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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
9,PL H.ae,� P-41
This certifies that ........ �/
/ ..................................................
has permission for gasinstallation
in the buildings of 'Z) 0
at... .........
Fee... Lic. No. ....................................................
GASINSPECTOR
Check #
9379
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY I MA DATE E5130/2014 PERMIT #
JOBSITE ADDRESS 273 Green St OWNER'S NAME A -,f C' -s +-Aj 0.
GOWNER ADDRESS ---. i TELI I FAX F— _j
TYPE OR OCCUPANCY TYPE COMMERCIAL EDU I CATIONAL RESIDENTIALE]
PRINT
CLEARLY NEW:E] RENOVATION: REPLACEMENT: El PLANS SUBMITTED: YES[] NOE]
I
APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 7 8 9 10 11 12 13 14
14
BOILER W34� N13
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER =F=
DRYER __j L—i L --j L—i L—i L�j L—j
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNIVENTED ROOM HEATER
WATER HEATER
OTHER[
Rdp Lace f—das Meter x
INSURANCE COVERAGE
I have a current liabiliminsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITYE] BOND E]
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 AGENT
I hereby certify that all of the details and inforrnation 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 Lwill be in gcop nce with all Pertinent provision ofthe
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
1*6?,
PLUMBER-GASFITTER NAME 1,�oseph Marino LICENSE# 8736 / I &MATURE
MP El MGF [I JP [:1 JGF [j LPGI [j CORPORATION []# PARTNERSHIPEI# LLC [I#
COMPANY NAME: truction Co ADDRESS 141 Central St
CITY ZIPI 01501 ��TELF
I STATE E087)-�32-3295
FAX 1508-926-4347 j CELLI 508-832- EMAIL @RHWhite.com
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CERTIFICATE OF LIABILITY INSUMNICEPage I of 1 08129/2013
THI�_C_ ERTI'FICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POHOY(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terMS and conditions of the policy, certain policies y require an endorsement A Statement on th is cartifleate does not conferrig hts to the
certificate holder In lieu of such andorsement(s). ma
willia 09 massaclaunotts, Inc.
c/o 215 comtury Blvd�
P. 0. Box 305191
Xaghville, TR 37230-91-41
R. H. White Construction company, rnc.
41 Cantr*Z Street
P. 0. Box 257
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INSURER(8�AFFDRDINGOOVERAGE NAlOrt
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INSURERA.- The Charter Oak rino Inauracce company 25615-001
INSURER 9- TrILV41*rS Property CaqUalty Cor�lpany of Am 25674-0011
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INSURER C: NatiOnAl Union Fire InBuranca Company OE 1944S-001
U -i mp yc 2 S 65 8_001
INSURER D; TrAvOlera Indmnity Company 2S658 -Dal
UVL;K/kki&U CERTIFICATE NUMBER: 20287680 REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN [$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDIN13 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF: SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAD CLAIMS.
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ACCORDANCE WITH THE POLICY PROVI$IONS.
AUTHORIZED REPRESUNTATIVEE
Coll:4197604 rxpl:1694012 Cert:20267680 @)1988-2010ACORD CORPORATION. All rights
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OFFICER/MEMSER EXCLUDED? F11 I NIA A/2013 9/:L/2014 E.L.r;ACHACOIDE
Marldeto In NH)
E.L. 131811ZA68- EA
U ON U)- WhiRATIONS below I TTC2MM
Evidence of Inauxance
mareeptica
21000,000
1,000 /_000
1,000,000
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SHOULD ANY OF THr= ABOVE DESCRIBED POLICIES BE cANcELLED BEFORE
THE EXPIRAMON DATE THERE -OF, NOTICE WILL 13E DELIVERED IN
ACCORDANCE WITH THE POLICY PROVI$IONS.
AUTHORIZED REPRESUNTATIVEE
Coll:4197604 rxpl:1694012 Cert:20267680 @)1988-2010ACORD CORPORATION. All rights
,CORD 25 1 (2010/05) The ACORD n2MO and logo are registered marks of ACORD
Location
No. 200 Date
LORT"
TOWN OF NORTH ANDOVER
0�
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
9ther Permit Fee
$
�t,-
lewer Connection Fee
$
krer%connection Fee
$
tl 15 kv
-t d4T
4
Building Inspector
6212 Div. Public Works
Pl��tllm NO.
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. rl/ PAGE I
14AP +40.
LOT NO
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZONE
SUB DI LOT NO. or
LOCATION cll/ �r'3
PURPOSE OF BUILDING
'b 4
OWNER'S NAmEZ&1toea1Ae Y y-fi L Ile
NO. OF STORIES Bak
I -y
---
OWNER'S ADDRESS,,�73 C-
BASEMENT OR SLAB /U -
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS ISTZ)( 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET en
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 ADDITIdN 0
MATER:AL 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 A/.
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE I FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS ? UST BE FILED AND APPROVED BY BUILDING INSPECTOR
7-0-7-7T3
RE OF OW
AGENT
F E E /4_/
PERMIT AN ED
19
2
OWNER TEL.
CONTR. TEL.
CONTR. LIC. #
3 PROPERTY INFORMATION
LAND COST -
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
la
13wr
1-7 )
BOARD OF HEALTH
PLANN-11416,80ARD
BOARD OF SELECTMEN
LINGLE FAM
MULTI. FAMI
APARTMENT
2 FOUNDATION
3 BASEMENT
BUILDING RECORD
OCCUPANCY 12
I S�ORIES THIS SECTION MUST SHOW EXACT -DIM
T �FFI�tS LOT LINES AND EXACT DIMENSIONS ENSIONS OF LOT AND DISTAN - CE FROM
OF,\BUILDINGS. WITH`,A*,6.RCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION 'j\
8 INTERIOR'-hNiSH
3 1 2 13
P INE
HARDW D
PLASTER
RY WALL
I UNFIN.
-17
AREA FULL
10 PLUMBING
FIN. B M T AREA
CLAPBOARDS
8
1/1 1/2 14
2 3
FIN. ATTIC AREA
TOILET RM. 12 FIX.)
CONCRETE
—S—HED
t!O 8 M T
WOOD SHINGLES
FIRE PLACES
EARTH
LAVATORY
WOOD SHINGES
HEAD ROOM
KITCHEN SINK
MODERN KITCHEN
SLATE
NO PLUMBING
ASBESTOS SIDING
COMMON
__�_S`PH. —TILE
ROLL ROOFING 1_�
MODERN FIXTURES
4 WALLS
10 PLUMBING
9 FLOORS
CLAPBOARDS
8
1
2 3
DROP SIDING
TOILET RM. 12 FIX.)
CONCRETE
—S—HED
WATER CLOSET
WOOD SHINGLES
ASPHALT SHINGLES
EARTH
LAVATORY
WOOD SHINGES
ASPHALT SIDING
KITCHEN SINK
HARDN'J'D
SLATE
NO PLUMBING
ASBESTOS SIDING
COMMON
__�_S`PH. —TILE
ROLL ROOFING 1_�
MODERN FIXTURES
VERT. SIDING
TILE FLOOR
STUCCO ON MASONRY
6 FRAMING
STUCCO ON FRAME
WOOD JOIST
PIPELESS FURNACE
BRICK ON MASONRY
ATTIC STRS. & FLOOR
BRICK ON FRAME
STEAM
CONC. OR CINDER BLK.
HOT W T'R OR VAPOR
STONE ON MASONRY
WOOD RAFTERS
WIRING
STONE ON FRAME
RADIANT H'T'G
SU ERIO _P20�O�R�
E
ADECILIARTE NONE
5 ROOF
10 PLUMBING
GABLE
GAMBREL]
FLAT
jjtIP
I
BATH Q FIX.)
MANSARD
TOILET RM. 12 FIX.)
—S—HED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING 1_�
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. & 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
AS
__
OIL
Wh
I st
2nd ELECTRIC
—i,d NO HEATING
C
2 . 71100
IIBASCS.
Location
No. 7a.1-0 Date
.0�xedol
� rA-) -
Building Inip—ec—tor
Div. Public Works
TOWN OF NORTH ANDOVER
04"'.0
10
I.. A�iagddIilllk
Certificate of Occupancy
$
Building/Frame Permit Fee
$
CH
Foundation Permit Fee
$
Other Permit Fee
$
Oewer Connection Fee
$
SI CIA
ater Connection Fee
$
AID
TOTAL
$
/0100
.0�xedol
� rA-) -
Building Inip—ec—tor
Div. Public Works
PERM IT NO.. W-7-OFTY
MAP +40. L
APPLICATION , FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
INSTRUCTIONS
SEE BOTH SIDES
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
ANS MUST BE FILE AND APPROVED BY BUILDING INSPECTOR
E FILED
SIGN�� OF OWNER OR AU7/RIZED AGEN C2 2
- , _ - I- _ — - A 10
F E E
0 av
PERMIT GRANTED
4t4/4-. 19
CONTR. TEL, #
CONTR. LIC. #
3 PROPERTY INFORMATION
D COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDINa iNBPECTOR
OT No.
2 RECORD OF OWNERSHIP IDATE
BOOK '.PAGE
ZON E Asp-
SUB DIV. LOT NO.
LOCATI
11 171 xylt��Yf
PURPOSE OF BUILDING&,4,4�&
NAME 12,
O!N
NO. OF STORIES
j
�10
ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME C
eUILDER'S NAME
SIZE OF FLOOR TIMBERS ISTVyll 2ND
3RD
SPAN x -dkl;l�
-41 AW,4vl
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERSO
wax
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER;AL OF CHIMAEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMEN OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY tv
IS BUILDING CONNECTED TO TOWN SEWER
"40
IS BUILDING CONNECTED TO NATURAL GAS LINf
INSTRUCTIONS
SEE BOTH SIDES
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
ANS MUST BE FILE AND APPROVED BY BUILDING INSPECTOR
E FILED
SIGN�� OF OWNER OR AU7/RIZED AGEN C2 2
- , _ - I- _ — - A 10
F E E
0 av
PERMIT GRANTED
4t4/4-. 19
CONTR. TEL, #
CONTR. LIC. #
3 PROPERTY INFORMATION
D COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDINa iNBPECTOR
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DATE
JOB LOCATION
Number
H 0 H E 0 W N E
Name
PRESENT MAILING ADDRESS
Town of North Andover
BUILDING DEPARTMENT
HomeownerXicenqe Exemption
Stre'eL Address
Home Phone
ection of town
_1_z7211),;1_11z211
Work Phone
I
t y State Zip code
The current exemption for "homeownersil was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
ethat the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
,structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
..to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for ' all such work performed under the
....building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
,North Andover Building Department minimum inspection procedures and
..'requirements and that he/she will comply with said procedures and
.�:equirements.
-HOMEOWNER'S SIGNATUR
�APPROVAL OF BUILDING OFFICIAL
j:N6te: Three family dwellings 35,000 cubic feet, or larger, will be
Iquired to,comply-with State Building Code,Se'ction.127.0, Construction'
rp
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