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Home My WebLink AboutMiscellaneous - 39 SARGENT STREET 4/30/20189 A-5 -// Z - Date..................... TOWN OF NORTH ANDOVER A�," r % PERMIT FOR GAS INSTALLATION This certifies that .... lf,-elmg�4 has permission for gas installation ... in the buildings of Sq MQ S'I" at .... N rth A,,Iover, Mass, ojn Fee.. .... Lic. No.. 14?M� . . ...... GAS INSPECTOR Check# Z60 7- 8293 �Ij. F GOWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: /�{QY� ��p%-- MA. DATE: PERMIT # JOBSITE ADDRESS: �n OWNER'S NAME: e— ADDRESS: TEL: FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLACEMENT0 PLANS SUBMITTED: YES ❑ NO!�r APPLIANCES7. FLOOR Bsmt 1 2 3 4 5 g 7 8 9 10 11 —12—F-13 T 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 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 INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YE0<'rNO ❑ 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: OWNER F] AGENT E]SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate t jhe best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be i ith all Pertinent provision of the Massachusetts State P umbing Code and Ch ter 142 of t e General Laws. .07 PLUMBERIGASFITTER VME: dl{' 1' LICENSE #�I SIGNA E COMPANY NAM /L ADDRES7 CITY :STATE: ZIP: FAX: i 7 TEL: CELL: Ao--72 EMAIL: MASTER JOURNEYMAN 0 LP INSTALLER ❑ CORPORATION ❑ = PARTNERSHIP [] # LLC f . '-4 H 0 z z 0 F U W a a Q 0 E a z z o NF -1 W o o W E n- z F- N N W ¢ d W a W x W Q Q O a ¢ N U x 0-1 a �n � w x w U- W F °z 0 H U W a N Q C7 C7 � O a Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... � n, e 4 7. -/ C/4 �/ ...... has permission to perform r plumbing in the buildings of ... C -e ................. at ..... �-T ............ o AndQver, Mass. Fee 441. ��d4 '!�7q Lie. No../P`F`/�. ........ PLUMBING INSPECTOR Check ff z6o -z— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ° POWNER TYPE OR PRINT CLEARLY CITY`f Q0�' _ MA. DATE ) �-- PERMIT # JOBSITE ADDRESS, �ft�ti' OWNER'S NAMEI! L� ADDRESS TEL FAX OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL9 NEW: ElRENOVATION: ❑ REPLACEMENT:Z PLANS SUBMITTED: YES ❑ NOX FIXTURES 1 FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Ye�No El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE BOX ONLY: OWNER E] AGENT ❑ Signature of Owner or Owner's Agent 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 Knowled a and that all plumbing work and installations performed under the permit i sued for this application will be in compliance with all rtinent provision of he Massa husetts State Plumbing Code and Chapt he General Laws. PLUMBER NAME /'dC SIGNATURE LIC # 10110 MPj;� JP ❑ CORPORATION# PARTNERSHIP ❑ # LLC El# COMPANY NAM 1t%C-4 `� rY ADDRESS: po &-e Z%U� CITY STATE/" ZIP EMAIL TEL CELL (/�0 • ' FAX 6f'�3 ^O 41 x r C z n z b n y 0 z z 0 C-7 m = m C/3 r D � y r x D b Z a m m c m 0 Elf -A< f Ch y o z ❑o a r b 0 z z 0 y r� ZtO 6 5 Date ....... ?/V�/ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... /0 Iq .. VI -V ....... z ...... has,permission to perform ................. ....... W! ............... wifing in the building of ....... / ... C7 -.x.-e . ............................... at.;, ..... 37 .... North Andover Magi'�' Fee..7,3.'..O�.. Lic. No.IfY.70 ....... ........... . ............. E i;�M LEcrRicAL INS� I�CTOR Check # 121 ) (f1mmonweahk of Maeeacltuselb 2eparlmenl of]ire Service9 BOARD OF FIRE PREVENTION REGULATIONS Orl�c�(I Use Only Permit No. � .5 Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pert'ornied in accordance with the Massachusetts Electrical Code (,"IEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYI'E ALL iN[-ORAL I T ION) Date: - �'� -2— City or "Town of:Q/9-m To the Inspector of Jk'ires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location (Street R Number) 313 SL -W64-5-1-1 7 - Owner or Tenant •7AMI-76%v1u` Telephone No. Owner's Address Is this permit in conjunction with n building permit.' Yes LJ No ❑ (Check Appropriate Bos) Purpose of Building Utility Authorization No, Existing Service Anips / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: lei rc �,�I jy�2►,J�-� Completion of the folluivine table may be n-nivrd bu dr In cnrrMr n% 11/irnc No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of 'rota( Transformers KVA No. of Lighting Outlets No. of Ilot Tubs Generators KVA No. of Lighting -Fixtures 0 Above In- S++•innuing Pool n►d. [Irnd. ❑ o,o mergency ►g ►ting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALA ,IS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons g No. of Alerting Devices a No. of Waste llis users P Heat Pump Totals: Number Tons. I KW No. of Self -Contained Detection/Alerting Devices No. of DisbNraslters Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating A Appliances PP •• K1V Security Systems: No. of Devices or Equivalent No. of \Vater KW Heaters No. of N. o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IiP •Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSUR!\NCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: /acv �- (When required by municipal policy.) Work to Start:9- s O 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj•, under the linins anti penalties of petjtu)•, that the information on s ai plication ' trite and complete. F1101 NAAIL: t// E t LIC. NO.: Licensee: �l t/l�� LsG/�� Signature �C. NO.: (If applicable, enter "c1enrpt " in the license number fine.) Bus. Tel. No.: Address: 61 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent s/ Signature Telephone No. PI'RiLfIT FEE: S D PLEASE FILL OUT BACK SIDE U) U) m 0 0 Q z _Q U U w J w w a. Location No. /C� Date 40*Th TOWN OF NORTH ANDOVER Certificate of Occupancy $ CYO Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15827 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: J DATE ISSUED: �^ SIGNATURE: C Building Commissioirer/Ingmtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ -1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 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: Not Applicable /❑ / Licensed Construction Supervisor: License Number Address Expiration 11ate J Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 1t�•y .�✓' A,,.i(�...� Registration Number �i to �/O, Expiration Date Si nature Telephone a 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 ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) 19 -'Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed le"7 SECTION 6 - ESTTMATF.D C'ONSTRTI TION cOCTC v. Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) ` 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 --- Check Number bhUHUN 7a UWNEK AUTHOKIZAMON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, //C/��% / `7/G)/!%-� , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in afters relal3ye4e'work authorized by this building permit application. O Si nature 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 of Owner/Agent Date NO. OF STORIES SIZE —� BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DHAENSIONS 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 NM R0 NO. P0220 DATE: 7/27/02 TWOMEY & LEGARE CONTRACTING Building & Remodeling SHAUN TWOMEY Kitchens - Baths - Custom Woodwork DOUG LEGARE (978)685-7447 Complete Interior/Exterior Carpentry (978) 556-1547 NAME OF OWNER: Jay & Jane Tamagnine ADDRESS OF JOB: 39 Sargent Street North Andover, MA 01845 TEL: (978)687-0559 DATE OF PLANS: NONE We hereby submit estimates for: New Kitchen Remodeled 1.1 Remove old cabinets & sub floor; Install new cabinets 1.2 Install new sub floor 1.3 Create 2 new openings: 1 Kitchen to Den: 1 Den to Family Room 1.4 Plumbing - new supply: drain, set sink, disposal, & dishwasher 1.5 Electrical - bring kitchen up to code 1.6 Overlay kitchen walls & ceiling; plaster to be smooth walls - skip trowel ceiling 1.7 Den - overlay ceiling - skip trowel ceiling (skim walls) 1.8 Den - rip down drop ceiling & paneling 1.9 New bathroom door - new kitchen window (glider); casing on 3 doors, 3 windows; Case openings & 1x5 with rosettes 1.10 Close up openings 1.11 Vent microwave - (based on electrical allowance - Will determine if budget fits 4 recessed lights) *Owner responsible for: Paint/kitchen; den floor finish; sink, faucet, disposal, & dishwasher; Appliances We Propose hereby to furnish material and labor - complete in accordance NAdth above specifications, for the sum of ($18,680.00) dollars Pavnnent to be made as follows: 1St - $6,500.00 upon signing; 2nd - $7,000.00 Rough plumbing & electrical; 3rd - $4,000.00 slam coat 4th (final) - $1,180.00 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner accordingto standard practices. Anv alteration or Authorized deviation from above specifications involving extra costs will be executed Signature only upon written orders, and will become an extra charge over and above the estimate. All agreements contnngant upon strikes, accidents. weather or delays beyond our control. Owner to carry fire, tornado and other necessary NOTE: This proposal may be withdra%nn insurance. Our workers are filly covered by Workmen's Compensation by us if not accepted within 29 days. Insurance. Acceptance of Proposal - The above prices, specifications and conditions are satisfacton' and are hereby accepted. You are authorized to do the worn as specified. Payment will be made as Signature outlined above. Date of Acceptance: Signature :ffe tlo�x-�rz�7zu�cz�l� �� fLQ1.Sftr✓tri BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 067560 Birthdate: 10/25/1966 Expires: 10125/2003 Tr. no: 7850 Restricted: 00 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER, MA 01845 r1 Board of Building Regulations and Standards NOME IMPROVEMENT CONTRACTOR Registration: 136779 Expiration: 8/26/2004 Type: Partnership TWOMEY + LEGARE CONTRACTI SaAWN TWOMEY 61 PATRIOT ST. _ N. ANDOVER, MA 01845 Administrator i!•� Administrator r License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 - Not valid without signal 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) Signature of Permit Apoicant ?Z'1 0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print City / fv�>�'�/��i.� • Phone # e � I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F7 I am an employer providing workers' compensation for my employees working on this job. Company name: - Address City Phone #: Insurance Co. Policv # Company name: Address City Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as well_as_civll.penaltiesin-theform-da STOP WORK_ORDFR.and_a fine -of SVOM)-aiday -against -me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the Signature. 11 and penalties of perjury that the information provided above is true and correct. Print name Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept OCheck if immediate response is required 0 Licensing Board O Selectman's Office Contact person: phone #: O Health Department . El Other m m m m 0 p CA C � - - m CACD C2 Z y CD o -v CL � O C2. _• y o C.) o p CD CD O Q CD CDo CD vo w _9. C CD y CD CL O y CO CD p CO2 o I Z CD o CD 3 C CD o �• CO) O Q' fA _a®Sm = y = m 0 ® C) o CACISnC m Z =r-0CD H �_ CL CL m CD -4 O 0 H C y 'O O '� m = H m .0 O C) O H C9 .• CD co rCr/^) C, c :c b VJ 0 CD � cn er • c'n? V� m n m m V- ON ON .�. • �p .n.► O O p C9 CD: n cn CWD o �► Cn O a 1 �.cnCD NJ : N CDrCD nom• :P O= n� �Z _ 0 CI PIT" rD OZ 9w "�'� d z H G rn � m R. ro r :Dr, H O w c O rA 0 w �crQ °c �7"' G zig c O b CD O O 9 d O x 0 N • O C Location Nd. Date 14 –a//41�1 N TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1.7 '5— Foundation Permit Fee /I!VtPermit Fee j &nn VwwV V., VV 4 A& Water Connection Fee '9-F0'/'1%e,qOTAL zze, j ��07 3 u 4 9 "s Building Inspector Div. Public Works s r J+ LO n m �Y T x c — b D D n Y D — A — m Z. Z. V " r' m w � Z Z O T (� 7 N N T. v � _ V. A y V r Y Trr N v v z L � O R. LO n m �Y T x c — b D D n Y D — A — m Z. Z. V " r' Z N Z y Z Z O T (� 7 N N T. v � _ V. A y V r Y Trr N �� v z L � R. N - ? ro r m _ � � ?' 1� w x C) x -) R UJ v n v � J � 3 � Gl- Z r O Z N N N yy . - N JF ?� z - O � dx -i N C z N � I w m m m m U) 0 _v, 10 C � O d CO) Cl) 10 0 CD n Z CO) CD o �_ CL r n• CO CO o CZ =• CO) ® co a� O CD CD Er CD O CD W C CD Cn• C= O y = I CO CD � v y O � Z O O C7 ,••r o CD 0 CD W I r-' Q N W c' o m m 1 b 9 O " CD co• m ..r C o G O W Z r .d. m N N -� T � r OQ x w ., ► m C T,C/)91 GP17- 0 r R7 _ N N cam=* O CD m o• C2 c O N co, .m L _ lJ C CL ? N a( ' :\ c0 CL �► r« O CD m m N I v cn m ,0 CD CD N Q C : Q G I j N C N 1j 3E m rN N m m CD Wim: rF h � L c co O : CO) .0 O j m =r C CDCD CD o' C teW: a -o C-) ;0: C oe: CD 1 b 9 O " :3 CD d o G � W cn 7y G 00 zr � M w � r OQ x w n G m T,C/)91 GP17- 0 r R7 0 9 v y 0 9 0 c Town of -North Andover ct 40RTH OFFICE OF 3� ,•` °'° COMMUNITY DEVELOPMENT AND SERVICES ° : p 27 Charles Street . °0,. . North Andover, Massachusetts 01845 �y Q *�° ." C.) WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions 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 c 11, S 150 A. The debris will be disposed of in: WA S , Lr- /14,04 6 Ems✓) f -j -7-- (Location of Facility) Signatur -Pefft A phcant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through -the Office-of-the-Buitdinganspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town oLNorlh Andover Ot NORTk , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street^o North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-9542 DEMOLITION OF BUILDING AFFIDAVIT DATE ES M /9 6 ,Jl ,-.) CF 2, OWNER'S NAME & ADDRESS :T-A,^J E /M ' /IAS A C LOCATION OF PROPERTY TO DEMOLISH A�;OJE DESCRIPTION v /7 ,Y l No OT1411 `) t 6S� CONTRACTOR'S NAME & ADDRESS DEPARTMENT SIGN -OFFS DEPT. OF PUBLIC WORKS WATER: SEWER: GAS FRAC ELECTRIC TELEPHONE CABLE TAXES POLICE (V10lrZIAl 4- l�6a i't'eATOR DUMPSTER - ON/OFF STREET DIG SAFE NUMBER DATE REC'D BLDG. INSPECTOR q- Z1, "J' S2y3 y BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 y? Town of North Andover f AORT4 , OFFICE OF �? o "'0 `1�o°c COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 �'9s WILLIAM J. SCOTT North Director (978)688-9531 Fax(978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. / DATE X JOB LOCATION 32 ,,// Number Street Address XSection of Town "HOMEOWNER /` 9 (09>-0,s- i�� a5 os - Number Home Phone Work Phone PRESENT MAILING ADDRESS City Town State The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) Code 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 to six family dwelling, attached or detached structures ac, cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 SIGNA APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply, with State Building Code Section 127.0 Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 —ASS 9ETTUNIFORM APPLICATION FOR PERMIT. TO DO QASFITTINQ (Print or Type) NORTH ANDOVER, % Building Permit # 7 Locatlon S ' r/��(r 5 7 - Owner's Name New ❑ Renovation Replacement ❑ Plans Submitted: Yes ❑ No heck one: Cerilficate Installing Company Name A- Corp. Address [j artnerahlp ❑ Firm/Co. Business Telephone 77 - 2C321 Name of Licensed Plumber or Das Fitter INSURANCE COVERAGE: Chec o 1 have a current liability Insurance policy or Its substantial equivalent. Yes No ❑ If you have checked Ye, please Indicate the type coverage by checking the roprlate box. A liability Insurance policy Other type of Indemnity 11 Bond 11OWNER'S INSURANCE AIV R: I s ware that the licensee does not have the Insurance coverage required by Chapter 142 of a Mass. General La and that my signature on this permit application waives this requirement. Check one: SIgJ" Owner ❑ Agent ❑ na o or er's en I hereby rally that all of the details and Information I have submitted (or entered) In above application ar us and accurate to the best of my k e and that all plumbing work and Installallons performed under the permlt Issued for this apps n will be M compliance with all perU t provlelona of the Massachusetts Stale Gas 0 a and Chapter 112 of the r3enesa A-m— I3y This Cfty/Town AfTnONED (OFFICE USE ONLY) Tof Ucense: Plumber - go cense u�T'm6�er o� 1 astllter license Number ffilmaster Journeyman '—'�---- MINN NIN on on IN IN N MINN NNE N MR N MEsit 0 heck one: Cerilficate Installing Company Name A- Corp. Address [j artnerahlp ❑ Firm/Co. Business Telephone 77 - 2C321 Name of Licensed Plumber or Das Fitter INSURANCE COVERAGE: Chec o 1 have a current liability Insurance policy or Its substantial equivalent. Yes No ❑ If you have checked Ye, please Indicate the type coverage by checking the roprlate box. A liability Insurance policy Other type of Indemnity 11 Bond 11OWNER'S INSURANCE AIV R: I s ware that the licensee does not have the Insurance coverage required by Chapter 142 of a Mass. General La and that my signature on this permit application waives this requirement. Check one: SIgJ" Owner ❑ Agent ❑ na o or er's en I hereby rally that all of the details and Information I have submitted (or entered) In above application ar us and accurate to the best of my k e and that all plumbing work and Installallons performed under the permlt Issued for this apps n will be M compliance with all perU t provlelona of the Massachusetts Stale Gas 0 a and Chapter 112 of the r3enesa A-m— I3y This Cfty/Town AfTnONED (OFFICE USE ONLY) Tof Ucense: Plumber - go cense u�T'm6�er o� 1 astllter license Number ffilmaster Journeyman '—'�---- 0 Z O m J < � W N m � 00 0 O F W N z o 4 IL 0 W 70 < d Z m I N K J ► O J N � N d LL 0 ` N z _0 N Z WIL : N O a W C Z 0 f O Z 0 LL LL 0 F I W x W a Z 0 m LL r 0 J LL 0 W K < W z f 0 Z u O LL 0 0 W J U. < 0 m W W N < N 1 N W O 0 u �CWLL 0 N H W _ W Cy z w a z LL 0 Z i O C ►- Z 0 u 0 < Ix 0 W U O J W < < Z d l7 C7 p t O 0 j 0 J J m O m m J < 01 N 3 m 6 00 u u J IJ N z 0 ]�'`. N z 8 �i I t 0 O J JLU ui � F J W 3 o f o O U V = I Tc�c� nng Ix°z DD OoCo O O N 7COnnODD mOV UO vOD rQM-Ai CINamZ nAnn~VXQT v P. mm mA D N; O O p S N m Z Z m Z Z O O° 00000 O N S° A 0 \ C A m m T Z D m 2 �' N co '^m z2 r T n;; ZzZN ZZ� 3 a 0w 0 N;; o a 0 NOn ~ O _ Nmi; x p 30 ;0DNOC,0 ; 0 > 3 Z�c ; << VI O N m Z V T m Z m Z m Z N m T ~ c Ir iii: v z < is { < ~ °z N 0 �ITTFF IIIIIIIIII Iillllilllllll _��_ 1111�I C Z O O C A D x N T V -1 ti; N Z A N D N D D n x n ; T T T C° T x T .� Q N — DZD OmOv .. .- '�Q D OD °C NODDO t0 OmZZ T A D D On�Ny2�O�Dnm r mm0� n>m�S O m -_/ =;o Az ° {NpZ W /CC TO m A 2 Z O ;° N ° T p r V m y A y O— n y x m A^ D Z` m m m_ Z N D N C Z O N D O N ,y O Z A N N 'ten yx°�o Ox QOTOmN<n;'_' TJO y '^ZO m �cnn3 D ° -+ O G7 p��0 pX`2 z NO_x r P T 1A DD Z N OA DZ T -ap0A ya C = mp a 0 OZ < A1Dl A. T O T I I I I D D I I .0 O T m O y X O I I I I Ir N Z 0 Z AZIILm I I I I I TZ I�j 1 1 1 1%1 1 1 111 I III 1 -ti I_I_ I I_ 1 _1.1 11111 1111 1- 1 1 1 1 11 1 1 11 1, C) -1ON yrN Zm m m ff n O y>Z °� MXi D n 010 Nvi °mX =fn mo �z_o mN3 rTOM DAN_ C m0°O r O -Z v F r°O Z &)r >�D m Z iZ A xa O o� 70 v nz x0 mm (n In DO ' .. r Y/w 60mmoiwicetIll, /' &.;Jac/We11j L'I.11WENT' OF PUBLIC CTY CO"" TR ;l PT IQN 0I;PHIISOR LICE _q, res: birthdate C, 0 3 561'17 12-i15i]997 111/15,'1541 a RPSUICLed To: K"i 0 a. RAYMOND V BERUBE 16, CIIT ICKERING RD N MOVER, MA VMS 11 , WILLIAM J. SCOTT Director F i y Town of North Andover. OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover,. Massachusetts 01845 In accordance ith the provisions of MGL c 40 S 54, a condition of Building Permit Numberis that the debris resulting from this work shall be disposed of in a properly licens d solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (L cation of Facility) f Signature -of Permit Applicant Y-A'e 1.7 ��— Pat-e-- NOTE ,a -e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 0 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 0 Cd C/) 0 cf) 0 or- -Z; p U [z CD V) C/) C/) 0 cf) CD Cc CD E co co E.E 0-i wM E ID 16-'0 CD 0 CD lo: CLC.> CD cr- CM -Coll 0. t: 2 co cm Cc =OF m C2 z LU E C.) co 5E C/) 0 cf) Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ss "US Foundation Permit Fee $ Z�WPermit Fee $ 3 7, Sewer Connection Fee $ _4Vater Connection Fee $ TOTAL $ Building Inspector 6374 Div. Public Works m a a _W � R p W I0A Z CLL O N O < 0 Z m Z 0 P 0 0: 0 z N r m a K W m E a O J LL LL O W N m m mmmm z LL a C a W C Z O 0 z 3 0 LL LL O f• - S O W Z W O I a r' z O Ir LL x I 19 z_ r 0 0 U. 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