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HomeMy WebLinkAboutMiscellaneous - 48 ASHLAND STREET 4/30/2018 -48 ASHLAND STREET J 210/017.0-0022-0000.0 Date . )Az-1 j J-7,-- TOWN -7,!TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that dly , t"? . n._.1.�,!. . . . . . . . . . . . . • _ . . . has permission for gas installation . . . rf,,j bo. GN in the buildings of._. f e l L: . . . . . . . . . . . . . . . . . . . . . . at . . . . 4V -q f ��, %... . . . . . . .North Andover, Mass. Fee . C�U.-. . Lic. No. �� � A . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# _ 8529 � I •` MASSACHUSE71TS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ _ %✓ _ - II MA DATE _7//"2— PERMIT# JOBSITE ADDRESS � �SO G► a '� OWNER'S NAME GOWNER ADDRESS _ TE _5ZggS- _ f FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL CLEARLY NEW:[1 RENOVATION:Dj REPLACEMENT:[1] PLANS SUBMITTED: YES Q NO Q APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE �.1 . _ ..-G-� f -_ ( .f ._. ,._ DIRECT VENT HEATER .I.)-- __- DRYER FIREPLACE FRYOLATOR FURNACE I f I GENERATOR T GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT L._.�_ OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT - ... _ _- . _ ._. I.- T.::- Q.. _._) TEST _-.._,�I_J =_1 I _JI =--I -----1 _—f UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER r rC ' . f f! TJIr-__��_�_.E I 111- _I = TINSURANCE COVERAGE i have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JC_]r IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY ( BOND 0 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 [-JI AGENT �( SIGNATURE OF OWNER OR AGENT 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. PLUMBER-GASFITTER NAME� i LICENSE# 30270/_I SIGNATURE MP 0 MGF C JP JGF LPGI CORPORATION _�# PARTNERSHIP�# LLC[ # ^ COMPANY NAME: ADDRESS T( �T 57. CITY STATE ZIP TEL _ - FAX --------�.,.,.�: CELL EMAIL Z 1 Z7 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 AW ��lfl3 J a Commonwealth of Mas usetts Division of Registrati Board of Plumb' THOMA EN j 429 WAV APT 1 o NORTH A 4 Journeyma u PL32701-J 05/01/2014 �M sve 0049-5 i License No. Expiration Date. Serial No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): U,,, w& Address: M POP —S7-. City/State/Zip: /V4'f rf1 ,}ft1ayd1` /►1, _4 4 aS Phone#: 9 7g-W-X6 Y 6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ,employees(full and/or part-time).* have hired the sub-contractors E]Remodeling 2. ,employees a sole proprietor or partner- listed on the attached sheet.$ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 1011Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: Ike, 6k.r7' p-d Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 147"5Q,+FL ST, City/State/Zip: O Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: J�� //"—y Date: l a;Ot 71'Ion• Phone#: 4 "0�6 Y6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 09737 Date .MZ.I??�,z..- . `f TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . .�. . . :4/�^^. -�►.t? . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of—.—Ke X.11.0L . . . . . . . . . . . . . . . . . . . . . at . . �. .�. -. . . . . .North Andover, Mass. Fee s i . . Lic. NoA l . . . . .O'd• • . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ _� MA DATE ��- I�r _ PERMIT# I JOBSITE ADDRESS OWNER'S NAME sJ-C POWNER ADDRESS / ro _� /1� s TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION:EO REPLACEMENT:Q PLANS SUBMITTED: YES ® NO E] FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE =- 1 ( ......._.....,_,[ DEDICATED SPECIAL WASTE SYSTEM ======== _......... ..__...... _J DEDICATED GAS/OIL/SAND SYSTEM --JI _._._. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _._f ....._._..__( DISHWASHER === DRINKING FOUNTAIN ___[ ----I FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _[ .-I .-_-_-_i -.___i ....___.. 1 -f ___..___i -..__...i _.______ _...__._.i __..._ KITCHEN SINK 1 _-..___I .____.._ I _..__-� __.._J ..._...__.1 __.__-.._.I __.___a ._._..._t _._.__( ......_...._.( _--_-J _.-.-.._► __I ..._......... LAVATORY _____._._I -_-._._( _._-__1 __-._..! ROOF DRAIN SHOWER STALLI SERVICE/MOP SINK TOILET i _._.._..._! -_ [ __.-_d URINAL I -.._.__.._( ( J 1 � ....._._....i I J ` ...___.._.; ._.___.f :..._-' --_...__I _--..._.....J WASHING MACHINE CONNECTION i f . _- ' I 1 __._.-.l i ! ` _� WATER HEATER ALL TYPES _f _____-._! —11.. __- - WATERPIPING OTHER .............t - ( -I -..._ -'..A HF-I -.771 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESE] NO D N IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND Q 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 0 AGENT J0 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. PLUMBER'S NAME _ _t. 4exol t' LICENSE# 30?- q ._- ' SIGNATURE MP© JPFj] CORPORATION .# _ _ ;PARTNERSHIPS# LLC COMPANY NAME ADDRESS-71 I CITY !STATE ZIPO!� TEL S-- FAX CELL �EMAIL ....._ __.._._....._..._..._... ._. .__' 1_ Z 1 1..�1k✓U..-e�+- V%y' ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No �1/ n THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ / FEE: $ PERMIT# PLAN REVIEW NOTES t. 1 Y s ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;aibly Name (Business/Organization/Individual): "]�aFpn u $ t• ©Pno Address: M I=cro rs-r. City/State/Zip: /1/'0 r7 „�ey G/� /h _o Id aS Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1 1.❑ I am a employer with 4. El am a general contractor and I � have hired the sub-contractors 6. F1 New construction employees(full and/or part-time). 2. employees a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. 9 y p ty ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �I $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. 1 I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. A Insurance Company Name: Ike, 6 cP&^c(. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 147"5 6 fFSZ�i. , 6VOt ,,d Ci /State/Zi 01N.5, .� �� ty p Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: '� .n`—'�� Date: l��� ZKIX Phone#: 4 026 Y6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 AXAXAV macc an-VhIia } /r r i Commonwealth of Mas usetts • Division of Registrati " Board of Plumb' i THOMA EN W 429 WAV APT 1 o NORTH A Journeyma flu PL32701,-J 05/01/2014 S e 004905 License No. Expiration Date. Serial No. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z/50— /3 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION' y'SPrint a5: �p S PROPERTY OWNER Print 100 100 Year;Old Structure yesno . MAP NO: 011 PARCELOZZ ZONING DISTRICT: Historic District yes no Machine Shop.Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition No or more family ❑ Industrial ❑AI eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District v4ater/Sewer DESCRIPTION OF WORK TO BE PERFO MED: dentification Please Type or Print Clearly) �/ b OWNER: Name: �JSSEL__ Alaj ICPhone: Address: A fpPU L w�- ptAss CONTRACTOR Name: C kr!S�ap4c,- n �c—��rc� Phone: °l Address: Supervisor's Construction License: C S ~O_S?SC?!9 3 a Exp. Date: v Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: r Address: Reg. No. r. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 , Obi FEE: $ /a 01 Check No.: 7y0 Receipt No.: o?66�y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �S g;nature of Agent/Owner Signafute of contractorj_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan El Stamped Plans ❑ Location No. `F! Date t • - TOWN OF NORTH ANDOVER • ���7'I.ID l�ya,` t , • -- Certificate of Occupancy $ Building/Frame Permit Fee $�/211)— t'= elFoundation Permit Fee $ Other Permit Fee $ ,� TOTAL $ Check#7Z-0 26059 /B ilding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools 0 Well ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r r Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towp. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Mai il Street Fire Department-signature/date ` COMMENTS A, G� INSPECTIONS SERVICES LOG DATE:_ ���` �� 2-0 l� ADDRESS , • � Q e- INSPECTED BY: NAME DATE O NSPECTION: PHONE (� f 1 � ASS FAIL' OTHER ORREC ION NOTE/INSPECTIOAI COMMENTS: PERMIT# OFFICE NOTE: E LIDNREQUEST: ESCIFOOTIN FOU D TION FRAMEROUGHL OTHER L1� TIME IN: TIME OUT: DDRESS 4 INSPECTED BY: AME L/ PATE OF INSPECTION:, a ONE PASS FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: =KNIT# OFFICE NOTE: 3PECTION REQUEST: ESCIFOOTING FOUNDATION FRAME OUGH FINAL OTHER TIME IN: TIME OUT: r !NSPE SP_CTEn BY: VIE DATE OF INSPECTION: )NE . PASS , FAIL OTHER W11-1CORP.ECT30NNOTE/ INSPECTION COMMENTS; _ OFFICE NOTE• 'ECTIONREQUEST: ESCIFODTINW' FOUNDATION FRAME UGH FINAL- OTHER TIME IN: TIME OUT: CESS NSPECTEDI3Y: .{ = DATE OF 10PECTION: PA55 FAIL OTHER IE CORRECTION NOTE/ INSPECTION COMMENTS: IIT# - OFFICE NOTE: CTION REO••UEST-. 'ESC/FOOTING FOUNDATION FRAME H FINAL OTHER TIMEIN:IN � TIME OUT: .-=xrr�>F:�r,.xxr>r ;r:.:.:.:.;.->==.�r==.F==____••�;_:==ter>�#=.;�-�:.-:�.��.=�.T,- ._><:�*_�:�;:=.::tt��.;:t�:�=r;>r�>=,:�<-�*�:__,..-<x-=���_�-,-�-r:..--...r-,..>*;;:��:->--�_ :SS INSPECTED BY: ^ DATE OF INSPECTION: PASS FAIL OTHER CORRECTION NOTE[ INSPECTION COMMENTS: OFFICE NOTE: NON REQUEST: ESCIFOOTING FOUNDATION FRAME I FINAL nTNFR 'itMFfN• vrnrt�rn�r. NORTH own o s E : ., ndover 0 C% h ti ver, Mass, /-i 2/2 '/y �J ccc.uc.."... �1 J9 A�R�{TED I'4�`�,�5 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System // `/ BUILDING INSPECTOR THIS CERTIFIES THAT ......�'� r'%.. ./..�7..�:::' ^`��� ........................................................................................ has permission to erect .......................... buildings on . .s-��....... -..���?........ ........ Foundation Rough to be occupied as ....... !....G,.` �4....................................... ..f. .��c. ../. ifs :::uj�..., :�' ..:... chimney provided that the person accepting this permit shall in every respect conform to the termt of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough J ................. Service .................... ....... ....r Final BUILDING INSP R GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-087832 C CHRISTOPHER12,4I Fjw,, H 48 ATKINSON S Methuen MA 0144 f Expiration Commissioner 04/24/2014 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use i I t LJ Notified for pickup - Date I ' t I Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. l 1 Roofing, Siding, Interior Rehabilitation Permits � i o Building Permit Application a Workers Comp Affidavit La Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application Li Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit { a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building permit Revised 2012 Location r` i No. Date i ip TOWN OF NORTH ANDOVER n Certificate of Occupancy $41 ¢ Building/Frame Permit Fee $ zACMUSFoundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ r, TOTAL $ co Building Inspector rr' 10972 Div. Public Works ._.>�..•w.t. ...a�,"u . - .,-.,. ;,.. - .-^: - � �:.'•.�x _� ,Y M ..,>"...�=i �r� �r �:.c�.-+•'e. �Y. �� _ -^rte... 7-Or O. r RM liIT NE3: -MAS&,,: PAii>i AflUCATIOM fOft /ERMR T���UILO�-MORTH ANOOVEf�. n:MAP.NOIt•/,•%7��_ LOT NO .,.Z'�.r� .x„ s��=. r W:_RECORD,0F OWNERSHIP" DATE'.: BOOK PAGt i 6, ZONE. SIJd DIV.LOT NO. _ "— OCATIOt�f s - g^ rump"a OF nuk.D!Nl*_ _ _ OWNER'S MAMQ _. Md. OF STORIES-i, OWNEWS ADDRESS_ BA"MENT on,[LAR' ARCHITECT'S NAM[' OF FLOOR T1148[RZ F iBTi t _ 2ND BWLDEII'S NAME SPAM -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS • AREA OF LOT FRONTAGE NIGHT OF FOUNDATION- - THICKNESS ♦ -`'IS BUILDING NEW SIZE OF FOOTING. ... - 11' IS BUILDING ADDITION MATERIAL Of CHIMNEY 10 BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS Of CODE IS BUILDING CONNECTED TO TOWN WATER. BOARD Of APPEALS ACTION. If ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINO. INSTRUCTIONS 2 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. SLOG. COST PAGE 1 FILL OUT SECVIONS 1 - i EST. BLDG. COST PER 614.1 FT. � PAGE 2 FILL OUT SECTIONS 1 - 12 [ST. SLOG.COST r[R KOOK SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST■E FILED ANP APPROVED Y BUILDING INSPECTOR DATE FILED U.DING INBPRCTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E s OWNER TEL I PERMIT GRANTED CONTR.TEL I' (Oa 3 O- s Q (1—1 , ( COMM UC.I 627 2-V- H.I.0 I IOU 60 Z sx BUILDING RECORD i OCCUPANCY J2 - SINGLE AMllr .o ' s THIS SECTIONrMUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM n. ENTS = oFFlces� LOT LINES AND EXACT DIMENSIONS OF BUILDINGS.`WITH PORCHES., GA- FROM- APARTMENTS RAGES. ETC. SUPERIMPOSED.THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH ;.._ ...;.._ CONCRETE I 7 3 -CONCRETE BL-K. CINE BRICK OR STONE HARDW O _. PIERS PLASTER DRY WALL _. UNFIN. 3 BASEMENT ._ _.; AREA, FULL FIN. B'M'T' AREA _ FIN. ATTIC AREA J'q B Ml FIRE PLACES _ MEAD ROOM��J_ MODERN KITCHEN 4 WALLS S PLOORS WBOARDS B 2 7 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDw'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPIC.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON XD3=y-- ATTIC SIRS,L FLOOR BRICK ON FRAME CONC.OR CINDER BLK. TONE ON MASONRY WIRING STONE ON FRAME y SUPERIOR POOR 7E NONE ADEOUA S ROOP 10 PLUMBING , 1 GABLE 1, 1 HIP BATH 17 FIX.I , GAMORELI MANSARD TOILET RM. 12 FIX.1 IFf T SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY ' SHINGES KITCHEN SINK NO PLUMBING TAR i GRAVEL STALL 3140wER ' ROIL ROOFING MODERN FIXTURES TILE FLOOR _ . TILE bADO 6 PRAMINO YVC= JOIST PIPELESS FURNACE - FORCED HOT AIRF RN. TIMBER BMS.i COLS. STEAM STEEL BMS. a COLS. HOT W'T'R OR VAPOR k WOOD RAFTERS AIR CONDITIONING RADIANT H'T"G - Y. UMT.NEATERS 7 NO. OF ROOMS GAS u OIC 2nd _11140 ELECTRIC tN Sid - HEATING ' ` �6 NORT/y Town of. Andover No. 2 vo 19 * s dover, Mass., 94:cocN cH WICK OW4TEp PP` �C BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR L THIS CERTIFIES THAT................................................P s.45 'i(. ............f�1� 1� ��.1 C`. .................... Foundation has permission to era&...... buildings on ... 8.-.`55./���..RI`�. ............................ Rough t0 b8 occupied as.... AV 47 Chimney provided that the person accepting this pe rmd A all 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S Rough .............................. . ..... . .. . ..... ..... .............. .... ..... Service 10 B 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. Smoke Det. f r Location ' '` Of No. Date A&(11177 �Iil t No* 4 TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee $ sACNUSEt'�' Foundation Permit Fee $ iu Other Permit Fee $ Sewer Connection Fee $ I` Water Connection Fee $ �~ TOTAL $ Q U, \ N f Ue,' Building Inspector tTO 10 19 Div. Public Works Rim NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE ] N,AP d-4�`. �� LOT NO. 2 RECORD OF OWNERSHIP [� E BOOK PAGE { �. — ZONE I SUB DIV. LOT N0. I LOCATION yci-t-M ksVL.Awl;D PURPOSE OF BUILDING I OWNER'S NAME Pv i��LRY.]�`G� NO. OF STORIES SIZE "tT ' OWNER'S ADDRESS 6-4POMN,)j" � � •(�� '( 1 N\�., BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD { BUILDER'S NAME 'P>G-rj5p, fJA, S SPAN -- I DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS kA!2 52 CQO i DISTANCE FROM STREET - POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS -• 1 AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS y IS BUILDING NEW N p SIZE OF FOOTING R IS BUILDING ADDITION Mo CrJI��.De WL-D ' ` ` ��� MATERIAL OF CHIMNEY IS BUILDING ALTERATION ``,OFLS�� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE s PROPERTY INFORMATION INSTRUCTIONS • LAND COST SEE BOTH SIDES EST. BLDG. COST a�l�U` �,, •�:,,.,,. PAGE 1 FILL OUT SECTIONS 1 - 9 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. i ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ' ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AN/DAPPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT OWNER TEL# PERMIT GRANTED CONTR.TEL N CONTR.LIC.# O q7-EP " H.I.C.# MAY 14 1997 1 i f BUILDING RECORD �• ti i 1 OCCUPANCY 12 SINGLE FAMILY STORIES 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 EPLACES PLOT PLAN. CONSTRUCTION ��e LC9 c 2 FOUNDATION _ 8 INTERIOR FINISH ; CONCRETE _ a 1 2 I3 CONCRETE BUK. PINE _— — BRICK OR STONE HARDW D PIERS PLASTER _ I _ DRY WAIL UNFIN. 3 BASEMENT I } 1 AREA FULL I FIN. B'M'T' AREA 1/4 �h % FIN. ATTIC AREA NO B M'T FIRE PLACES — i HEAD ROOM _ MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDYJ'D �_ s ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY i STUCCO ON FRAME SONRY ATTIC STRS. 3 FLOOR _ BRICK ON FRAME I CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR IPOOR � ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.► _ GAMBREL MANSARD TOILET RM. 12 FIX.! FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ A WOOD SHINGES KITCHEN SINK $LATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 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 7 NO. OF ROOMS GAS OIL Baf T 1TRIC 3rd I NOC HEATING , MUK I VAVt VLU 1 PLAN 40-42 / 44-46 / 48-50'. ASHLAND STREET NORTH ANDOVER, MASSACHUSETTS p SCALE: 1" = 40' BUYER: RUSSELL HERTRICH MARCH 2O, 19Z4 rn �t a �Tq "ba � � c , r SEP 7,n G.C. �.4/✓ �4`S/3.5 8 NOTE: THIS IS NOT A SURVEY AND IS TO BE USED FOR MORTGAGE PURPOSES +� ONLY. N.B.- DO NOT USE OFFSETS FOR ESTABLISHING LOT LINES FOR THE ERECTION OF FENCES, WALLS, HEDGES, ETC. 1�10/sTtv�� I HEREBY CERTIFY THAT THE BUILDINGS ON THIS PROPERTY ARE s,.i• LOCATED AS SHOWN ON PLAN AND COMPLIED WITH THE LOCAL ZONING SET BACK REQUIREMENTS WHEN CONSTRUCTED. "*NOTE: SIDE YARD REQUIREMENT FOR SHED IS TWENTY FEET. CYR EWANEERM' SERVICES' MIC, I FURTHER CERTIFY THAT THE ABOVE DWELLINGS ARE NOT 304 CANAL STREET LOCATED IN A FLOOD HAZARD ZONE. LAWRENCE, MASSACHUSETTS 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 local or state law, regulations or requirements. I ****************Applicant fills out this section***************** APPLICANT: u S S Phone LOCATION: Assessor's Mar Number Parcel Subdivision Lot(s) Street �� /4S/`'1'fi.��� St. Number ********************* Official Use Only************************ RECO ATI AGENTS: (/' Date Approved Fill Conservation*Odministrator Date Rejected t Comments W%44 WM" A** • Date Approved j Town Planner Date Rejected fC I Comments Date Approved i Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments -Public Works - sewer/water connections i - driveway permit Fire Department Received by Building Inspector Date +! i'• � I OR t over Town of o m No. 2 29 .. _ 777 —* 5 1 dover, Mass., oA.4 E BOARD OF HEALTH E Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT P.W_.a-'5 (.Ix,�... tch(.•"••"......•"""••"""••• Foundation has permission to erect............ADD............... buildings on d './y�-• ! •1� Rough- ..... -T..6........SA ....- �. .. ......................................................... Chimney to be occupied as............................................ R............ ...�c' C ... provided that the person accepting this permit shall In eve res ect 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 INSPEC"I'OF VIOLATION of the Zoning or Building Regulations Voids this Permit. Rom Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECPO UNLESS CONSTRUCTION ST S Rough .................................... ... .... eG Service BNSPEC'POR 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. Smoke Det.