Loading...
HomeMy WebLinkAboutMiscellaneous - 559 JOHNSON STREET 4/30/2018 559 ZHZN STREET / G 210/038.0-0027-0000.0 3 4 31 Date..16 .1. :. `.. ... NpRTH O TOWN OF NORTH ANDOVER pFi�.ao ,a1'� PERMIT FOR GAS INSTALLATION n ,SSACH USEt This certifies that . . . ), /! . . . , . 4. .f. . . . . . . . . . . has permission for gas installation . . yt/.�. �. �.�' .?... . . . ... in the buildings of . . . `' . . . . . . . . . . . . . . . . . . . at . . . . !. ),-.—.,-North Andover, Mass. Fee.;/._ :.- . Lic. No.. . . ..,,... -�,. �. . . . . . "GAS INSPECTOR IV WHITE:Applicant CANARY:Building Dept. PINK:Treasurer .� nlra��h�,n��cj a vwmrwnivl r%rru%.,M11VIV r-ojti f tzfiMll IU UU LiA5Fl1 I1NLi (Print or T�) AA) �� , Mass. Date J� 70v -COW d Permit #_ Building Location, J`7 Jpl� b� �J% ers Name (��G2 E7 jp ype of Occupanc oVP iQrPa�l�td / New ❑ Renovation ❑ Repiacement/K Pians Submitted: Yes❑ No ❑ N cc W WN Y Z R N N to U CC } N ¢ N ¢ O =) a) x �. W W Wtl 0 U m t J Z O W 1- Q CC Z O x= Cr � < m W Q J W 0 N d C me 4 N tl W Z Q. W CC in W W CO J z Q x a: cc < cc x W t- W I Y H a ZN W W O > W I-- W J }. W Y < W < C }' >- N 0 2 O Z Q O N x Q W > rr W Z. < CC Q x '.x O tl x u. 3 C d J a M y p a F- O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR • 4TH FLOOR STH FLOOR e 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone -683-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No If you have checked yes, please Indicate the type coverage by checking the appropriate box. 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 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 El hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accu%te to the best of my knowledge and that all plumbing work and Installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. By TvDe of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 8697 City/Town 9Journeyman APPRdVED O FIC SE ONLY Date. �. . . `. . . N° Of , 3r HORTM 4TOWN OF NORTH ANDOVER ��,�`•- OL p PERMIT FOR PLUMBING t SS US This certifies that /�s,. . ��. .'.�`'.` . . . l.S . . . . . . . . . . . . . . . . . has permission to perform . . . T . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . at . . . .S.>. .`.!. . ...I. /.<>. : ::. . . . f. . . . . . . . , North Andover, Mass. •PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PER O DO PLUMBING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS S-hy/00 Building Location 55- Hj4j SC Aj Owners Name P9V I ���ZC��- Permit# / 7 Amount Type of Occupancy aevel//"Ny New m Renovation 0 Replacement 1:1 Plans Submitted Yes No FIXTURES 0 w z Ln a a W ►-� W F W F d zrn Cr Cf) F A x Cn Cn F- t F W F F- CG A. d d a ,.a SLRE IC BS)QM ISE HSM 210 FLOM 3M FLOM 4IH FLOQ2 5M FlaR 6M R9R Mi HIM SIH FLOQt (Print or type) Check one: Certificate Installing Company Name 114110d4'✓ �LvM .N f� 0 Corp. Address P.o. (�oX S 7Z - F1 Partner. 4d}w4,PNCie M m- • O Business Telephone &1'57-9,5 O y El Firm/Co. Name of Licensed Plumber: 'To m /-/.q 11D/1 - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy ® Other type of indemnity ❑ Bond Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner EI 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 ylumbing Code and Chapter 142 of the General Laws. By: Igna ot.Licenseci Plumber Type of Plumbing License Title 13 C a'3 i —eQm' erCity/Town Li Master Journeyman APPROVED(OFFICE USE ONLY Date....... '. `• 3L, 30 ,40RTN TOWN OF NORTH ANDOVER pf6,4, 3j ,6 6 PERMIT FOR GAS INSTALLATION 41 s,o''o .' �,SSACNUSEt This certifies that . . x,t— ��:"' : . . ���.... . . . . . . . . . . . . . . . . . . has permission for gas installation . . LA! . { in the buildings of . . . :, -1./:. . . ! /.,-!. . . . . . . . . . . . . . . . . . . . . . . . at . . . . c. ?. . . . . . .. . . . . . . . . . . . .. North Andover, Mass. Fee.,).T.. . . . Lic. No.).".)-. J GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 > MASSACHUSETTS UNIFORM APPLICATON FOR PERIYIIT TO DO GAS FITTING Type or print) -ate ij //S NORTH ANDOVER, MASSACHUSETTS Building Locations S S C/ TO HN SOS S r permit# 3 Y3 Amount S Pio U L- C �or 74 Owner's Name New© Renovation ❑ Replacement ❑ Plans Submitted rt� N m _ 1 z c =c Z Z ,1 LZ = Zz f. W --f. — c z SU 8 -8A SENI ENT BASEM ENT IST. FLOG R 2N 0 . FLOUR 3RD . FLOOR .1"r I1 . F L O O R sTil . FLOOR 6T It F L 0 O R 7T 11 . FLOG R 8T 11 . FI, 00 R (Print or type) Check one: Certificate Installing Company Name lozamS,'c��/ ❑ Corp Address P D /3 D?C 5 7 2— ❑ Parmer. Business Telephone G� 5_gj'p y ❑ Firm/Co. dame of Licensed Plumber or Gas Fitter /O.m ��j�,i/oe�✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EE�— No❑ 4 If you have checked ves,please indicate the type coverage by checking the appropriate box. i Liability insurance policy rV1 Other type of indemnity ❑ Bond ❑ � i 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: Sienature of Owner or Owner's Agent Owner ❑ Asent ❑ 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 pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 7i Bv: Signature of Licensed Plumber Or Gas Fitter Tide ❑ a D Plumber C� 3 CiryiTown ❑ Gas Fitter License iNumoer ❑ Nlaster APPROVED(OFFIC, (ISE ONLY) FA Journeyman Date.... .... .../��v. N-o ._ �„� 3 wORT1t °��``°;•'"° TOWN OF NORTH ANDOVER �� PERMIT FOR WIRING ,SSACHU`�� This certifies that '-—.......................t1 ( yj``1 l 1 T l' C ............. ....... ............................................. n....... ... has permission to perform �� f'� ........................... .../....................................... wiring in the building of ................. —l- . ��G, h Sd", - It at....... !...........1..... .::............... ........................... .NorthAndover,Mass. ll // � j Fee...,�? :. Lic.No..41.6.17..(..... . j 711"L INSPECTOR Check � l �' WHITE: Applicant CANARY: Building Dept. PINK:Treasurer l,ommotiwea[lli o f M9eachudelb Official Use Only cc� Permit No. 2eparintenl-Ij ire Servicee BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with the Massachusetts Electrical Code(NI •C),537 CNIR 12.00 (PLEASE PRINT I V 1 VK OR TYPE ALL INF-ORM,17•iON) Date: �f �l City or own f: /V, (,L C -r-- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfor r the electrical work described below. Location (Street R Number) 5 i Owner or Tenant )a-LIL Telephone No. Owner's Address ,aAgA=e _ Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. r Existinb Service Jknnps / Volts Overhead ❑ Undgrd ❑ No.of Rletcrs New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Locations and Nature of Proposed Electrical Work: + F Completion of the/ollouii table map be it dived by the Ins error of II'ires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of "Total Transformers KVA No. of Lighting Outlets No.of Ilot Tubs Generators KN'A No. of Ligltting Fixtures Swinnnning Pool Above ❑ ln- ❑ o.o mergenc. Lighting rod. rnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARA•IS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No. of Ranges No.of Air Cond. Total No. of Alerting Devices Tons No. of Waste Disposers Heat Pump I Number lTons KW No. of Self-Contained "Totals: Detection/Alertino Devices N No. of Dishwashers S ace/Area Heating KW Municipal p g Local ❑ Connection 0 Other No. of Dryers Heating AppliancesICV Security Systems: No.of Devices or Equivalent No. of WaterKey No.of No.of Data R'ir%ttg: Heaters KW Ballasts No.of Devices or Equivalent No.Hydromassage Ba11►tubs No.of Motors Total IiP I'el ecommurications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the o%viier,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 certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Ej BOND ❑ OTHER ❑ (Specify:) (aspiration Date) Estimated Value of lectrical Work:, (When required by municipal policy.) Work to Start: LIAlet Inspections to be requested in accordance with N1EC Rule 10,and upon completion. I certifi', under the pains acrd penalties of petjur)•,that the information on this application is trite and complete. FIRI%I NAVE: LIC.NO.: Al Fit q Licensee: pPtPr Man .P11 i TT Signature LIC.NO.: (If applicable,enter '•ex nrpt-in the license number tine.) Bus.Tel.\ 1 Address: Aq Main St . W Gt•.fmrd MA 01 886 °�7$-58���FL1 r Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check onc) ❑owner ❑ owner's went. Owner/Agent Signature Telephone No. P1:R/1IIT FE•E: S 4-0, Location No. Date q �� �o Noo TOWN OF NORTH ANDOVER f „ � A Certificate of Occupancy $ sBuilding/Frame Permit Fee $ �'b4no•A� ` �ssEMUS*. Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector Div. Public Works PERMIT NO. f � APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER MA 111APNO. LOTNO. ]� 2. RECORD OFOIVNERSIIIP DATE BOOK PAGE 70NE SUIS 1)IV. LOT NO. LOCATIONPURPOSE OF BUILDINGL4 O11'NER'SNARIE ? NO.OF STORIES v SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAIVE SIZE OF FLOOR TI,MBERS'' 1 2ND 3Rll BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONSOFGIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING K IS BUILDING ADDITION MATERIAL OF C111111NEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTEp TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST PAGE I FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST.BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. Aft AA AVA& ATTACHED GARAGES MUST CONFORNI TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED ^ OWNERS TEL# CONTR.TELll SIGNATURE OF-OWNER OR AUTHORIZED AGEN CONTR.LIC# 33 FEE $ .5 & r PERIIIIT GRANTED ap, #Vo gr A? L- --Fz 19 Revised 5/5/99 JAI u The Commonwealth of Massachusetts Department of Industrial Accidents d Office of Investigations Boston, Mass. 02191 5yay'0 Workers'Compensation Insurance Affidavit Please Print Name: Location: Cit Phone F7am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address C'-�51,L•� � City: Phone* Insurance Co. . Policy# Company name: Address City: Phone#• Insurance Co. » Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature_�e �il,�=—�-� c�.��' Date ?lei Print name kka NC ty CSS C 0►1 -C,- Phone A Official use only do not write in this area to be completed'by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Lincensing Board ~' ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Loca ' n of Facility) Signature of Permit Applicant to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector } tAORTH � ` p 'r own of L ®Ver No. 11111 �A C0C ,C � dover, Mass., /CPR ORATED P,OL S SE BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ........... ...11..�. '� 'J �j / �Q� L Foundation has permission to erect....v..� ..[.. .............. buildings on .... �, ...7....... 0..'1. x( ........... Rough to be occupied as........V./...W.�N Chimney Is ...... . . .................................................................................................................. ...... provided that the person accepting permit shall in every respect conform to the terms of the application on file in Final 1 this office, and to the provisions of the Codes and Sy-Laws relating to the Inspection, Alteration and Construction of I Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough OZ' r PERMIT EXPIRES IN b MONTHS I Final P. 3 UNLESS CONSTRUCT10 • 5-�- ( ELECTRICAL INSPECTOR Rough R,c '33 9p, ` Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, 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.