HomeMy WebLinkAboutMiscellaneous - 38 CHESTNUT COURT 4/30/201876U4 Date. . ThrA ........
r 1-10N, TOWN OF NORTH ANDO ER
.fflw&*A
.111155
PERMIT FOR GAS INSTgLATION
This certifies that .................
has permission for gas installation ... W v :t� � ..............
in the buildings of .. .......................
at A4 North Andover, Mass.
Fee. Lic. No...
G'A'S IN..%!•�lrs. ,:�.. .
Check#
M
CIVIr
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: '"Yl,��dU f 2 MA. Date: Permit#
Building Location: �2 f��.f ,� �// t (ti T Owners Name: 44 ej7o-1,•••-
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential E4—
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [!J— Plans Submitted: Yes ❑ No ❑
CIVIr
INSURANCE COVERAGE:
I have a current liability,insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Fej No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 21— 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
Signature of Owner or Owner's Agent Owner ❑ Agent E]
By checking this box ❑; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
v Illy fV lvVVIVUUV drlu LFId[ au pmmomg wore ana Installations performed under the permit issued for this application will be in
--•••I•••'••"" ^•`•• ... • �•��•••���� r�v��A�V �� VI LI IV IVIOA*dGl I UbtMb OLdLB rlumoing Voae ana t;napter 942 of the General Laws
By Type of License:
❑ Plumber J." "4 ef
Title ❑ Gas Fitter St ature of Lice ed Plumber Gas Fitter z
❑ Master
City/Town ❑Journeyman License Number:
APPROVED OFFICE USE ONLY El LP Installer
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Installing Company Name:
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Check One Only Certificate #
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Name of Licensed Plumber /Gas Fitter:
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INSURANCE COVERAGE:
I have a current liability,insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Fej No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 21— 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
Signature of Owner or Owner's Agent Owner ❑ Agent E]
By checking this box ❑; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
v Illy fV lvVVIVUUV drlu LFId[ au pmmomg wore ana Installations performed under the permit issued for this application will be in
--•••I•••'••"" ^•`•• ... • �•��•••���� r�v��A�V �� VI LI IV IVIOA*dGl I UbtMb OLdLB rlumoing Voae ana t;napter 942 of the General Laws
By Type of License:
❑ Plumber J." "4 ef
Title ❑ Gas Fitter St ature of Lice ed Plumber Gas Fitter z
❑ Master
City/Town ❑Journeyman License Number:
APPROVED OFFICE USE ONLY El LP Installer
Date. /. /3;/ .0 - � ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
' 2 y
This certifies that ......
has permission for gas installation ....
in the buildings of 0 0.1
.............................
at ...... North Andover, Mass.
Fee. rP.CJ77� Lic. No. . . 7,77). 3.
GAS INSPECTOR X
Check# U J
5283
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
(Type or print) i
Date
NORTH ANDOVER, MASSACHUSETTS ,
Building Locations 3=
Owner's Name
New D Renovation Replacement IT
Permit # 3
Amount $ L�
(r -,-
Plans Submitted
(Print or type)` Check one: Certificate Installing Company
Name �Z �f s,A(��tLrz. e �Y�
Corp.
Address �� �' �/T
El
Partner.
Business Telephone 131irm/Co.
Name of Licensed Plumber'or Gas Fitter lf� I b,
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes 1" NoO
If you have checked yes, please indicate the type coverage by checking the appropriate box,
Liability insurance policy 131*� 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 1:3 Agent13
I herehv rPrfiAi *h.+ X11 . F+t. A :I _J :_r_W -- '
____ ___ _.... _ ..,,,,,,,,,,,,,,u "" , „UVF „,VIII ,«CV kur emerea) In aoove application are true and accurate to the
best of my knowledge and that all plumbing work and insta11 t' ns performed under Perini Issued for this application will be in
compliance with all pertinent provisions of the Massachus tat asC de jd Chapt 142 of th eneral Laws.
!��
By:
Title
City/Town,
APPROVED (OFFICE USE ONLY)
6 -
Signature of Licensed Plumber Or Gas Fitter
Plumber
❑ Gas Fitter ricense Mumoer
Master
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SU B-BASEM ENT
BASEM ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)` Check one: Certificate Installing Company
Name �Z �f s,A(��tLrz. e �Y�
Corp.
Address �� �' �/T
El
Partner.
Business Telephone 131irm/Co.
Name of Licensed Plumber'or Gas Fitter lf� I b,
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes 1" NoO
If you have checked yes, please indicate the type coverage by checking the appropriate box,
Liability insurance policy 131*� 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 1:3 Agent13
I herehv rPrfiAi *h.+ X11 . F+t. A :I _J :_r_W -- '
____ ___ _.... _ ..,,,,,,,,,,,,,,u "" , „UVF „,VIII ,«CV kur emerea) In aoove application are true and accurate to the
best of my knowledge and that all plumbing work and insta11 t' ns performed under Perini Issued for this application will be in
compliance with all pertinent provisions of the Massachus tat asC de jd Chapt 142 of th eneral Laws.
!��
By:
Title
City/Town,
APPROVED (OFFICE USE ONLY)
6 -
Signature of Licensed Plumber Or Gas Fitter
Plumber
❑ Gas Fitter ricense Mumoer
Master
0 Joumeyman
'e� O
TOW OF
p
PERMI FOR
Date ........
NORTH ANDOVER
GAS INSTALLATION
This certifies that ...P,1 ............
has permission for gas installation ,.............
in the buildings of ............................
at ... .6............i North Andover, Mass.
Fee. .7.. Lic. No..7 `.) ... .....t,, .. U -^t1, ......
6AS INSPECTOR 1
Check #
55511
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO
(Print or Type)
r-
DO GASFITTING
W k T H A N OV C e— _.Mass. Date_446_ Permit #_�_
Building Location38 CiCSTOI)lX CT Owner's Name C ) P-0 56r,LIJ
)Type of Occupancy k SI Dt N 7IAlL
New ❑ Renovation ❑ Replacement �] Plans Submitted: Yes❑ No ❑
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET U Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone 9 7 S- 6 8,7-"l 10 5 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have aYceusrenntt liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy K Other type of indemnity O Bond O
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❑ Agent O
I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accupte to the best of my
knowledge and that all plumbing work and installations performed under the permit *ZZ=1
pliance with all
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GeT e of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter
Master License Number _374-5
City/Town PJourneyman
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Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET U Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone 9 7 S- 6 8,7-"l 10 5 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have aYceusrenntt liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy K Other type of indemnity O Bond O
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❑ Agent O
I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accupte to the best of my
knowledge and that all plumbing work and installations performed under the permit *ZZ=1
pliance with all
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GeT e of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter
Master License Number _374-5
City/Town PJourneyman
AP PPOVIEff O C—F9S—F--0—NTW—
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Location `,�� r� r�`'`""�'� `�
* No. U Date
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TOWN OF NORTH ANDOVER
3 .,
a
Certificate of Occupancy $
CNUS
C Et� Building/Frame Permit Fee $
�
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
'18633
$ f1
�� Building Inspecfc(r
i/
APPLICATION TO CON!
BUILDING PERMIT
SIGNATURE:
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
,TRUCP REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY I
oulltun t-oMMlSStoner/1 ctor of B
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.3 Zoning Wormatiou:
Zoning District Proposed Use
1.6 WELDING SETBACKS ft
Front Yard Side Y;
Required Provide Rerntired
TE ISSUED:
Igs Date
1.2 Assessors Map and Parcel
6 616
Map Number
1.4 Property Dimensions:
Area (st) Fr(
l
Provided Keaton
00sq
Parcel Number
Rear Yard
Provided
1.7 Water Supply M.G.L.C.40. $ 34 1.3. Flood Zone Information:aG ISP
1.8 Sewerage oral System:
Public 0 Private ❑ ZOIIe Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
ea sa,�,son OU UVIJ�n-AAJ
Name (Print) Address for Service
_� Z3 A00, figZ)o V`��
Signature Telephone
2.2 Owner of Record:
a
Name Print Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
Address
Signature
3.2 Registered Home Improvement Contractor
Company Name
Address
cam. , o--
Telephone
- L p.3 -9
License Number
Expiration Date
Not Applicable ❑
Registration Number
Expiration Date
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SECTION 4 - WORKERS COMPENSATION (MG.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.
Signed affidavit Attached Yes .......❑ No ....... ❑
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:
Vinvi �s l(AIYA
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
Is 880
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee.(e) X (b)
/ d
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 matters relative to work authorized by this building permit application. /
17_ 1 (,p los
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, 124 v 1 S YX e Lv A2 E 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, s
Prim an Y r — --11r
/-�' A
Si atire of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRVIBERS Isr2 No3 RD
SPAN
Dl v1ENSIONS 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
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Board of Building Regulations and Standards
mom
` HOME IMPROVEMENT CONTRACTOR
` Registration: 104569
Expirai%on 7114/2006
Type Private Corporation j
DAVID CASTRICONE ROOFING,!SIDING &
David Castricone
7 Hillside Road.. r. —i✓
Boxford, MA 01921 Administrator
i
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
at: 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.
Also,.note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
V4. � . 4&0-, ill — — LL a,r,J <,,- l rir_. , <c-nlern . 6NJR
Fire Department Sign off:
Dumpster Permit
(Location of Facility)
Signature of Permit Applicant
Z'2 -Z6 /A
Date
DAVID CASTRICONE
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845
7 HILLSIDE ROAD, BOXFORD, MA 01921
In North Andover 978-683-3420 In Boxford 978-887-6147
In Haverhill 978-374-7314
I/we the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on premises b\elow escribed-,)
Owner's Name..... 1 �1 u.. ........ ....................... Telephone #.....6.. 16........ .. .. .:1�......
Job Address............ %. ;. ......CV0.................. City...... .4 .......... State......�14 ........
Specifications:
....u..�..x..
,.
........................................................................... ............... ,
VApply vinyl siding and corners. Type:
.r4� ..-.�—�.:1
Cover fascia boards and rake boards. LksF ll vinyl soffit - soli orate „'z. d' ! l G c,.....................
K �� _
........................................................................................................................-.-_.........:�............................................................ .
,,,Cover wood casings around windows. /place any gable vents and dryer vents with vinyl.
..........................................
Areas to be
covered:........... ....5.i.. ..1.. ........eL .......... ..... 0..t�.t ..y:. -.r................................................................
.�....�.. n. ��., ....... r..�. ,�................... .............. �.:�.�.1. -..� ......
l
..
............ .�.3.+t,.. .:..�=;i. e...........y!ja... ............. .Q;�..� .....
..ii.S..tZ,.,c......(�.. .......... �,.Si�.............. .............. .............. ............................
..... . . . . % . ..... .. ..
.r2.. x..4,4.. j ...... �.,;7.. ....... ...... d! _:. ............
:... -3 .....: 4N.,1V ........ PT .. ....... G. ...... I. ..,.... ......
......................................................................................................................................................................................................................
One Year Workmanship Warranty (Not Transferable)
Manufacturer's Warranty as specified b manufacturer
Materials and Labor to cost $..../..g...7.0............ Payable.....0...... on .....� ....
. .......
Payable ............................. on .................................. Balance payable on completion of job
Owner or Owners are not responsible for Property Damage or Liability while job is in operation.
Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or
conditions resulting from application of materials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic or other living
spaces, water stains when roofing shingles have not had adequate time to cure).
Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation as requested
by contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It
is agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid,
that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.
It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates.
The undersigned warrant(s) that he is (they are) the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) names(s).
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is the contract
dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all
parties.
All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place
Room 1301, Boston, MA 02108 Tel: 617-727-8598
Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner who secures his own construction -related permit or deals with
unregistered contractors shall be excluded from access to the Guarantee Fund.
Approximate starting date of work..................................................................... Completion date ..............................................................
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing
provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be
binding upon the parties and that all of the agreements and understandings of said parties are contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Owner has three business days to cancel this contract and incur no penalty.
IN WITNESS WHEREOF, the parties have hereunto signed their names this .......... day of .. a G.�-c .fi., 20....r??
Accepted:
dtcPer........ ... a.4,...... � . hd..�ri?Y.hrC✓
Representative
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Signed......................................................................................... Owner