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Home My WebLink AboutMiscellaneous - 64 MEADOW LANE 4/30/2018 64 MEADOW LANE J 210/045.F-0032-0000.0 r Date........... ..................................... NonTh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that.. ................................ .............................................M....... has permission for gas installation I........... in the buildings of at......�PA....... ...... ...................... North Andover, Mass. Fee :.2........ Lic. No.Sao...... Mb........................................................ AA( GAS INSPECTOR Check MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I N.Andover MA DATE 5/6/2014 -J PERMIT# JOBSITE ADDRESS 164 Meadow Ln OWNER'S NAME It� GOWNER ADDRESS I Same TE=_ IFAX � TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW:® RENOVATION:0 REPLACEMENT:® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE -' DIRECT VENT HEATER DRYER _ I FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER a ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Meter x and Piping as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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 AGENT 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 be3ipliance with all Pertinent provision ofthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws.PLUMBER-GASFITTER NAME Jose h Marino LICENSE# 8736 S GNA UREMP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# 3285C PARTIP❑# LLC(_ # COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP101501 ]TEL 1(508)832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com n ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 61,1/z a L/ � r 1 ry ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES + Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES CJ4/CJJ/ LrJ14 14, rJ4 JCJ00040 1 J1 ICrI Wrll 1 C I.,UI`IJ I KUI,I I"i-1UC. F7L/rJL AC � DATE(MMID15NYYYI CERTIFICATE OF LIABILITY INSURANCE Page 1 oP � 08/29/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the poliey(ios)murt be endorsed. If SU13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certiflcate holder in lieu of such endorsement(s). PRODUCER CONTACT 9vf11iQ Of Maesachuaette, Inc. PHONE PAX c/o 26 c0ttury Blvd. 'NO_FXT1: 877-945-7378 N0). 888-467-2378 R. 0. Box 305191 -MAIL Naghville, TN 37230-5191 D.DS>�s cexcate�cifw•iIlia.cOm INSURER(S)AFFORDING COVERAGE NAIO n, INSURED INSURERA: The Charter Oak fire Tnaurancg Company 25615-001 R. H. White Construction Company, Inc. IN8URERB:TravalmrLa Property Casualty coMVany oi' Am 25674-003 41 Central Street INSURER C:NatiOnll Union Fir P. 0. Box 257 g Sneurnnep Company o£ 79445-001 Auburn, MA 01.501 INSURER D;Travelers Indamnity Company 25699-001 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUGD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEQFINeURANCE DD SUB P POLICY EFF POLICYFJ(P vuvn POLICY NUMBER LIMITS A GENERALLIA6ILITY VTC2000 977RO948-13 9/1/,2013 '9/1/,2014 EACH OCCURRENCE F 2,000 OOO X COMMERCIAL GENERAL LIA911.ITY r� TO RENTEO aoceuranc:f R _ 300,000 CLAIMS-MADE10OCCUR MEDEXP(Anyone anon R 10 00 PERSONAL&ADVINJURY $ 2 0UO,000 GENERAL AGGREGATE $ 4J000 000 GEN'LAGGREGATFLIRITOAPPLIESPER; PRODUCTS-COMP/OPACsG $ JQOO QOO POLICY LOC 13 AUTOMOBILE LIABILITY VTJCAP 977K955A-13 9/1/20x3 9/7./2014 $ §50DILY g�NeDSINGLEI.IMiT nt is 2000,000 X ANY AUTO INJURY(PerPerson) Is ALISCHED"ED AUT08ULED AU OW BODILY INJURY(Peraccltlent) $ X HIREDAUTOS X NON-OWNED AUT eracCident S X Co Defl Ccll pea C UMBRELLALIAS X OCCUR BE8766140 /1/207.3 9/1/2014 EACHOCCURRENCE $ 5 000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ P,000 000 DED X RETENTIONS 10,000 $ D ANDPL YERS'LSAILIT VTRKUB 8205A,185-13 9/1/2013 9/1/2014 X o AND EMPLOYERS'LIABILITY YYYY/JJJNNNN TARYU D ANY PROPRIETORrPARTNFRIFXECUTIVEX NIA VTC21(1JB 9203.A71A-13 9/7,/2013 9/1./2014 E.L.EACH ACCIDENT .S 1,000 000 OFFICERmIEMBFREXCLUDED7 LTJ iMendn�orybafin E.L.DISEASE-EAEMPI:OYEE $ 1,000,000 U��VKill I JUN W-QPURATIONS Belew E,L,DISEASE.POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEWICLES(Attacil Acord 101,Addltonpl Remarke Schadaln,It more elmea la mqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Evidence Of Inmuzance AUTHORIZED REPRESENTATIVE Colli4197604 Tpl:1694012 Cert:20287680 ©1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD a t i o n `7 9 — Date ,9n�—�`,3 NOR*" TOWN OF NORTH ANDOVER Certificate of Occupancy $ + i ?}}}fffFyyy Bilding/Frame Permit Fee $ -- 7 SACMUSE� �';F�C.FoundPer on Per it Fee $ thermit e $ /�9, t G �A SIbwer Connection Fee $ \ Water Connection Fee $ -- �9i9� TOTAL $ Z,� S-6 Building Inspector Div. Public Works rERmrONO. 3 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK !PAGE ZONE SUB DIV. LOT NO. �I I LOCATION PURPOSE OF BUILDING 1 OWNER'S NAME Q f - DO I-C3 NO. OF STORIES ZE �� -�-� BASEMENT OR SLAB OWNER'S ADDRESS Ep O Lv / tl q�� - ARCHITECT'S NAME ��T,V SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME Ile Al fl, A [3 are vj �_ _ SPAN -- DISTANCE TO NEAREST BUIL ING (� 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 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENT F 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 f PAGE i FILL OUT SECTIONS I - 3 EBT. BLDG. COST PER B FT. 4 PAGE 2 FILL OUT SECTIONS I - 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 BUILDING INSPECTOR DATE FILED ( q BOARD OF HEALTH SIGNATURE OF N OR AUTHORIZED FEE � U OWNER TEL.9-6 LL9 PLANNING BOARD PERMIT GRANTED CONTR.TEL.# Gr CONTR.LIC.# 03 S �� 19 ,117 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 $ INTERIOR FINISH CONCRETE _III 3 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D — PIERS PLASTER UNFI N. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 % FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD%'✓'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE I 5 ROOF 10 PLUMBING r r GABLE HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT 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 11 HEATING WOOD JOIST PIPELESS FURNACE --—µ FORCED HOT AIR FURN. TIMBER BMS. 3 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 2nd _ ELECTRIC 1st 13rd 11 NO HEATING ! COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY =` Fjs�l�ohviusra;'aatoBnU�fn� OF ONE ASHBORTON PLACE OtI�o/scause fornnocaUon MASSACHUSETTS BOSTON,MA 02108 LICENSE r r CAUTION EXPIRATION DATE �y f CONSTR. SUPERVISOR FOR PROTECTION AGAINST 1 2/1�/1 995 �IGr�VEFFECTIVE DATE LIC-N0. ESTRI TIONS I THEFT, PUT RIGHT THUMB NONE '06/30/1993 035867 PRINT IN APPROPRIATE BOX ON LICENSE. ➢RAYMOND BERUBE V °361 CHICKERING RD P 'BLASTING OPERATORS s S$ # 014-32-3921 ZN ANDOVER MA 01845 MUST INCLUDE PHOTO. m _ PHOTO(BLASTING OPR ONLY) FES: � 1 Y 0.00 NOT VAP L SIGNED BY LICENSEE AND OFFICIALLY ) (I HEIGHT: /STAMPED OR SIGNATURE OF THE COMMISSIONER i '- 1 I • DOB: I: _ 12/15/1941 `,..- 1 L SI NAME'l FUL 'ABOVE SIGNATURE LINE ' THIS DOCUMENT MUST BE; - CARRIED ONTHE PERSON OF; IGNA7UREOFLICENS •Wl� 1= THE HOLDER.WHEN EN.1 . i OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION., ISSIONER ,�, „�•�- _, �';; �..,,.._,_.,., ...rte . � onnnzooP.�aeall/c°�2�,aaoac/uartla' ., .� � - � • 7r"> n� � - �� -� w a� Ga+- �'R �y y'18+1i��'•r �f 1< �_�' ��•` A xR1 J .,4 r t tJ'iGiIC; %ciUJc R J l • `.a.• r,' +g r i ':hund 'l ci!1'vc, j' _ cml CHI R ':f� V .r�twpy 3Y ADMINISTRATOR - I Page of UUMI .0 D�7��Ile PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME I r f CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit estimates for: / � 1 i �U We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ r ) Payment to be made as follows: All material is guaranteed to be as spectfied.All work to be completed in a workmanlike manner according to standard practices. Any alteration or Authorized , 1 deviation from above specifications involving extra costs will be executed Signature only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. NOTE:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Acw#ance of Propo.7 1 — The above prices, specifics ions and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment Signature will be made as outlined above. Date of Acceptance: - Signature ' NORTI-f ToVM of C ` ) Aindover 39Z .o N s 4:. ,. o *- E 'or dover, Mass., SAF IT, m? 19 I� COCHICHEWICH V %A -J ORATED S H BOARD OF HEALTH rPERMIT T D Food/Kitchen s Septic System a BUILDING INSPECTOR THIS CERTIFIES THAT............... 0 �� .. ...... .. .................................... Foundation has permission to erect.. 4®.4e...... buildings on . ... r 04 .�.*OA 0 WA ....... Rough h to be occupied as..... �k .�..o. ... .. ..... 9oim .. � � .... ' Chimney provided that the person accepting this permit shall in every respect. espect 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. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Al � i `, Rough ' ...... ............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT