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HomeMy WebLinkAboutMiscellaneous - 429 MARBLERIDGE ROAD 4/30/2018 429 MARBLERIDGE ROAD "' oZ� J 1 Date ..t'.6..................... �NORrH, o:. ao �.• �rO ' o °� TOWN OF NORTH ANDOVER . � m PERMIT.FOR GAS INSTALLATION This certifies that ...:........ .. . has permission for gas installation ..V.. A......................� Q, in the buildings of............. �t "�--�................................................................. at.. - `'1. '' + � rCc¢. , North Andover, Mass. Fee kno .. .....................................................Lic. No. ..��..1...'�4 .... ..... ................................................. GAS INSPECTOR Check# n `� r 94 A 3 ouMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY N.Andover MA DATE 4 7/311201PERMIT# `4`-H,5 9— JOBSITE ADDRESS I 2gg Marble Ridge Rd OWNER'S NAME GOWNER ADDRESS Same TEL IFAXI TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT ® ❑ RESIDENTIAL® CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES❑ N00 APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE I FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER THEIR ate lace 1 Gas Meters x nd Associated Piping INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY ® BONDE] 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 ❑ AGENT Lj SIGNATURE OF OWNER OR 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph MarinoLICENSE# 8736 SIGNATURE MP❑ MGF® JP® JGF® LPGI CORPORATION Q# 3285C PARTNERSHIP[J# LLC❑#D COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 i�JTEL508 832-3295 FAX 508-926-4347 JCELLI 508-832-4614 EMAIL JMarino@RHWhite.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES J t tiA1��1L.TH OF MASS `G: lt1 fT ` = =F�I;UtjfBRS AND BASF- •-- 1 A5: -_ &ED AS•Fi--M---:ITER F'�[J - - ''ISSUES TH£`•aHQVE"LIG6NSE l.'�:"='"'�':=,;a _�<: '`t-- 3 FA1?'},-114 G7 �3N ST _. `=VJQ _ ES7R ' MA 0 a G=�3- 3I 0^ — 8 6 05/01/14 _O.©i ilUl NEA "0 OF ASSA :4�� MASSA _S�7�5'= iERS AND GASFIT`TERS-- �._ AS A JC2U.€ NFYIVIA-VP 714 TSSUES THE ABOVE UPLNSE TO- 7' ''FRR:R7NGTON ST. IR R e MA a150:r�'=A1�19 05l01l1 - " i AC RC7 0 r CERTIFICATE OF LIABILITY INSURANCE cogs 1 oQ �, FDATE 29/201 P—';aHIf�ERTIFICATE IS ISSUED ASAMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIGES ELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the polioy(Pos)muet be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does notconferrights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT willim of Maesnchunetts, Inc. PHONE C/o 26 Cottury Blvd. FAX R. 0. sox 305191 No EXy[p 877-945 7378 _to): 888-467 2378 NnM71vi11e, TN 37230-5191 DDR ss cextrificatepgw•i1lis.�om INSURER(8)AFFORDINGCOVERAGE NAIOrf INSURED INSURERA!The CbArtor Oak Fire Ins uranp9 Company 25615-001 R. H, White Construction 0. Box 257 Street Company, Inc. INSURER s-Travalmrs property Casualty CGshpazzy cis Aum 25674-003 P. 0. Boa 41 INSURER C:Nati=al Union Piro Inourancm company o£ 19445-001 Auburzs„ MA 01507. INSURER O;Travelers Indmmnity Company 25658-001 INSURER F; INSURER F; COVERAGEu CERTIFICATE NUMBER.,2QI87680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIPS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR- NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IJZL NSR TYPEOFIN$URANCE DD' 7VTC20CD�977994 ILICY EFF vuvn C7M_'000 A GENERALLIAeILITY IMITS 7./2013 CURRENCE $_ 2,000,000 X COMMERCIAL GENERALLIABII,ITY TORENTF,pg Eaocemancr S 300CLAIMS-MADE�OCCUR ( QU O(Any one arson s 10-000 L&ADV INJURY S 2 000,000 AGGREGATE $ ¢�000 000GEN'LAGGREGATF LIMITAPFUES PER;PRO- S-COMP/OPAC�G 9 �QQQ OOD POLICY L0C >3 AUTOMOBILE LIABILITY VTJCAP 977K955A-7.3 9/1/2013 9/7./2014 $ OMBINEDSINGLELIMIT S 2000,000 X AM'AUTO act dent ALI.OWNED SCHEDULED BODILY INJURY(Perpemon) S AUTOS AUToe BODILY INJURY(Peraccident) C X HIRED AU POs X NON-OWNED Co Defl AUTOS X X Cv11 Deg eraccldanl S S C UMBRELLAUAS X OCCUR BE8766140 /1/2013 9/1/2014 EACH OCCURRENCE X BXCE88 LIAt3 CLAIMS-MADE DED X RETENTIONS AGGREGATE $ $,000,000 10,OD0 D WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY Y N `TRKUB 8205A1a5-13 9/1./207.3 9/1/207,4 X - o - D ANY PROPR(ETORIPARTNFRIFXECUTIVE� T IHYAF. OFFICERIMENIKREXCLUDI:D7 NtA VTC28uB A203A71A-13 9/7/2023 9/1/x014 E.L.EAGHACCIDENT s 1,000 000 ffdd.3 b1 NH) E.L.DI8EA9E-EAEMPI.OYFE S 1,000,000 fyea,deo lho Ll'd).' Unsuil+1 IUN OF UPFRATIONS Balow F,L,DISEASIsPOLICY LIMIT Q 1,000,000 )FSC RIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Asch Acord 1117,Additonpl Remarks Schedula,If more epeon la rmqulrad) ,ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. xvxdence of Inaurance AUTHORILLDREPRESENTATNE Coll,-4197604 Tp1:1694012 Cert:20267680 ©9998-2010ACORDCORPORATION.All rights reserved. CORD 25(2010105) The ACORD name and logo are registered marks of ACORD Deems, Maura From: Deems, Maura Sent: Tuesday,August 26, 2014 9:44 AM To: 'JDerry@Rhwhite.com' Subject: FW: Gas Permits - Marbleridge Road and Abbott Street in North Andover, MA James, Still waiting to resolve 249 Marbleridge Road gas permit.As I mentioned before that address does not exist,could it be 429 Marbleridge Road? Please let me know so that I can issue the permit. Thank you, Maura Deems Building Department Assistant Town of North Andover ! From: Deems, Maura Sent: Thursday, August 07, 2014 12:08 PM To: 'JDerry@Rhwhite.com' Cc: Hurley, Jim Subject: Gas Permits - Marbleridge Road and Abbott Street in North Andover, MA James, We received a number of gas permits yesterday for meters.The streets the permits covered were Marbleridge and Abbott. One permit was for 249 Marbleridge Road and that address does not exist. Could it be 429 Marbleridge instead? Please confirm so I can process the permit. Another permit was for 407 Marbleridge Road which is a single family home but you have two permits for the address, ! one for Floor 1 and one for Floor 2. Please confirm this permit as well as this home should not have two meters. Thank you, I Maura Deems Building Department Assistant Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2035 North Andover, MA 01845 Phone 978.688.9545 Fax 978.688.9542 Email mdeemsCa@townofnorthandover.com ! Web www.TownofNorthAndover.com 1 4235 Date... ot TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU � This certifies that ..... q, ........�/', has pernussion to perform ........ ...................................... .................. wintig in the building of........ ..................7 ........ 0 Ando at.........eY....0-1... .:e,/.........e ,N rth And S. Fee. ... Lic.No. ......... ... ................ LECTRICALINSPECTOR Check # THECOMMONWEALTHOFMASSACHUSETIS DEPf1R M1ATOFPUBIlCS4FM Office se only BOARDOFFREPMEMONRMMHONS527CMRI2.VO P ermit No. ,35 ccupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORMELEC1MCAL RK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12.00�O (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date I/ oZ I 0 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location(Street&Number) e R�D�e RD r Owner or Tenant Ac Owner's Address Is this permit in conjunction with a building permit: Yes No �� ! (Check Appropriate Box) Purpose of Building V/�Tl /ly =2 XM Utility Authorization No. Existing Service �/D�O Amps 17d/Zd�/-2Volts Overhead Underground � No. of Meters New Service Amps / Volts Overhead � / Underground E3 No.of Meters Number of Feeders and Ampacity ---------- Location avAd Nature of Proposed Electrical Workl it OF /f` /ff' ,07i rraw co P ZR&I No.of Lighting Outlets AA No.of Hot Tubs No.of Transformers Total No.of Lightlig Fixtures / Swimming Pool Above BelowKVA Generators KVA No.of Receptacle Outlets round round /O No.of Oil BurnersNo.of Emergency Lighting Battery Units No.of Switch No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones No.of Disposals Tons No.of Heat Total Total No.of Detection and No.of Dishwashers Pumps Tons KW Initiating Devices Space Area Heating KW —�� No.of Sounding Devices No.of Self Contained No.of Dryers �/f Detection/Sounding Devices t' Heating Devices KW Local Municipal Other' Vo.of Water Heaters KW No.ofConnections No.of Si ns Bailasis Jo.Hydro Massage Tu s No.of Motors Total HP HER. ADD /Zome 1,5!' /o1'CeMT w re.^ AT -------------- uanoeCov$age.A»tothemgmm MOf'M scernaliaws waamatLiatxlrt k=rdmePohy>AxhrgC,crTCo criisst> 1��y t�submWdvalidproofofsametotrOffim YES YES NO ED box )fyouhavec3 kedyFs,plea�if dv&thetypeOfODWgPby LRANCE� BOND OTHER (P"wSpmdy) F�tpuah ��� ktoStart 0 // VmofEkCalWork$ Aunder�ieP _of� 011 Rougtr - !//�6��Z Final �//LC CfjL� IQNAMB U/U TP, No x_22 I�AAV , t o> ly AA oi7KY BusinessTelNo. Ala . � �q7J=sr�� IER'SINSURANCEW Alt Tel No. SA/ e AVER Iamawa�ethattheLicense1! iothavetheinstuarmcOvt�ceOrilssubstantialequivalaiaswqunedbyM%affi>settst Laws atmysi�k�ttueonthispearritapplicah®thisregtutrrrul !se check one) Owner Agent ® _ Igna ure o caner Or Agent Telephone No. PERMIT FEE ® CO Location No. Q Date /C)0.1 �p HORTh TOWN OF NORTH ANDOVER �? •. • O ~ 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ "7 SSACHUS 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t p Check #p70/l04-;), 5 4A Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING e }+ ° BUMI)ING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Conunissioner/I , for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 8� 16 Map Number Parcel Number 1.3 Zoning Information: 1.4, Property Dimensions: 2"g Distr et Proposed Use Lot Area Frontage it 1.6 BUH DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required, Provided Required Provided 30 30 ' 136 ' C 1.7 Water Supply M.G 1-C.40. 34) 1.3. Flood Zone lnfonnation: g,,,- 1 8 Sewerage Disposal System: a Public Private p Zone Outside Flood zone Municipal j p On Site D67eial System f� .SECTION 2-PROPERTY OWNERSE[IP/AUTHORIZED AGENT n 2.1 Owner of Record Name(Print) Address for Service 2-6 Signator Telephone• i .2.2 0111yer of Record: s gm e' C I Ne rint Address for Service: n Si ature Telephone SECTION 3-CONSTRU ON SERVICES 3.1 L' sed Construction S Sor: -�- Not Applicable 0 1110 . JD HN I-�f�S��M J�� dc Licensed#Construction Supervisor: C /33" //l/. S / WD f 494b/,v G- O.- • D l IRC,�/ License Number Address 7P—66 K' r// ` Expiration Date Si re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 C Company Name Registration Number r Address r -71 & Expiration Date Si re - Telephone 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 it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Workcheck all a ble New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 0 t> �X/F sv//Roo/-f tv If'et+I o SECTION 6-ESTIMATED CONSTRUCTION COSTS, . Item Estimated Cost(Dollar)to be Completed by permit plicant 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 AC `� 5 Fire.Protection F 6 Total1+2+3+4+5 �� S O O Check Number . SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGE1YT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ,as Owner/Authorized Agent of subject property Hereby.authorize �/Ofy✓ . / 5l���1 `(� PieeS to act on My behalf ' ma relative to wo autho b is/building permit application. y-y z Signature of Owner Date SECTION 7h OWNRWA UTHORIZED AGENT DE TION I, f fres, >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 J o/%✓ �' �•Fls 4-,Pqy 2 Print Name Si tore of Owner/A ent Date t NO.OF STORIES SIZE Y i P /S-X Z Z 6 Afe - Y BASEMENT OR SLAB S f3 GR�`�C �w L sPA�� iv Svti�en0�-! 'SIZE OF FLOOR TMERS Z 1 2 3 RD SPAN 8 2- 'DHAENSIONS OF SII LS -z-Xb OF POSTS DRvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION Al THICKNESS /0 SIZE OF FOOTING -;25'X ui X MATERIAL OF CHIMNEY No N� IS BUILDING ON SOLID OR FILLED LAND So e- PD IS BUILDING CONNECTED TO NATURAL GAS LINE /,/0 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 thebuildin it. Signed affidavit Attached Yes....... No.......❑ SECTION-=51•Descrition of PM""34 Word(cbeck aR a Me New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: N /C�G�R o ��CTC it/ l-> 61AeACrCS + S—rub y -{- ra w (3 5 f b t SECTION 6-ESTIMATED CONSTRUCTION COSTS.. Item Estimated Cost(Dollar)to be Completed by pmmt a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(+)x (b) 4 Mechanical HVAC �� 5 Fire-I'Wet ioit yD S?�IJ 6 Total 1+2+3+4+5 S3, SO O 7 Check Number SECTION 7s OWNER AUTHORIZATION TO BE COMPLETED'WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby.authorize JOff i✓ ji95f/t'�1 l,e. i"ReS. to act on ' din t application. My behalf,m�mvlatLivgooworkauth ,by b 1 g perms pp V- Signature of04m& Date SECTION 71b OWNER/AUT116RUSTI AGENT DE ON fces, a � s, ,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 yr y-a z Sigfidure of Owner/Agent Date NO.OF STORIES SIZE /£r Y Z Z 6 Af-, BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Z INV 2ND 3RD SPAN OM DW ENSIONS OF SIId,S Z- g DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS /0 " SIZE OF FOOTING idX z_o X MATERIAL OF CHRvINEY NONE IS BUILDING ON SOLID OR FILLED LAND 56)c-1 D IS BUILDING CONNECTED TO NATURAL GAS LINE /,/0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR.RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,. BUILDING PERNIlT NUIv1BER: DATE ISSUED: OR SIGNATURE: Budding Commissioner r of Buildings Date .. SECTION 1-SITE INFORMATION (� 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ` `fes Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Ftanta ft 1.6 BUILDING SETBACKS R Front Yird Side Yard Rear Yard Required ProvideProvided R Provided .30 S:3 ' Z-0" 30, :30 ' /36 1.7 water Supply M.G.LC.40. 34) 1.5. Flood Zone Infounation: —/ 1.E Sewc age Disposal System: Public Private a Zane Outside Flood Zone {1' municipalTp /�e On Site Disposal System D' SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT n 2.1 Owner of Record / Ev lu + K M -13A 4 Name(Print) Address for Service: 6y2-0 Signatu Telephone i .2.2 Owner o ecord: Afinl, Address for Service: . n STelephone SECTION 3-CONSTRUCOON SERVICES 3.1 L'cen sed Construction Supervisor: Not Applicable 0 IAS hers( .10 H n) cs 11111 Licensed � Licensed Construction Supervisor: License Number �PRQ,%v D 6 y 1 Address A ' sa�& Expiration Date Si re Telephone r �1 3.2 Registered Home Improvement Contractor Not Applicable 0 �/� Company Name 02- n Registration Number r Address 0 r y—" V Expiration Date Sin re Telephone J. FORM - U LOT RELEASE FORM �` ` ' S�'J") 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. ■t■ttttt.tEno■Boom ttMEMO ass was mammon t\\t!tanon man l.attttrwas\\tttNam ONO\t!!\\■ APPLICANT ,O—U[0 PHONE (21�`p (c�0- ASSESSORS ASSESSORS MAP NUMBER ( LOTNUMBER ( l.O SUBDIVISION LOT NUMBER S'TREE'Tt � STREET NUMBER `f • ... ............ ........,...\tt\\lrtt\....................BEN t\soon OFFICIAL USE ONLY 1t\tt!\ltttit■ttt:!!■!\ltttt-ti\)!\•tlGa■■\ ltttt ' RECOINIlVIENDATIONS OF TOWN AGENTS l\tot tt\!\■tttr\■\t■�t■t■tt!■llatr■!\\at.\\.t!-\\t\!ar\\\\\!t\\■ mammon OEM n Gy DATE APPROVED / ,2_ CONS ERVATION AD TOR DATE REJECTED COMIytENTS Wt EP4 Liu � DATE APPROVED TOWN PLANNER a r � DATE REJECTED co'fv ENTS y L DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED ^ � 5� DATE APPROVED 10 lq O Z SEPTIC INSPECTOR-HEALTH f- 4- DATE REJECTED ttrv COMMENTS � S n WItf PUBLIC WORDS-SEWER/WATER C ON l 27 DZ DRIVEWAY PERMIT i DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR _._ DATE NORTiy Town oE D . . Andover 0 �- L > >dower, Mass. Vd 4KwAR �A \� ORATED P? C7 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .�. .... .. ........... .. ,.... . .. .. ............................. . .. Foundation has permission to erect...../48..*W/46r.. buildings on ..is V.I. ) *4;C /a..Af �� Rough J to be occupied as..,, AMO r000..W. P..*#r CO.A Chimney provided that the person accepting this permit shall in every respect con orm to the terms of tV4. � plication on file in Final this office, and to the provisions of the Codes and By-Laws relating the Inspection, Alteration and Construction of Buildings in the Town of North.Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. "Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough ......... ........ .. ..:.................................................................................... 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. I A 10/01/2002 19: 51 5035423357 ARCO EXCAVATORS INC PAGE 02 ARCO Excavators Inc. 1.7 Court Street Exeter,NH 03833 (978) 807-6096 North Andovcr Health Department Sandra Starr, Health Director 12 Charles Street North Andover, M.A.01845 October 1, 2002 RE: 429 Marble Ridge Road Dear Ms. Stan, This letter is to inform you that ARCO Excavators Inc. has contracted with Hashem Construction and Devin and Kim Barry for the installation of a sewer connection. The sewer installation will begin as soon as the municipal sewer becomes available to the Barry's property at 429 Marble Ridge Road. If you have any questions regarding this correspondence please do not hesitate to contact me. Sinc ly, William Sawyer, President ARCO Excavators Inc. ' 00 NST 9�&- -�Gy- ytgl MORTGAGE PLOT PLAN EK SURVEY 17 ROYAL STREET, LAWRENCE, MA. 01841 TELEPHONE 508-975-1413 MORTGAGOR SURN DEED REF. BK. 22g PG, I�� ADDRESS OF PRINCIPLE BUILDING PLAN REF. P1.01 7Q71 DATE OF INSPECTION G i 1 ` \�A M �ax,F 1 qp{, 15 1 S' 6,AA�, OF S}C 2.2. Z,z t\y��• �g�y.�r E?CTEr�S'ioN o ALBERT T. ✓, TRUDEL N xr M •a No. 36880 ��rC KOAP SCALE I" = 1 I FURTHER STATE THAT IN MY PROFESSIONAL NOTE: THIS MORTGAGE INSPECTION WAS PREPARED OPINION THE PRINCIPLE STRUCTU$E/S AND ACCESSORY ,S"'QU�O/ZHS SPECIFICALLY FOR MORTGAGE PURPOSES AND IS NOT TO OUTBUILDINGS WITH THE SETBACK REQUIREMENTS OF THE LOCAL BE RELIED UPON AS A SURVEY. EK SURVEY ACCEPTS NO RESPONSIBILITY FOR DAMAGES TO ANYONE OTHER THAN ZONING ORDINANCES, AND THAT NO ENCHROACHMENTS THE SAID MORTGAGEE AND ITS ASSIGNS IN CONNECTION WITH, OF MAJOR IMPROVEMENTS EITHER WAY ACROSS ITS PROPOSED MORTGAGE FINANCING TO SAID MORTGAGOR. PROPERTY LINES EXCEPT AS SHOWN. ALSO: Mkp Z-,5-00 98 -ovob G CERTIFICATION TO: AV-1:1 `i I IP/JAILI41 ('OR 1, PROPERTY IS NOT IN THE 100 YR. FLOOD HAZARD AREA THIS'CERTIFICATION IS BASED ON THE LOCATION OF SURVEY MARKERS C]Z PROPERTY IS IN A FLOOD HAZARD AREA OF OTHERS, AND DOES NOT REPRESENT A PROPOERTY SURVEY, TIIEREFORE O00 INFORMAT ON IS ISUFFICIENT TO DETERMINE FLOOD ON FROM THE LATEST FEDERALAZARI OFFSETS SHOWN ARE NOT TO BE USED FOR THE ESTABLISHMENT OF FHAZARD INSURANCE RATE MAP PANEL# �I 3 TW3452-2 No i t� 0{ TMJ rn rnksin :{-i X D 7C y Oil sl ON rnni 70 � D� - o �g 6� 70 6 — =� 11 D 0 t Pog 0 C n z � n rn TsN 77oo N � r D� D §_ p0 o 00 ON m z 4 1=WG8ob8 2'8/6'8 -p Q' N ❑ ❑ ❑ ❑ II 0 Q Q EXISTING STRUCTURE NEW CONSTRUCTION PROPOSED ADDITIONS RENOVATIONS BARRY ' RESI DENGE 421 MARBLERIDGE ROAD ' ANDOVER, MA. V —CONT. RIDGE VENT O 6 1 2 SHINGLES 5/8" EXT. PLY AV. SHEATHING 2X10 RAFTERS R=30 FIBERGLASS BATT INSUL. 2X8 CEILING JOISTS lU uj Q Uu lu METAL DRIP EDGE TOP OF PLATE SHALL BE = CONT. SOFFIT VENT 0 Lu (� FLUSH WITH EXISTING SIDING TO MATCH EXISTING �/ _u } WR (� ADJACENT TOP OF PLATE - HOUSEAP EQUAL TO "TYVEK" — 13 VERIFY IN FIELD Yom. SUBFLOOR 1/20 EXT. SHEATHING Q � � Q 3/4" T d G PL 1J !L d 2X8 FLOOR JOISTS R=19 FIBERGLASS BATT INSUL. 10" CONC. FOUNDATION OLO BITUMINOUS DAMPPROOFING nn0,, 100X20" CONC. FOOTING ll- O 6' CRUSHED STONE W/ VAPOR BARRIER TYPICAL NALL 5EGTION 1/4 11-0 C la' I8' O } a' O 2X10 • 16" O.G. Z (3)2X10 JU w 0 � Ivo � d t ) QtDI 2X8 ® 16" 0.0.'--\ 2X12 RIDGE O N Q U..I O OL O OL EXI5TIN5 STRUCTURE NEW GONSTRUGTION EXISTING 5TRUCTURE NEK CONSTRUCTION FLOOR FRAM I NC PLAN ROOF FRAM I NO PLAN R ' 18' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - J_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- - - - - - - - - - - - - - - - -J I I I Oz_ I� oN3 I I m - - - - - - - - - - - - - - - - - - - J - - - - -- - - - - - -- - - - -- - - - - - - , 0 �r z o� 4' 5'-6" �o = 8 C7 0 � c z O O PROPOSED ADDITIONS RENOVATIONS � �3,�fi�fi�Y RES I DENGE f � II 421 MARSLERI DC E ROAD , ANDOVER, MA. 1 i k ., � � � � � �_ ., . .� I i . .� - .. w s . r .. t Location No. - Date ?� MORTM TOWN OF NORTH ANDOVER 0 C ; Certificate of Occupancy $ Building/Frame Permit Fee '$ 2—�A Foundation Permit Fee $ s�CHus< Other Permit Fee $ o Sewer Connection Fee $ �i Water Connection Fee $ , TOTAL $ :� ' Building Inspector � =$ = 1007 Div. Public Works PAGE 1 PER111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. L.,MAP 4-40. 031 LOT NO. 00 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE - ZONE ✓ SUB DIV.-LOT NO. F L. COCATION /1� A �o -PURPOSE OF BUILDING u I �d� "C _ Cry d ;--OWNER'S NAME / 1 - r. NO. OF STORIES SIZE)i V C.,OWNER'S ADDRESS r1011?1� BASEMENT OR SLAB lt! ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD L,.-BUILDER'S NAME pff,� woo /�i��+L,►�n �J„� SPAN --- DISTANCE TO NEAREST BUILDING v vvvf YI,I�Sr .L�l DIMENSIONS OF SILLS DISTANCE FROM STREET /1 ”' POSTS DISTANCE FROM LOT LINES-SIDES o REAR / " GIRDERS AREA OF LOT ,\ _ FRONTAGE! HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY ,,.''IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER i/ y BOARD OF APPEALS ACTION. IF ANY tl Oil !I/1e, IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST A/Rw PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS L PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR II DATE FILE 17 �3 19 BUILDING INSPECTOR SIGNATURE/OF OWNER OR_AUfAllRIZED AGE y� F E E �'� OWNER TEL.J/ PERMIT GRANTED / CONTR.TEL.# 19 CONTR.LIC.# W7 a H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ S'ORIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/2 l/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 111 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ —I ASPHALT SIDING HARD"J'D _ ASBESTOS SIDING _ COMIACN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR _ ADEQUATE I� NONE 5 ROOF 10 PLUMBING GAM MA BATH 13 M. ( = GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET t ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK i SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ +� ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL 8'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING I f °y. �-'- �"� p�., � .yy.•,h ••A FACExv NEW EN' GI� WHI E PINE OR TEX .� �p '-3.> .. � _ +^.., X80 •. • • ... i� .ilv �"�n.z�xer- .0 YflSu� g".v�P-^r'�S�'c"4•S•�s-' — •-t ys,m--e...�. �,F tsps -�� Ks u.�,��. � �s�-�•'r�� ..�^ .,,,�.�-�- ,,�,� c' ••'r„' aau. ..[s '"ss._ -'°r`vm-�s'•- '�"^, t ` v9a�.zi�-x -» ,ate _��s yr ms's:�' .sc `w/ettra mr�--s.� �'.z -� ��'"i��-.a •'*',� -sa„ ?::7y L _:-. ?aA"['S•_.'^'"s�u.rs..:£aZ"`Ri3...Y"G @n _:;¢-�_.",:�T.�'�.�..xeR>.'}'.^�'i�:..a�Ec H;:�. �-'44tx,.'<:iccva. ` >ffi t '� �3 � 3 h� f �493: . f t Cx91 mix"z* c�3�1""op,A IA&�',�q } Pg ,y a .,ter •,�Qi • V.F � s- • - _ - tel: _ a -✓ ',+� - e ts„7 • ;�.. � --' "�..-_. `. s.�..>� 'G�. - ` tet,.e -_ . - -'h 9IfA142 t�MS. tre.'nam:li%R' 3?'�'�{a'�4RE1:91a9-� '�tFAR36.i+�4�id. � ""''-t•• 1_Y '�a^YY" v".F :.tea."53K6a�t.�.:g�ffiA�Si+"i'RS+hLn t "k WS.RC'�h'9�A�Y.'89Q>rTP�9::��>i�+'tai. .' ..+.T..•..t'.Y . -•.� #3}^.(�*Y Y�iC JFr k- '+Fv.'Y�s&?0.73:'N��.RYA"reS+mFSu°_'�2RnaFdF_.9+G'��W�.'+�'Po..•+ - r�Ss'n'c�.»a3 �,.i^nd M.-•T.L m�'S'�bs'37�u FC.£i��w_ '2k@' ...".+sJSa 'ct 'i xn . t"a•.S .'4- �K'SL�< ^.�'-P:i£ •�'.?'`haro..r �lWi7iffi°T`Y-r F'Tn'•nY+rsG+a �,._��`� 4�•z S .gF'�"vx✓�b�+ara �z'�h�✓�r.'B,.TGa'wvd§-¢�sCr��' '�'a�iEsr�3..K.,� k - :`_'---._"_•-.., � 1 L lin 64`k+sf,"n""3 r,>R.Z6:,S 1 fl�"`F�"...�`r'��Af'�4.8-;��:.s��`>+nd'r-�T'„A .ve'�'�'L. �A�+'9. :}� S ...+::r "'_ ,tY C.�x i�'e �"T m.Fif' `{22®1'a�4'.�L"r���1.'�i�'�"� 'T.'.'�' 'arm' tom`�2a .d.`S^i`�f'vi�.•+Fl. �� � ;�� ` 'gt -----. �,a'��•f^Y fl "��Y! _..,_ �• ,..'...s�.a> ' ����.;".. 'u'��°� a '�`f.s,.. rJ?'�ri€§tom rye C� • �v. �"acy� 3aR �v = '+.; v..s tw{'+i � d -- ., a� 3a 'S.s .-'' t3xiF rorc,.:g'�.c' tFti*� . Y+,���ts.+�w'm. � w,. 1 � �� �� � ••'+.� �_ ��. �jiA�� i.�� h 31� �q'Y h i� � ' t�'_ as .�� s-. •ta �" �# } •yS�'.F-*a N iB �3 a � � r�•'4ks� s ova F cute ♦ F P s •, a 4'� 3 '�bsS.6'^9tSs c . I Al *`Jw �. i. 3.-.qhs - • rtvt`W'im`^��.�-•k�.14M'r ...x�r� �+•— r-4 a „� J.4k.[�...G � a: •� i '•s � �i-'Yt�44 j r ,f s•'�3•T.+y I /:- i a"�`p�.� r +oh hr 3 r j - �.Y:• dC �'.+.'4' � 1�•"'Ti� �e :yT.,� - �1�_. • 1 2 5 1996 1{(!r ro zoo TM Aan his 1 vort ighl wiffi g( nPOST WOODWORKING, INC. ng< � nyt .tilif I ven �vai 2'xl Roof is supported by engineered trusses Roof sheathed tight with 16"on center exterior plywood (A. Aluminum louvers with Self-sealing asphalt shingles 41 screen in all models (20-year guarantee) Ve s a, Strong 16" ma! on center framing ' t,it Drip edge on all roofs les, Tongue and groove k for a quality finish ;ear siding secured with argi . :int galvanized nails eve Dark security plexiglass '0ui Double studded crank-out windows with cce: corners for rigidity screens(lets you see out cc Iva but others can't see in) 2•xi 16"on center floor joists Extra heavy-duty x 4 pressure trea a hardware throughout foundation beams for extended lif�e/5/8"exterior grade Post's own patented plywood floor IroncladTm Hinge Covers / Shed Roof & Gambrel Roof Features V1. All buildings completely assembled on your property by 17. Crank-out aluminum windows with dark security plexi- ,–skilled craftsmen. glass protects your valuable tools from visible detection. ✓L. Free set-up and delivery to most areas. All windows come with screens. 3. 16"on center kiln-dried framing. 12. Screened aluminum louvers on each gable end allows 4. Galvanized exterior nails. ventilation that ensures the longevity of the building. 5. Roofs and floors are made from top grade exterior plywood. Vents are important if flammables are being stored. 6. Top quality self-sealing asphalt shingles. 13. Roof drip edge for a superior quality weather-tight finish. V7-4 x 4 pressure treated foundation beams for extended life. 14. Roof is supported by engineered trusses 16"on center. 8. Heavy-duty security latches. 15. Flashing is used to ensure weather-tight seal where gable 9. Three heavy duty hinges on each door. and wall meet. 10. Post Woodworking,Inc.'s own IroncladTm decorative 16. Meets nearly any residential or commercial building code. hinge covers. Salt Box Features 1. All buildings completely assembled on your property by 8. Siding--Cedar,Pine or 5/8"thick Texture 111 front wall, skilled craftsmen. back wall and end walls are 5/8"x 20"x 48"Texture 111. 2. Engineered Trusses. 9. Screened aluminum louvers on each gable end allows ven- 3. 2 x 4 construction throughout. tilation that ensures the longevity of the building. nh 4. Galvanized exterior nails. Vents are important if flammables are being stored. 5. Roofs and floors are made from top grade exterior plywood. 10. Stationary,clear tempered glass window. 6. Top quality self-sealing asphalt shingles. 11. Roof drip edge on roof front for a superior quality weather- S} 7. Post Woodworking,Inc.'s own IroncladTm decorative hinge tight finish. _il covers. 12. Meets nearly any residential or commercial building code. MORTGAGE PLOT PLAN EK SURVEY 17 ROYAL STREET, LAWRENCE, MA. 01841 TELEPHONE 508-975-1413 MORTGAGOR I'1 EWAL DEED REF. BK. --2Z2-- PG. ADDRESS OF PRINCIPLE BUILDING PLAN REF. P101 z� qz� �IAI'l%,Lr KIt���T NnII- DATE OF INSPECTION r(ar'I hl �Irn>a'!L r r�L� 1 , �9 aI tri M 11 I SIOk'+/ OF qDa' ALBERT T. �✓�!' TRUDEL 1• No.35OB3 �bC + ��•V r ,r,•1r r JUL 2 51996 SCALE 1" = -16' 1 FURTHER STATE THAT IN MY PROFESSIONAL - - OPINION THE PR -- INCIPLE STRUCKR E S AND ACCESSORY D NOTE: THIS MORTGAGE INSPECTION WAS PREPARE OUTBUILDINGS SG1L1�"�LrIJ SPECIFICALLY FOR MORTGAGE PURPOSES AND IS NOT TO WITH THE SETBACK REQUIREMENTS OF THE LOCAL UPON AS A SURVEY. ETC SURVEY ACCEPTS OACHMENTS BE RELIED THAT NO ENCHR FOR DAMAGES TO ANYONE OTHER THAN ZONING ORDINANCES, AND No RESPONSIBILITYER WAY ACROSS GEE AND ITS ASSIGNS IN CONNECTION WITH OF MAJOR IMPROVEMENTS EITHER SAID MORTGAGEE , THE AS SHOWN ITS PROPOSED MORTGAGE FINANCING TO SAID MORTGAGOR. PROPERTY ONES EXCEPT ae#3 ALSO: /✓rip Z-6"00 99-000b L CERTIFICATION TO: AED '/ I ri,.1A IA rfVP• 01. PROPERTY IS NOT IN THE 100 YR. FLOOD HAZARD AREA THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY MARKERS Oy PROPERTY IS IN A FLOOD HAZARD AREA OF OTHERS, AND DOES NOT REPRESENT A PROPOERTY SURVEY, TIIEREFORE 03, INFORMATION IS ISUFFICIENT TO DETERMINE FLOOD HAZARD. OFFSETS SHOWN ARE NOT TO BE USED FOR THE ESTABLISHMENT OF FLOOD HAZARD DETERMINATION FROM THE LATEST FEDERAL FLOOD PROPERTY LINES. INSURANCE RATE MAP PANELf NORTFI Town of 4 over .. O •I"�'- _ ri'(Y 'L'i No• s6w dover, Mass., 1�� � �o �-- L A- E o 9 �� COCHICHEWICK i �ADRATED '4S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System � BUILDING INSPECTOR THISCERTIFIES THAT ...................................... ...........0! .A.R.y........................................................................... Foundation has permission to erect....... ..............-imiumw on ......... Z7.....M. ..?�I3L. .R...I.p.. .c . .......... Rough tobe occupied as ...........................I.......... g...........S�-.6'....................................................................... 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-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S � ELECTRICAL INSPECTOR Rough .................... . ..... . .. .. .......................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR la in a Conspicuous Place on the Premises — Do Not Remove Rough Display Y P Final No Lathing or Dry Wall To Be Done Until Inspecteand Approved by the Building Inspector. FIRE DEPARTMENT d Burner Street No. Smoke Det. Date. . �. . MaRTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING I . SSA�MUS� This certifies that . . .� . �. . ./. �^� .��. . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . '. t1l.t, / . plumbing in the buildings of . . . . . . . . .` . .. . . . . . . . . . . . . . . . . . . at . . . P+. .' . . . . . ., North Andover, Mass. Fee. A/.7. . . .Lic. No. :i... . . . . . . . . . . .r . . . . . . . PLUMBING INSPECTOR Check # r ` 5510 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) p�h 1A IV�.a� Mass. Date -- j'b3 19 City,Town Permit#_ ���l D owner'AT: l ���`I�1 AS L A`r`m R-17 Names K/ ✓►\ '344e, r Type Of Occupancy: Q " New ❑ Renovation 1A RaincMA"ll it ❑ FIXTURES Plans Subrnirted Yes ❑ No ❑ z za t zIIc x a a OZ F' > A Z W x J a ?� V < a4 0 CM C z 0 < �is C = r Z O = la o. � O W r Wa Y! •,•. k z z �..IC p Z I d a z i 3 x O O• .Z t led 0>C z < W AQ Z J - G d a A LL IG x w r < o0 b Z Z a er0oZc x Id < N O < < m, < O < r SUB-nBS MT. n BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check One: Certificate Installing Company Name Corp, 94OG !� Adams y eM i•C� c � ./2. ❑ Partnership Q. i�i A t'JA) 1 'fi' p Firm/Company Business Telephone Q Zb-77&6 4- k 8 Cl� Name of Licensed Plumber or Gasfitter mlionti�5 CI I heueby ecu*that all of the details and information I have submitted(or entered)in above application are true and accurate to the bat of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent proviaious of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insaratrcx including completed operations coverage, Sipo—d O—/Ap* I have a current liabril"insurance policy to include completed operations coverage. BY Signature of Licensed Plumber Title City/TownType of Plumbing License 1.EJ,-,j' �] Master ❑ Journeyman APPROVED (omc E usE ONLY) License Number