HomeMy WebLinkAboutMiscellaneous - 390 JOHNSON STREET 4/30/2018 (3)�J
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,NT(NA4. a Letter or statement on the as -built indicatin
n accordance with the intended desi
,0 and In y
Date
3/12/15
FORM U - LOT RELEASE FORM
` r ( ,(c M(:L.-t- Rer-V\04
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 or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION*********
APPLICANT ic�ad ai PHONE Cf
aw
LOCATION: Assessor's Map Number 8 PARCEL Z3
SUBDIVISION ( LOT (S)
STREET ST. NUMBER 7 "
********k****** ************************OFFICIAL USE
ND OF TA GENTS:
CO WERVATIC614 XdMCNISTRATdR DATE APPROVEDIt? 11
DATE REJECTED
COMMENTS
TOWN PLANNS R, DATE APPROVED 10 4
V.14 kt-i DATE REJECTED
fi,q
COMM"'T�
S
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
0
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED_
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
.......................,...�.......,.. Permit No.
DOARDOFFMPREVEMONREGUL47YONSM7CMl2VO o�
Occupancy & Fees Checked `
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
",EASE PRINT IN INK OR TYPE ALL INFORMATION) Date ' %' or
i 6wn of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address '
No M
Is this permit in conjunction with a building permit:
Yes
(Check Appropriate Box) a G L1
Purpose of Building Utility Authorization No.
Existing Service Amps�Volts Overhead Underground M No. of Meters
New Service c,�24" — AmPF/A) volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
,.�
Swimming Pool Above
round
Below
ound
Generators
s
®
No, of Oil Burners
No. of Emergency Lighting Battery
fl
Mishwashers
No. of Gas Burners
FIRE ALARMS
No. of Air Cond. Total
Tons
No. of Heat
Pum s
Total
. Tons
Total
KW
No. of Detection and
Initiating Devices
No. of Sounding Devices
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Heating Devices
KW
Local Municipal
Connections
No. of
No. of
eaters KW
FdroMassage
Sions
Bailasis
Tubs
No. of Motors
Total HP
Total
KVA
KVA
No. of Zones
PIIIR]�ftbttleIel]L➢CHr�g.SOTNIc�1392U5Ciei�t8l1aW5
dyity�>tx�g�mPl� Covet�eaitsstrbstarriale�trival�it YES13 NO
Iptoofcfs=oDft0ff= YES �If)ouhaNedledtEdYES,plea9eltldc*fth Imcfwv�by
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FIRMNAME / 11=mNo. d J 0'/ Z -
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OWNER'SINSURANCEWAIVER;IammmthattheLio=doesnothautetheirstaa=amr,gearilsab tx alapvdmasregmedbyMassadEMGaaWLaws
,,- mysipa mecndiisFnTAffkafonwaivesthisregtmanaL
:se check one) Owner Agent cam'
Telephone No. PERMIT FEE $
Igna ure of Owner or Agent
MEMORANDUM/REQUEST FOR WAIVER
To: Heidi Griffin, Director
Town of Andover
Division of Community Development and Services
From: Michael A. Demers
Subject Request for Waiver of Watershed Protection District Special Permit
Property: 390 Johnson Street, North Andover
Date: September 30, 2004
I am respectfully requesting a waiver for the requirement of a special permit for
the purposes of interior construction within a pre-existing structure within the
Watershed Protection District.
TheP roposed construction will not expand the ea disturb sting fexist ng topographyootprint of the ng
structure, .is already on town sewer, and will not
ing by the addition
The proposed construction will change the exterior edtto accommodate to a private
of 3 dormers; additional interior
bath.work will be upgraded
office, recreation room a
Respectfully,
Michael A. Demers
.t
et
MEMORANDUM/REQUEST FOR WAIVER
To: Heidi Griffin, Director
Town of Andover
Division of Community Development and Services
From: Michael A. Demers
Subject Request for Waiver of Watershed Protection District Special Permit
Property: 390 Johnson Street, North Andover
Date: September 30, 2004
I am respectfully requesting a waiver for the requirement of a special permit for
the purposes of interior construction within a pre-existing structure within the
Watershed Protection District.
TheP roposed construction will not expand the ea disturb sting fexist ng topographyootprint of the ng
structure, .is already on town sewer, and will not
ing by the addition
The proposed construction will change the exterior edtto accommodate to a private
of 3 dormers; additional interior
bath.work will be upgraded
office, recreation room a
Respectfully,
Michael A. Demers
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MASSACHUSETIS
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
�j
IV/lze 4)�,, .DpK"Q Owner's Name
Newj0 Renovation 1:1 Replacement 11
TO DO GAS FITrI' NG
Plans Submitted
Date 9F
Permit #
Amount $
(Print or type) �J��
Name
Address 7(/ i?d K.
ness leiepnone
,e of Licensed Plumber or Gas Fitter
C
Check one: Certificate installing Company
Corp.
Partner.
® Firm/Co.
JRANCE COVERAGE U Check one: .
re a current liability Insurance policy or it's substantial equivalent. Yes No
)u have checked yes, please indicate the type coverage by checking the appropriate box. ❑
duty insurance policy Other type of indemnity Bond
aer's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
cs. General Laws, and that my signature on this permit application waives this requirement.
Check one:
nature of Owner or Owner's Agent Owner ❑ Agent
;reby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
t of my knowledge and that all plumbing work and installations pe ed unde ermit Iss dor this apBlidation will be in
apliance with all pertinent provisions of the Massachusetts Sta as CodeM _ hapter `of the Ge aws.
tle
ty/Town
FPROVED (OFFICE USE ONLY)
Signature of License&Plumber Or Gas Fitter
® Plumber
® Gas Fitter tcense um er
ZMaster
r7 Journeyman
11
SUB-BASEM ENT
■■■■■■■■■■■■■■■■■■■■■
■■■■■ri■�■■■■■■■■■■■r��%■■
1ST. F • • .1[2ND.
■■■■■v■�■■■■■■■■■■■■■
FLOOR
�3RD. FLOOR
ATH. FLOOR
ray i�w
�7TH. FLOOR
�8TH. FLOOR
(Print or type) �J��
Name
Address 7(/ i?d K.
ness leiepnone
,e of Licensed Plumber or Gas Fitter
C
Check one: Certificate installing Company
Corp.
Partner.
® Firm/Co.
JRANCE COVERAGE U Check one: .
re a current liability Insurance policy or it's substantial equivalent. Yes No
)u have checked yes, please indicate the type coverage by checking the appropriate box. ❑
duty insurance policy Other type of indemnity Bond
aer's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
cs. General Laws, and that my signature on this permit application waives this requirement.
Check one:
nature of Owner or Owner's Agent Owner ❑ Agent
;reby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
t of my knowledge and that all plumbing work and installations pe ed unde ermit Iss dor this apBlidation will be in
apliance with all pertinent provisions of the Massachusetts Sta as CodeM _ hapter `of the Ge aws.
tle
ty/Town
FPROVED (OFFICE USE ONLY)
Signature of License&Plumber Or Gas Fitter
® Plumber
® Gas Fitter tcense um er
ZMaster
r7 Journeyman
11
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location 3�y—Fd/escn l
of
TION FOR PERMIT TO DO PLUMBING
Date
Permit #
Amount
New Renovation Replacement Plans Submitted Yes No
FIXTURES
'D^nt or type)
alling Company Name
rens `v
Check one: Certificate
ElCorp.
ElPartner.
11 Firm/Co..
ie of Licensed Plumber: < i' %_. lwe!, % �
rance Coverage: Indicate th type of insurance coverage by c king the appropriate box: ❑
ility insurance policy Other type of indemnity ❑ Bond
•ance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
insurance
3ture Owner ❑ Agent ❑
-eby certify that all of the details and information I haves mitted (or a eyed) in a ve applica ' n are true and accurate to the
A my knowledge and that all plumbing work and instaPions perfo ed under PfifrnJt Issue is -application will be in
diance with all pertinent provisions of the Mass ch ,eta State Wa Ch of the General Laws.
i a ure ce
inse er
Ty e of Plumbin License
Town icense lNum5er Master ® Journeyman ❑
'ROVED (OFFICE USE ONLY
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NORTH ANDOVER HEALTH DEPARTMENT
a • North Andover, MA 01845
Tel. 978 688-9540 9 Fax: 978 688-9542
email: healthdept@townofnorthandover.com
Complaint Investigation/Inspection Report
OWNERl�t_�.I
ADDRESS
DATE
Rev. 6/04 INSPECTOR