HomeMy WebLinkAboutMiscellaneous - 38 SAUNDERS STREET 4/30/2018co
Date. 7�,/,q�.'.........
"OR
OfTM 1M1'
` TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . I1.6? H f� `: ,/"'< < `.
has permission for gas installation '........
in the buildings of . V. / f-- .............................
at. 3. �...?�� ...� Y.�:.................. North Andover, Mass.
Fee. . . ' .. Lic. No./ P. 2 A f ... .....:-...�., �--..... .
AAS INSPECTOR ",
Check # q (-? Y
J 53
MASSACHUSETTS UNUMMAPPUCATONFORPERNMODO GAS FfrnNG
(Type or print)
NORTH AND,
Building Locations
v� J_er1f
Date g �� wo,
Permit # J L J (
Amount $
Owner's Name
New ❑ Renovation ❑ Replacement Plans Submitted
(Print or type)
Name
Address
Name of Licensed Plumber or Gas Fitter
Check o : Certificate Installing Company
ra
Partner.
FlFirm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance poli r it's substantial equivalent. Yes No[]
If you have checked yes, please in�ate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D 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:
Signature of Owner or Owner's Agent Owner
1 hereby certify that all of the details and intormatton i have subrruttea (or enterea) to aoove appncanon are true ana 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 Massachu)etts State GayCodeyd apter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
gnature of Licensed Plumber Or Gas Fitter
Plumber
Gas
H --;
fitter License -Number
er
aster
❑ Journeyman
Date ./M 9 . �. ' .
"pRTM TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
i Y
,SSACMUS�
This certifies that i ...........
.
�� ��
has permission to perform ... .. ........................ .
plumbing in the buildings of .. f.,04.x. (° 4r ..................
at... ...�?.......................... . North Andover, Mass.
Fee. �' ?^ .... Lic. No../.��.�. j.` . .........
:..':. .......
PLUMBING INSPECTOR
Check #
6631
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU'
(Type or print)
NORTH ANDOVER,
Building Location
of
New 0 Renovation Replacement
► 1i 1;
V Date
'eel Permit #
Amounts-;
Plans Submitted Yes ❑ No ❑
(Print or type)
Installing Company Name
Address
it 4-4 f Alecw'
Chertificate
orp.
0 Partner.
0 Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the t of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
threeinsurance
signature Owner Agent El
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 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 Plumbing Code and Chapter 142 of the General Laws.
By: signature of acenseaum er
Type of Plumbing License
Title
City/Town MUM NumDer Master Journeyman ❑
APPROVED (OFFICE USE ONLY
Location i, -5fe ?A U'Ut-4' rel S
No. S03 Date / -
,.oR,h
TOWN OF NORTH ANDOVER
`, `•O .',hoop
F?O•
i •
Certificate Occupancy
• ; ,
of
$
<�
s+HusE
c
Buildin /Frame Permit Fee
9
$
Foundation Permit Fee
$
•�
Other Permit Fee
$
TOTAL
$
Check # �� 3
i
l �; 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: .7
C
SIGNATURE:
Building Commissioner/Ingwor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number � 1 Number
1.3 Zoning Information:
Zoning Dia6c—t Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide R red Provided
Re red Provided
1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Infomution:
Public ❑ Private IF Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
aur TAI o R ek-t)
Name (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:
Licens nstruction Supervisor:
hkq�j
Address (�
I-Vnature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
T
M
X
Z
O
d
v
m
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.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work checkA applicable)
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
deck tMS ami/ wo'Ad ul S d c�S'�i12� nDCG�
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost (Dollar) to be
OFFICIAL USE E` NLY
Completed by permit applicant
1. Building(a)
Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
7
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
Hereby authorize
My behalf. in all
Signature of 0
SECTION 7b
),
act on
re'p;ve tw work authorized by this building permit application.
kA, , /l Swe - -2rL
Date
AUTHORIZED AGENT DECLARATION
subject property
I, 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
of Owner/Anent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR THVMERS I ST2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DM ENSIONS OF POSTS
DM ENSIONS 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
C)� � PWpI"(k C ( ") tig 7gc�_, +-
S i -at N s � .• LY
FORM - U - LOT RELEASE FORMbn� 2�n.a�ti
9 -1100
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
APPLICANT �2 u TA 10 Y , P ___JHONE
Gy
ASSESSORS MAP NUMBER 0 I LOT NUMBER
SUBDIVISION LOT NUMBER
STREET STREET NUMBER 3
OFFICIAL USE ONLY
...........................................................................
RECOMMENDATIONS OF TOWN AGENTS
DATE APPROVED- -1,
CONStRVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
�7 �/"-u � � v �! (, ( 6L—,
CON84ENTS
RECEIVED BY BUILDING INSPECTOR DATE _
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CONMIENTS
DATE APPROVED
FOOD INSPECTOR - HEALTH
DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CON84ENTS
RECEIVED BY BUILDING INSPECTOR DATE _
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Date...........................
TOWN OF NORTH ANDOVER
°L
0 ' PERMIT FOR WIRING
This certifies that .......
.. ��`'`............................
has permission to perform .... ....... ? `e
wiring in the building of ....... (...............•f ....................................
-u.................. !, North Andover, Mass.
Fee. ... �......... Lic. No f &:1.�J .,C. ......................
�--- ECTRICAL INSPECTOR
Check #
THECOM41ONWE4LTHOFMAS94CHUSETTS Office Use only
DEPARTMMT0FPUXJCS4FM Permit No. q 2a
BOARDOFFREPREVEEMONREGULAHONS527CMRI2.-M
Occupancy & Fees Checked
APPLICA71ONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover
To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street i
Owner or Tenant
Owner's Address
Is this permit in ct ,........ , I-- u , Ullu„1r, Ycrrtrrt.
Purpose of Building
Existing Service /1)j p Utility Authorization No.
� �
zes`J No U
(Check Appropriate Box)
—Fa.4.0 I Volts
Overhead L -j Underground
No. of Meters
New Service Amps
Volts
Overhead Under found
g
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical
Work
U
n `�(J
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
No. of Lighting Fixtures 3
Swimming Pool
Above
Below
Generators
KVA
No. of Receptacle Outlets
No. of Oil Burners
round
round
KVA
Emergency Lighting Battery
Units
No. of Switch Outlets
No. of Gas Burners
No. of Ranges
No. of Air Cond.
Total
LARMS
Tons
No. of Zones
No. of Disposals
No. of Heat
Total
Detection and
No. of Dishwashers
Pum s
Space Area Heating
Tons
ting Devices
�s
EFIRE
Sounding Devices
Self Contained
No. of Dryers
Devices
tion/Sounding DevicesHeating
Municipal
Other
No. of Water Heaters KW
No. of
No. of
Connections
No. Hydro Massage Tubs
Si ns
No. of Motors
Bai]asis
Total HP
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lbawawnentLiQilrtyhRn=pblicymdd gGmvCoWageoritSmbstarri apivalent YES12 NO
'haven>txrmmdvafidproofofsamerotheOlfioe YES 1 ` /1 gyuuhaved YES ind�et rgWofmv�aWby
Igo box L��...•11
NSURANCE BONDED m1ER ED (p SP Y) 4 J lo
VolkbStatt v�nDa�Rec�d
ignedt nder'iePtdofpaW
IRMNAME
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EstimatedVakrofE1cdncalWotk $
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Ieea�ae 1 iii✓►Q.1 LCL r( Signature -7- LkffwNo 3Z6L z
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W1�TFR'S IIVSURANCE W Ah Tel. No. -
ANIIt;IamawarethattheLuisedoesnothave theirmHancecoverageoritssubstantialetL Ydei1aswpiedbyMassachusettsGeneralLam
iddlatmysgnahu m hispmi tVphmhmal tfislt�gtiu t
'lease check one) Owner Agent a
Telephone No. PERMIT FEE $�
Signature ot Owner or Ageni