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HomeMy WebLinkAboutMiscellaneous - 36 WEYLAND CIRCLE 4/30/2018� 3 y N Date ..... /)..o***/****�".5 . . ............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION kf ;This - certifies that .......................................... .. ....... .......................................................... has permission for gas.1 ation ...... .... ..... ................................... 1 in the buildings of ....... 7. ....... c ....... ........................... .............. . North Andover, Mass. Tee. ............... Lica No. ..... ..................................................................... GASINSPECTOR Check:# 102. GOWNER TYPE OR PRINT. CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: k)orttn 4060cJ'Pr MA. DATE: '4 \5 PERMIT# b� JOBSITE ADDRESS: `3lv OWNER'S NAME: �a �;� LCL NtA 3L AI DRESS:',I1p Lk).Q ab a G '� T CNA2., TEL: (,oQ51 & 91S!j FAX: .00CUPANCY TYPE: COMMERCIAL [:3 EDUCATIONAL El RESIDENTIAL I PLANS SUBMITTED: YES ❑ NO NEW: ❑ RENOVATION: ❑ REPLACEMENT:K JocL u,n��t C APPLIANCESI FLOOR- Bsmt 1 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER BOOSTER CONVERSION BURNER C , OK STOVE DIRECT VENT HEATER , DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER IN COVERAGE �,/' 1 ha re a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 11 N0 ❑. If you have checked YES please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY %[ OTHER TYPE 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: OWNEff V9 ❑ nlrn nn wnr�IT V JIIiIVH1 UKC Vr VVYIVCI[ vrt r,vr_iv 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: MQ'r_V\_ 0 no LICENSE # 11555_ SIGNATLTRE COMPANY NAME : M l a a � t m BSS: tYYiY\QSS ADDRE CITY: a 31.E STATE: N� ZIP: Q\ FAX: TEL: 9Ac $316 ?-LRS CELL: cid - $3l0 - MI 3 EMAIL: VIA STERQ�JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATIONEU- 32 a -6- PARTNERSHIP ❑ # LLC ❑# X4 `L, N Workers' Compensation Insurance Name (Business/Organization/Individual): Address: . i + OA- At 5 i 't Acl 1 A,ree you an employer? Check the appropriate box: 1. L(1 am a employer with -3 4• ❑ I am employees (full and/or part-time).* have 2. ❑ I am a sole proprietor or partner- lid' ship and have no employees Thes working for .me in any capacity. emp: [No workers' comp. insurance com: 5. ❑ We : required.] 3.0 I am a homeowner doing all work offs myself. [No workers' comp. right insurance required.] t c. I f If 9, Industrial Accidents of Investigations ass Street, Suite 100 , MA 02114-2017 Builders/Contractors/E.lectricians/Plumbers Phone #: /— C77? k--�'-s G� Z 15 -3 . general contractor and I tired the sub -contractors on the attached sheet. sub -contractors have yees and have workers' insurance.* e a corporation and its rs have exercised their )f exemption per MGL , 61(4), and we have no ,yetis. [No workers' insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit s affidavit indicating they are doing all tiwork and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide tlieir workers' comp. policy number. I am an employer that is providing workers' torr, information. jj Insurance Company Name: klot, T kycj, Policy # or Self -ins. Lic. #: Job Site Address: -AX,, W -P j \.0.XA ( ' Attach a copy of the workers' compensation policy c Failure to secure coverage as required under Section 25 fine up to $1,500.00 and/or one-year imprisonment, as of up to $250.00 a day against the violator. Be advised Investigations of the DIA for insurance coverage verifi I do hereby certifv under the Pains and F:3 4!�— Zf 5 Official use only. Do not write in this area, to be City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. b. Other insurance for my employees Below is the policy and job site >6 Expiration Date: d y 40 City/State/Zip:.. A.pt_i0UjF9_ A/4 Jaration page (showing the policy number and expiration date). of MGL c. 152 can lead to the imposition of criminal penalties of a 11 as civil penalties in the form of a STOP WORK ORDER and a fine at a copy of this statement may be forwarded to the Office of that the information provided above is true, and correct. by city or town official Permit/License # Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #• ACOROF CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 14-./ r 3/20/2015 M THIS C9RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A Ci NTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER EA Stevens Company, Inc. 389 Main St. P. 0. Box 188 Malden MA 02148 NAMEACT Eva Caperon PHONE (781)322_2324 (JM 0.(781)397-7672 l EMAIL ADDRESS:evac@eastevensins.com INSURERS AFFORDING COVERAGE NAIL a INSURERA-Mart ford Fire Insurance Company 19682 F INSURED MAGNIFICO BROTHERS PLUMBING HEATING & GAS FITTING, LLC. 31 FOREST STREET MIDDLETON MA 01949 INSUREFIIB:Safety Insurance Company 9454 INSURERc:Twin City Fire Insurance Co. 29459 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. RLT R OF INSURANCE L ADDTYPE UBR POLICY NUMBER f POLICY EFF Mw Y EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED PREMISES Ea occurrence $ 300,006 A CLAIMS -MADE ® OCCUR 8SBAUQ5370 !24/2015 /24/2016 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY B PRO LOC $ AUTOMOBILE LIABILITY EOMBBIINdED SINGLE LIMIT 1,000 000 BODILY INJURY (Per person) $ B ANY AUTO BODILY INJURYPer accident) $ ( ALL OWNED rVI SCHEDULED AUTOS AUTOS 5053635 ✓24/2015 x $ NON -OWNED HIRED AUTOS AUTOS [/24/2016 PROPERTY DAMAGE Peracadenl $ Medical payments $ 10,000 X UMBRELLA LIAR 3 OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE J/24/2015 DED I X I RETENTION$ 10, OOC $ DBSBAUQ5370 /24/2016 C WORKERS COMPENSATION% WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETORIPARTNERIEXECUTIVE N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) SNECRJ9050 /24/2015 /24/2016 E.L. DISEASE - EA EMPLOYE $ S00,000 ff yes, describe under E.L: DISEASE - POLICY LIMIT 1 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule; if more space is required) Hartford Fire Insurance Company One Hartford Plaza Hartford, CT 06155 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE,EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACC RDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE Cares, Jr/9C ACORD 25 (2010/05) I ©1988-2010 ACORD CORPORATION. All rights reserved. INW175 /9nlnnsi ni The Arman name and Inn^ are renieiar^A maAre ni aT`nan BOARD OF AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER MARK 8 MAGNIriLQ 31 FOREST ST ril 61)LETox MA 01949-2015 25002 05101 / 16 204668 —20 PLUMBERS AND GASFITTERS ISSUES SHE FOLLOWING LICENSE REGISTERiD AS A PLUMBING CORP MARX MAGNIFICO MAGNIFICO BROS PLB&HGT,GAS FITTI 31 FOREST ST MIDDLETON MA 0 1949-2015 3266 )5/QI/16 204666 iia PNWE.ALTH OF MASSAC n7s BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE. LICENSED AS A MASTER PLUMBER MARK 8 MAGNIFICO J 31 FOREST mw TRE STREET :uj Ml DDLETON IMA 01949-2015 13599 05/01/16 204667 �F . ...... BOARD OF AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER MARK 8 MAGNIriLQ 31 FOREST ST ril 61)LETox MA 01949-2015 25002 05101 / 16 204668 —20 ' 3'744 Date A' . e� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............ has permission to perform ..,................ ..�. ......: ........... plumbing in the /buildings of-' -:� . ............... at. [!`'' .c!;�-. , North Andover, Mass. Fee !�S� ... Li a ?�%%�. .............................. PLUMBING INSPECTOR 06/25/98 14:16 WHITE: Applicant 15.44 PAID CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT ODO PLU BING (Print or, Type) MA Date 19 1& Receipt# Permit# Building Location 36 JA C /and l_-kdPOwner"sName Map: Lot: Zone: Type of Occupancy New 1211- Renovation ❑ Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No Installing Company Name Checkone: Certificate a Address -7 Gc,, r1 �e l T eG- a �a f flUl �i ❑ Corporation EstimateValueof Work: 6 i O ❑ Partnership iTo���� 'o Business Telephone /— �1-Firm /Co. Name of Licensed Plumber or Gas Fitter eR INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yeses No ❑ If you have checked y&s, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner Agent❑ Signature of Owner or Ownees Agent I hereby certify that all of the details and information I have ' ted (or entered) in above ap on are true and accurate to the best of my knowledge and that all plumbing work and installat s perfor d nderthe per it issu or th' application will in compliancewith all pertinent provisions of the Massachusetts State umbing Co d Ch Ater, 42the en al La By Signatuni o Licensed Pluml5er Title Type of License: Master ❑ JoumeymanA City /Town �1 p APPROVED OFFICE USE ONLY License Number .�., Revised 02WJ98 wm� l Z Gf T m O O a m Cl) H z N 1 V C m i t r 0 Z } l Vi ua Nr Z - a r z N i 'C m A O Z N m A N v r c Z > 9 v m m m -Di r n. _ > m m z 0 N c O m O v l Z Gf T m O O a m Cl) H z N 1 V C m i t r 0 Z } l Vi Date.' �� ": ✓ I �. 00'N2 4042 TOWN OF NORTH ANDOVER :a PERMIT FOR PLUMING o SSACHUS� ti This certifies that .. .... ........ �� has permission top erform -� !.: plumbing in the buildings of �!'-', at ... ...... , North Apdover, Mass. ` Fee o�.kh . � Lic. No.�`'? C ... PLUMBING INSPE 05/27/99 11:40 25.E PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer. IF Hr R MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM[31Nr, (Print or Type) t�/ �Q < l /U© 011VX Mass. F ate _ /r! 19 Permit # I" till F j Building Location•�� _ �/e G,9�✓� C/�C Owner's Name -9,e Type of Occupancy QeS1A/t/t!'/ New Renovation ❑ Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No B� STARK & CRONK Installing Company Name 3W MA�t Check one: Certificate GROVEIrq Address Corporation 7dn! ❑ Partnership _ Business Telephone ❑ Name of Licensed Plumber Torr f/ /,'c� a0.3S� INSURANCE COVERAGE: I have a curren ability insurance policy or its substantial equivalent which meets the requirement: of MGL Ch. 142. Yes No rJ If you have checked yes, please i lcate the type coverage by checking the appropriate box. A liability insurance policy t_ Other type of indemnity 1=1 Bond,C7 OWNER'S INSURANCE WAIVER: I am aware Ihat the licensee dues not have the insurance coverage required by Chapter 1.12 of the Maes. General Laws, and that my signature on this permil application waives this requirement. Signalure ,f ()wrier or Owner's Agent I hru•bl ,.•nil, that all o Ihr drlail. and in(nt m.uiun 1 have SO glt,•d 1- t•ntrir 1)is vnr algdii .uinn au• hur .uul acrur,Nr pt III and in�l.ill.ilin•. prr(unnrd under Ihr 1n •nnil i•aut•tl Inv 111i, appli..item will ht• in t nit t' nr r will'all Ir •rlinrnl Imwi••ic Macs: li • - Sit;uatuu• of lit rn.ed I thr — I�In• o(1 itrnse: M."Ierc (nurnryman I 1 Cily/luv... Ii—me Numbrr •\,'PROVED (OFFICE USE ONLY) Check one. Owner ❑ Agent U (Amy kledge and Ih.tt .ill plumhinl; Sutk ; SI -IW I'IumbM9 ( (rile and Chapter 142 of the Z Z oY Z U Y In V H t/l W W H Z IA IL N= t.) tY y Y Z Of: Z y y a F in? G vJ Z o� EL d °� O S ~�0~3sdiy3�dOiz O `X�x`� O u SUB-BSMT. BASEMENT 1 i 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR STARK & CRONK Installing Company Name 3W MA�t Check one: Certificate GROVEIrq Address Corporation 7dn! ❑ Partnership _ Business Telephone ❑ Name of Licensed Plumber Torr f/ /,'c� a0.3S� INSURANCE COVERAGE: I have a curren ability insurance policy or its substantial equivalent which meets the requirement: of MGL Ch. 142. Yes No rJ If you have checked yes, please i lcate the type coverage by checking the appropriate box. A liability insurance policy t_ Other type of indemnity 1=1 Bond,C7 OWNER'S INSURANCE WAIVER: I am aware Ihat the licensee dues not have the insurance coverage required by Chapter 1.12 of the Maes. General Laws, and that my signature on this permil application waives this requirement. Signalure ,f ()wrier or Owner's Agent I hru•bl ,.•nil, that all o Ihr drlail. and in(nt m.uiun 1 have SO glt,•d 1- t•ntrir 1)is vnr algdii .uinn au• hur .uul acrur,Nr pt III and in�l.ill.ilin•. prr(unnrd under Ihr 1n •nnil i•aut•tl Inv 111i, appli..item will ht• in t nit t' nr r will'all Ir •rlinrnl Imwi••ic Macs: li • - Sit;uatuu• of lit rn.ed I thr — I�In• o(1 itrnse: M."Ierc (nurnryman I 1 Cily/luv... Ii—me Numbrr •\,'PROVED (OFFICE USE ONLY) Check one. Owner ❑ Agent U (Amy kledge and Ih.tt .ill plumhinl; Sutk ; SI -IW I'IumbM9 ( (rile and Chapter 142 of the z D r � Z N .9 1^T' Q 0 z N X n n x T O T � � V1 h � W A z Re z D r � Z N .9 1^T' Q 0 z N X n x T O T T ii W A z Re O T W o a m r W v C z 0 COC G O ., z R AV� V z A 3 ., T rm v i>c ¢v °o m W O I � I G n A rn ul N z N rm nT f1 O z � N � i Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... Ile................. ............ .... has permission to perform ..................... plumbing in the buildings of ... ...... .................. at. &.c ........... ...... .. ....... North Andover, Mass. > U1, Liy 3 > Fee ... Lic o.. 233?. # INSPECTOR Check 5671 MASSACHUSETTS UNIFORM APPLICATION (Print or Type) G , Mass., Date(2a 19 r Building 6/1 New ❑ Renovation ❑ FOR'PERMIT TO DO PLUMBING A5,5 2QC Permit # .Owner's Namq'/�U� Type ofOccupant �t5i QE!J it�A(.._ Replacement 2"' Plans Submitted: Yes ❑ No ❑ FIXTURES Installing. Company Name 0 me -i jQ • '5Pfr M A" TA'e 7 Check one: Address _� r"? LO A C 14(rA n) A, A ❑ Corporation lY) E T14 0 �n1, Al A 0 t sVL/ ❑ Partnership Business Telephone (?f Z -1-/9'7 B 9-A'rm /Co. Name of Licensed Plumber 'r5 f;,�3 F;e 7- 5AMd A regeO Certificate IPSURANCE COVERAGE: I have a curreg)i2bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' I% you have checked Yes, please/indicate the type coverage by checking the appropriate box. A liability insurance policy Ad 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 I have submitted (or entered) in above application are true and accurate to the best of my knowiedge and that all plumbing work and installations warformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws. BY vI.v Title SLOatbre of LicensedPlumber Type of License: Master % Journeymab E] City/Town APPROVED OFFICE USE ONLY) License Number 233 1 • Y • • • s • ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ Installing. Company Name 0 me -i jQ • '5Pfr M A" TA'e 7 Check one: Address _� r"? LO A C 14(rA n) A, A ❑ Corporation lY) E T14 0 �n1, Al A 0 t sVL/ ❑ Partnership Business Telephone (?f Z -1-/9'7 B 9-A'rm /Co. Name of Licensed Plumber 'r5 f;,�3 F;e 7- 5AMd A regeO Certificate IPSURANCE COVERAGE: I have a curreg)i2bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' I% you have checked Yes, please/indicate the type coverage by checking the appropriate box. A liability insurance policy Ad 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 I have submitted (or entered) in above application are true and accurate to the best of my knowiedge and that all plumbing work and installations warformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws. BY vI.v Title SLOatbre of LicensedPlumber Type of License: Master % Journeymab E] City/Town APPROVED OFFICE USE ONLY) License Number 233 1 I- z mr O z � O m Z In m In r N fl c -0 Z 2 M C C A � z A =� O v O V r C a IO z N m m I If hpcation 3(0 rio. Date ccr TOWN OF NORTH ANDOVER v' ,sJgCHUSEt a 4 Y Certificate of Occupancy $ Building/Frame Permit Fee $1- Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee w- $ Water Connection Fee $ TOTAL $ ^Tn 8294 �.- Building Inspector Div. Public Works Location Ge - No. eNo. Date � TOWN OF NORTH ANDOVER Certificate of Occupancy $ 5"Z? Building/Frame Permit Fee $- Foundation Permit Fee /$ O4 Other Permit Fee $ Sewer Connection Fee . r Water Connection Fee $ , Z41 TOTAL $ b� "ty' Building Inspector' V- +CU La q s q 2 e� Div. Public Works i' �J J,pcation Q6. Date CL 00* "00 TOWN, OF NORTH ANDOVER "T" U'7 Certificate of Occupancy $ rz Building/Frame Permit Fee $ Foundation Permit Fee $ ga Other Permit Fee Sewer Connection Fee Water Connection Fee TOTAL ti la77, B u i I di Inspector beu06 works i . 4 Location 42, -34—C ? f No. Date _ TOWNIS . , OF NORTH ANDOVER Of MO_.O.RoT, �4._ eE �. $.5 5 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fe $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ Building Inspector Div. Public Works PER%flT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 IAP +40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. (r ` ++ � C' ✓� — LOCATION -i� PURPOSE OF BUILDING s % !/ w OWNER'S NAME �'�'. c.'C�.y,1;� Wd�JLJiJ O OF T IES > SIZE / o J OWINER'S ADDRESS 7^7 J SEMEN OR SLAB J ARCHITECT'S NAME BUILDER'S NAME ® C SIZE OF FLOOR TIMBERS IST n7 ,1/-y 2ND •l l�C V 3RD, /� SPAN 4` DISTANCE TO NEAREST BUILDING O DIMENSIONS OF SILLS -_ x POSTS DISTANCE FROM STREET .� DISTANCE FROM LOT LINES - SIDES REAR a GIRDERS AREA OF LOT /i o c i FRONTAGE /p'� m` , HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW i/��` i SIZE OF FOOTING /' X n I IS BUILDING ADDITION 9 0 A MATERIAL OF CHIMNEY IS BUILDING ALTERATION ,� IS BUILDING ON SOLID OR FILLED LAND �� // Y �,/ !Zp tS' WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER 1/ BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ' IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY REGULATED BY PARA. 114.8-S. B.C. PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 DATE ' FEE PAID 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 .r Y + SIGNATURE OF OWNER OR AUTHORIZED AGENT /% /J 17 F E E , PERMIT GRANTED �//� PERMIT FORFRAM:EIBUILDING L _19a�r • DATE: FEE PAID:._. Rm FmJ1!FmL zscc LESS FDA _:._._..Loo' DUE FRAME PERMIT $' l l"Ki 3 PROPERTY INFORMATION LAND COST - ��y EST. BLDG. COST /- J (d �' v 111> ���� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM -SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. # CONTR. LIC. #. 6 7.f - 3.2- -7 H.I.C. N 83i 1. - � ?.,01.4-, s z�l- 492AO4- - BU.IDING RECORD 1 OCC U PA NCY 12 C SINGLE FAMILY.. S-OkIES - THIS SECTION MUST SHOW E"CTf,DI,M•ENSIOyS OF, LOT AND DISTANCE FROM MULTI: FAMILY OFFICES LOT LINES AND E)(ACT DIM N51Ot4g',OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS R•EPLAC.ES,PLOT_ PLAN,. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH \,, _ CONCRETE I d . 1_ 2 I3 CONCRETE BL'K.PINE BRICK OR STONE HARDW D PIERS PLASTER DRY VJAtL- � _ - UNFIN. , 3 BASEMENT AREA FULL - FIN. BM T AREA _ '/, 1/2 '/+ 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 7 EARTH ASPHALT SIDING HARD"J'D — ASBESTOS SIDING _ COMMON VERT. SIDING _ - ASPH. TILE _ ; • ly ,' 1 `� '•� , STUCCO ON MASONRY ,STUCCO ON FRAME-. BRICK ON MASONRY - ATTIC STRS. & FLOOR BRICK ON FRAME - CONC. OR CINDER.BLK. STONE ON MASONRY WIRING STONE ON FRAME _ -- - - - SUPERIOR II POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 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 •1-1 HEATING i r• f e ''. WOOD JOIST '- PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS.'& COLS: STEAM STEEL BMS. 8&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 ELECTRIC 7,—,L.( 13rd NO HEATING �o 7 - 4,3 zz,o8o s� • =o. so�9 Ae. 04 7-1 OA/, r lo I/ 'r ,�E.PEaY cE,cTiFs- To RL or RL.4/t% T17 THE BR.V.Y TygT ;'11-c- /S LOCATED av TyEGoT.19 .S.SG/ W ANO TiSG4T/T ORES CO,t/Fae1w /N TdwN• OF Alla IVA140ye&- ZON/wa ,-E6lm"Int s iQL�6+I.e0/.tRi SETBAC.CS F•�OA1 STREETS f LOT UHES. 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Z m C n.. � � v 'fl V N V� C.D co CL m Ozip 'O Z eNv cm40 H .0..' CL, 19 E L N H O i N c O W m cm c m L O cm C C N CD t O Z O I t 4 O CIE W L. z O U U) r-� z 0 LL co O � V � � Z ^' C Q H = Qq I � cca o Qco •�ui Q U Ag �E m m z O i ~ w O •�V C co ' 0 cc Q OCa a o � Cc 'a JCD Ct -a. CL c cm Z CD z O Q O C-3 COD C _ CD ND C 3 0 z Z � k � � �� � / � ¢¥ �. - FORM U — IAT RFr:RASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: D x ) 0 8 �,P a p T' GO r 0Phone LOCATION: Assessor's Map Number Parcel Subdivision ®X w 0 0 J Lot(s) x,13 Street ��i/la1'1'/ C1rC/ ::St. Nu:.=er ************************Official Use only*******************W**** RECOMI�NDA I 7NSZI T AGENTS: SDate ADoroved cons er:azion Adrninistramcr Date Rejected Cc=er. cpi rLiLgx Date Approved z37 Town Planner Date Rejec ad Co=_e :s fL� Fccd Sept_c Ir.spec:�o;�r-�-iea_t CO:'r. e::'_= Date Approved Date Re -i ec zed Date Approve• Date Reiec=ed Wcr:;s - sewer/water connections dr_veway per-mit- Fire ermitFire Department Received by Building Inspector Date i [► ,REN H.P. ` d .o...., F Town of - 12oMain sr�i, 01M NELSON • �<.. Dimror - t - -: NORT�I ANDOVER soap ssz-s4ss BUILDING •ti' CONSERVATION DWIS10 sof HEALT LANNH PL:1��lNG PLANNING & COiiLMUNI = DEVELOPMENT CHIMNEY APPLICATION AND PERMIT DATE f a oe �D y LOCATION rd OWNER'S NAME �j.v(61 t' BUILDER'S NAME 1 n� J � MASON'S NAME c4 4L Vl I " lam,C, MASON' S ADDRESS ie -3 MASON'S TELEPHONE 641 ©3 Y MATERIAL OF CHIMNE'_' PERMIT # 3 ....� � INTERIOR CHI 4NEY moi! a �� E:{TERIOR CHIMNEY NUMBER AND SIZE OF FLLTrc THIC_-CIESS OF HEARTH 1, wi _'_ chir.,nev or f_r_c + _ce conf..__.. to require::eis of the code and ha.; v rul es and regulations bee-. received DAZE r=Q/ SIG!'ATURE OF MASON CONTR. LIC. = ®�✓ �� r T CONSTRUCTION COS T ICO..TRAC': PRICE PER' GRAZiF TED �Q 3 kii: /�'1I A � ROBERT NICETTA, INSPECTED REMARKS Sc -T-10 -RTIC{ REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES O'� -- - S� , 10/20113-45 17:13 6172754448 The MZO GROUP DESIGNERS ■ ARCIHITECT:S is PLANNERS IN THE C-%`Ifi/QILEI,�E I-RAI)I'1'I(>N . October 20, 1995 Mr. Dick Tobin Evergreen Management 733 TurrApike Street #311 No. Andover, MA 01845 RE: Lot 43 Foxwood Dear Dick: MZ I GRDJP R g -'n 4 /\pdr'lvv*V Zalen'ski, A',.A. Ninrip.1 John ). Cretan, J, isrin!!pa! 92,14,14. Q'�ulli�an, C.5 1. prin:�ipa! C'.aude H. Mique!;e smivr "dvirp' We have reviewed the spars of the Hirst floor joists for the Cameo, T 3T�e I house which you have built on Lot 43 and altered by pushing the rear wall of the family room out 2'-4", This results in a condition where the allowable span has been exceeded. As a correction to this condition we. require you to install a bearing wall in the basement which would consist of 2x4's G 16" o.c. This wall should be located at the corner of the garage foundation, parallel to the main girt (approximately 4`-6" from the girt) between it and the rear exterior wall. `osis will result in a span of under 15' for the existing 2x10 joists which are at 12" o.c. If you have any questions, ;please call me. Si ,cerely, -_ o No. 500 z r David H. O'Sullivan, CSI � I c : kE MA � f Principal file. foxwoodf/14 92 Montvale Avenue, Suitt 2400 0 Stoneham, Mab6aChusem 02180-3528 0 Voce 61'7^ 279- WiI5 6 Fax 1517.2.79.4448 9 Internet: n xe�tial.net IR- v� M W v w , G W cu .r h�lx � M ILE V �� � o � p T W o a o �, . o u j C c N E c c �' 3 o '� U W j o „ ❑ °�° m o G w z D c o b E w v cu P'� G V) cq co cry cn M r �c I I CO) y .E L co C 0 co C.2 M CO2 0 c� .y C 0 cc a t� CL CIO L c V y J — z 0 C C Q W Oman z �= o J' 13 go 1 V O �P Q m c v Q La. LO d m • C P'� cq � o 2 11G O `gym %/! H r W � : m�W o a Lu N c w .r m c E a :r m a Q1 m N c.mzicc p �- C43 • N O O mm amc C :CooQ � acs mom m V N Z O c Q m m o 0 H p m o.2 F- N m co m W ;''• at . ` O Z °CE WCIA v a rmiad+' o CIOm co CL. a y . y O —cm r �c I I CO) y .E L co C 0 co C.2 M CO2 0 c� .y C 0 cc a t� CL CIO L c V y J — z 0 C C Q W Oman z �= o J' 13 go 1 V O �P Q La. 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