HomeMy WebLinkAboutMiscellaneous - 3 COLUMBIA ROAD 4/30/2018N2 4672
�O
MANO
Date./-�) -.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING.
This certifies that . .'r�
has permission to perf
orm ... ........
plumbing in the buildings of k.A .............
at 3. ........ North Andover, Mass.
Fee—�70. Lic. No.. . ....... .......
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
7
.j 'C' -
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTHANDOVER, MASSACHUSETTS
Buildini'Location --?
of
Name '00�,/
Amount
Replacement Plans Submitted Yes NO
New Renovation
/—, 7AX 0 e
(Print or type) Check one: Certificate
e
Installing Company Nam Corp.
Address ------ cl� Partner.
Firm/Co.
Business Telephone
Name ofLicensed Plumber
insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not haVe any one of the above
A
three insurance
Signature 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 fi this application will be in
W'
compliance -with all pertinent provisions of the Massachusetts S umbing,/ode a5�ter_lj4of the General'Laws.
own
?,OVED (OFFICE USE ONLY
Type of Pluffibing Jdcense
U, 'L �. —
TNumoer Master F� Joumeyman
E&ZI
(Print or type) Check one: Certificate
e
Installing Company Nam Corp.
Address ------ cl� Partner.
Firm/Co.
Business Telephone
Name ofLicensed Plumber
insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not haVe any one of the above
A
three insurance
Signature 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 fi this application will be in
W'
compliance -with all pertinent provisions of the Massachusetts S umbing,/ode a5�ter_lj4of the General'Laws.
own
?,OVED (OFFICE USE ONLY
Type of Pluffibing Jdcense
U, 'L �. —
TNumoer Master F� Joumeyman
3 4 21
0
Date '0 ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ................... . .......
has permission f6r�as installation ........... ...............
in the buildings Of ..................
...... North Andover, Mass.
FeeO-��.. Lic. No.:-�Vk*:�. -10-4—ev . . ......
G" AS INS CT
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
NLASSACHUSETTS UNWORN APPLICATON FOR PE RA111T TO DO GAS F=(;
�'k-l�ype or print.)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
Owner's Name
New Ell Renovation Replacement
Date
Permit 9
Amount S
Plans Submitted
P-5
t
Business Telephone
.Name ofLiccrtsed Plumber or Gas Firter
Check one: CerEificate [ristalling Company
0 Corp.
F� Partner.
F7FIrm/Co.
INSURANCE COVERAGE Check one:
I hm a current liability Insurance policy or it's substantial equivalent. Yes r7 No r7
If you have checked ves, please indicate the ty = . t,
pe coverag , e by checking the aopropnate box. Bond 7
Liability insurance policy Other ty I
7 , pe ofindemnity 7
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:
S1 anarure of Owner or Owner's A -enc Owner A-aent
ZI
I hereby c,,-,tifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best ofmv knowledge and that all plumbing work and installations pertbrTned under Permit Iss d to r this application will be in
ea
complla=! with all pertinent provisions ofthe -Massachusetts State �4s Codeland Chaptep��-- lofthe General Laws.
By:
Title
Ciry/Town
.APPROVED (()Fi-ic;- (IS F' ! )Nl� Y)
ignature of Lic, sed Plumber Or Gas Firte-
fflumber
-,P'1�2url C2 -
Gas Fitter Lic,�nst TNuVnot,
Nlasie�-
Joumevi-rian
A
ts
z
7
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U
z
z
z
cn
�n
z
S 0 3 3A 5 ENI E NT
BA S EM ENT
I sT F L 0 0 R
2.N D. F L 0 0 R
3 R D . F L 0 0 R
Tr IF F L 0 0 It
Tr IF F 1. 5 o R
6T il . I; L 0 0 R
77 IF F L 0 0 It
3"r ii. F L 0 0 R
t
Business Telephone
.Name ofLiccrtsed Plumber or Gas Firter
Check one: CerEificate [ristalling Company
0 Corp.
F� Partner.
F7FIrm/Co.
INSURANCE COVERAGE Check one:
I hm a current liability Insurance policy or it's substantial equivalent. Yes r7 No r7
If you have checked ves, please indicate the ty = . t,
pe coverag , e by checking the aopropnate box. Bond 7
Liability insurance policy Other ty I
7 , pe ofindemnity 7
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:
S1 anarure of Owner or Owner's A -enc Owner A-aent
ZI
I hereby c,,-,tifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best ofmv knowledge and that all plumbing work and installations pertbrTned under Permit Iss d to r this application will be in
ea
complla=! with all pertinent provisions ofthe -Massachusetts State �4s Codeland Chaptep��-- lofthe General Laws.
By:
Title
Ciry/Town
.APPROVED (()Fi-ic;- (IS F' ! )Nl� Y)
ignature of Lic, sed Plumber Or Gas Firte-
fflumber
-,P'1�2url C2 -
Gas Fitter Lic,�nst TNuVnot,
Nlasie�-
Joumevi-rian
N2 2641 Date ....... e�� ..................
TOWN OF NORTH ANDOVER
0
AL
0 PERMIT FOR WIRING
This certifies that .......... P..��m.., ...... L,:t r . 0 . 0 .. t . ................................
...... ..........
has permission to perform ...... R.. �.. (.V1.6. d. t ... I .............................................
. ... .. ... ...
T C
.4 U
wiring in the building of ......... ........... k . ..................................................
( () / ("I /, z 'I I
4t ......... ................................. . North Andover
,Mas
Fee ..... rd..-.d� Lic. No. 4�4 il.ci .... 11:z�zz.:zz--
AL INSPE�
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
—&ff--icialUse Only
Permit No.
7?15 657 W55,46M.555-1-7.5
S4,0 Occupancy & Fee Checked__
BOARD OF FIRE PREVENTION REGULATIONS 527 CIVIR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work clescribe��elmav
Location (Street & Number, 11 (10
Owner or Tenan r Zq ulq /V
Owner's Address 3 re> 'd i"T
Is this permit in conjunction with a building
permit Yes J� No 0 (Check Appropriate Box)
Purpose of Building_ A.& 1,n, fility Authorization No.
U
Existing Service Amps its OverheadA Undgmd 0 No. of Meters
&
New Service Amps__Voits Overhead 0 Undgmd 0 No. of Meters
Number of Feeders and Ampaci
Location and Nature of Propose8 Electrical Work
No. of Lighting Outlets
No. of Hot fuse
Total
No. of Transformers KVA
Above 0 In El
N45. of Lighting Fixtures
Swimming Pool
gmd 0 gmd El
Generators KVA
No, of Receptacles Outlets
No. of Oil Burners
No. of Emergency Lighbng
Battery Units
No,bf Switch Outlets
No of Gas Burners
FIREALARMS No.of'Zone
No. of Detection and
Initiating Devices
No. of Ranges
Total
No of Air Cond Tons
Heat Total Total
N 6,'Diposal
No.
Pumps Tons
KW
No. of Sounding Devices
No./ of Self Contained
Detection/Sounding Devices
�Om,', Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices
KW
0 Municipal El Other
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hy I dro Massage Tuds
No. of Motors
Total HP
- I " - A
OTHER:
J/
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (F!�ease Specify)
Estimated Value, of Pectrical I
Work to Start I Q I ) / I 6r,
Signed under the l0eBplies of
FIRM NAME re L, )
Inspection Date
(Expiration Date)
LIC. . No. 2UZ5
LIC. NO.
C4 Bus. Tel No.
Address ';r— Aft Tel. No.
C.
OWNER'S INSURAI C - v-0,MVER: I am aware that the Licenses does n
General Laws. And rny si ture on of have the insurance covera�,9 or its substantial equivalent as required by Massachusetts
this permit application waive§ this requirement. Owner Agent (Please Check one)
X I
/ �&4 4)4-�Ptcm,_Telephone No. PERMITfE
7i 7'sTpaiii—re o—f Owner or Agent) E
Location 3 ro 07 IeC)l
No. Date
Check# C)/X
11-4
14179 Building Inspector
TOWN OF NORTH ANDOVER
Certificate Occupancy
$
of
.1 CHUS
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check# C)/X
11-4
14179 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT �KP�R, RENOVAT4; OR DEMOLISH A ONE OR TWO FAMILY DWELLING
A
BUELDING PERMIT NUMBEk D ISSUED: 9
SIGNATURE:
Building Commissioner/Inspector of Build6g< Date 7— <06
SECTION 1 -SITE INFORMATION
1.1 Property Address:
^ C
'-� —0/am hie /�l
dou e—E 12'
1.2 Assessors Map and Parcel Number:
112—
Map Number Parcel Aunber
1.3 Zoning Information:
Zoning Dia;ict Proposed Use
1.4 Property Dimensions:
Lot Area (st) Frontage (ft)
1.6 BUIULDING SETBACKS (ft)
Front Yard ; Side Yard
Rear Yard
Re�ired Provi& Required Provided
Required Provided
I
+—
1.7 Water Supply M.G.L.C.40.1 54)- 1.5. Flood Zone Informatto, a:
Public 0 Private 0 Zone Outside Flood Zone 0
1.8 Sewera tern:
Municipal 0 ge Disposal Sys On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT
2.1 Owner of Record
co�u on6ft. Ed
Name (Print) for Service
a—, au fKXfy-Q gig LIM — F�
*ignaWtu,.
Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
r -,r -,e (3 cqe age-'CA.gel
Llt�nsed Coia,4ruction Supervisor:
A
Address
%
4
Signature Telephone
Not Applicable 0
. -n I
4 (zg
- ? 4-
License Number
-2 f, --Z6(02-
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
N.— `-,
. S 4�1 'I
I SECTION 4 - WORKERS COMPENSATION (XG.L C 152 4 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 o Proposed Work (check
applicable)
New Construction 0
Existing Building 11
Repair(s) [I
Alterations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
F�emo d.0- (;t) A'4�V\Q 0 (A Fv�
N t ir, �e (A C �p
5 1 a -e- 4 -4
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
1. Building
(a) 9111=g Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
-3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAQ
5 Fire Protection
.6 Total (1+2+3+4+5)
R 9n). ("Y0
I Check Number
SECTION 7a OWNER AuTHojf1k*iON4 TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, I as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building 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 infonnation 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
iST Nu—
SIZE OF FLOOR TMMERS 2 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CFMVMY
IS BUILDING ON SOLD) OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
D. Robert Nicetta
8uilding Commissioner
(978) 688-9545
.�.(978) 688-9542 Fax
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
HOM "OWNER LICENSE EXEMPTION
Please print
DATE
JOB LOCATION
"HOMEOWNER
PRESENT MAILING ADORESS_
City Town
Street
Of 14ORT),
0 0
too.,.
ACHWUS
Man / Int
co�uvj'�
st- Ile
Work Phone
Zip Code
The current exemption for "homeowners" was extended to include owner-occuPied dwellings
of two units or less and to allow such homeowners to engage an individual fbr hire who does
not possess a license, Provided that the owner acts as supervisor. (State Building Code Section 108.3.5. 1)
DEFiNITIONOF HOMEWOWNER:
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'ane or two family dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than one I home in a
two-year period shall not be considered a homeowner.
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 uncle nds the Tom of No. Andover
Building Department minimum inspection Procedures and rsta wn
comply with said Procedures and requirements. requirements and that he/she will
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFIC
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
tAORTH -"**N
0 * ,.f L. a 0 1 A
0
In accordance with the provisions of MGL c 40 s 54, and. a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 1 50a.
The debris will be disposed of An. /at:
V ACq-- auikA���
�'iji�ature of Appli'cant
9
Date
NOTE: A demolition permit fi7om the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
'�epz-tv, si-%- IV, S Cf , 1 1,0 0
FORM — U — LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
dommannam Oman
noun
APPLICANT Q�)e�ev)an PHONE
ASSESSORS MAP NUMBER 0- -.2 -LOTNUMBER- O�/
SUBDI'VISION LOT NUMBER
STREET STREET NUMBER
....-amsemsom MONSOON "a
............ no ..... a .. ......
OFFICLA,L USE ONLY
ONS OF TOWN AGENTS
it-^
",( . 1 5 t--< DATE APPROVED'O
CONSERVATIONAMNISTRATOR
DATE REJECTED
k
TOWNPLANNER
COT-%-*)!EN7'S
FOOD INSPECTOR - BEALTH
SEPTIC INSPECTOR - BEALTH
CONOAENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTNIENT
CON94ENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTOR DATE
�'— //— 61e)
MORTGAGE INSPECTION PLAN
NORTHERN ASSOCIATES INC
401 SOUTH BROADWAY, LAWRENCE MA.01843-3522 TEL:(978� 837-i335 FAX:(978) 837-3336
MORTGAGOR- PATRICK& LAURA QUEENAN
LOCATION -'3 COLUMBIA ROAD DEED REF. 1246 / 396
CITY,STATE.- NORTH ANDOVER MA PLAN REF. #4053
DATE.- JULY 24,2000 SCALE. 1"=20
JOB #.' 2001.04282
103.72'
PARCEL A
7699 SF±
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