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HomeMy WebLinkAboutMiscellaneous - 338 SALEM STREET 4/30/2018N O Ow C.0 w W D o m C 8m m O m 0 Date. �//? - A I . . ,,4 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..................... has permission to perform ... � ........................ plumbing in the buildings of A c.1 ..................... ............. at .... North Andover, Mass. Fee. .... Lic. No..�%( .. ...... Check # PLUMBING M13ING INSPECTOR 0 MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING City/Town.'r%)cr 1-11n4pV Q,^r' , MA. Date: 3 2@'► �Q Permit# Building Location33� 5%� le1nn 1z,A Owners Name:S%SgrN \hr 4 S Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential KI New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No 91 4tler.e_ lk� lzv1 % (Z,*—v \ ) It Z 3 FIYTI IRFC INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ® No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 Aaent 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 nnowiedge and that an piumomg work and mstauations 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. rN By Type of License: Title ® Plumber Signature o Licensed Plumber City/Town ® Master ,I 1 � �, APPROVED OFFICE USE ONLY []journeyman License Number: ' Z z W OIL °- U) z Q 1- fA z } J -j 2 H U W W w z w to Z a H to O X Q Q O? a N pCL Q z O Q z cin c7 L)) a LL :D O LL P 1 = D w x Z a tL � a Y a= w w w � a a N N° a m m o o a o��� o= Y g g °o =° Qz 3 u_ o: 0 1- D 3 3 0 1 1 SUB BSMT. BASEMENT 1 FLOOR 2 No FLOOR 3mu FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: QrB R k H 4* y % r--34 c, ® Corporation i j, 1 Address�6el ��rnR k is ` City1Town�a 1 `ate State"t A ❑ Partnership Business Tel ya\ 63`% Lyt LA I Fax: El Firm/Company -..r t Name of Licensed Plumber: t �C%%- Ick ���c�ngnn INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ® No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 Aaent 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 nnowiedge and that an piumomg work and mstauations 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. rN By Type of License: Title ® Plumber Signature o Licensed Plumber City/Town ® Master ,I 1 � �, APPROVED OFFICE USE ONLY []journeyman License Number: ��~ Im 93. uj co LU 4A r/I LIJ CL rA CA rp- ��~ Date ... ...... or `0 TOWN OF NORTH ANDOVER M • X PERMIT FOR GAS INSTALLATION This certifies that ............. has permission for gas installation lu ff ................... in the buildings of A ............................. at ......... North Andover, Mass. Fee. ..... Lic. No.. t . / INSPECTOR Check # )7f-% Ti 8- 5 MASSACHUSETTS UNIFOR1(1 APPLICATION FOR PERMIT TO DO GAS FITTING AA ll / city/Town �i o1r' �1Y� tle0 QY MA. Date: ? \a Permit# Building Location:Owners Name�V�,T4�r1 Type of Occupancy: Commercial ❑ Educational ❑ In ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No Q� N'cb'nq. * A �c ? 'Z '4 `+" SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5Tff FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name �++������ t �� Corporation Address , +c�n(a`�ct � City/Town:J� ��? a an State ❑Partnership Business Tel: 1-W rolls I-kctl`_11 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE GUVhKA(jt: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes :C No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 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 thisCheck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A ent By checking this box ; 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. By Title City/Town aPPPOVFo (OFFICE USE ONL Type of License: ® Plumber ❑ Gas Fitter Signature ollicensed Plumber/Gas Fitter Master Np� ourneyman License Number: 1�2� ❑ LP Installer mom mom i���������������a��u���mom ON iM MINN mom=== �®a�����NNOWN mm ===Mom=== O5�����mmmommm-momm�� NONIMMOMMMOOMMIMMOMM 0000MM MWOMMM Installing Company Name �++������ t �� Corporation Address , +c�n(a`�ct � City/Town:J� ��? a an State ❑Partnership Business Tel: 1-W rolls I-kctl`_11 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE GUVhKA(jt: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes :C No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 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 thisCheck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A ent By checking this box ; 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. By Title City/Town aPPPOVFo (OFFICE USE ONL Type of License: ® Plumber ❑ Gas Fitter Signature ollicensed Plumber/Gas Fitter Master Np� ourneyman License Number: 1�2� ❑ LP Installer a o z 0 U k. W fS, O � w Wti CL V C 0 a at a o rAz k. O � w W o A 0 W at F F' _U w p a W i a O 0 va w 3 Eu W F C7 Q F z w a o. 69 Q a o rAz w a F a w va Eu F z w o. uj a ' [i Q U a a w U F Location 3,38 No. Date - d �- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ swCHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # 15442 V Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissionerfl for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: `�/ Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rcquired Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zane Infotn ation: Public ❑ Private ❑ Zane Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ,jc�zA •� �:a nc�� S z � :� Name (Print) Address for Service rO P (9 U—,A 9-2 fi%-1 �I c� G' Q lq ,-, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: `r Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone • z M O ic r 1,1 r z 0 r SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 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. affidavit Attached Yes .......❑ No ....... ❑ -Signed SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Er Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: T •ea r' D F F_ Sja: J t �a_ lei cc v C Lc *rq ` o P e p IctG1p i J i� f" e �J CC eh " 'rCr , 4dy ,S cavi d 562'Je5 3 7C SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit applicant ��CJoU Tri I / apc� OFFICIALXxISE (a) Building Permit Fee Multiplier ONLY u �h 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) �- V' ` 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 BUII.DING PERMIT I, U Z G ip% / le_ 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 I, �5y Ll%C "n e. rte 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 C I` Print Name Signature ofOwner/A ent Z/ Date INN NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TUVIBERS 1 ST ND 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D. Robert Nicefta f3uliding Commissioner. (978) 688-9545 .1_-e978) 688-9542 Fax Town of North Andover .Building Department 27 Charles -Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION Number ".HOMEOWNER Name PRESENT MAILING ADDRESS -4) City Town Address Home Phone I Map7jot 3;W -Phone i RUQ Zip Code The current. exemption for "homeowners" was Wended to include owner-cccupied,-dwellings of two units or: less, and to allow such homeowners to engage an indMduaIii*hire whoAoes. not possess a license,. provided that the owner acts as supervisor. -(state-BUldng Code Section 108.3.5.1) DEFINITION OF HOMEWOWNEPZ Person(s). who owns a parcel of land on which he/she resides or intends. to reside, on which there is, or it intended to be, a one or two family dwelling, attached or a etached structuresac- cessory to such use and/or farm strictures_ A person who consmxft Mot* than one e 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 code!§, by-laws, rules and regulations. The u - ndersigned 'homeowner' certifies that heishe understands the Town of No. Andover f a Building Department minimurninspection procedures and requirements and that hefshe will comply with said procedures and requirements, HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL North Andover Building Department Tel: 978-688-954; 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: (Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from tl?e Town of North Andover must be obtained for this project through the Office of the Building Inspector 6 z 1 0� 1 2 V O 0 U) Lu - U) W W w LLJ U) c c a m c O t5C a �c a . O N : C A V V ; dA ea m C o m as H E A vEQ -C 2 u >)' chi t Pw CIO G o c w° opo C2 v U w C. Ta w 0-4 W °�° � c� w ,n V °�° d m w w w� o cn u 'o V) 1 2 V O 0 U) Lu - U) W W w LLJ U) c c m c O t5C �c . O N : C A V V ; dA ea m C o m as H E : •- Cc, • o u ccm CD O y H � •(A C=M(X. m 1 y CcC Ce soo e'o y m � , rc Cf CIO N C) Z p CM C O s ¢ H C OCOOD CC O H O p F- Gi LZ •+ H m •,. _ .y Z " c a (CDJ ca Z CD LD m c m c_ . g coo CL O O -0 O sam s 1 2 V O 0 U) Lu - U) W W w LLJ U)