HomeMy WebLinkAboutMiscellaneous - 34 GLENWOOD STREET 4/30/2018N
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..... ....... `.. ........ .
has permission for gas installation _ ...............
in the buildings of . `.�: '..�....
at ..: �.`%....-: ...... .:....., North Andover, Mass.
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5646
MASSACHUSErIS UNUDRM APPLICATON FOR PERM TO DO GAS FnTNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
I.
Owner's Name
New a Renovation ❑ Replacement I
Date 7—e� Qlp
Permit #
Amount $
Plans Submitted
(Print or type) - Check one: Certificate Installing Company
Name _l�i��/�.1� C/�(7.o�P7— ❑ Corp.
11 Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter nlj,rj',q
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ®� No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 1:1 Bond 13
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 13
I h—k o.r'f— rh..r ,.11 ,.f .L. ,. a., .1_ —
__..._I ... .. , ... ,... ,.— ,,,—... QL,V„ j „QVU bUU,111ueu kur emere(l) in aoove application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theme General Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
lumber L"r8 9
Gas Fitter License IN um er
Master
M,-J6rneyman
Eli
6TH. FLOOR
7TH. FL414111
(Print or type) - Check one: Certificate Installing Company
Name _l�i��/�.1� C/�(7.o�P7— ❑ Corp.
11 Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter nlj,rj',q
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ®� No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 1:1 Bond 13
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 13
I h—k o.r'f— rh..r ,.11 ,.f .L. ,. a., .1_ —
__..._I ... .. , ... ,... ,.— ,,,—... QL,V„ j „QVU bUU,111ueu kur emere(l) in aoove application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theme General Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
lumber L"r8 9
Gas Fitter License IN um er
Master
M,-J6rneyman
• Location
No. Date
TOWN OF NORTH ANDOVER
'a.
Certificate of Occupancy $
��b'•^°''<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # J^/w�
Building Inspe&for
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 Co missioner/I or of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
34- C-G�,c, waao s%`-
1.2 Assessors Map and Parcel Number:
6 -4�)
Map Number Parcel Number
)y O ( /1"iy�0���
1.3 Zoning Information:
Zoning Distrid 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) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
115tU 1C IS nct QS 0
2.1 Owner of Record
L e (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
' 3.1 Licensed Construction Supervisor:
%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
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SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 6 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.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
x
6i u nab cotes oS'�T�� 2 x
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIA USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
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 BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf in all malts relative to work authorized by this building permit application.
Si afore of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, ,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
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS IST 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS 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
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 MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facility)
11
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used. to verify that ani necessary approval / permits from
Boards and Departments having jurisdictionhave been obtained. This does not relieve the
applicant and or landowner from compliance with any applicablerequiements.
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APPLICANT ✓01�4) PHONE 97p� �D 7 7¢20
ASSESSORS MAP NUMBER LOT NUMBER
SUBDIVISION
�� /�2 Zy GUS% ��F� LOT NUMBER OD 6 d
rSTREET (SLE > STREET NUMBER 3�
OFFICIAL USE ONLY
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RECO ATIONS OF TOWN AGENTS
$...■ Name,
a.a■a.....■a.■..■a.a'no a.woman aaaf.women .as was a a a■a■■aa.'...aa....�
I
` DATE APPROVED �
CO SERVATION AD TRATO
DATE REJECTED
COARVIENTS
TOWN PLANNER DATE APPROVED
CONUVIENTS
FOOD INSPECTOR - HEALTH
SEPTIC INSPECTOR - HEALTH
COMMENTS
PUBLIC WORDS — SEWER / WATER CONNECTIONS
DRNEWAY PER1trI1T
FIRE DEPARTMENT
COMMENTS
RECEIVED BY BUILDING INSPECTOR
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
It
s
Town of North Andover
Building Department
p
27 Charles Street
a °
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542. Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DAf E
JOB LOCATION 34- (�T C• e Q0 S`f ` M* FCp PgA 49
Number Street Address Map / lot
"HOMEOWNER t/ohj (�/p'U�'E l��f�tJl 970-' 637 74- a& X477
Name Home Phone Work Phone
PRESENT MAILING ADDRESS ✓4 ��Gri(.i wa0��
/t/o • /T,Ut� v�� ,O�i� /� l '45,
City Town State Zip Code
The current exemption for "homedwners" was extended to include owner -occupied dwellings
of two units or less and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)
DEFINITION OF 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 one or two family dwelling, attached or detached structures ac-
cessory 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.
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 No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S
APPROVAL OF BUILDING OFFI
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1 - Lam- l.►�'' .
TOWN OF NORTH AN
PERMIT FOR PLUM
This certifies that ..,, ' ......
has permission to perform ..
r
plumbing in the buildings of ...:.. ......................
di
at.,t- • • • • , North Andover, Mass.
Fee.!L(� .... Lic. NoJ �J.�. �•; -�-!� ........ .
PLUMBIOG'NSPECTOR
Check
I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
New ri Renovation
Date
Owners Name 11l7d1�% �/�(f����-�J// Permit #
of Occupancy Amount
Replacement
FIYTtTDVC
Plans Submitted Yes 1:1 No ❑
(Print or type) i
Check one:
Installing Company Name _` eh/ ��,1, �P�� �� � Certificate
Corp.
Address S/ ❑Partner.
Business TelepKone Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy r Other type of indemnity ❑ Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application (toes not have any one of the above
three insurance
Signature Owner ❑ Agent ❑
I hereby certify that all of the details and information 1 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 for this application will be in
compliance with all pertinent provisions of the Mass. isetts St e lu in C Ch r 142 f h
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
_ I `� o t c General Laws.
Type of Plumbing License
icense um er Master ❑ Journeyman F/'