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HomeMy WebLinkAboutMiscellaneous - 54 MILK STREET 4/30/2018 / 54 MILK STREET 2101060.A-0001-0000.0 J h Date..... :..::.i.:..:.:...`.F.... NORTN TOWN OF NORTH ANDOVER V PERMIT FOR WIRING 1 ,SSACMUSE� This certifies that f ` ..::..�^...fl �'ti.:. f...S.t�...'...�. ........�...t?......... l f_l has permission to pefform .......... ±--...1,:.:... : �.r.. .. .................................... wiring in the building of..... ...... ./. '('.��::. t�..S........................................... at...... �' ....5. -................................. .North Andover,Mass. Fee.....s.5...: Lic.No. .�!/.3.�.?...�`:..... ... i�RI'(A- � ELE -INSPECTOR rI Check # �� �l Commonwealth of Massachusetts official Use only Permit No. Department of Fire Services Occupancy and Fee Chec BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL M�WORK All work to be performed in accordance with the Massachusetts Electrical Code/ `G5 b b 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: North,,Ahdover To the Inspector of Wires: By this application the undersigned gives notice of his"or her intention to perform the electrical work described below. Location(Street&Number) 54 Milk S t r e e t Owner or Tenant Tom Powers Telephone No. Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑` No ❑ (Check Appropriate Box) .Purpose of Building residence Utility Authorization No. a�Iing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ==Number of Feeders and Ampacity Location and Nature of Propbsed Electrical Work: C,-," aOC Tr Ak ti Completion of the ollowin table may be mived by the Ins eetor of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fanso.of Total Transformers KVA No:of Lighting Outlets 4 No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above El r- 11Batte Emergency LightinggrnNoUnits .of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 No.of Gas Burners o.o Detection an Initiatin Devices No.of Ranges .. No.of Air Cond. Tons Total No.of Alerting Devices No.of Waste Disposers HeaTot Pump Number I Tons KW No.Detection/AlertingofSelf-Contained lf-Co ainDevices No.of Dishwashers 1 Space/Area Heating KW Local ❑ Municipal C3Other Connection No.of Dryers Heating Appliances KW ec ri oSystems: or Equivalent 0 0.-of Water KW, o.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or Equivalent OTHER: W-irin of kitchen Attach additional detail if desired.or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned cecTfes-that such coverage is in force,and has exhibited proof of same to the permit issuing office:. CHECK ONE: INSURANCE IM BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 1 , 210 .00 (When required by icipal policy.) Work to Start: Inspections to be requested in accordanpe with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the informatio Sn t ' pplication is true d complete FIRM NAME: Andover Electric Services I c LIC.NO.14302A Licensee: Robert J . Branca Signatur LIC.NO.: (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: �$ � Address: P.O. l3 o x 629 , Andover, MA 1810 Alt.Tel.No.; OWNER'S INSURANCE WAIVER: I am aware that thfXicensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ �s Signature Telephone No. please advise '7. Z.S.- o 4- Ali Date. . .� .'. .-. 7 0' 4 0 DT:14, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 . o SSACHUSf This certifies that . . . ?.o C'. !'.� '�: �. . . . . . . . . . . . . . . . . . . . . . has permission to perform . . P. -. . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . , : . . . . !. ... . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. e-;/ r Fee. . < .. . . . .Lic. No.. .-. . . . . . . . . . . . . . . . . . . .. . . { . . . . . . . . . PLUMBING INSPECTOR Check # , log MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING jf3v? (Print or Type) Z , Mss. Date GC-- — Permit # �(;� Building Location / Owner's Nam, N A2ZAI&XI zua Type of Occupancy 'fir S+ D E IJ T I r1(-- New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES _Z Z N NZ Y a N N N O Z > N W Y J N Q O Z dH V HO a< NO 0O a¢ Z O W r- W N N Z (7 z<¢ J ; y N S ¢ U W N V N u. 0. X Z ¢ Wa < ¢ aO W cc W 3r W W = 1- 2 O Z 2 Y 0. 0F a l ¢ G W ¢ W W �C W h- V > !- O = 0. N f. Z O O N _= Z W F- O V Z < O < -J J a ¢ ¢ a < O < F- Y J rD N C p J 3 Y H H W O O a a S ¢ oQ O SUB—BSMT. t BASEMENT IST FLOOR i 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name '-41mm -TA 0 Check one: Certificate Address L A C I4(Y)rT n) p) ❑ Corporation �Y) E TA-4 0 ), fo A U 1NL/ ❑ Partnership Business Telephone_ kif Z-J177 2-ri"/Co. Name of Licensed Plumber 'EQ 6 ::e'7- INSURANCE INSURANCE COVERAGE: I have aY current jability insua No rance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checkedrtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Ad 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's agent Owner p Agent ❑ 1 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 nerformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum 'ng a and apter of the oral Laws. BY re of Licensed Plum er Title Type of license: Master •� Journeymab p City/Town APPROVED(OFFICE USE ONLY) license Number y 33 5 r BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES � PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR NoDate...... ......... f - LiJ NORTM °I<�``°:•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �ss�cMusE� This certifies that ../..i./:../... ..K?.-........... .... ... : r �.::. ........... has permission to perform � wiring in the building of ..................................................... at......:J..:i.....�:�.: ...::�� ...... : ......................... .North Andover,Mass. Fee ..... Lic.No. ..........:=.rte !.... ....... .............. ELECTRICAL&;iP TOR.... i - 02/23/99 10:56 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only U191014e &Mmuitwettlt4 of Magscdr4usetts Permit No. �a&1'5 Ilepartinent of Public %feta Occupancy& Fee Checke BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 2/5/99 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 54 MILK STREET Owner or Tenant NANCY RIZZA Owner's Address (987)686-0069 Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps _1 Volts Overhead ❑ Undgrnd ❑ No. of Meters f New Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity L Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No, of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No.of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring BURGLAR ALARM No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES G NO ❑ 1 have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND. ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 134.00 Work to Start 1/28/99 Inspection Date Requested: Rough Final 2/1 /99 Signed under the Penalties of perjury: FIRM NAME ADT Sprurity Services, Inc. LIC. NO. 1.931C Licensee nonal d A. Brooks Signature _ LIC. NO. _ 1231C_ Bus. Tel. No. (203) '741-4008 Address __ 111 Morse Street, Norwood, MA Alt. Tel. No. ?78-1111 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please chock one) _.__.. Telephone No. _ ..— PERMIT FEE $_ 35.00 (Signature of Owner or Agent) x•GSGS Location No. Date Of �ORTM TOWN OF NORTH ANDOVER t...° , �M 3? � _ Ot N S + Certificate of Occupancy $ �'�s'•••°•'tom Building/Frame/Frame Permit Fee $ � s�CHust 9 ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /21z, r� Check # J I .; 0 J _ / Building Insp cT r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING foxltC frit rn BUILDING PERMIT NUMBER: /'Q DATE ISSUED: X SIGNATURE- Building CommissionejTns pector of Buildings Date T--d Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors/Map and Parcel Number: 6A Ae, ©� Parcel Nu ber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ on Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Y aS��f f�-& (S n Cao-,<< �' �/'r ( ��G f�/�1 (Ly Name(Print) Address for Service Z Y S f^ 1 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3A Licensed Construction Supervisor: Not Applicable ❑ L{ -r- Sk-f?L, S Licensed Construction Supervisor: g j�' Y/ C 61 elf4-."r 061 61 y P7, - t! License Number mn Address �J �@ 7 _ ?,I Z 71e-,?-:% .#— -/f��— 7(/-a —L �'�f f Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ S�d ",'�l L'r.� f la �,�T_�r r `ff /01-r-��►f O Company Name rn Registration Number r Address r! /� !2 aG v r T Expiration Date ^� Signature Telephone ", r 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 buildipermit. -Signed affidavit Attached Yes.......V No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s). ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify �* Brief Description of Proposed Work: // a. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(0) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ry-C) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �( C"(. LJy1014#rCel1"A1¢s,�s Owner/Authorized Agent of subject property } Hereby authorize to act on My behalf,in all matt s relative to k uthorized by this building permit application. Signa taii�ure of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION {- r / n /, S('li'la i i� &1 f�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 Si nature of Owner/A ent �— Date NO. OF STORIES SIZE BASEMENT OR SLAB SIRE OF FLOOR TMERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DDAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MA fERIAL OF CH 4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓/ie Pomvrrwnuea/,ft o�✓�aaacu�ccae� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR .� Number. CS 069951 Birthdate: 08/27/1955 `•_k Expires:08/27/2002 Tr.no: 1511 Restricted To: 00 j LEE G STEPHENS 81 CHESTER RD#2 RAYMOND, NH 03077 Administrator — Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 108985 Expi ration: 08/28/2002 TYRe: Supplement Card SYLVAIN CONTRACTING LEE STEPHENS 58 ISLAND POND RD. I ATKINSON, NH 03811 l Administrator I -- i ' - The Commonwealth of I'>✓lassachusetts i Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affi davit Please Print Name: Location: City '01A . PhoneZ ` am a homeowner performing all work myself. 01 am a.sole proprietor and have no on6 working in any capacity I am an employer providing workers'compensation for my employees working on this job. Companyname: 5�1Uc( /el �C"1 JlaC �z Address Ci#y: �a �s��� ��� C �S S� Phone Ins: ce o. cc Z f- Ao,-7,r'lr cci policV. Vii?1 ny name: Address City; Phone#- Insural oe:-po Pollcv failure to.secure coverage as required under Section 26A or MGL 1,52 can read to the imposition of criminal penaltift.of a fine UP to$1, .00 and/or one years'imprisonment as well as cJW penalties in the fort of a STOP WORK ORDM and a-fine ot-($10f?00)a day against understand that a copy of this statement may be forwarded to the Office of Investigations,of the DIA for coverage verftation. /do herby certify under Te pains and sales of pedury that the i&nnatban provided above is true and coma Signature Date Print name. .f S�e�OGi+,� GG Phone# CC - 0 —7�I Official use only do not write in this area to be completed by city or town official' [] Building Dept ' OGheck if immediate response is required Building Dept 0 licensing Board Q Selectfrtan's OfficeContact person. Phone# 0 Health Department 0 Other i.St WORKMAN'S COMPENSATIDA! NvRiM Town of over 0 No. Lo C' ndover, Mass. , I C.C.,CX Cc W_ 0 f?A T E D PPS H BOARD OF HEALTH Food/Kitchen PER Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................ ........ .... . ... ....................................... Foundation has permission to erect ........................................ buildings on ............................................... . ............................. Rough to be occupied as.... ............9044 Chimney accepting provided that the person accepting permit shall in every respect c to the h- application**'**" *'*'' '***-o*'n'**file' " in Final this office, and to the provisions o e Codes and By-Laws relating t t Inspection, Alteration and Construction of Buildings in the Town of North An I dover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............................ Service BUILD G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Office Use ON \V P Lfnmmuntut #� If �a05ar4U9kft9 Permit No. lL` u '43tpartment of Puhlir 3$afttq Occupancy A Fee Checked { BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date WQ or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 6-4 Jk 17',Tee17_ Owner or Tenant DR I I Z Z El Owner's Address 4 1Yyzlk C l—k ee? Is this permit in conjunction with a building permit: Yes Er No ❑ (Check Appropriate Box) Purpose of BuildingFf}/19/��/ �BcelW Utility Authorization No. Existing Service Amps Volts Overhead U Undgrnd ❑ No. of Meters New Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work —'eaggI4 ?/ Od""' No. of Transformers Total No. of Lighting Outlets 3 No. of Hot Tubs KVA No. of Lighting Fixtures 3 I Swimming Pool Above In- g 9 grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 7 No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Air Cond. Total No. of Detection and No. of Ranges tons Initiating Devices No.of Heat Total Total No. of Disposals �- Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal r--7Other No. of Dryers I Heating Devices KW ❑ Connection LJ No. of No. of Low Voltage 7 No. of Water Heaters KW I Signs Ballasts Wiring Q PT1 P IPW 1- No. No. Hydro Massage Tubs "' No. of Motors Total HP OTHER: O P 7-/ ,VW_Z1 4- INSURANCE INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES _ NO 39 1 have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND OTHER : (Please Specify) . (Expiration Date) Estimated Value of Electrical Work S /! �e 1' P Work to Start Inspection Date Requested: Rough t� r !,g Final ft✓( L L (_i44—L. Signed 4LL- Signed under the Penalties of perjury: LIC. NO. 244-01 FIRM NAME Licensee _ ^�' ' Signature 0,1 Algal -� LIC. NO. 4 'G 4 �^^ 2 Bus. Tel. No. Address Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 14t ,) Telephone No. - PERMIT FEES (VV/ v (Signature of Owner or Agent) x•6565 Date.........e.......'Jf...... NORTH °`, `° ;•'"o TOWN OF NORTH ANDOVER ° ' PERMIT FOR WIRING ACHUSEt� rt � This certifies that ...... �f.,Il!3.��1 .... �..�. .11:�4 ......................... has permission to perform .... Ct 4al.'..�c..�.'l L...................................... A wiring in the building of , at........,....``.....!�J.�.....�..��........ L............................... ,North Andover,Mass. Fee.3.V.,..A.0... Lic.No. ..Yr.(,.51 �ECNS CTOR 07/20/95 09:14 30.00 PAID WRITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File r Location No. Date (10 x A gORTM TOWN OF NORTH ANDOVER O0G p Certificate of Occupanc ry $ ` • ; Building/Frame 41mlt4ee $ =' ' �t s'roe&Ech Foundation Permit Fee $ ltMUs Other Permit Fee $ —ter Sewer Connection Fee $ g- r Water Connection Fee $ M TOTAL $ L t- j, Building Inspector Div. Public Works PERMIT NO. zl�;-9 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP i4O. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. �I LOCATION M �-e PURPOSE OF BUILDING ' OWNER'S NAME ZV77NO. OF STORIES SIZ- ea OWNER'S ADDRESS // IBJ/ BASEMENT OR SLAB -- /� ARCHITECT'S NAME '��` _/�Pr1eWtlIQKS SIZE OF FLOOR TIMBERS IST A r 2ND 3RD BUILDER'S NAME fLlj' Ll1 SPAN 1� V[AJ& 1j _ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING P X IS BUILDING ADDITION MATERIAL OF CHIMNEY D'vAIe- IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER {vim BOARD OF APPEALS ACTION. IF ANY �ilr IS BUILDING CONNECTED TO TOWN SEWER �fC� IS BUILDING CONNECTED TO NATURAL GAS LAE �fI ct/4 INSTRUCTIONS 3 PROPER INFORMATION 4/ /y/yam� LAND COST SEE BOTH Sq[ 4-03-2_ EST. BLDG. COS O PAGE 1 FILL OUT SECTIONS 1 - 3 VEST. BLDG. COST PER 6Q. FTC 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 PLANS MUST BE FILED AND APPROVED BY ll�UIILLDDING INSPECTOR DATE FILED f' 1 4� (a) z BUILDING INiPRCTOR SIGNATURE OF OWNER OR AUT ZED ENT_f f � 'F-E E OWNER TEL.M D �/" O PERMIT GRANTED �- CONTR.TEL. v 0 CONTR.LIC.# y H.I.C.N qo ism Pt #g 2� LC 4(.[8 OF- 7ZD4 -'b Ectac,►1 S 64 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES O. LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS Kh RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH " CONCRETE a 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT /JC11 AREA FULL FIN. B M AREA 14 1/2 % FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIN D ASBESTOS SIDING _ COMRACN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR R I_ ADEQUATE NONE 5 ROOF 10 PLUMBINq GABLE I I HIP I II BATH (3 FIX.) I GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO _ c 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS 1_ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd ELECTRIC E IstIst 5-13rd I NO HEATING NORT Town of � � � � 4Andover � L p � .:fir �•+1� � � No. Q 5 n _--_¢ rt dower, Mass. �U'I•�� l2. I9 T 0 l� LAKE ,f COCHICHEWICK '7,9 ORATED E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System .—.. BUILDING INSPECTOR THISCERTIFIES THAT u. . ........................................................................................................................ Foundation has permission to ereet•.AdF.(2..''ADD6.0buildings on ...�J .....V"ll1..14...... ................................................. Rouge, tobe occupied ^.6 ............................................................................ Chimney provided that the person accepting this pehnit 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. ��� "�6c°�iDp Z [tough ��l�LlcXl WAW— "TD F t1�L. Final 03)t'1 PERMIT EXP MONTHS •d3Z ELECTRICAL INSPECTOR UNLESS CON TRT Rough Service R BUILD SPECTO Final Occupancy Permit Required to Occupy Buildin GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Ck y BK 4254 Fig 213 f REC..IVNED >. DANIEL L t Any appeal shall be filed TOWN Frt►"�� CLE within 120) Gnus atter the taxa , NORTH ANOOVEIt . date of .: ng of ttiis Notice e�.�eu+ �6 307 e� y In the Office of :ha Town . Clerk. TOWN OF ANDOVER VER ACIiUt3F.'i .. .. BOARD OF APPEALS it NOTICE OF DECISION 41 nrrre•arr+�teemtxlan Date..August.16..19.94......... �'' taw erceea sere asH d CK11"and Meese yd.n.t0i Petition No....031-9A............ [ Idobe A enaerse I. . Tpeagest Data of Hearing..August.9. 1994. +• h ,h j I• Petition of .....John.&.Nancy.Rizza.......... ......................................... - Premises affected 54111k.Street........................................................ ,.:. - Referring to the above petition for a variation from the requirements of tlrec..Section.7. R Paragraph 7,2.., 7..7 and.Table.2 of.the,Zoning.Bylav......................... , �f. r so as to permit relief of one.(1).foot for..the.sides.yard.setback..twenty-five..(15) z foot.relief.from.the.front.setback.and..7..454.sq—f t..reli.af.for.tha.lot.arei.. After a public hearing given on the above data,the Board of Appeals voted to...GRANT...the F> variances as. requested.. and hereby authorize the Bmlding Inspector to issue a " -: 0 permit to .John 6 Nancy Rizza. ... ...... .... ................................ The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will 7 tot adversely affect the neighborhood or derogate from the intent and purpose 1 of the Zoning Bylaw. Signed j. Su 4?161 ian J ' Sullivan, Vic alma �c Walter Soule, Clerk Q r' . I .. .. �A Robert Ford a$;— ,,(,�, Scott Karpinski Tbwn Cl''' Board of APIs 11!11 i. I�w ? r yes_' •t. ;yy 'W"'- st:a!I be fitted .,q„% GK 4254 PG 215 f Pei ! (201 days atter the d+ (� WIt ir+^+�• REC IVES k �; ,to of;I:nB of L':is Notice =•. pA►ia L 11G 4 In the Office of the Town . TOWN ct:RK {� ` : NORTh At49OVER Cterk TOWN OFOC'fRITH ANDOVER AUG 22 II 21MASSA r„. >. '..w BOARD ; OF APPEALS Vii, � �` ��.”-;• NOTICE OF DECISION 1 r cFr; TNelebeenryfietwTrtm dI r �eWiaestimfud Date.4uguat.22...f994.......... JDOMA. Petition No....031-94............ T"n cwn ' L Data of Hearing...Ausuec.9,..1994. I •J Petition of .....John and Nancy Rizra.. .... .. ... ...... ..................... t. Ptecal w affected .5.4.Milk.St:eet. . ... CJ Referring to the above petition to a variation from the requirements of W. Section•7,,•. ..Paragraph 7,3 and Table 2,of the.ZoAing $ylev•• •„ .. so a to permit relief of five (5) feet f.gr.the. aide yard• setback.rgqulrempat•..... .... .. ...... ....... ...I......... .. .... Attar a public bearing given on the above date,the Board of Appeals voted to ALLOWI.TH£.viii PETITION ` *: •'2x: J, TO WITHDRAW WITHOUT ptl6CtY21i OC I LOt y: t . william111aa J. Sullivan, VSc chairaa:f ya:ter Soule, Clerk. s ATrE91% ATroeCopy .Robez.: Eord Scott. Karpinski tt; Rbwa Clerk } . � s cl'i Board of Appeo4 SL g ! T IN s C .I ' I+�� �KAv f..•ti � 1� •' r Bk; �ti��r:....- .a `•;dy"• k. 4?`4 FG 217 RECErvt� Any appeal shall be filed �n .•:r the TOWN�` within L201 c'r; araw ANDOVER date of.iC..f:.:� '•..i���::4. `., - c.ice - 3 In the Or�i,:e of ,�,_ Yc:+'n �`6 07 Clerk. TOWN OF NORTH ANDOVER MA93ACHUSETTB BOARD OF APPEALS i F NOTICE OF DECISION h�w���doot�� Date..August.16,.199.4......... Dardiy�.iw %i99� Petition No....MrM............. ! .i V TonnpsAs Date of is r Petition of +. ..John.6 Aaney.Rizza ..................................................... Premisaa aSeeted 54 Milk,Stzeec.••.••.•.•.••......................................... ,'c i 1'• �r ", Special Permit under r Referring to the above petition for a Section.9..... �i Paragraph.9.1.of.the Zoning.Bylaw........ ........................ L E'": � • so u to permit construction of.an,addition.to a.non-conf arming.structure......... {.7t e $ ... .. ....... ...... ......................................... ... After a public hearing given on the above data,the Board of Appeals voted to . .CBA.\S .. the Special Permit as.requested .. and hereby autborias the Building Inspector to inane ae permit to John b Nancy Rizza........ .. . ... ... co yil' r The Board finds that the petitioner has satisfied the provisions, of Section 1 Paragraph 10.31 of the Zoning Bylaw and that granting of this Special Permit ie �ea� particular will not derogate from the intent and purpose of the Zoning Bylaw nor vill it adversely affect the neighborhood. vii Signed WSlliam J. ul'liven. Vice- airmen '�� -• ........... Waiter Soule, Clerk Robert Ford 't •. Aams copy pix �.S Q ,• Scott I:arpinskl 'ibarn Clerk Boyd of Appeals t °1 �F R j uF r.• s I r�. i • G � �Sf� IZ. •.f R:,•A � 1 l"�� Y`iJ��� Yii+1 .. •,�•', .iy 73Ict ri7t hist g-,19 OW `vim �rei JMELCOMMONWEALTH "`'�urett�aoasaaraaatrrrent DEPARTMENT OF PUBLIC SAFETY _ '�gasiibaaa�astnieaj�di OF ONE ASHBORTON PLACE e?iditi�aasfor rivoc ifta MASSACHUSETTS BOSTON,MA 02108of 1111181fe+asc LI EXPIRATION DATE 037'9 CONSTR. SUPERVISOR CAUTION 02/24/1996 EFFECTIVE DATE LIC-NO. I FOR PROTECTION AGAINST RESTRICTIONS t THEFT, PUT RIGHT THUMB NONE 06/30/1993 002685 PRINT IN APPROPRIATE ROBERT M LA NG EVI N BOX ON LICENSE- SS 016-36-2451 7NO 95ADALEESNTREET845 `�` S4G(DATORS MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY( 00 J t!l 0 71?`.'3 - X10 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY - = HEIGHT: (5 STS OR SXaNATURE OF THE COMMISSIONER } Y_-• :. DOB: d LI 02/24/1947 iLJf o c THIS DOCUMENT MUST BE (I SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIEDON THE PERSON OF SI NATURE OF LICENSEE f THE HOLDER WHEN EN- OTHERS- N-OTHERS-RIGHT THUMB PRINT GAGED IN THISOCCUPAT)ON. �( ER I HOME IMPROVEMENT .CONTRACTORSREGIRATION' Board of Building_Regulations_ and Standards� .. ..One As, button-Place -- -Room 1301 - _Bost' n; Massachusetts 02108 ] � I HOME IMPROVEMENT C' NTRACTOR = - r- ------=------- ----------------- Registration ----- -- Registration 11199 ��Expiration 02/11/ ?• • TYPe INDIVIDUAL- ,r­ HONE IMPROVEMENT.CONTRACTOR Regi tration 11199017 ROBERT M LANGE"VIN , Trp - INDIVIDUAL ROBERT M_ .LAN EVIN __Expiration'-- 02/11/91 795 .DALE .ST P .._ r N ANDOVER MA 451 - - ROB TSM LAN6EVIN 18 - ROBEtT M. LANGEVIN { G Cf-1&4 Zwpto7951 ALE $T "°'° '°mIN 01845 A OVE A 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. ****************Applicant fills out this section****************** APPLICANT: - Ott /�7 Phone �? 0 / LOCATION: Assessor's Map Number Parcel Subdivision / T Lot(s) Street i �(� L' / St. Number ************************Official Use Only************************ r RECOMMENDAT ONS OF TO AGENTS: 4bs- Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - dviveway pe it re Department Received by Building Inspector Date Location ' No. Date NORTH TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ * i Building/Frame Permit Fee $ ` E Foundation Permit Fee $ JACNUS t Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ r Building Inspector Div. Public Works PERMIT NO. `�? APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 .A MAP dJO. '' LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK PAGE — ZONE I SUB DIV. LOT NO. OC ION T� G' PURPOSE OF BUILDING . AW O/ NAME �lO. 7C �z , NO. OF STORIES �s SIZE,` "-6WNER'S ADDRESS �•/ J BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD vla(UILDER'S NAME ]/Cf/ /,jlj SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' " POSTS DISTANCE FROM LOT LINES —SIDES 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 15 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 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 0 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. ELEC',TRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS /PLtNS MUST BE FILED D APPROVED BY BUILDING INSPECTOR FILED BOARD OF HEALTH ;,FW G TORA R Ed AGENT OWNER TEL.A V 7 F E E D �' C --CONTR.TEL.# CONTR.LIC.# PLANNING BOARD PERMIT GRANTED ►4�-� 7 19 9i BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 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 REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _I 8 INTERIOR FINISH CONCRETE _I d 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN 3 BASEMENT 11 AREA FULL FIN. B M T AREA _ '/. 1/2 3/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMGN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) — GAMBQEL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ 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 7 NO.'OF ROOMS GAS OIL B'M'T 2ndELECTRIC 1st 13rd NO HEATING ti ' � NORT1y 9 own6 OL ndover No. 341 o DRIVEWAY E=NTRY PE=IRM1- er, Mass. aQi,�j Z _ 1971 C HI MEWICK A �V ORClaim ?� SS ^x BOARD OF HEALTH ERMiT �VI • THIS CERTIFIES THAT............a,Y Awl .. S • " t ZZ n ................................................................... `�� l �` �v Tt�CZf BUILDING INSPECTOR haspermission to treat ......................... buildings on ...... .....�.V.�.,.....I�.................................... Rough �� to be occupied as... •p 4.IN�le 00 v� Chimney �..T. 1..... .........��........o .....wt ,rL.!.4 -........... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service Final ..... ... .... .......... .............. . ............... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove , Burner No Lathing to Be Done Until Inspected and Approved byRESmoke oet. Building Inspector N.L. BOUDREAU GENERAL CONTRACTOR 46 SANBORN ST LAWRENCE MASSACHUSETTS 01843 (508) 691-5030 SUBMITTED TO: JOHN RIZZA 54 MILK ST 14 ANDOVER MA 01845 We hereby submit estimates for removal of roof shingles 1 . REMOVE ROOF SHINGLES & DEBRIS WE propose hereby to furnish material and labor in accordance with above specifications, for the sum of : $175.00 PAYMENT TO BE MADE AS FOLLOWS: BALANCE DUE UPON COMPLETION. -ACCEPTANCE OF PROPOSAL- The above prices,specifcations and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above . Date of acceptance Signature Signature t UE NORT,y, ` " Town of f a •„•.•��.• � 12O Main Street OFFICES OF: . pr Om APPEALS ,'. NORTH ANDOVER North Andover, BUILDING40 Mi1SSM IMSCIIS 01845 C ONSERVA'HON SSACHuuei DIVISION OF ((i 1 7)685-4775 H EAL"I'H PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECI'O11 In accordance with the provisions 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 111, S 150A. The debris will be disposed of in: va4lo ,. CaN�,A D 11X16ld c��Jvv�. 1 A/ 4 - (Location v4(Location of Facility) Signature of Permit Applicant ate 1 NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE JOB LOCATION Number Street Address Section of town :'HOMEOWNER" /'� c5 /�/J7� y �/ 5 Name Home Phone Work Phone PRESENT MAILING ADDRESS c�4ij'1'GQ. City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six 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 109 . 1 . 1) DEFINITION OF HOMEOWNER: 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 to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit . to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1) 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 .. .North Andover Building Department minimum inspection procedures and ..requirements and that he/she will comply-, with said procedures and requirements . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OF_ CIAL 'Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0, Construction Control . Date. . . . "QR'II TOWN OF NORTH" ANDOVER PERMIT FOR'PLUMBING ,SSACMUS� This certifies that . . . . . . . . . . . : ... . ✓. . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . ... . . ,. . . . . . . . . . . . . . . . at . !. . . .�. . . . . . �-'� . .!%,'. . , North Andover, Mass. _ . . . . . . . . . . .Fee =� Y PLUMi MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLtiMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Q , �`' �`� Date �I-Sr 0 Building Location b [� Owners Name I0 VA �o ul Q/" � Permit# c Type of Occupancy Se/� Amount 26_ New Renovation Replacement Plans Submitted Yes No ❑ FIXWRES I F4 Z r i r � z a r !r t 3 r z A 3 z r c 3 � a��v>avr >.HJDM MH 3M M" 4MFLOM SM FL" 6MFLOM 71H HJDM ## (Print or type) Check one; Installing Company Name .p `f Certificate y ��.rt ❑ Corp. Address e( S I. H P• ner. Business �eiep one L Fi rm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate th type of insurance co rage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 Signature Owner ❑ Agent ❑ I hereby certify that all,;f the details and infermation 1 have submitted(or entered) in above;upplicaticn:ire true and aCCLirate to the best .;f my knowlecige;and that all plumbing work and installat' ns p rf, • �d under Permit Issued for thus application will he in compliance with Al pertinent provisions of the Massa whur tts .t:i c lu. hi g(-ode and Chapter 1•f?O1 the C;encral I3 y' ulna a ce ucens um 'r Type Of Plum it Title License (.s— APPROVED ' t1-cTnse-77-7775-7 MasterJ�J/ loumoyman APPRO�ED cr-FtcE USE ONLY Date. . . . . . .... .. . ..`.. .... WORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION � a SACMU5Et 4� This certifies that . . . . . . r" 'r .... . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .,,,rti �.,�_ . . . . . . . . . . . . in the buildings of . . . .. . . . .'. . . . . . . . . . . . . . . . . . at . . . . . . . . .. .. . . . . . ., North Andover, Mass. Fee Z'?. f Lic. No..!"_' . . . . . . . . i `GAS INSPECTOR Check# �— MASSACHUSETTS UNIFORM APPUCATON FOR PERNIrr TO DO GAS MING (Type or print) Date ?—s-- NORTH —s—-NORTH ANDOVER,:MASSACHUSETTS Building Locations _ELf A I (c sf Permit# �((' ,A. Amount$ tAAr(G. Owner's Name .4,,— �� � �� New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ W � x H z Z o x w d a w p � Gw w c 94 a w w a H W F CG � o' � wz SUB -BA SEMEN T B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . F L O O R 4T1I . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR LIE 8TH . FLOOR (Print or type) ( Che k one: Certificate Installing Company Name Lb4c.� _PG—jA- o��� _ Corp. 9 Address o _ c4 d S�, A-L o VCS/' �/=,(6e Partner. Business Telephone 7 CSG y Z 3� Firm/Co. Napie of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I''mve a current liability Insuranc policy or it's substantial equivalent. Yes 1:3 No❑ If you have checked}_es, please ndicate the type coverage by checking the appropriate box. Liability insurance policy 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 ektere )(,,n,,bove application are.true and accurate to the best of my knowledge and that all plumbing work and installations p formermit Issued for this application will be in compliance with all pertinent provisions of the Massachuset State a,C pter 142 of the General Laws. By. Signature of Liinsed Plumber Or Gas Fitter Title ❑ Plumber City/Town Gas Fitter License iNurnoer RMaster APPROVED(OFFICE USE ONLY) ❑ Journeyman