Loading...
HomeMy WebLinkAboutMiscellaneous - 45 MAIN STREET 4/30/2018 / A5 MAIN STREET 210/029.0-0051-0000.0 �I I Date.. .�.. ... ...... ,AOR TM o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION �,SSACMUSEtt This certifies that . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . in the buildings of . ' "`. .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,r at . . . . .. North Andover, Mass. .y Fee.:?-�. Lic. No.�.��',!4& . . GAS INSPECTOR r Check# i, 56 =( MASSACHUSE IN UNIFORM APPUCATON FOR PERMPI'TO DO GAS FTITNG (Type or print) Date i �l I 0 3 NORTH ANDOVER,MASSACHUSETTS Building Locations t I !V CA r) S T, Permit# Amount$ Owner's Na e �e����l IV1c•�rk�� S New Renovation Replacement Plans Submitted Ij w w a x O x x z Z C4 Z F ° W ° W F G zx � a c x > WW W W v� ¢ �" a W a W F A F x C4 z C7 WF Z WF Z F, FW W U O > W F V H R: IM O x A C7 a OU GOG A 00. F O SUB -BA SEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR ## I ELI I (Print or type)-TcKre� R�� is Check❑ . Certificate Installing Company Name ,y 6 Corp. Address H 1 Partner. Business Te ep one ^7 - a Firm/Co. Name of Licensed Plumber or Gas Fitter �SP p►1 iVtQY-01 S INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No If you have checked yes,please indicate the type coverage by checking the appropriate box. 'Liability insurance policy Other type of indemnity 13 Bond 13Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.G r La a d tha atu a on this permit application waives this requireme t. Check one: ❑ Sign r f w er or Owner's AgentOwner Agent i heif that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of m owledge 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 Gas Co e and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By. Title Plumber 5yc� City/Town Gas Fitter License NumBer 0 Master APPROVED SOF MCE USE ONLY) Journeyman Location No. .3 G Date ,4011701 TOWN OF NORTH ANDOVER ` y Certificate of Occupancy $ s i •.ebb+,���`,.• ; r7 _ 'ss�caust�� Building/Frame Permit Fee $ 0 t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 O 161 i 9 -Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING :e "119 Sa.ftiK�"><ciAl Use Unl BUILDING PERMIT NUMBER DATE ISSUED: -121 •' 03M* eAA SIGNATURE: ' Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.4011 S4)�. "' I.S. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 NINA Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) �Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 Z Y 7,37 C O ,�1 y�j / / !1� License Number mn Add Tss .� ,� . Z 7 Expirat on Date ic Signature Telephone 3.2 Registered Homme Improvement Coonntractor Not Applicable �❑/ Company Name _�— Registration Number 1 r �s r Addrpr `3/4" OV-1 i ;�'1�T/l�/ 7 �` Expiration Date ^� 'Signature Telephone Y' p ` 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 check aft applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ T Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify. s "" Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building c.r"�/` (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN E S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 2 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Signature of Owner/Agent Date 41-11 NO. OF STORIES SIZE BASEMENT OR SLAB KD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1lEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL,OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 c 11, S 150 A._ The debris will be disposed of in: (Location of Facility) Sign/ature 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 t Boa d of�u�i�in��g�*egulafio(�S a� to d Ards ^� HOME IMPROVEMENT CONTRACTOR Registration: 130406 c) Expiration: 3/6!2004 Type: Individual RUSSELL BARBEAU RUSSELL BARBEAU 288 LITt'LETON RD.LOT 207 CHELMSFORD,MA 01824 Administrator } s ✓1�s �'anr�nnruneal!/ o�.•�1(h��*�s�dts BOARD OF BUILDING REGULATIONS 4 License: CONSTRUCTION SUPERMSOR Number: CS 024730 Birthdate: 11/2711954 ` Expires: 11127/2003 Tr.no* 10880 RestActed: 00 RUSSELL C BARBEAU � / 288 LITTLETON RD CHELMSFORD, MA 01824 Administrator L 1 ' w The Commonwealth of Massachusetts = d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 workers,Compensation Insurance Affidavit Name Please Print ��' !� �46"'�t"lr'Ga �G'fi//.•¢ c /c=F' Cj`�i-'C'�lq / �d�5c"•// /✓lv�-4'�,.' Name: ,v j�S c Location•�'7 �� "y7 ��r•1 .�/ City%��7 / ✓�`i�L ���v � (46 Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 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-weD_as_civil penaltiesin>theSoun-faSTOP W-ORKARDi=R md..a finecf_($1-0100)-aAW.against_� 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby cer ifyjurfder the �innn and na/ties ofPe�jury that the information provided above is true and coned Signature ��1-jam%! � , L � Date L'/ f _ _ Print name Fy s s e- /� �i't5J'ea G' Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone#: ❑ Health Department Other AV rT I ry Town of � Andover o z- LAEo overMass. COCMICM W GK > �d ORATED S 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ..�.................... .....wl .. .. ............................................................. Foundation has permission to "M....Rr..&/.r buildings on ......... y� �� N.......S ... ........................................ .... ..... .. Rough to be occupied as......�1......., r M+ � �N a AS Jr W"401L Chimney provided that the person accepting this perm shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. a ZIA 1 '$ 07 0 -momPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulatiois Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough .......... Service BUIL G 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. Date. / !. . c. ., ORT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACH This certifies that . . - f=. .�. !. . . .��.f. . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .t?. . . .. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .0, !.! . . . . . . . . .�?f.'.�;.�. . . . . . . . . . at. . . . .. . . . . . . . . . . . . ."Y', North Andover, Mass. Fee. . ./. . . . .Lic. No.. . > . . . . . . . y . . . . . . . . . . . -,. . . . . . j: PLUMBING INSPECTOR Check # / r 5498 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Klk kor -0coy e-r Mass. Date 6� _ :200 , Permit # - W Building Location y 4 0&4 j Owner's Name L/Aa�c c �C,�c��•/ Type of Occupancy 1_49)'r-CaA16 New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ • '1 SV• FIXTURES B.P. # SEWER # SEPTIC # z Z � Q Y ¢ > rn J U } 8 Q Z ljj W 2 ~ Z p= O per.• ~� J In W fA _ lA 1- U W CO Y Q rn 2 Z K_ Z X oUC w 0 S w ¢ W Cc Q W o. J Z IL a: O LL W Q = 3 3 o Z = 3 Y o_ t- ¢ YQw w�c w i 3 Y m o 0 3 3 o a ° -' ¢ E Q ¢ a Op Q t=- I- rn LL. O o ¢ 3 ac m o t SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name APOLLO PLG & HTG INC Check one: Certificate # Address 1SHATTUCK ST PO BOX 466Kj Corporation 1097C LAWRENCE, MA 01842-0966 ❑ Partnership Business Telephone 978-688-1755 ❑ Firm/Co. Name of Licensed Plumber DONALD DESRUISSEAUX INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes LXl No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. KI 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 installation performed under the permit issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title Signature of Licensed Plumber Type of License: Master )t) Journeyman 17.1 City/Town License Number 8699 APPROVED (OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHEr? PROGRESS INSPECTIONS FEE N0. APPLICATION FOR PERMNT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR