HomeMy WebLinkAboutMiscellaneous - 5 WEST WOODBRIDGE ROAD 4/30/2018i
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Location 3— '.� ',�/�( '/ A
d _
No. C;�G Date
3--'", TOWN OF NORTH ANDOVER
rr oL
it
Certificate of Occupancy $
�'��°',•�°''tom Building/Frame Per Fee $
Foundation Permit Fee $ _
Other Permit Fee (idol $ 3S
—
TOTAL $
Check # '3
14 C 5 2
r yBuilding Inspector
Location //�rs� Zt�COWPjafio-
v
No.
02�� Date
_f NQRTIy,. TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'�s'•'° 't�
Building/Frame /Frame Permit Fee $
s�cMu�E 9
` Foundation Permit Fee $
Other Permit Fee pe:,ol $ 3s
TOTAL $ 357
Check # '33&q
14852
Building Inspector
A.
•
SIGNATURE:
Building Commission or of Buil
SECTION 1- SITE INFORMATION
Date .
1.1 Property Address:
k/,esf wood6o&g,
SECTION 3 - CONSTRUCTION SERVICES
1.2 Assessors Map and Parcel
_�� -
Map Number
Number:
f
Parcel Number
�� /�
A&W7
Expiration Date
1.3 Zoning Information:
Zoning District Proposed Use
3.2 Registered Home Improvement Contractor
Not Applicable ❑
1.4 Property Dimensions:
Lot Area
Frontage ft
1.6 BUILDING SETBACKS ft
Expiration Date
Signature Tele hone
Front Yard
Side Yard
Rear Yard
Required Provide
Required
Provided Required
Provided
1.7 Water Supply M.GJ-C.40. 54) 1.5. Flood Zone Information: 1.8
Public ❑ Private ❑ Zone Outside Flood Zane ❑ Municipal
Sewerage Disposal System:
0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
d n '' y[efJ1/1 �y�� 1G> �' L.✓� J T N Yv QS� WOOdl,21-1 Gl�Qe /'lel
me (Print) Address for Service : t
Telephone
2.2 Owner of Record: `
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Su7sor:
Q i : , rs
�/dC rcti
tcensed Construction Supervisor:
t/, d �,� �(, �/� ��•
Address
Signature Telephone
Not Applicable ❑
,/ .
fl 3 9 .5 L
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Tele hone
SECTION 4 - WORKERS COMPENSATION (MG.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fails
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check aR applicable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
d ve- c'r' unci
I SECTION 6 - ESTIMATED CONSTRUCTION COSTO I
to provide this affidavit will result
Addition ❑
Item
Estimated Cost (Dollar) to be
a fu}�
2_`_1
Completed by permit applicant
1.
Building
(a) Building Permit Fee
Multi lier
2
Electrical
(b) Estimated Total Cost of
Construction
3
Plumbing
Building. Permit fee (a) x (b)
— ^
O ` -----"
4 Mechanical HVAC
5 Fire Protection
6
Total 1+2+3+4+5
U, 00
Check Number
�JV-1IVA is UWAERAuIHUX LA11UjN TU BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n,Im
t> A llJy �►!/— as Owner/Authorized Agent of subject property
Hereby authorize `' to act on
lga -i-all matt r re ve to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1> ,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
SIZE
Pa
THICKNESS
X
FORM - U - LOT RELEASE FORM
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.
/��.■■■.■■■■..■■.......■■.■...■r....■..■...... ..■■..........r...r...........■
( APPLICANT �r1 n� Il�/C�Cc rr PHONE 571 '6a',3 ' /J 6g
SORS MAP NUMBERLOT NUMBER
SUBDIVISION LOT NUMBER
STREET
�s� wc)(W rl Rd STREET NUMBER
�" I�
...........................................................................
OFFICIAL USE ONLY
............................. '............ r......■ ■................. summons
RECONPv1ENDATIONS OF TOWN AGENTS �t
....... a0 . .�...............r........■ . .... no so ..........
��''_ _yy,^{L,� DA APPROVED
COCO—NS RVATIONADNIINBTRATOR
DATE REJECTED
COMAIENTS 11 % h la6 -. U6
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMMENTS
FOOD INSPECTOR -,BEA -LTH
SEPTIC INSPECTOR - HEALTH
COMMENTS O L ��-�� A
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
DATE APPROVED
DATE REJECTED ��
DATE APPROVED 6: /��� /
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTOR DATE
"
-
HOME IMPROVEMENT CONTRACTORS REGISlAATIDN
Board of Building Regulations and 6tandarda
one Ashburton Place - Room 13O1
Boston, Massachusetts 0210�
HOME IMPROVEMENT CONTRACTOR ir�tion 07/22/01
Registration 113956 Exp
Type - PRIVATE CORPORATION
ROGERS POOL PATIO & TOY CO INC
GARY E. R08ERS
150 MIDDLE ST
LOWELL MA 01652
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NOR71y '.
TOWN OF NORTH AN OVER
t
p PERMIT FOR�PLU-' BING
�SACNUSc. ..
This certifies that ............
has permission to perform ...... ............. :..........
plumbing in the buildings of
at ...�, ......... ,North Andover, Mass.
Fee 3L ...... Lic. No.. f r-> G/. ?d. .. _�. r . ....... .
PLUMBING INS�TOR
Check #
7879
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: A. Date. Permit#
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Building Location: ers Name: ,Z(zl/�
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential,<
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑
FIXTURES
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [ggo ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy j 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
1 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.
By Type of License:
Title ,� mber Signat re of i, cQ sed Plumber_
Cityrrown
Raster V /�
APPROVED OFFICE USE ONLY ❑Journeyman License Number:
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15TFLOOR
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3 FLOOR
-4'FLOOR
5THFLOOR
6 FLOOR
7 FLOOR
8 FLOOR
Check One Only Certificate #
Installing Company Name: I''lmaek- TI'd
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Address:e20 City/Town: gem State:
[I Partnership
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Name of Licensed Plumber: / �/ /' Teo, ejje&—
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [ggo ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy j 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
1 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.
By Type of License:
Title ,� mber Signat re of i, cQ sed Plumber_
Cityrrown
Raster V /�
APPROVED OFFICE USE ONLY ❑Journeyman License Number:
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F= �` °A TOWN OF NORTH ANDOVER f
11
41
PERMIT FOR GASH STALLATION
CMUSEt�y♦
I
This certifies that . jv� l X' �°° h L -P. �` .7'. ��!�� ... .. g
has permission for gas installation .....................
in the buildings of ... 5�i C (� L.' .......................... .
at .. S ..l!t �..E!�' ".` ?`` �` ` . C n ..... ,{}North Andover,. Mass.
Fee. .... Lic. No/ %7 ?"`. ��,.-1
GSINSPECTOR
Check # `?
6574
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town:.1 7GrV - 4�. -_ Date: a . Permit#....:. .5 7 p
Building Locatio / �;' Owners Name:(O/d'�,,.i?/C/� m
Type of Occupancy: Commercial w Educational r4 Industrial Institutional; r Residential Xa
New Alteration Renovation = Replacement '_ Plans Submitted: Yes'. No
FIXTURES
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1 FLOOR
2 FLOOR
3 FLOOR
4 FLOOR
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67H -FLOOR
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7 FLOOR
-i'FLOOR
Check One Only Certificate #
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Installing Company Name ` �rYi!'Ylrr� , lr�/
. _
Corporation
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Address .� PQ/% 'fir Pr/� City/Town�j//�� State MA ; -
'
..�.. Partnership
/ 0.,.,•
Business Tel Fax
'Firm/Company �. - ,---.,,
Name of Licensed Plumber/Gas Fitter- , IGQj;G�
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policyl Other type of indemnity - Bond
OWNER'S INSURANCE WAIVER: 1 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 Owner's Aqent
By checking this box ❑; 1 hereby certify that all of the details and information 1 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.
By .,
Title.
City/Town
Jjpf e of License:
Plumber
Gas Fitter nature of Lice
-:Sig
Master �*7
Journeyman License Number:
LP Installer
LA -X _ ( ` .
mber/Gas Fitter
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