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Home My WebLink AboutMiscellaneous - 278 GREENE STREET 4/30/2018CA W CO ---I m P m C, Date.6—kv%].tj... I TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........................... ........................................................ has permission for gas installation ... ...... 5 ............ in the buildings of .... . . ... ........ ccl(� P4 at ..... .............................. 9 ... . ....... . North Andover, Mass. Fee..710 ............ Lic.No.��.D� . ..... ..HPv� . .................................................... GASINSPECTOR Check #C-16-� P 9380 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEE5/30/2014 ]PERMIT# CO 6- JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS I Same TE FAX TYPE OR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL RESIDENTIALE] PRINT CLEARLY NEW: RENOVATION: El REPLACEMENT: PLANSSUBMITTED: YES[] NOE] -j APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER BOOSTER L—J= 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 ATEST UNIT HEATER L—J=L—JL-- LINVENTED ROOM HEATER WATER HEATER OTHERf Re lace Gas Meter x INSURANCE COVERAGE I have a current liabili!Y insurance polity 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 0 OTHER TYPE INDEMNITY [j 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 [j AGENTE] 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 pcance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I _4osep_h Marino LICENSE # 8736 8IGNATORE MP El MGF [] JP E] JGFE] LPG1 0 CORPORATION [J# PAR ERSHIP[J# LLCE]# COMPANY NAME] RH White Construction Co ADDRESS141Ce ntral St A CITY STATE=ZIP101501 ]TEL jj(508) 832-3295 FAX CELLI 508-832-4614 JEMAIL D.RHWhite.com '30 0 El z U� cn w 4 < > co z 0 CA 0- 0- < Lii w CA is� i!.. X:- ql: Ln LU CD A,41 J!'E I m DATE (MMMDNVYY CERTIFICATE OF UABILITY INSURANCEPage I of 1 08/29/2013 1 F THII� CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS 140 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERVFICATE 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 P01i0Y0@s)muGt be endorsed. if SU13ROGATION Is WAIVED, subject to the terms and conditions ofthe policy, certain Polities may require an endorsement. A statement on this Certificate does notconferrights to the certificate holder in lieu of such endorsoment(s). williv of MR86achusotta, Inc. c/o 26 CoAtury Blvd. P. 0. Box 305191 Nftmhville, TH 37230 -MIDI R. H. White constrixotion company, rnc. 41 Cmntraj Street P. C. Box 257 AnhUrnj MA 0150;L NA112 11 INSURERA: The cb=tal' �-k Firo TnEI�C,9 ilS_ 001 INSURERS: Trava:LmrL, Properhy Casualty Coxrklpany of am INSURERC:Nati0)aA1 Union Fire) Insuranca acmpaay OE 19445-001 INSUREIRD;TrAvelers Indamnity company 25658 -Dal 1�wv=KAUEU CERTIFICATE NUMBER: 20187680 REVISION NUMBER; THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 16SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA7ED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIF-3 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. TNSFZ DO,[ SUB ?ULI(;YEFF I POLICY EXP I TYPr, Or- INSURANCE vvvn POLICYNUMBER - LIMITS GENERAL LIANLITY VTC2000 977X9949-13 9/l/2023 1--9/1/203.4 -1 EAGHOCC IRR5NGE 6 9-nnn-nnr I C Bit. 599 LDWL X GOMMPRCIAL GENERAL LIABIL17Y CLAIMS-MADEEX I OCCUR' rEN-LAGGRr=GATr.LIMITAPPLIESPFR, T-1 POLICY LOG AUTOMOBILE LIABILITY VTJCAP 977K955A-13 ANY AUTO ALI.OWNED SCHEDULED AUTO$ AUTOa HIREDAUTOS X NON -OWNED X AUTO$ Coi Ddd X C911 Ded X 1.1111112RELLALIAS OCCUR 2XCESS QAB CLAIMS -MACE X DED I V IRETENTIONS :LC), 000 W0;tKRR8COmPEmsATiom AND EMPLOYrRS'LIABILITY 9 AMY PROPRf ETORIPARTNF YLN ,R1F.XECUTIVEFX-] VTC2XM 820A71A-13 9 OFFICER/MEM@r�n EXCLUDED? N(A f MaridatmMN161) IrS r U ,,,d63,r,Ibd 00(v U KIII ON UF QftRATIONS below Lvidonce of InMUZance MED PENERALAGGREGATE PRODUCTS - COMPIOP A00 BI�ED SINGLE 1. )/1/2013 9/1/20:14 �M 0 7—MIT s 2,000,000 B Sol ODILY INJURY(Per person) $ B 1301 ODILY INJURY(Peraccldtni) /11203.3 19/j/2014 AGGREGATE /1/.2013 9/1/2014 X WMT H- _F_ __JTo t112013 9/l/2014 E.L. EACH ACCIDENT 1,000 000 E.L.DISSAGE-EAEMP1,0YEn S 000,000 S 1,000,000 E.L. DISEASIH. POLICY' ;rtrzssl 111 "1 —((1)) 000 0' LIMIT i - " KernarKs zjcnodula, If more sogeb SHOULD ANY OF THr= ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED ArPRESUNTATME COXI:4197604 TPI:1694012 Cert:202676$0 @ 1983-2010 ACORD CORPORATION. All rights 'CORD 25 , (2010105) The ACORD name and logo are registered marks of ACORD PRR7AIT �b. ZIP APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. (.,/PA G E I -.3 m MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE 1-1 ZONE SUB DIV. LOT NO. i 'LOCATION sr. PURPOSE 9:�' 6'W 'S NAME /. 4, NO. OF STORIES SIZE-�L.A qf4NFR'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD 4'UILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATEWAL OF CHIMNEY ql!r-ABUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 'W I L i:rl LDING CONFORM TO REQUIREMENTS OF CODE 5A ye IS BUILDING CONNECTED TO TOWN WATER 4-OARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 INSTRUCTIONS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ZL NS MUST BE FILED tND APPROVED BY BUILDING INSPECTOR PLATE FILED z PERMIT GRANTED OWNER TEL. #-22,5 CONTR. TEL. CONTR. LIC. 3 PROPERTY INFORMATION LAND COST ,-fST. BLDG. COSTff, 010 EBT. BLDG. COST PIEF(*Q-. FT. EST. BLDG. COBT PER Room SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN sh BUILDING RECORD OCCUPANCY 12 _ SINGLE FAMILY S RIES MULTI. FAMILY 0 FFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE - E a 2 13 - CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY TWALL NFIN 3 BASEMENT AREA FULL FIN. B M*T AREA 1/1 1/2 1/1 FIN. ATTIC AREA tlO 8 M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOOR$ CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING B 1 2 3 _�CONCRETE TARTH HARD%?J'D COMtAC;N _��SPI TILE VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOQ�R CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR 222R ADEQUATE ONE 10 PLUMBING 5 ROOF G LE AMBREL IP BATH (3 FIX.) MANS RD TOILET RM. (2 FIX.) TL_AT _] SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES_ KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & 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 B�M-T . � 2nd I Ist 3rd I EICTRIC W NO HEATING 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. OFFICF-S OR. APPEALS BUILDING CONSERVATIUN HEALTH PLANNING Town of NORTH ANDOVER 2-C ... &" DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 12() main street North Andover. tvlass;wl ms(,11S 0 1 H45 (6 17) GH5-4775 1n accordance with the provisioll.s of MGL c 40, S 54, a condition of Building Permit Number is that the dcbris resulting from this work shall be disposed of in a properly liccnsr-d solid waste disposal facility as dcf-incd by MGL c ill, S 150A. The debris will be disposCd of in: 41 (Location of Facility) Sigpature of Pcrini. pliczini 404 p ani r -Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. C, I =r 0 acr ta A 4c co 0. CD C.3 CD —9 m c2 CL 0 C) CA CO =r -O A CO) COD CD — =r CL cL 0= Mn CD =r M n =r -P CO CO2 co -4 CD CA 0 -*'o CD :E c=,,r Sol CD Cos co 2>4 C3 0 C) CD C-) a La. C.) CA 6 * co Z-7 CD CA > z cop) ca CL CD Er A CD CD (J) CD 7 C-)= 0 k 0 CD i"m CL 1CL CO) Is CO) co, 0 CL.W cr o '0 -4k 0 CD (-Q dc 0 U2 CD %mc = C42 CL cr =r CD sm i - CD CC22 C) CD 0 CD CD cn CD M= ED CA <- CL cop) CD > CD CO) 0 ;w co) Cd SDI a CD Cl) CD go 0 CD 0 CD co 0 CD C/) 0 rD C/) Q CD :J (-D 071 �L PCJ 0 r- GQ z w Cp CD " ;z 0 C ra crQ :J eL OQ 5 0 rz C/) Cf) --e al P� ;4. r) tz 0 t7l 5, 4) ri) rA 0 )Nlq 0 9 0 4e4 CD ol Date. ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ................................................ has permission to perform ......................................... ... .. .......................... wiring in the building of ...... ............................................. at -W ................................. . rth Andover, Mass. Feelf .. . ...... Lic. Nor�q..ZJ�,. k7, ...... ......................... ..................... 9LEemcAL IN EcrOR Check # 9'17� 5 4 '2' 0 TBECOAMONWEALTHOFAL DEPARTAIEWOFPUBLIC BOARO OF FBZEPREVEVHONRE( APPLICA77ONFORPERA41TTO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover Ile undersigned applies for a permit to perform the electrica work/describi Location (Street & Number) IIS 6-f - -� /5 -r— Owner or Tenant Owner's Address Office Use only CW120 JPermit No. Occupancy & Fees Checked IRM ELECMCAL WORK ELECTRICAL CODE, 527 CMR 12:00 Date below. To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 2,00 Amps Aa 2-q*olts Overhead =Underground No. of Meters New Service Amps I Volts Overhead r-1 Underground No. of Meters Number of Feeders and Ampacity qAd -,), q rl",e Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground [D 2round No. of Receptacle Outlets 0 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 Connections Other Nb. of Dryers Heating Devices KW Vo. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP L91 I -, In LO kM[MICC CDMXdW- Pawant ID the mgAunaVs dMassadv= Ggmii Ihaw ,,a an �nt LL*&y Im lance FbhLy ff chd T Cmpl& O=ad& s Cc IhawsAxiimdvandpicofafsm-cbD&Offim YES INS[VIANCE [7 �J BOND OTIER J 3ifft . YES = NO M If)cuhaNedrclodYB,PkmBmdc*thevA)eofoomr,4pby 01 C�- E0TwdValueofE1ecftJcalWbjk $ WciktDSt&t kqeclicnDaeRoWested Rcugh Final signeduridAranakmofpmw (C., LOMSeNo Z�V71 FIRMNANE 2— eg 01 Lice� 2-1 ? 7Z Businm Tel. No. V79— 117f-11-1-7 41 Tel Nb. OWMM'SINSLRANTCEWAIVER;Iamawmdxtthel-xx!rwdoesnothawthe'mrmwec)mngeorAsabswntolegxvalerilasm4uredbyNLi%ahmmcordLam and damysignakwon duspwitapplicahm wa*Rts dus wquimmm (Please check one) Owner Agent 01;1 M T�lephone No. PERMIT FEE $ Signature of Owner or Agent � DEPARTA1ENT0FPUBLJYCS4FE7Y LPer—nmt No, J z0o BOARDOFFMPREVEMTONREGULAHONS527CM120 Occupancy & Fees Checked 40 ALWORK APPUCATION FOR PERMT TO PEffORM ELECMC ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 Date & OLEASE PRINT IN INK OR TypE ALL INFORMATION) To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1'7 $ - 1. P, 0 wner or Tenant A0 - �77 e V) Tu Owner's Address -)CUAI%) r_,� VV A Is this permit in conjunction with a building permit: Yesm No (Check Appropriate Box) Purpose of Building Utility Authorization No`.��'W 2,,YV Amps __Z40 �i- e)VOlts Overhead Underground No. of Meters Existing Service No. of Meters Amps I Volts Overhead Underground ED New Servic I A A "I Number of Feeders and Ampacity' Location and Nature of Proposed Electrical Work . . of No. of Lighting Fixtures of Hot Tubs Swimtriing Pool q r.11 No. of Transformers Generators I Vial A No. of Receptacle Outlets f— . 0 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Gas Burners FIRE ALARMS No. of Detection and Initiating Devices No. of Zones No, of Switch Outlets No. of Ranges No. of Air Cond. Total Tons No. of Disposals 0 No. of Heat Pumps Total Tons Total KW Dishwashers No. of Sounding Devices No. of Self Contained Space a Heating KW Detection/Sounding Devices Dryers Local Municipal M Connections Other Heating Devices KW i Water Heaters KW No. of No. of I Signs Bailasis FRo-. —ofmolors Total HP dro Massage Tubs I vaWp[cdofsa=1DftOffiU-- YES .kWectionD&RbqueWd 5 @eorilssiibswnUafiivabt YES NO� ]fWuhaNedrdodYB,pb=i&&dr�WOfODVaaWby Prefferr v-lcr4t, 0 - a ftwe speffy) Z�zw F4irafimD& E"i&dVahrofEle=aWc& $ Ra* Fmal op (- C-1 LmiseNo. zjt 2-1, ,4r1eeZ/ZT BusilmTeLiio. 1,5--? 2- 6de.--,L &(,44 0 AIL Tel NoL 6 M r iv-)(- iER'SINSLRANCEWAfVER,Iammmftd-clj=wdoesnot drmammcowWorAsabstmMeqnval=asm4�byNim�CtnffalLam —Dwoui�nW-qgramondiispwnit*pbcMonva'%,esd,,sregmi M-01 . (Please check one) Owner ED Agent 0 Telephone No. PERMIT FEE $ signature oru-wner or Agent 1247 - (f Dozz., YIW7) Fl /V# VGro 0,4-1 SF4vtcF- Af-txrz- 99" 4CCM C 49 t5o&ow RW C-51) 2-607,e-1 4/i, -,t/7/" cAv xi. -r ru A lu a s 115- 70(0) �,6-) A4 4SAE7L /A/ C?- 2,0- �y ....... Date ........... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................ has permission for gas Ainstallation in the buildings of .......................................... at 1� ...... over, Mass. Fee�� ..... Lic. No. .... .......... Check # 4853 MASSACHUSErIS LNUORM (Type or print) NORTH ANDOVER, M Building Locations C(,/ �j Owner's Name New Renovation Replacement 3--'� FOR PERNU TO DO GAS MING Plans Submit ted Date Permit # Amount$ (Print or typer--, — / Name Address Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner. 13 Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 0 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 13 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 Iss this application will be in compliance with all pertinent provisions of the Massachusetts S apVr 7jq7ther`C6)neral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Plumber Gas Fitter Master r—l—lGemeyman L=F 4-TH. FL06R E -Z a 7TH.FLOOR ,8TH. FLOOR (Print or typer--, — / Name Address Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner. 13 Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 0 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 13 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 Iss this application will be in compliance with all pertinent provisions of the Massachusetts S apVr 7jq7ther`C6)neral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Plumber Gas Fitter Master r—l—lGemeyman L=F Location CE'l"*e'92Y— QJ�� No. Date TOWN OF NORTH ANDOVER AL 0 Certificate Occupancy $ of Ar MU Building/Frame Permit Fee $ TO Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -7- 17368 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING IdWU 317 7-7 BUELDING PERM[IT NUMBER: DATE ISSUED: SIGNATURE: Building CAmmissione /I t f Buildings Date SECTION I- SITE INFORMATION �� 1.1 Property Address: - 1.2 Assessors Map and Parcei'lNumber: — 6 Map Number Parcel Nurnber 1.3 Zoning Information: 1.4 Property Dimensions: f -el - - qw4o-�- A/-1. Zoning District Proposed Use Lot Area (sf) Frontage (ft) 1.6 BUI--LDING SETBACKS (ft) Front Yard Side Yard Rear Yard Rgequi�red Provide Required -Provided Required Provided 1.7Water SapplyM.G.L.C.40 54) 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal On Site Disposal System 0 Public [A," Plivate 0 SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT 1z 2.1 vner of Record N n Address for Service 7 Signdture Telephone 2.2 Owner of Record: Name Pn t Address for Service: "z- W�Llo�s V " - Z��Iignature kTelephone �ECTION 3 - CONSTRUCTION SERVICE% 3.1 Licensed Construction.Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Appficable -0 ,FEornpanyNarrie 4 pan� Registration Number ------------ z '��Iress Expiration Date 7 Signature Telephone fill SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) I 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 ....... 0 No ....... 0 SECTION 5 Description of Proposed Work (check applicable) New Constniction 0 Existinp Buildinp- 0 Repair(s) 0 Alteratilons(s) 0 Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL. USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing 3;=" e;l '5;1' Building Permit fee (a) x (b) '91 17 i� 4 Mechanical (HVAC) Fire Protection .7, e, C_' .5 6 Total (1+2+3+4+5) 4<1_0e)v I Check Number SECTION 7a OWNER AUT HOIUZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIEES FOR BU]ILDING PERMIT as Owner/Authorized Agent of subject property Herebv authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner Date —SECTION 7b OW-NER/AUTHORIZED AGENT DECLARATION I Ar 4�� as Owner/Audiorized Agent of subject propek — ( loop— Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief W, P5111 11"ill ' 020FAN"I FORM — U LOT RELEASE FORM 151 Q�jeq� INSTRUCTIONS: This fonn is used to verify that all -necessary approval/ pennits from Boards and Departments having junsdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements- E&SAINSM Bauman man a am a a an 11 ME am a a. PPLICANT —PHON ASSESSORS MAP NUMBER —LOTNUMBER SUBDWISION LOT NUMBER ,STREET &,�I:v STREETNUMBER Infilmanwam*4108 ..... n ....... asswas "sm's ------------- CIL 01FF1 4L USE ONLY I a a awn ass 0 0.110-aws a ass a a a am a as a a as ammenews a an a awe a ME 0 a.. .,11 . ... 11 . . a . RECOMNIENDATIONS OF TOWN AGENTS Ina am a amen ME ass a a NEWS no Mass a an as a &IRowns mans am Massa on a we a Ann== so a a a am Oman 0 a . a a DATE APPROVED CONSERVATIONADNHNISTRATOR DATE REJECTM CONMENTS DATE APPROVED TOWN PLANNER DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR HEALTH ------- DATE REJECTED CONRVIENTS PUBLIC WORKS - SEWER WATER CONNECTIONS -DR-TVEWAY PERMT . DATE APPROVED FIRE x DATE REJECTED ---------- 17 :C RECEry BUILDING INSPECTOR DATE 7:1 Z 7 -V CN�' i v .� ,e h � ,�- y . ons /�,q.-ra. JL-a-�cJ 2�� j i GREENE STREET PREPARED 8 Y - JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS lJl PARK STREET, NORTH READING, AM. (978)-688-4899 JOB NO. 5216 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 IVIGL c 11, S 150 A. The debris will be disposed of in: CCL ir\ (Location of Facility) e; ( I i, I/ 141-�--/' 'W"44" Signature 'of PermiVA�pKcant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: S7?--ZK ��t F/&4/ Est. Cost Address of Work Owner Name: Date of Permi- I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pernit No. Job under $1,000 Date Building not owner -occupied _Owner pulling own permit -Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date, Contracior Name Registration No. -OR: Z ZtNotWithstahcling the above notice, I hereb y-�a permit as the owner of the above propeq: !!�pl r. -D 4at- 9fwn6r'Narne V�k -7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit r—Na 7 e Please Print N . ame: Ro La -V\ ev Location: Q �A , A Yx,�). i ve r , mi!, - I am a homeowner perf6rming all work myself. I am a sole proprietor and have no one working in any capacity # CA -1 3 — 31 -IS7 - 9L-1 -7 L F-1 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. Policv Company name: Address Cily: Phone #: Insurance Co. Polia 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 -well-as-civil,penalties inke formof -a-STOPWORK-ORDER-and-a fine -of -($1.0.0.00.)-a -day against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage Verification. I do hereby certify penalties of pail information provided above is true and correct. Signature Date P . rint name Ric ioe_r-4- M I Phone# -7 1 9 . ... I . . 7-�T- ai� Official use only do not write in this area to be completed by city or town cificiar . Pty or Tow - n Permit/Licensing El Building Dept �MChebkifimr�ediate*06i7�eisieguirpd C] 7 Lfiqensip�J'Boaid Selecir�an'� Contact person., Phone Ei -Health -D6jlJ6Ah&nt _'1-7p -0 7 N- Zr�:, 7r.; 7 �.- , �. �� u E E� 3 ,.tea � � �t�� ml rl 117e) C�1-21.f)eQ ME � Vtit, lr�� or on, MISS vs, 27 s Ff-A aw 2--1 b CW -W,3 � 1 ^-),- (., '4"1 / mix 2--1 b CW -W,3 � 1 ^-),- (., '4"1 / IL it iiE Date. "�� ......... TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING 41 SSACHUS This certifies that 7-- ..................... j has permission to perform ........... ....................... plumbing in th�,�uildings of ... ... ... ..................... . at ........ .................. (r-- .,—,North Andover, Mass. Fee. fl ..... Lic. No. .... .. . --1 21 TIC ....... �Z�LOMBIN�ONPCTOR Check # 'A2 62,35 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location New 1:1 INV - r W7 I.- I rs'-171 M.111110C Renovation -4-2 of Name IM -1 CATION FOR PERMIT TO DO PLUMBIP Date :z Permit 04) Amount Plans Submitted Yes No (Print or type) I---- Check one: Certificate installing Company Name aW A/ El Corp `7 Address ,56 igcv�, El Partner. W (2-A y 6� Business Telephone 7 1 ;;—L 5 cJ E] Firni/Co. Name of Licensed Plumber: insurance Coverage: Indicate the tyq5e. of insurance covekte by checking the appropriate box: Liability insurance policy Other type of indernmity Bond a El insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent 11 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 install tions performed under P Issued for this application will be in compliance with all pertinent provisions of the in ing Cod an agfe—r-1747V the General Laws, By: 77—gn—arurF or LicensearjumBer Type o Plumbing License Title City/Town License INIumDer Master Journeyman APPROVED (OFFICE USE ONLY I I No 01. V3 W 0 1.0 0 tkcl ui CD ci :'alp CD C:F CD u %3 CD CCD ra oft LA GF) cm 0 I lip: -402 CD WC.3 9L a: CL 0 16.: 0 CD CA coo ccuis ca CL 1-0 0:5 0 0 CL CO3 CD 4.0 LU C3 CD L3 0-01 A co CL 0 Go C) C L M 0 Cf) P-4 t; P4 F� C/) CO u C/) C/) E ts G3 CL. CO2 cm COD 10-0 03. LA ccl E a) CD CL CD C* co L- CL CL. CM< 9 Cc cl CO2 z ts CD C3 CL C..3 CO2 Cc cc CL CO3 LLI W. U) 19 w w 19 LLI LLI U) cc u 41 �2 >- 0 x 7a �o 0 ui CD ci :'alp CD C:F CD u %3 CD CCD ra oft LA GF) cm 0 I lip: -402 CD WC.3 9L a: CL 0 16.: 0 CD CA coo ccuis ca CL 1-0 0:5 0 0 CL CO3 CD 4.0 LU C3 CD L3 0-01 A co CL 0 Go C) C L M 0 Cf) P-4 t; P4 F� C/) CO u C/) C/) E ts G3 CL. CO2 cm COD 10-0 03. LA ccl E a) CD CL CD C* co L- CL CL. CM< 9 Cc cl CO2 z ts CD C3 CL C..3 CO2 Cc cc CL CO3 LLI W. U) 19 w w 19 LLI LLI U) Date.. - . <9q. 0./. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 10 41 SACHUS This certifies that ............... ..... a has permission to perform ....................... plumbi I in th buildings of . a t . .......... ............... , North Andover, Mass. Fete.,��2� ...... Lic. No .......... P NG INSPECTOR JL rM�� Check # 6 18 7 MASSACHUSETTS UNIFO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location New 13 Renovation Replacement APPLICATION FOR PERMIT TO DO PLUMBIP Date 6'�l Name Permit # 61f9l Amount ipancy FIXTURES Plans Submitted Yes No . 1:1 El (Print or type) Check one: Certificate Installing Company Name Corp Address Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent F1 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 installatims performed u: er apte ed for this application will be in C O:d Ch compliance with all pertinent provisions of the Ma��'ch �alumbing 142 of the General Laws. By: S-17n`=ureoI-LicenseayTumDerF W Type of Plumbing License Title / City/Town e INUMDeT Master El Journeyman 3---" APPROVED (OFFICE USE ONLY.