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HomeMy WebLinkAboutMiscellaneous - 475 MASSACHUSETTS AVENUE 4/30/2018 475 MASSACHUSETTS AVENUE � 210/045.G-0043-0000.0 - - i II J ll 1 i I Date.51.2-7...,.1` .........:............ �NowTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION. This certifies that ......i3 .......................... ................................. ... ...................... has permission for gas installation ..�..... C..l���j!�7...........Q�..."4fn,�-� in the buildings of....�.�r-.. tL- . .. .. . .... .............................. ............................................... at........................................G1SS.............................................., North Andover, Mass. Feet)...--........ Lic. No.�� .... .................................................... t - GASINSPECTOR Check# 1 9321 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FLITTING WORK • CITY North Andover MA DATE 5122/2014'PERMIT#_ I�211 JOBSITE ADDRESS 475 Massachusetts Ave OWNER'S NAME GOWNER ADDRESS Same TELFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES[j NDE] APPLIANCES Z FLOORS— BSM 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER OOF TOP UNIT TEST I NIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER -------- ---------------------------------- -- Replace 1 Gas Meter x and-associated,piping..................... L—JH INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E]NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [D 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 ® AGENT 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME jjqseph Marino LICENSE# 8736 SIGNATURE MP E] MGF® JP® JGF LPGI® CORPORATION E]#I 3285C PARTNERSHIP®# LLC®# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIP JTEL 508)832-3295 FAX 508-926-4347 1 CELL 508 832 4614 EMAIL JMarino@RHWhite.com 1 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 C)MM;O�IVWEAL TH OF It16A1?s ' '==E!LU(VjBCRS ANd GASFIT ,--r=•.~ " J'=- S I.C'ET SED �►S'R.Mr=STER f?. - fSUES TFI='ABQUE LIGi NSE l`Os'= -T 't - ;JPO S E`PH.. `D PZ A R.I N Q e' l 0;; "ihf` R_GES7`ER ' MA 0i `f =; I:pr+ �•�:. : 05/01/1�o- " w �:'-: CERTIFICATE OF LI,A,BILITYINSURANCEpage 1 of 1 =ATE5NMI THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 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 PoNCOes)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not conferrights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 97illiq pE Masanchusette, Inc. PHONE PAX c/o 26 t'Q�itvey Blvd. NO,EXT1: 877-945-7378 _NO) 886-467-2378 NO- P. o. Boxlle 305191 3 0DRFW ce_rtifica,te�9l�wdllia_GOTH Nnlghville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAICIF INSURED INSURER A:The ebartar Oak Tiro Snauranao Company 25615-001 R. H. White Construction Company, Inc. INSURER 19:Tr1Lv4],gr8 Property Casualty Company of Am 25674-003 41 Cmntra7 Btxeet INSURERC:NatiQzlal union Firg Insuranea Ccmpanl P. 0. Box 257 r o£ 79445-001 AuhUrA, MA 01501 INSURERD;Travelers Indamni,ty Company 25658-DOl INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN[$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA7ED. 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. I TP TYPEONNWRANCE DD' SUB P wyn 4LICYNUMBER POLICYEPF POLICY EXP LIMITS A GENERAL LIABILITY VTC2000 977109948-13 9/9./.2013 9/1/2014 EAC?'IOCC,URRENCE IF_ 2,000,000 -VVW1 X COMMERCIAL GENERAL LIA911.ITY 0� TORENTFD �� Is g(Ee TFD crl $ 300.000 CLAIMS^MADE OCCUR MEDEXP(Anyone anon '� IP,000 PERSONAL&ADV INJURY S 2 000,000 GENERAL AGGREGATE S 4�000 000 GEN'LAGGREGATELIMITA17 ,rPPLIESPER; PRODUCTS-COMPIOPpCyG $ 000 000 POLICY PRL LOC B AUTOMOBILE LIABILITY VT,7CAP 977K955.A-13 /1/20x3 9/1/2014 NN $ x ANYAUTo �ac�IdeDSINGLF.I.IMIT S 2,000,000 AIBODILY INJURY(Perpemon) F I,OWNED SCHEDULED AUT08 AUTOS BODILY INJURY(Peracoldonl) 6 X HIREDAUTOS X NON-OWNED AUTOS eracddenl X Co Ded X CQ77 Ded S C UMBRELLA UA$ X OCCUR BE8766140 /1/201.3 9/1/2014 EACH OCCURRENCE $ 5�00O 00 X EXCESS LIA6 CLAIMS-MADE AGGREGATE $ $ 00 DED VRETENTIONS 10,000 S D WORKERSEMPLOOMPENSAILIT `r RXlJB 920SAI05-13 9/1/209.3 9/1 207.,4 $ U AND EMPLOYERB'LIABILI7Y y N / TOKy.LJ 0 ANY PROPRIETORIPARTNFRIEXECUTIVEra� NIA 'VTC2xuB 8203.A.71A-13 9/3,/2013 9/1/a01�4 E.L.EACH ACCIDENT Z,000 OQQ OFFICERmtEMB6REXCLUDEm LFRI MendetoryrnNIH)e0lbaunB E.L.DIAEASE-EAEMPLOyp.E S 1,000,000 U�tSOK11-11UN Uf UPFRATIONS below F.I.DISEASC•POLICY LIMIT S 1,0Q0,000 )ESC RIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Auaell Acord 101,Addlfonal Remake 3thedula,If more ep eea la mqulrad) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCQ.I.ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, aUTHORIZEDREPREaBNTATNE Evidence of InlaLtxance coll1*4197604 Tp1:1694012 Cert:20267680 ©1988-2010ACORD CORPORATION.All rights reserved. ,CORD 25(2010105) The ACORD name and logo are registered marks of ACORD Date.7-. "°RTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS US This certifies that . . . . . . . . . . . . . . . . . . has permission to perform --.-r< v. .:��. . . . . . . . . . . . plumbing in the buildings of ..-�rG- - . . . . . . . . . . . . . . . . . . . . . at . . .. . . . . . . ... . . . .F�, North Andover, Mass. Fee. �. .Lic. NoP3, / . .�. . . . . . . . . . . . . . . PLU?vKel INSPECTOR Check # � f/ 6897 � i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS � ?./zZ-/0 Ig Date Building Location y7f_ /N#SS• 4p�e_ Owners Name -Jro*lz. ' C e Pernrit# Amount Type of Occupancy 0LAJ'e i'"i New Renovation Replacement .©C Plans Submitted Yes No FIXTURESCIF _ - Cn STB�fi51t l�avr 2D.F1E" 4>fIl~I��t EllS _>EI t (Printor type) Check one: Certificate Installing Company Name T Pc L L o:�A vJ p�-f'� Corp. Address `'d " G?� 5 7�, 0 Partner. W fZ .v C e tM A Z_ Business Te ep one Irl -7 S-y5 G y D rum/Co. Name of Licensed Plumber: 7Ah M ras Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D Bond D 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 ignature Owner 13 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application areWe 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 Massachusetts State Pjpynbing Code and Chapter 142 of the General Laws..- By: Signa ure� cen�sec glum Type of Plumbing License Title 1103 33 City/Town ricense 14um er Master D Journeyman APPROVED(OFFICE USE ONLY t Date. . 3 " s . l�� •. „ORTM ?0* 'eA O 0 3 TOWN OF NORTH ANDOVER 9 • PERMIT FOR GAS INSTALLATION SAC MUSE��y+ .. This certifies that . . . . . ... . . . has permission for gas 'nstallation . . . . . . in the buildings of � per.• �-�-�- -�. �s✓ at . y . . �! . . . = . /. ., North Andover, Mass. Fee . . . . . Lic. Noy 33 . . { GAS I's s CTOR Check# 0 76 5503 MASSACHUSETIS UNHDRM APPUCATON FOR PIIMT TO DO GAS FrrnNG (Type or print) Date A Z/. NORTH ANDOVER,MASSACHUSETTS Building Locations ,T'P/�SJ S • ye Permit# �O�s°✓ �E✓e�e� Amount$ Owner's Name New❑ Renovation ❑ Replacement ® Plans Submitted ❑ x w z C4 V W^ r Fd W F v� o• CO > d zW �" C4 w a F W U z WCW z ,.f W�W "a F F v� z O z O vFi SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) /y�_ Check one: Certificate Installing Company Nam /%e 411,9 R'9 A.-, P1,Vo4 Corp. Address ey �OS� S72 fl9c✓ ule M� OppIZ ❑ Partner. 8"S= 9S� y' Business Te ep one rl Firm/Co. Name of Licensed Plumber or Gas Fitter t INSURANCE COVERAGE Check one: l have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No Wyou have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity 0 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 Massachusetts State Gas Code and Chapt 142 of the General Laws. 41-1 —` By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber ; YY3,3 City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) r5i Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT O DO (3ASFITTLNQ .,, .• �, ra" ''.P t or T 15 Mass. Oale V Iri Permit * ��4 S !' Owne's am Type _ ccupan Now ❑ Renovation O Replacement 00", Plana Sutxnllted: Yes W W O N V x C cc W; N OC W W O N cam„ W V as Its O O W ft W = Is Of lu W W itsaC p W W C C1 O: W U. W X W O > F A W aC 't O 10 • O .C)N( W O O W 0. O f V aC y A a x k OO Sun—nsh1T• nAZZINICHT 1sT FLOOR �..... � , 3H0 FLOOR � j• .:. ♦ .fir .: 3R0 FLOOR 4TH FLOOR , T e. STH FLOOR .. ..,; a.�. 4TH FLOOR TTH FLOOR STH FLOOR , Installing Cornpany Name CI ails; ZFVVIM Check one: Ce Address 1 i ❑ x Corpmatlon i x t7 P rtnenhtR y eplane d !�m Name Of Licensed Plumber ~: ' or Oaa FUler 3 • INSURANC ., E OV.E GE 1 have a torte t: a Insurance '" policy,or Its substantial which meets the requirements of.Mt3t: No O. It you havectfl�cked ` s , plesse,lnd a the type coverage by checking the-appropriate box ,., A x;1.3 0lha'tYpa.Ot.Ittdemay 1 Bond O OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the Insurance covetage,requked'by' Chapter 142 of the Mass. General Laws. and that my signature on this permit application waNe: this requkemePt, Check one: ," Apnalure. : '01 owner:Adent OwnerO Agent❑ t hereby e*dVY andThat aq of the details and Iniwmallon(have subrnlited(or entered)In above appitcatlon are but and aomale to the best of my nowiedat and that aqp�umbin�work and Installatlons performed under the permil Issued for this application VAN be b ort1nenl provistor►sYol the Massachusetts Slate oaa Codi and Chapltr 142 ofthe Oe Laws. cornpliance , Y. lot Ucseale slibor naore o ce umltor or s sliaslorUcensswneymanNumbor --- -- ; ^' "SyN•v.{y1 ii+k�kN , V/ `r�'C .. '�'s'4:%!L!tirU ...«..,�.,,,l�.wv.:_-•--w+.,:...,...... .. ...a.. ...r+.. —l'i, .. ._ ... .T... .r,-•-�,.- a.:�:� , ��.. Fw- 4 : /yy+/' 'i � . . � � ♦ _eat � •s• •t ' . '� a � �4 rFT t•,'3'�.F+:3;t �• -fit - .'" �.r ,' s 1 1'. i t. sf • - .ply,_ '• l' , 51 APPLICATION FOR PERMITTO DO OAMMMO NAMES TYPS Of QUIL161NO • _ LOcATiON 01<BUTLOINQ _ PLUMBER On QASPTTTER + • 1 .•�, .. ..-i •'� .-. . ....+. �,., T •Vit' '-� ,w.cy..a,.•.aJ^*,y...w. ,l:.J ..,rt:.•!e'"rr{sti+.. .c .. .•<• .'�. '4 ,'� 4. li 'Y', i' � } � 4 f' . t•. ;: — ,, e,,,.... s= PERMIT ORAM*t RA! INSPECTOR , 2 8 / 7-Ir Date.�a/.14,�! �.f ... ..... r / / MORTM TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION $ O � Ifl 1- 9 iU s i, � • SACHUSES '4 This certifies that .a.'DOA -r.(Zs. . . . . � � . . . . . . . . . . . . . . � 0 has permission for gas installation . . .R./- . . . . . . . . . . . • • . . in the buildings of . . n .. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . , N�Andover, Mass. L Fee.� ?.. . . . Lic. No..162I? 7 . .. +''�'� AS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI�N ''' 1 (Print or Type) NORTH ANDOVER Mass. Date 5 _ Building Location / C% � Pe mit # / i.. Owners Name : New Renovation D Replacement Plans Sub itted D S FIN' ' - cc 14 W N N 09 U us LU Z m w -.4 W w O o a a W tw- N a V W m 4 m O G > w W W 07 CL- Z < + [t Q a W rt W W O ? LL Q W < cc: 4 G Q m O O N Z C ,u > t: W _ C w O 0 = U ¢ > Q c, H O BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4THFLOOR 1EE111 11 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name Corp. Address Partner. Firm/Co. Business Telephone: / "J o Name of Licensed Plumber or Gas Fitter Insurance Coverage. Indicate the ty of is-isura-ice cove. ge by checking the appropriate box: Liability insurance policy her type of indemnity F 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 U Agent El I hereby certify that all of the dcuils and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that aU plumbing work and installations performed under'Permit iueed for this application will-be in compliance with all pertinent provisions of tho hLtsachusetts State Cas Code and(3wpter 141 of tho General Laws. By TYPE LICENSE: 262-04 Plumber Title Gasfitter gnature of Licensed City/Town: Master Plumb rr a fitter APPROVED (OFFICE USE ONLY) Journeyman License Ium er Date.. ....... NORTH TOWN OF NORTH ANDOVER pF4+�ao ,e 1tip o? p� PERMIT FOR GAS INSTALLATION N A t s s ACHUSEtth This certifies that . * :/: :: . . ":. .'�-�!. . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . in the buildings of . ./: . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . :. ` . . . . . . . ., North Andover, Mass. Fee. Lic. NO.. . . .`! . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD: File � Location MA-,: .S /) r No. Date �oRTM TOWN OF NORTH ANDOVER F A ` Certificate of Occupancy $ • ^ ' ' 36) ,s3ACNUSBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17193 Building Inspector ' 6 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATIONTOCONSTRUCT REPAI RENOVATE, OR DEMOLIIS�HrA ONE ORTWOFAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: (0s II-7 ZO SIGNATURE: Building Commissioner/I for of Buildings Date SECTION i-SITE INFORMATION O X1..1 Property Address: 1.2 Assessors Map and Parcel Number: PZ*AJ# L or 3 y Map Number Parcel Number 1916/ppno QE/1 1.3 Zoning Information: 1.4 Property Dimensions: s y Zoning District Proposed Use LA Ar ss T Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided Required Provided 1.7 Water S M.GL.C.40. 54) 1.5. Flood Zone information. / 1.8 Sew a Disposal System: Public Private ❑ Zone Outside Flood Zone G7/ Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT HistoricDistrict: Yes No M 2.1 Owner of Record _ Name(Print) Address for Service: /7/7 tgnature Telephone 2.2 Owner of Record: Name Print Address for Service: r Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construc n Supervisor: License Number mn Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable a D-- Comp any Name Registration Number Address r Expiration Date G) Signature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L. C 15,Z J 25c(6) Workers Compensation Insurance affidavit must be completed tted 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 Descri tion of Proposed Workcheck all applicable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: {/U� ODO/� S- �G�i�l0 �irlS��/y�' 's�/9�•�r� %/y�/G �•�lifCE SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 4IF `dCIAL=USS Q} y Completed b ermit a licant � r �. < >. 1. Building �QQ/yj/TiE!/AGS (a) Building Permit Fee '✓ Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlurnbiB& Building Permit fee(e)X(b) 4 Mechanical HVAC 5- Fire Protection 6 Total 1+2+3+4+5 © O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, A 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 OW AUTHORIZED AGENT DECLARATION r I, .������� �l E� ,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 leo G Si atur wner/A e Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS OT 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS t 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 pR6Et YFt Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 5ACHuy� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE �G D � y JOB LOCATION Number Street Address Map/lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESSoe& zj&�_ Si9/ylE �S' �a`E City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two 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 108.3.5.1) 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one a home in a two-year period shall not be considered a homeowner. 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 re uirements and that he/s will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDI OFFICIAL Location: 475 Mass Avenue, North Andover, MA ' t+of Date: 8/24101 Scale: 1"=40' EDWARD c Buyer: Weier, Jonathan A. & Stephanie L: o 5 P tl �+ Deed Ref: 1683116 Plan No: -4566 4 Drawn per City/Town of N/A Tax Assessors Map OVAL Lr�NoS ti DECK DOT 34 A=15,400 sf. � O /P/)Z Po S R I n �. It Q 12 STORY W/F fil DWELLING N PN MASSACHUSETTS AVE To: RBMG. Inc. I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not intended or represented to be a property line or land survey. It can not be used for establishing fence, hedge, walls or building lines. No responsibility is intended herein to the land owner or occupant. The location of the original building(s) as shown herein was in compliance with the local applicable zoning bylaws in effect when constructed. with respect to horizontal dimensional requirements, to lot lines or is exempt from violation enforcement under Mass G. L. Title VII, Chap. 40A, Sec. 7, unless otherwise shown herein. I further certify that the property is not located in the flood hazard area as shown on FIRM map Community No. 250098 Dated 6115/83 Job No. 01-5202 EASTERN ASSOCIATES, P. O. Box 4459, Peabody, MA 01961 (978)535-8934 FORM U - LOT RELEASE FORM 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 dN d� PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET SS�«UsLE/�� (��/�v� ST. NUMBER��� **********k******************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERMATER CONNECTIONS i DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm NORTH g Town of ? - Andover 0 dover, Mass., 6 COCMICH6WICK s RATED l U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ~ Foundation has permission to erect....�� O.V♦ buildings o ........ ....................... A Rough ............... ........... Chimney to be occupied as...................................................M ....5....... -........V..��1.1"...'�...,Q�/�.�..�.�..1�.. y 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-Lawsing to the Inspectio Alteration and Construction of Buildings in the Town of North Andover. rel t 43 360 .0000, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough OF ............ 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 !Nall To Be Done EIRE DEPARTMENT Until Inspected and-Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. N011TH own ® Andover No. o � dower, Mass., LAKE I� COCMICHEWICK ,� RATED AP�,��(5 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � � r�M � •A� I� �+, � � BUILDING INSPEC'T'OR THIS CERTIFIES THAT.......... ....... ...... .............................. ......... Foundation has permission to erect.... ♦..... buildings o .......: ..............,........ .. ....... ... Rough ............... . .......... t0 be OCCUpled as r' 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-Lawsing to the Inspect Alteration and Construction of 4,!y%5467 &/.3 Buildings in the Town of North Andover. — /S 6rel t &/.3 3Sao OOW . PLUMBING INSPEC'T'OR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPEC'T'OR UNLESS CONSTRUCTION ST TS 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.