS— 2— Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature "fele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Add ess �� ` S — ✓�C /a[ 44 E pirat" Sign re Telephone /0%jj44&,-,,e %fir —3,2_ 3.2 Registered Home ImproveiT ontractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Si nature Telephone SECTION 4 - WORKERS COMPENSATION 04G.L C 152 6 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. Sighed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolitions 0 Other ❑ Specify Brief Descnption of Proposed Work: (� C. Lot ( IU 1� �J lCp{ N corn. "G Gi 1N &4, u. S �WOdO` t ro.z�a�z , SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant q CIpI jIS ?i� l y 1. Building'q a (a) Building Permit Fee Multiplier 2 Electrical 7 (b) Estimated Total Cost of Construction / jJ 3 Plumbing Building Permit fee (a) X (b) 0 �-- 4 Mechanical (HVAC)d 5 Fire Protection 6 Total 1+2+3+4+5 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 authoriz'---/q2"'Z to act on My behalf, in all matters relative to work authorized by this b ding permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DrMENSIONS OF POSTS DIMENSIONS OF GIRDERS HI:-lGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE O H 2 01,44 Lij z � a o r a o a c T; r rj H ¢� d O w v v cn WO. O x q 80 O C aw, � O ooa z O G w A w 7 2 01,44 Lij z � gi 0 TITP4 A 0 U) LLJ Cn IrW W Ir W r c T; r rj •,� u a p, c R !O � O � N Z•+ Ea o 4"3 4D 00 0 ; c RE y CO E mm N M m h roi, 3 •'/ o' 3m N ��m1s y O 1C C O m cm a� m m N 4D m V N O C7 •� Z v O ` •..- 01 Q .;ae0 p:c o m i� O C O:mwc c O = m N W O m w C A 0,C i° cc ai nt 5 E v`�mcm m Z o v 0 c � c g H Z O_ O -0 m � w -0 om= O =�a-m� gi 0 TITP4 A 0 U) LLJ Cn IrW W Ir W TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING „_ _,. �. , . 777 BUILDING PERMIT NUMBER: / n 1 DATE ISSUED: SIGNATURE: /" 66� Building Commissioner/I for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: `,� S opal A u e n u,t 1.2 Assessors Map and Parcel Number: x-13 3 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rcquired Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record (� �h �4 a-= 'hn Lf2v:o u o?,S 4 Urn r >� ( rint) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 7 AddessQ �/I % / V t/ a 6 P s ✓rAr i 414 Sign re elephone �z AA Pp Not Applicable ❑ �(— U 9/ 7? �-,— License Number E iration Dat 3.2 Registered Home Impriowillpntractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone Mpp M z O 1�1 f rt - W 0 pZpr� 1�1 mn ic r r r Y♦ r SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition' ❑ Other ❑ Specify Brief Description of Proposed Work: J df S- L C. L.o C l N RA.0 0 JC A( �%� -PcecpV`S %c Gy:tN a aD u. S �W '5�>ot r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OMCIAL USE ONLY 1. Building(a) 670 Y_ Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction f 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this b ding permit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED 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 Owner/APent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 NO 3 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 m 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: of Faci ' PMRAXiicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector Proposal I � I Proposal Submitted To: - Job Name Address Job Location 2 S Jo o A ue N fivi do v �- Date Phone # Fax # We hereby submit specifications and estimates for:...._.. _..............�..._'_� o_t!�..___....C..__ Architect # of Job # Date of Plans ... ........... .._..._._.....__.._._.___.._._.__.._._._._.__...... ..... _...... _..._.......... .._____..____.__.__...._.._____.__...____..._.__.__...._ .__.........___.._...____.___.._.__.____.._____.__._..._._____ __ _ __ _ ...- .___ ____.__ _ ________ _ _ _ _ ...... ..... ____ . ____------------ ------ We__ We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: Iii " NC3819 MADE IN USA Dollars days. with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully / executed only upon written order, and will become an extra charge over and f ,i submitted ' above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this proposal may be withdrawn by us if not ac ed pted within 2captanct of Joropool The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature Iii " NC3819 MADE IN USA Dollars days. 0 F04 .a Q CA aG o w cn a v> � O z z pa o w° C w a Fo` C w a w � chi w p z Mro a�' w w W W v m' O z cn v o W ON LJJ z W co .E co C CD ci _m CL y 0 .CL y C O .0 !C y ,moil 41 do r A: Fo` o 00 g •0 o. 00ICU om H L : CD °� c 1 • L N .00 O d:mc E O L N/�N N CD 3c •'/ 3� N x C N N O C C- 22 m mo cm W:ymm � O N d cm m �:•CDJRr- ss� v z `� o rn �ZCD _� a O N m C C = m y m ~ m W o o of aLoc Z U-0 mN O V m v m C Q* a m� a.-m:a. W co .E co C CD ci _m CL y 0 .CL y C O .0 !C y ,moil _As sv Na4 o T I LC572- 2- l o � 53 i L07-32 L OT3 3) 4L 3 0 LOT 29 w 13,556 46.QP Cpt,44j) � q i T4, Fat -- 2- _7,f 4� r--� Fat v£ z STo C . 1 IV ` �uu Ir IN,v E -NJ U F, LOATION OF STRUCTURE((S�� BAED ON UNES OF OCCUPdTiON ONLY, AMORE ACCURATE LOCATON WN.LarIRE AN INSTRUAIEkT kf Scale: 3 0t _ai urine x 1!31 JNhI-,aAll ' PROFESSIONAL LAND SURVEYOR, )O. HEREBY CERTIFY THAT THE AMERICAN SURVEYING COMPANY 'BONE MORTGAGE INSPECTION 'LAN R 1264 Main Street, Waltham, MA 02451 ,(781) 893-6477 WAS PpREEPARED FO oVA1Tl2`{WtJ] I}v^ S. IN )ONNECTION WITH ANEW MORTGAGE 'ND IS NOT INTENDED OR REPRE, FMortg-4 SENTED TO BE A LAND OR PROPERTY .INE SURVEY. NO CORNERS WERE THE LOCATION OF THE ORIGINAL SET. IT CANNOT BE USED FOR ES- DWELLING SHOWN HEREON EITHER ABLISHING FENCE, HEDGE OR WAS IN COMPLIANCE WITH THE LOCAL WILDLING LINES. THE LANDAS SHOWN APPLICABLE ZONING BYLAWS IN EF- iEREON IS BASED ON CLIENT.FUR- FECT WHEN CONSTRUCTED WITH RE- JISHED INFORMATION AND MAY BE SPECT TO HORIZONTAL DIMENSIONAL IUBJECT TO FURTHER OUT -SALES, REQUIREMENTS ONLY), OR IS EXEMPT 'AKINGS,EASEMENTS AND RIGHTS OF FROM VIOLATION ENFORCEMENT AC. VAY. NA RESPONSIBILITY IS EX- TION UNDERMASS.G.L.TITLEVII,CHAP. 'ENDED HEREINTO THE LAND OWNER 40A, SEC. 7, UNLESS OTHERWISE )R OCCUPANT, IT IS NOT INTENDED NOTED OR SHOWN HEREON. A CON. '0 BE RECORDED. FIRMATORY INSTRUMENT SURVEY )ATE d IS ADVISED WHEN STRUCTURES ARE ;LIENT G)ZC15� L-1 S SHOWN TO. BE 1' OR LESS FROM ;LIENT REF G O PROPERTY OR REQUIRED ZONING O.# O o 90 i SETBACK LINES. inspection Plan )RDED AT COUNTY REGISTRY OF DEEDS K _ 12 -JA o PAG 7 ha LL. Cert. # I REFERENCE: -� ^U"• 90 NN PER TOWN OF ASSESSOR'S # - c- �..: DATED SUBJECT DWELLING LIES IN FLOOD ZONE —X AS SHOWN ON NATIONAL FLOOD INSURANCEPRO RAM FLOOD INSURANCE RATE MAP DATED— J V Ai COMMUNITY PANEL # FIELDED .DRAFTED CHECKED BY L . DATE S l4-0.Jb-q dr /G GQ/ F.B. PGE. iav� ��—® Date .....ZNDOVER ,�ORTIy o? �` TOWN OF NORT PERMIT FOR GAS INSTALLATION h t �9SSACMUSESIC This certifies that ..,.' F...�.. ... '�. .-//................ . has permission for gas installation . ; .......... in the buildings of ..:�...-r":. .-. ............. . at . . 4V ..... ........ , North Andover,Mass. Fee:- ..... Lic. 1111 i GAS INSPECTOR Check # /03.; V 6444 MASSACHUSETTS UNIFORM APPUCATON FOR PERMrr TO DO GAS FITTING (Type or print) Date ZFunrc- NORTH AN DOVER,. MASSACHUSETTS Building Loq,ations ���r P ' 't # �� Off O ?' _ . J . Owner's Name New Renovation Replacement erm� Amount $ -a, Plans Sub itted (Print or type) Name��_ c Address ness Check one: Certificate Installing Company 0 Corp. Partner. Firm/Co. Name of Licensed Plumber'or Gas Fitter �res�p�j I INSURANCE COVERAGE Check one: Y have a current liability insurance, policy or it's substantial equivalent. Yes a— No0 I If you have checked yes, please the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity .13 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 13 1 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 Massach St7te GCo _and-Qffpler–�the General Laws. By: Title PROVED (OFFICE USE ONLY) Master Journeyman w x a vi 14 o$ z F U w x z o > W ° z Q x w v, a w a m F A F x 1- w z > �, a F W m z O w z W p F a w dz a x O x .-zr G Cd7 z > D SUB -BASEMENT UO e0. F O BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOG R. STH. FLOOR (Print or type) Name��_ c Address ness Check one: Certificate Installing Company 0 Corp. Partner. Firm/Co. Name of Licensed Plumber'or Gas Fitter �res�p�j I INSURANCE COVERAGE Check one: Y have a current liability insurance, policy or it's substantial equivalent. Yes a— No0 I If you have checked yes, please the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity .13 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 13 1 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 Massach St7te GCo _and-Qffpler–�the General Laws. By: Title PROVED (OFFICE USE ONLY) Master Journeyman Date ... :fG n 3 ...... ..... NOR7M TOWN OF NORTH ANDOVER 20 0 PERMIT FOR WIRING ;ass^cHusE� This certifies that ......................... �:................................................... 4as permission to perform .......... wiring in the building of................r�!................................. at ..�7.. ...... . , North Andover, Mass. .............................................................. Fee...A..�. "..... Lic. No /G' ZK... ;..... ......... : ........................................... / ELECTRICAL INSPECTOR Check # ��a 44600 THECOA MONWEALTHOFMASSACHUSETTS Office Use only DEPARTAIEWOFPUBLICS41NY Permit No. 1_ BOARD OFFMPREMMONREGMHONS527CMRI2M (a Occupancy & Fees Checked APPLICAHONFOR PERMIT TO PERFORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Yes E29. No r --J (Check Appropriate Box) Overhead Underground Overhead Underground Utility Authorization No. No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers V Total KVA No. of Lighting Fixtures /i Swimming Pool AboveBelow Generators KVA / O( round and No. of Receptacle Outlets Q o No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No_ of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hlydro Massage Tubs No. of Motors Total HP OTHER- C�f. I / 4- ILC Eaki h�an-anreCo�ra� �theregtmal�c>f'Massada�ettsGa�aaliaws IhaNcaamattlmta7dyL)staatceRiCyinr)e>drgCmpl&CowWorisssubstatrialetlt� YES NO Ihavestt niWdNrAdptoo(ofsametotheOffioe YES 13cuMredreWYES,pk%eirtdcaiethe o(mverageby ax- IN'[JRAN�CE t BOND U IER M. ftwSpecify) 3 Esli rrxadValleofEecftcalWolk $ w1akiDstatt ktpectialDaeReWe" Rough Final IN SignedundffTr mk sofperjury. FIl2MxNAM6 w 41 d Loa�eNo l 0 y 9'4/ Lie �� t^.t IM L;oa�eNo rr E- [ �y p!, d Btls nessTel No. - r„9 _ 1,aj Arlrl,r�c !� .� CL i �► U 1 e w R I ' e f C ( V D Alt TeL No. • a - q0 of NA'SINSLRANCEWAIVFR;IamawdmdrttirLmwdoesnothavedrmaw&=oD rraworitsabstanialecfnvabtastac medbyMassachm2MGalerallaws and thatmysigaa mon thispemiapplicahmwaimfsihisWgiowlt. (Please check one) Owner Agent t Telephone No. PERMIT FEE $ Signature of Uwner or gen The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print 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. Company name: City: Phone #: Insurance. Co. Policy # Company name: Address City: Phone #. Failtwe to secure coverage as required .undw Section 25A or MGL 152 can lead to Viewnposition d aanirral penalties of.afine up to $1,5 and/or one years' imprisonment-as-wdLas_ciA.penaRmsinsheiau-dA-STOPYIK)W-ORDERand_afine�f�SltiD�O)�iiay�gainst_o understand that a copy of this statement may be forwarded to the Office of Investigations of the D!A for coverage verification. / do hereby cerW under Me pains and penalties of perjury that the w4bnWbon provided above ,is bye and correct Signature gate Print name Official use only do not write in this area to be completed by city or town officiar City or Town Penra/l icensirg � Building Dept Check i►immediate response is required Licensing Board p Selectman's Office Contact person: Phone k Health Department Ej Other