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Home My WebLink AboutMiscellaneous - 259 DALE STREET 4/30/2018Date.. . ...... L"'-� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING J � f This certifies that .......-^ -^ .— has permission to perform ..................... plumbing in the buildings of ...... .-' -' at��..-�'�` . ............. North Andover, Mass. Fee Lic. . ......... PLUMBING INSPECTOR Check # v 3 d 7764 FIXTIIRFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING U9City/Town: detk , MA. Date: k4d Permit# ' IMG 0-OwnersBuilding Location: Name: tJ ��+eA�d/e Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential - - New: 0 Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No FIXTIIRFS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes a -No ❑ t If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. iA 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. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 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 Knowleage and that all plumbing work and installations performed under the permit issued for this application will be in compliance withal I Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title0404ter mber Si ature of Licensed Plumber 1 a% Sl J ,%/ City/Town ourneyman License Number: APPROVED OFFICE USE ONLY Z Z W z Y O U U) a w z I W of F- U) U) zQ WQ j Y 2 z o X Q_ co o-i� a CL a< Q 0 w W O o f w fn z W z_ a U a u' cWn Q Y= 0 0 1- x z Q LL a Y Q x w w W Q, Q Q N -Q O F" aQ0=_5QaaaU) F - Q m m o a LL C9 x Y J J W 0 0 1- O SUB BSMT. BASEMENT 1 FLOOR --i 'FLOOR 3 Ku FLOOR 4 FLOOR 5 FLOOR 6 FLOOR -7 'FLOOR 8 FLOOR / Check One Only Certificate # Installing Company Name: �/i ciLf/iEE'S ff Address: l� S City/Town: ✓�� ,� State: ❑Corporation Business Tel: �p�/ l 6,41 % Fax: F] Partnership ❑Firm/Company Name of Licensed Plumber: �� ;i�w wkl INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes a -No ❑ t If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. iA 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. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 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 Knowleage and that all plumbing work and installations performed under the permit issued for this application will be in compliance withal I Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title0404ter mber Si ature of Licensed Plumber 1 a% Sl J ,%/ City/Town ourneyman License Number: APPROVED OFFICE USE ONLY Location AS'? 6 M -E SsZCS')tsl No. �z 70 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �4'y Building rispector Div. Public Works PERMIT NO. 1. v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KVO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK !PAGE ZONE SUB DIV. LOT NO. �- LOCATION qs'� p i� _S- PURPOSE, Pbtl7CQ17�G o' / b OWNER'S NAME rA NO. OF STORIES q SIZE OWNER'S ADDRESS c� �..1� �j BASEMENT OR SLABd• ARCHITECT'S NAME /'r' �Q / ^ _ 1 ,I ' SIZE OF FLOOR TIMBERS 1ST', 2ND 3RD BUILDER'S NAME g./i F /1 Q �^-Y� c� 0 PAN DISTANCE TO NEAREST BUILDING I'C RJ DIMENSIONS OF SILLS )1� (�(J -- -- DISTANCE FROM STREET f� G-"'�' '" POSTS DISTANCE FROM LOT LINES - SIDES r.f. Y�-f- REAR p� " GIRDERS C1 f AREA OF LOT 0 a FRONTAGEJ� 5� HEIGHT OF FOUNDATION THICKNESS (` y IS BUILDING NEW ,/�JO SIZE OF FOOTING % [I IS BUILDING ADDITION 'v ,0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION 'v V f� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO 4EQUIREMENTS OF CODE ,/ r—r IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY `1 J IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS GrAA�NfIQ 8viQ/ IIDEF2S OV6--739 SEE BOTH SIDES 113 ED.e r7, /Cs�� PAGE I 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 �LANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR [ITE FILED �"' J/SIGNATOR SOF AUTHO 1 D A F E t YD D PERMIT GRANTED 4Nt eA* 19 11 /_ t S . fib Clo�' D, o da� BLDG. PERMIY FEE LESS FDA FEE -- DUE FRA. PERMIT I -) IL, V-- '*Fv0:9— 's 3 PROPERTY INFORMATION LAND COST EST. BLDG. COSTdL fel DO EST. BLDG. COST PER SQ. FT. V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR INSTRUCTIONS GrAA�NfIQ 8viQ/ IIDEF2S OV6--739 SEE BOTH SIDES 113 ED.e r7, /Cs�� PAGE I 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 �LANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR [ITE FILED �"' J/SIGNATOR SOF AUTHO 1 D A F E t YD D PERMIT GRANTED 4Nt eA* 19 11 /_ t S . fib Clo�' D, o da� BLDG. PERMIY FEE LESS FDA FEE -- DUE FRA. PERMIT I -) IL, V-- '*Fv0:9— 's 3 PROPERTY INFORMATION LAND COST EST. BLDG. COSTdL fel DO EST. BLDG. COST PER SQ. FT. V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR h NV1d 101d S30V1d321 SIH.1 'a3S0dWlH3df1S '013 'S3VVLI -VE) 'S3H0LIOd H11M 'S9NI(311f19 d0:-S,NO1S�4,Klq 10VX3,aNV S3N11 101 WOUA 30NV1Sla aNV 101dOSNOISN3Wla 1:)VX3 MOHSiSf1W N01103S°SIHl z AONVdf1000 L GIODaa ONiaiina.,,_ r..�... I ' . 0NIIV3H ON _I Pic I 1 P"L � 1,W.9 D1N1D313 110 SVO S431V3H llNn SWOOM do 'ON - L V.1.H LNVIOVN ONINOUICINOJ NIV NOdVA NO N.I.M IOH _ A SN313VN QOOM 'S10D V 'SW9 13315 WV31S NNn3 NIV IOH 43DN03 3JVNNn3 SS313dId _ S10J'9 'SWE 839W11 1SIOf BOOM ONIIV3H Il I 9NIWV2ld 9 OGV0 3111 NO013 3111 S3Nn1X13 MKOW ON1300N 11021 N3MOHS 11VIS 13AVdO V NVl ONIEWnId ON 31V1S _ ANIS N3HDIDI S30NIHS 400M ANO1VAV1 S310NIHS 11VHdSV 13SO1� 831VM a3HS 1V13 132i9WVJ ('X13 L1 WN 131101 ONVSNVW 'X13 Cl HIVE dIH 319Vo 'JNIEW11ld 01 good S �NOIN3dns I 3 ('r! MOOd WHIM 3WVN3 NO 3NO1S ANNOSVW NO 3NOIS 'A1E NKNIJ 80 'DNOD _I NOOI3 8 'SdIS DIIIV 3WVNd NO ANNE ANNOSYW NO ADINE —� E I SHO011 9 3WVN3 NO onnoppiS ANNOSVW NO O��n1s 3111 'HdSV ONIOIS '1N3A ONIOIS SOIS38SV NONJWO� 0ti\QNVH ONIGIS IIVHdSV H1NV3 S310NIHS 0007A 31367607 6 I SO VO9dVID SIIVM IF N3HD11A NN300W WOON aV3H S3JVld 3613 LW 9 ON VRV :)I11V 'N13 % % A V3NV .1.W.9 N13 llnd V3NV t' 1N3W3SVE £ E L t _ E N13Nn — nvM Ad(] N31SVld SN31d O. MaNVH 3NO1S NO AJIN9 3NId 'A.19 313MOD 319dDNOD HSINId :IOIIJUNI 8 NOIIVON(10d Z N0110f1NISN00 S1N3W1NVdV S3DHd O — AIIWVI ulnW 53160!5 7F AlIWV3 310NIS DEPARTMENT OF-PUBU SAFETY sa COMMONWEALTH ' 1010 COMMONWEALTH AVE OF BOSTON, MASS. 02215. s MASSACHUSETTS . L I CENSE - _, C INSTR . iNERV I S 1 iFi � ' EXPIRATION DATE (-)' /' / F� 6 EFFECTIVE DATE LIC -NO. k '�' RESTRICTIONS 09 /-)1 / 1 'c1 7 045739' C ; LOT f Job No. 88 6 0 2 5 Z O C� 0 V) n —I 0 z CA 3 o m o CD m r�+ o c r v m 'n :3o °—' m n N m �M 7o -n °—' (A A <. m M o U3 m m ei Z a n vpup 7D o � c _n ZZ SO n T o _=r m. o VM O M v 0 T _ �• eb v � 00 O O O 'C a-• r— a=a• o r eD O Poo o POO eD eD 00 3 00—• H O chi, eD CL C� 0 V) n —I 0 z CA 3 o m o CD m r�+ o c r v m 'n :3o °—' m n N m �M 7o -n °—' (A A <. m M o U3 m m ei Z a n -n -3 °' 7D o � c _n ZZ SO n T o _=r m. o C c ri O M v 0 T _ I 14 6 F-I.I.-IM.-I Nan rti OF .. � OFFICES OF: 0, �� Town of APPEALS NORTH ANDOVER BUILDING CONSERVA'T'ION '6e"°N" HEAL,1'H PLANNING PLANNING & COMMUNITY UI:VI:LOPAI13N7' KAREN I I.P. NFLSON, I )IHI:C'I ( )It f �'I I t�lrtitt ..;nt •�•�� f': nlll .\II(If f't• t 11;ty� It 11([';( Ilscl)!t�l: 14;17)li8l-,dii.`i In accordance with the provisions of MGL c 41J, S 54, a condition of Building; Permit Number 7 0 is that the debris resulting Irorn this ctrl; shall he disposed of in a properly 15UA. licensed solid waste disposal lacilily as defined by MGL c I11, S ' The debris will be disposed of in: (Location o[ Facility) Ck_ _ tutc of Permit A NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Location ,S DA /E S No. Date 10 -7 D� NORTH TOWN OF NORTH ANDOVER F R Certificate of Occupancy $ J�CMUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ Check # i 7 G 9 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING I SECTION 1- SITE INFORMATION I 1.1 Property Ad 'Os(� !7��.J! 1.2 Assessors Map and Parcel Map Number Number: ��`` 00-76 Parcel Number -0 i ( s 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 Required Provided 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/AUTHORIZEDAGENT I historic Uistrict: YesNo 2.1 Owner of Record -S -7, (V--- Name (P t) Address for Service: 2.2 Owner of Record: Name Print Signature T SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Address for Service: Licensed Construction Supervisor:Duval Rig P.O. Box 637 Add re 01864 72 7E a �IdS Signature Telephone 3.2 Registered Home Improvement Company Name Duval Roofing PA.Box 6.37 Address ��-, North O leading, MA 10�7 7 c V �� Not Applicable ❑ y —STW License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date 89 �q M X ic z O v n m 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 buildiWidnrmit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check alta ticabte New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Desc ' 'on of Pr j ed Work: 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant O'MCIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b)� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 aQU I Check Number 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 ��) �) �}L - (��C l �� l=�\�� T) L J/ -� to act on . / My behal�, i 1 ma rs relati ork4ulhonized hu-tl— building permit application&I Si afore of Oyher Date SECTION 7b OWNER/AUTHORIZED AGM DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and infonAkY bNAMgoing application are true and accurate, to the best of my knowledge and belief P.O. Box 637 North Reading, MA 01864 Print N Si atur of Owner/Agent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DUVIENSIONS, OF SILLS DIN ENSIONS OF POSTS DIN ENSIONS 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 I• 1 1 1 ,'" � Page No. e ; P.O. Box 637 No. Reading, MA 01864 (781) 944-1984 � (978) 6S4-2557 of Pages PROPOSAL SUBMITTED TO r PHONE DATE � / STREET ; c JOB NAME ` 1-�$&6- � o CITY, STATE and ZIP CODE JOB LOCATION 11,16 ! i tom) C? f ARCHITECT DATE OF PLANS JOB PHONE UP PropoSP hereby to furnish material and labor — complete in accordance with specifications below, for the sum of: Payment to be made as follows: t dollars ($ _ ). r t 31V4 Deposit RNuired More Ordt-ing PItterv. ft. ElMn ", Duo Upon Day Of Cempletion All material is guaranteed to be as specified. All work to be completed in a workmanlike' -f manner according to standard practices. Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, acci- dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by Us if not accepted within days. We hereby submit specifications andestimatesfor: rou r r J L Acceptance of proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature t J a 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. F-1 I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. 91 ComDanv 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 vre➢_as_civil..penaltles in 2hefmn dA STOP WORWORDER..and..a fine of.($100-00.)-aAay agalW_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under Hie pains and penalties of perjury that the information provided above is true and correct. Print Official use only do not write in this area to be completed by city or town official' r # �> City or Town Permit/Licensin ❑Check if immediate response is required ® Building Dept C] Licensing Board p Selectman's Office Contact person: Phone #.• Health Department Other m m m m m m CO) 10 CD az CDCL O d da. acc -v .o 0 o p a� c� �d CD o c CORD —v CD co O CD H 10 CD 0 _v y, d d O CA 0 CO) C2 CD O CD CA . CD CO2 CD CD 0 CCD �• Er �� O m = COQ y -C y S ma•C, ; C Q O fl7 Z y S.- �•Cp y ow a � = y �a•+a o �0mm o � 2 S' IE Or a O j(�•'.��t o n co C = y"a Ito.� O ate.-.:� V) m O IF: � c C/) CS' l Ol CO) if n sat O dOr—Q ►a ,� m H O co0 0 !^ y o4 tod Cl rZ �� Km: CO tTJ: C O �q CA Cn W G} '1] G ►�.. G CO �p �. O Ti -CL ro ro ? O O ro oO x omi