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Home My WebLink AboutMiscellaneous - 64 JEFFERSON STREET 4/30/2018 64 JEFFERSON STREET 2101023�0062.H -- Date... j/.3 l l�` . ..... .. Of' o? ° TOWN OF NORTH ANDOVER F A • "PERMIT FOR GAS INSTALLATION SACMUSES \ This certifies that . 7�S? 1 . .RkgC.kerr . . . has permission for gas installation . A,'�4� in the buildings of f . . . . . . ate �!�s"'t. . � �� ?" . .�. ., North Andover, Mass. Fee.SS, c Lic. No..,O°1111. . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check#- Z ZZ9 7987 c MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: �J Qs-�kN 2.r , MA. Date: \z Z c i Permit# Building Location Colo,bi;',-70,12 �k t-\5-1)r" S� Owners Name-V� Qrcgk, (5040 V')Zo , \3N&!. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No[� FIXTURES W � co U = 0 W W OU (n HO = W Z Z ~ Z p tY w z W IY O p p Lu w W m O F- a H o o X W C/) O 0 = LLL U W Z --I 1— H O Z --I 0 u_ co :r W LU W W Z >- 'J Q Q m w O z O � F- > Z F- _ O Q w w _ Q > O O W z z w Q F- SUB BSMT. BASEMENT } 1 FLOOR 2 FLOOR 3 FLOOR 4TH FLOOR 6TH FLOOR 6TH FLOOR 7 FLOOR 8TH FLOOR I lilt - - T-H Check One Only Certificate# Installing Company Name: � L ��-w►ce,5 ❑Corporation Address:9C3 RAx y 3 2q City/Town: State:-IVNA ❑Partnership Business k, 0. Fax: L3Firm/Company Name of Licensed Plumber/Gas Fitte "Y� lcr�c � INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yes- No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy El 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 By checking this box❑;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. Type of License: By �7 Z— y Plumber Title r []Gas Fitter Signa a of Licensed Plumber/Gas Fitter , l Master Cityrrown ❑ \4A �\ Journeyman License Number: `•A APPROVED OFFICE USE ONLY ❑ LP Installer - k The Commonwealth ofMassachusetts Department of industrial Accidents Office of, nvestigations . ..600 Washington Street Boston, MA 02111 Workers' Compensation Insurance A vit guilvlders/Contt'actors/E A licant Information lectricians/Plumbers Please Print Le ibl NaITle(Business/Organizafion/Individual): Address: City/State/Zip:Qa c, � � Q r3 Phone#:`'7S 1I 6-G � Are you an employer?Check the appropriate box; 1•�,I am a employer with - --L__ 4• ❑ I am a general contractor and I �'Pe of project(required):' employees(full and/or part-time) have ' 2. lured _ 6. ❑ I am a sole the sub contrac []New constructi _ t o proprietor ors n P for P or ship and have no employees listed on the attached sheet 1 7• ❑Remodeling working for me in ancapacity. These sub=contractors have Y P t3'• workers' coin . ' g• E]Demolition [No workers'comp,insurance 5. P insurance. g• ❑Building addition required.]. ❑ We are a corporation and its 3•1:1.1 am a homeowner doingofficers have exercised their 10.0 Electrical r all work right of exemption per MGL insurancee required.]t 11: repairs or additions myself. workers'comp. c. 152'§ (`1),and we have no 1 �Plumbing repairs or additions r • employees. [No workers' 12-El Roof repairs comp.insurance;required.] 13•❑Other "�3'applicant that chec.,s box#1 ar � t .' Homeowners who submit this affidav t indicating L they a section bel or. shown. rte 'Contractors that check this box must attached an additional sheet all w or b hem wair V:,.eJmY syLan Policy gall work and y formation. then hire outside contractors must submit a new affidavit indicating such. e the name of the sub-contractors and their workers'comp•policy information. I am an employer that is providing workers'compensation insasrance for my employees Below ' information. is the policy and job site Insurance Company Name:M0,0'K -p SU C'c,�11 Policy#or Self-ins.Lie.#: VA` -77 2_ Expiration Date: of Ly 1'Z, • Job Site Address: %la 'A N n Attach a copy of the workers'compensation policy declaration page(showing the policy numbe` rande I Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the policy Position fine up to$1,500.00 and/or One-year' expiration date). Y imprisonment,as well as civil penalties in the form of a STOP WORK ORiminal DER and of a Of up to$250.00 a day against the violator. Be advised that a copy of this statement Investigations of the DIA for insurance may fine ce be cov forwarded er Y rw . age verification, arded to the Office of Ido hereby certify under the pains and penalties o.fP J er ury that the information provide a Signature- 1� bove is true and correc4 Phone#: i _ 1 Date: t Z, z"zi + official use only. Do not wr to in this area, to be completed by city or town o ffeud City or Town: i Issuing Authority Permit/License I.Board of Health2. Department 3.Cy/TownClerk.Other 4.Electrical Inspector 5.Piumbina b Inspector Contact person: j Phone#: i 45 Date. .1.13. ))-Z- 92 . . "•O°T:��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ' ,SSACHO \, This certifies that . . .`-. !'!. . l CSC l has permission to perform � `" W R� ! S . . . . . . . . . plumbing ' the buildings of . at. .� Q.�. . . . Y.�'f .'''�. orth Andover, Mass. Fee.4:��. .Lic. No..��°��. PLUMBING INSPECTOR Check # ZZ z9 h MASSACIIUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location (� �\ Date Owner Gz—kZ,-\ V_S)� ��(>C. Amount New ❑ Renovation ❑ Replacement E3 Plans Submitted Yes ❑ No FIXTURES SIB1W R4SM v1' ]Slr E10M 1 2MFLOW ! 3MIIOCR 4W ELUR K0W 6TH IIDiR 7M HDM SIH bIDQ2 (Print or"e) Check one: Installing Company Name �L- �-�►\(,A5 ❑ Corp. Certificate Address Po RZk "A�39 �)e c OWN , �`c\ a tabp ❑ Parmer. Business Telephone '��`_ �\�o_ 10�6� Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate thetype of insurance coverage by the clang the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made three insurance aware that the licensee of this application does not have any one of the above Signature ❑ Owner 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 'th all ent ovi . f the Mass chusetts State Plumbing Code and Chapter 142 of the General Laws. By: igna o icense um er Title 7 '�- Type of Plumbing License City/Town APPROVED(OFFICE USE ONLY icense um er Master Journeyman ❑ �1.-♦�.�Imo.+^'.r.!""�«�'.1�. +<^.-� .'.v�.L�..� R..r; ��J r"i�,r� �F. r.1.{. ..... Location ' . No. Date � f. TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ -# . • ; • Building/Frame Permit Fee $ �s �cHuS E<� _ Fpundation Permit Fee $ s i �01 er;P mit Fee $ 7P Sewer Connection Fee $ m Water Connection Fee $ TOTAL Building Inspector' "�- ,fo 7564 � �" Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MA'-,q-4O. LOT NO. 2 RECORD OF OWNERSHIP ;DATE (BOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATION /LL!-`Jp1- J.r PURPOSE OF BUILDING /JAP�L�ii�r OWNER'S NAME 1/� NO. OF STORIES SIZE?/ C/ OWNER'S ADDRESS � BASEMENT OR SLAB ARCHITECT'S NAME �L SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 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 B ILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOA*tD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ISI 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. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 APPPRROVED BY BUILDING INSPECTOR DATE FILED ��r/7� SUILDING INSIPECTOR SIGNATOR OFON%A UTH2.PjjZ&WwW ENT AYI F E E OWNER TEL.# 7QZ �3a PERMIT GRANTED CONTR.TEL.# a CONTR.LIC.Jl. 0.7 H.I.C.# // 7 I'. BUILDING RECORD 1 OCCUPANCY 12 3 SINGLE FAMILY _ S,OR1ES 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 B 1 2 I= CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M'T' AREA _ 'h 1/1 1/1 FIN. ATTIC AREA _ NO 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 HARDIV D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONIC. OR CINDER BLK, STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I.I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH FIXE GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT I I 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 8'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING t COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY r MASSACHUSETTS— ONE ASHBORTON PLACE ' I ��reINf !' r BOSTON,MA 02108Br1MAp EXPIRATION DATE r � 1 i•J 1';2 '''! 09/30/1945 ' - Jf != VT 5 F, CAUTION t RESTRICTIONS ) EFFECTIVE DATE . J t, y' LIC-NO FOR PROTECTION AGAINST r N()NE 4 THEFT, PUT RIGHT THUMB - PRINT IN APPROPRIATE BOX ON LICENSE. #1 028-34-9269 7(� 5S f0' JT Ja ;y is J f ��' V'''? ,A 1 4 c ( BLASTING OPERATORS PHOTO(BLASTING OPR ONLY) FE /� I <; ,MUST( y' nib 1UI.J I (a '.. NOT VALID UNTIL SIGNED RV LICENSEE AND OFFICIALLY f ` ' ��,Wr!✓.-f1 r�.=� HEIGHT: } STAMPED-OR-SIGNATURE OF THE COMMISSIONER I Ir 1 •IIlLpG1993 DOB: 09I3!l/1945 �C tj✓�I y.iY THIS DOCUMENT MUST BE CARRIEDON THE PERSON OF qq (~ I \ � ' R. f ,) �,✓. - ^" f(. THE HOLDER WHEN EN- j I SEE r SIGNLABPFE�G&TUR@GITj®� Tl`dtt•y 'r..�(r, ,.t..- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. �.—1 ?`• COMMISSIONER r, fi rj HOME IMPROVEMENT CONTRACTOR Registration 111436 A" Type - DBA i{L' Expiration 10/03/96 ~� ALL UNDER ONE ROOF-PEST IN PE r ' NORMAN GAY of"4-fEFFERSON ST ADMINISTRATOR NORTH ANDOVER 'MA 01845 ✓ r A. T0VM of ortAndover No. 449 §i North-Andover, Mass., 19 BOARD OF HEALTH ! Food/Kitchen . PER 1T .T0 BUILD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... .... ........ . .f&Z^ ....... n.0......:......... .T........ +� Foundation _,, / has permission to4w@*.... .�-. ........ buildings on . p - �o?........ Gov Rough to be occupied as........... ..�.-.. ......Cl w.1114.....S�/1/ ......:... ',. .1.1�=!�w............................ Chimney provided that the person a cepting this permit shall in every respect conform to the terms of the application on file m 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 E VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough - Final ELECTRICAL INSPECTOR Rough ........... .w...... ... ... ... ... .. . .. ..... . . . Service BUILDING INSPECTOR ! Final ! I � .�, 1 - 1 � GAS INSPECTOR - , ;.,�. Rough Display in a Conspicuous Place on the Premises — Do Not Remove 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