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HomeMy WebLinkAboutMiscellaneous - 410 SUMMER STREET 4/30/2018 410 SUMMER STREET 210/107.A-0080 0000.0_ 1 .. Date. .,�.". . .: . �-.. .. 40RTH Qf 91, o� °` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION � S �9SSNCMUSEt This certifies that . . ./�. . A Xp.l_.: .�.-.E� ; �. . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . t�. :/. . . . . . . . . . . . . . . . . . . . . . . . . at . . �V. z,.d•.: : €. . . .. .. . . . . . ., North Andover, Mass. Fee. ,. .:. . . Lic. NO.,t . :. . . . . . . . . . .J . C. !t ... . . . . GAS INSPECTOR l Check# 4154 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIIT TO DO GASFITTIlITG (Type or print) Dates /O5,7 Q — NORTH ANDOVER,MASSACHUSETrS mac— C Building Locations �i!t((� S(1 1/1/��l�Lt P 2 !��/! Permit# yIJ" Amount$ J Owner's Name r�-P,24 V New❑ Renovation ❑ Replacement Plans Submitted ❑ w O U rn � a O SUB-BA SEM ENT BASEMENT 1'S T. FLOOR / 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH . FLOOR (Print or type) Chgnk one: Certificate Installing Company Name Address –Cb 11L) k/ Fd l2 J S ❑ Partner. to- 1A 41.4 a U2 /-f- Business Telephone 6 7 (o 0 R' L 0 0--Firm/Co. Name of Licensed Plumber or Gas Fitter P3 l✓J INSURANCE COVERAGE Check one: i have a current liability Insurance policy or it's substantial equivalent. Yes 0 ' No❑ If you have checked M please indicate the type coverage by checking the appropriate box. 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. Check one: Signature of Owner or Owner's Agent 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 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 Massac/setts State Gas Code d Cha er 142 the General Laws. l v Signature of Licensed Plumber Or Gas Fitter By: Title Plumber (� City/Town Gas Fitter License INUMDer Master APPROVED(OFFICE USE ONLY) ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIN& � (Print or y e) rdvzc�, Mass. Date S building Location J�ta . Permit .� Ows Name-? c- ):�e s lift.l , Y • New '-1 Renovation D Replacement � Plans Submitted D FIXTUP-S N i a W W N Of V Z CCcc CC ca LU ~ LU dl � O V m r S N � � o w Q 1r a o a o Z r H e '0r to- in a > w US q rn v v, tz 4 CC W z W Q W F- W t- x - W df !_ W .r d tt Cf a a a fW > N O ? 0 t- W 0 f- w 2 .Q W C tr m O O N X Q ,W > W Z 4 G Q .4 O O W _ O W N Q = O O u. a s ..s u a y Q d 1— O SUQ-13VAT. BASEMENT 1ST FLOOR 2140 FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR �. 7TH FLOOR STH FLOOR (Print or Type) Chec one: Certificate Installing Company Name ANDOVER PLG. & HTG. CO. INC. EZ Corp- 1051 Address 57,31 SO. UNION STREET Partner. LAWRENCE MA. 01843 CJ Firm/Co. Business Telephone: 508-685-8383 .Name of Licensed Plumber or Gas Fitter Insurance Coverage. Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy i Other type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of, this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner AgentEl 1 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 woric and Installations pesformcd under Permit isseed for this application will be in compliance with aL pettincot provisions of the Massachusetts State Cas Code and Quapter 141 of the Genesal Laws. By TYPE LICENSE: r Plumber Title Gasfitter Signature of Licensed City:JToT.1rt'•'. pd' Master Plumber or Gasfitter ,., Journeyman;;. k ` 6739 APPROVED (60Flc>_ USE ONLY) License. Dumber ,,nj DateA gOFT�y TOWN OF NORTH ANDOVER , ... �? , t° PERMIT FOR GAS INSTALLATION s �9SSACMUSES 'S This certifies that �: . . . . . .�. . . . . / � ✓ has permission for gas installation . . .! . . .!. . . . . . . . . . . . . . . . . . . . in the buildings of . . j. . .•. .!�. .! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .°. . .. . . . . . . . . . . . ... . . . . . . . .. . . . . . .. North Andover, Mass. Fee. . . . . . . . Lic. No..f. . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10/06/94 08:33 15.00 GASINSPECTOR WHITE:Applicant CANARY: Building Dept. n K:Treasurer GOLD: File Location YA4 5u po No. 7Date NORTh TOWN OF NORTH ANDOVER 0 9 Certificate of Occupancy $ • oo ..��. + i�/ J ;�s"�•°'Et'`' Building/Frame Permit Fee $ �CNUS i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C ! `16367 r 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. SIGNATURE: � // Building Commissioner/lageclor of Buildings Date z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: A/0 d 111 / 1yt01K_ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record S =w � nv ?'/1G£1FA-1J !-f/O�U/ai�fn ST Address for Service: Name : / 011511'��rzr Signature Telephone 2.2 Owner of Record: C,(P61i5OU rr O Name /. Address for Service: rj- f)rf7f�7jy,? z 4iature M Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number mn Address a> 1 Expiration Date S Signature t Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r z Expiration Date ^ Signature Telephone G• 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..._...0 No....... SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify llt i"P9 c- 5r ow Brief Description of Proposed Work: S Tlf SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be RCIAta' E"QNI.Ry �� Completed b permit a _ �licant M �' �, 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC �02 0 5 Fire Protection 6 Total 1+2+3+4+5 2 00 o Check Number d 9 9 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r, RL � as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all ma rs relative to work authorized by this building permit application. -Signature of Owner Date SECTION 7b OWNER/A�U-THHORIZED AGENT DECLARATION -2 as 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 O-7 Si attue of Owner/Agent Date FREE NO. OF STORIES 1 SIZE _ BASEMENT OR SLAB j SIZE OF FLOOR TIMBERS 1 ST2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 t 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.. i The debris will be disposed of in: (Location o F cili ) r Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTh Town of North Andover Building Department '� �.•_-- • 27 Charles Street � c►+USEs North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Please printy DATERlf �7 �^ JOB LOCATION /Number { Street Address Section of Town HOMEOWNER 7< U J/ rrl J ! PY? r-7 �)Y3 9;lrzf7Y�r`J o Number Home Phone Work Phone PRESENT MAILING ADDRESS /�/ J � ✓T City Town State Zip Code 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) 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 wn of No.Andover Building Department minimum Winspectiocees and requir nts and that he/she will comply with said procedures a HOMEOWNER'S SIGNATURE 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. NORTH Town of ED Andover No. I,� °�A Z � � dover, Mass., DRATED PP��,�� 'Li,9s H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System S jie gg A v ou 41- rA"ft) .. _r 400 Ft.0./* BUILDING INSPECTOR THISCERTIFIES THAT........................................................................... .................. ....................... .... . Foundation has permission to erect....V.IIV y I......... buildings on ..... I..D........s ........5' ..... Rough to be occupied as.........#$.I..01IN.8......0N........R 4(4 0i C.` .......... ......... ................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Larelating to the I pection, Alteration and Construction of Buildings in the Town of North Andover. /0174478a 'aO PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR � Rough .................................... ..�,.... ..................................4A Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.