HomeMy WebLinkAboutMiscellaneous - 57 MILLPOND 4/30/2018 57 MILLPOND '
210/095.A-0057-0000.0 /
Locations? '� �' { r U
No. Date
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NORTM TOWN OF NORTH .ANDOVER s
A Certificate of Occupancy $
Building/Frame Permit Fee $ • 4 v Y
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'Ss+cmust tt� Foundation Permit Fee $ g
Other Permit.Fee $ 9
Sewer Connection Fee
{ , Water Connection Fee $ _'
TOTAL
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'Building Inspectora'�,
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Div. Public Works-o
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PERMIT NO:' APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP h40. I LOT NO. 2 RECORD OF OWNERSHIP (DATE (BOOK ;PAGE —
ZONE SUB DIV. LOT NO.
LOCATION I�� Vim- PURPOSE OF BUILDING
OWNER'S NAME (� pNO. OF STORIES / VSIZE
OWNER'S ADDRESS y _f BASEMENT OR SLAB -
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME I , �1 /' SPAN
DISTANCE TO NEAREST BUILDING 1 l.� 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 A j� SIZE OF FOOTING X
IS BUILDING ADDITION /A Pv MATERIAL OF CHIMNEY
IS BUILDING ALTERATION 'v 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 41 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
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.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS P
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
aUILDINO INSP CTOR
SIGNATU OF OWNER OR AUTHORIZED AGENT
lot
F E E 5 OWNER TEL.#
PERMIT GRANTED CONTR.TEL.# �(�' � �.� —31-140
19 CONTR.LIC.# `
Of-cipT t l H.I.C.# / ` y 60
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DEPARTMENT OF PUBLIC SAFETY
E ' CONSTRUCTION SUPERVISOR LICENSE r
Number: Expires: Birthdate:
CS 047224 06,/13/1999 06/13/1956
Restricted To: 1G
E LLO40 GREEN
est ,=
28 SHERMAN AVE 1
NAHANT, MA 01908
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 2!5-ev
(Print a(Type)
NO.'ANDOVER,MA , Mass. Date--/
Permit #
Building Location jMILLPOND Owner's Name 4.0� / -, kl-,�:
NO.ANDOVER,MAType of Occupancy RES
New ® Renovation ❑ Replacement Q Plans Submitted: YesQ No ❑
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Y ¢ vi
H ¢ N ¢ O N
N
W W ¢ O U m F' � = n
c7 G F- �l = L ,O t- W
4 m N f- < ¢ O O = O Z }-
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SUB—aSMT.
BASEMENT I
1STFLOOR
2ND FLOOR
3RD FLOOR 1 I I
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
BTH FLOOR
Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certmcate it
Address 91 BELMONT STREET C3 Corporation
NO.ANDOVER,MA. 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142-
Yes
42Yes R] No ❑ '
If you have checked Vis, please indicate the type coverage by checking the appropriate box.
A liability insurance policy fl Other type of indemnity❑ Band
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 watves this requirement.
Check one:
Owner❑ Agent C:1Signature of Owner or Owner's Agent
I hereby tartly that all of the details and information I have submitted (or entered)In ove application are true and accurate to the best of my
knowiedge and that all plumbing work and Installations performed under the permit sued for this applicati will b In pflance with all
pertlnent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral taw
BY
Type of Ucense: �'
-11 umbergnalur o c nse um a or Gas htter
Title 01 Casrtter
Master License Number M-3440
City/Town Journeyman
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Date. .. .. .. .6.. ..!. .
Ta 2049
N
+pR7h TOWN OF NORTH ANDOVER
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OFt�,.eo ,e7'YD
3? h� PERMIT FOR GAS INSTALLATION
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�9SSACHUSEt
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This certifies that . . . . . . . . .
has permission for as ' tallation ... . . .
in the buildings f _
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at J. 7 ., North Andover, Mass.
Fee �� Lic. No. b. . . . . . ... . . . . . . . . . . . . . . . . . .
(/�Q� GAS INSPECTOR
WHITE:Applican— t CANARY: Building Dept. PINK:Treasurer GOLD:File
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