HomeMy WebLinkAboutMiscellaneous - 357 RALEIGH TAVERN LANE 4/30/2018NORTH
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"�11 ,SSACMUSE�
TOWN OF NOR
PERMIT FOR
Date .% V.- ....
DOVER
MBING
This certifies that ......................
has permission to perform ..H L`. ...........................
plumbing in the buildings of ..� /? �.�^.'. `".................... .
at.. 3 .. r. ` .�.. <iS? �.��' �...� , North Andover, Mass.
Fee. 3U:.... Lic. No./ 3 A— C... .......L1...�-
iPLUMBING INSPECTOR
Check # 2 V y
7200
'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO' DO PLUMBING
(Print or Type) i
f N6 r¢ k A►1 A O Ie� F . Mass. Date 19 -c)b Permit # Z -cc) c)
9 f ".
_
Building Locatlon�� °( fr r 6 %� Owners Name CGI p—t P �ra
�c1 l a In /—A Type of Occupancy
by
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
ioa
FIXTURES
Installing Company Name x-17 )Af,,Q'S PL 6 .fi 416 L_L-C,
Check one:. Certificate
�. Corporatbon
❑ Partnership
❑ hrm/Co.
Name of Licensed Plumber ADD,4 r i D
INSURANCE COVERAGE:
I have aYes
cu ent . biiity insua
a No ❑ nee policy or Its substantial equivalent which meets the requirements of MGL Ch. 142:
If you have checked YL, please indicate the type coverage by checking the appropriate box.
A liability insurance policy .e! 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 Mass. General Laws. and that my signature on this permit application waives this requirement
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are We and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issaed f this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the Laws
By.
Signature of Lcensed Y
rue
Type of License: Master Journeyman ❑
City/Town /� "
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1ST FLOOR
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3RD FLOOR
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4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name x-17 )Af,,Q'S PL 6 .fi 416 L_L-C,
Check one:. Certificate
�. Corporatbon
❑ Partnership
❑ hrm/Co.
Name of Licensed Plumber ADD,4 r i D
INSURANCE COVERAGE:
I have aYes
cu ent . biiity insua
a No ❑ nee policy or Its substantial equivalent which meets the requirements of MGL Ch. 142:
If you have checked YL, please indicate the type coverage by checking the appropriate box.
A liability insurance policy .e! 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 Mass. General Laws. and that my signature on this permit application waives this requirement
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are We and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issaed f this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the Laws
By.
Signature of Lcensed Y
rue
Type of License: Master Journeyman ❑
City/Town /� "
(O NL tkense Number � � U
1
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Location
No. Date
TOWN OF NORTH ANDOVER
„ Certificate of, Occupancy $
` Building/Frame Permit Fee $
A=>• .
s t
'4cnuh Foundation Permit Fee $
ss s
s7,�-„� ermit Fee $_
i U' Sewer Connection Fee $
Water Connection Fee $
0
TOTAL $ A
i 10043
Building Inspector
0
Div. Public Works
PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP d40.
LOT NO.
2 RECORD OF OWNERSHIP (DATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
�-
LOCATION
IC/`OVL�.j/�
PURPOSE OF BUILDING
OWNER'S NAME �UL .� TO�,S
NO. OF STORIES SIZE
OWNER'S ADDRESS /7
O
`7 ��V��G•�
A�Ddl � ve,
/r CF 6-/'l�"
?
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'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
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION We JI>
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
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 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
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
3
SIGNATURE OF OWNER OR AUTHORIZED AGENT
FEE
PERMIT GRANTED
..► -
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BUILDING INGPKCTOR
OWNER TEL. #
CONTR. TEL. #
CONTR. LIC. #
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
—I
8 INTERIOR FINISH
CONCRETE
PINE
3
1
2 13
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
1/1 1/1 1/1
FIN. ATTIC AREA
_
NO BMT
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I
9 FLOORS
CLAPBOARDS
B
1
2
3
_
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARD114'D
COMMON
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MA N Y
BRICK ON FRAME
ATTIC STRS. & FLOOR _
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I_j POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I
HIP
BATH 13 FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
_
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
i l 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 _
to 13rd
ELECTRIC
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.
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