HomeMy WebLinkAboutMiscellaneous - 644 SALEM STREET 4/30/2018 644 SALEM STREET
210/065.0-0045-0000.0
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Bay State Gas Company
eNSI)
GAS INSTALLATION AUTHORIZATION
Date d0
Issued to �•�
Address
For Installation of: C�3< �
BTU Input
Restrictions
BSG Representative
PERMIT ISSUED _ BY
INSPECTOR
This Portion of Authorization To Be Returned etu ed to BSG.
Inspection Has Been Made of the Following Gas Equipment:
❑ Heating System (BTU Input ) ❑ Range
❑ Water Heater ❑ Clothes Dryer
❑ Room Heater
i
Location
All Work Has Been Done In Accordance With The Massachusetts
State Gas Code And Is Ready For Use.
INSPECTOR
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS PERMIT NO.721 LAWRENCE,MA
POSTAGE WILL BE PAID BY ADDRESSEE
BAY STATE GAS COMPANY
ATTN: SALES DEPT.
55 Marston Street
Lawrence, MA 01840
�.x:�,ayy..^"' *"c�C�••--=r.��+.�J.'.°."`yv .ti.•.�w-a��r-^v'1.e+si-f+..w-�.`r''�+C�,-..�--._'C,!"—�;+r..`-�-•r'Lr
1
Date. .�.�. .� ....
1944
-a.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
9SSACMUSE� _
,a
•w
. .
This certifies that 'll C--C.�Im( . . . . .
. . . pp .
i
has permission for gasinstallation
d• in.the buildings of .�C Uh . . . �l!�?t;'�. . . . . . . , . . . .
at (4.14 . . . . . . . , . . ., North Andover, Mass.
r F%17 � . . . . . . . . . . . . .LiC. No.. .`
I ! 4e55 . . . . . :.
zs.00 pgip GASINSPECTOR
t7Z s
WHITE:Applicant CANARY:Building Dept. - PINK:Treasurer GOLD: File
Location
No. 3 3 Date
NORTH TOWN OF NORTH ANDOVER
3? � •SOL
• : ; Certificate of Occupancy $
cMustt Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 41U
Check # Ct
6872
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI R,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/Inspector of Buildings Date z
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
CA/
I 'r) Ca l e M S� Map Number Parcel Numb
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided R aired Provided
v
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zane Infomration: 1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO rn
2.1 Owner of Record
J h r sty n-e- M0t4evr b(414 sate,, sq .
Name(Print) Address for Service
7 ' - ° 75-37'-
ignature Telephon
2.2 Owner of Record:
Namg Print Address for Service:
O
z
M
Si atur<- Tele hone M
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
Address
Expiration Date
Signature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name m
Registration Number r
Address r
qaqs
L
Expiration Date /1
Signature Telephone Y/
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 building it.
Signed affidavit Attached Yes.......❑ No.......❑
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:
'!�f r0c) 7C
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be z Q• SNLY� z .
Completed by permit 22plicant '
1. Building ,f ���� (a) Building Permit Fee
3 00. 0 0 Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a) x(b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number 7 7 177
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
-OWNERS
AGENT OR CONTRACTOR FOR BUILDING PERMIT
/
"V_ 1"I Y1 at 1 a' n as Owner/Authorized Agent of subject property
Hereby authorize to act on
My beh , ' all matters relaive ork authorized by this building permit application.
X7/-7 Ia00�
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, 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 ature of Own'
ent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TIIVIBERS 1 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
1354ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIIVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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:
/Lo I-
(Location of Facility)
Signature of Permit Applicant
-7L
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
VAORTH
TLED
® ® over
®
No. 3c23
C% �R
�� COCHIC dover, Mass., 3
AO
I� �S RATED P'PC�
H 4 BOARD OF HEALTH
Food/Kitchen
Septic System
,, PERMIT T D
BUILDING INSPECTOR
ChA11.64A.M.1THIS CERTIFIES THAT,.. .......M.D.V4.4.6 .............. .............................................. Foundation
has permission to erect....51M.1 .................. buildings on ...... ............. ....... .................... ....................... Rough
4
R
tobe occupied as........ .. !.r�.��.. 1............ .................................................... Chimney
provided that the person accepting this permit 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- ws relating to the In ection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
`S � 4lop
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
1 ER 111 EX MES IN 6 MONTHS HS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
Rough
.. ...... .................................. Service
BUILDING 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.
`s Office Use
- uhe Tummnnwmath of Mag5a>r4u5&S Permit No.
igepartmrnt of Vuhlit _afetq Occupancy& Fee Checked
01600k
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 1F-00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Q* or Town of NORTH ANnOV".R To the Insp ctor of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) ry �- )
Owner or Tenant �� ✓� �������
Owner's Address s.52'Z/44W. E;
Is this permit in conjunction with a building permit: Yes �✓o ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service .�_ Amps Its Overhead !�Undgrnd ❑ No. of Meters
New Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters
I
Number of Feeders and Ampacity _
Location and Nature of Proposed Electrical Work Z�O 610L7 c2Qz?7 (
Total
No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA
Above, in-
No. of Lighting Fixtures I Swimming Pooi grnc. _ gmd. r I Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners I Battery Units
No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones
Total No. of Detection and
No. of Ranges I No. of Air Cond. tons initiating Devices
No.of Hear Total Total
No. of Disposals Pumps Tons KW No. of Sounding Devices
No. of Seif Contained
No. of Dishwashers Saace/Area Heating KW Detection/Sounding Devices
No. of Dryers I Heacine Devices KW Local 1 Municipal Connection ❑Other
No. of No. of Low Voltage
No. of Water Heaters KW I Signs Sailasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the reduirements of `.lassacnusens general Laws
I have a current Liability Insurance Policy including Comcieted eratiens Coverage or its substantial equivalent. YESi
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 aopropriWebox.
INSURANCE OND = OTHER = (Please Specify)
(Expiration Datel
Estimated Value of ElectrIcai Work S :,L ,
�
Work to Start f 9 Inspection Date Recuested: Rough Final
Signed under the Pe aitie of perjury:
LIC. NO.
FIRM NAME -�
Licensee Sicnature UC. NO
�! ✓LBus. Tel. No. � �
Address �1 s ���� �4 ���r`� ' . 0 I 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 aopiicaUOn waives this requirement. Owner Agent
(Please checx one)
Teieonone No. PERMIT FEE S
(Signature of Owner or Agent) x-6565
Date..%,, Q..... . ...............
N°RT/f
TOWN OF NORTH ANDOVER
O AG
PERMIT FOR WIRING
,SSACMUS�
4'1
This certifies that .. ,c ..ktttt ......... ......'... .. ....................................
has permission to performt . �c:>.: ....1v s=.{ .....................................
wiring in the building of. .l..... ...... ... .....::.!......?.. ....................................
`k...... ......i............,'T'.......................... .North Andover,Mass.
1
Fee..�.� . ..... Lic.No ..`i. ............................................................ a
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
Office Use Only
uhe �ommoumalth of fflassar4imeftS Permit No. 2 ~l I
i9e;jart Itettt of 1JubUr —%feta Occupancy& Fee Checked
V . BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 s/so (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed
in accordance with the
Massachusetts Electrical Code, 527 CM 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(M)Q or Town of NORTH ANDOVER To the:
he In pector of Wires:
The udersigned applies for a pe/rm,it to peArform the electrical work described below.
Location (Street & Nber) `� �rr,]���� � pe� r
Owner or Tenant 11
Owner's Address
i
Is this permit in conjunction with a building permit: Yes L No (Check Appropriate Box)
Puroose of Building Utility Authorization No.
Existing Service Amps /20 / 2 ao Volts Overhead �Undgrnd ❑ No. of Meters
i
New Service Amps _l Voits Overhead ❑ Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity �
Location and Nature of Proposed Electrical Work Re L'``,'d
Total
No. of Transformers
No. of Lighting Outlets � No. of Hot Tubs I KVA
+ Above.— In-
No. of Lighting Fixtures / I Swimming Pcol grnd. grnd. ❑ I Generators KVA
T I,- CCC No. of Emergency Lighting
`-1� No. of Receptacle Outlets No. of Oil Burners I Battery Units
No. of Switch Outlets j I No. of Gas Burners FIRE ALARMS No. of Zones
Total No. of Detection and
No. of Air Cond.
No. of Ranges ( tons Initiating Devices
No. of Disposals I No.of Heat Total Total
Pumps Tons KW No. of Sounding Devices
No. of Seif Contained
No. of Dishwashers I SpaceiArea Heating KW Detection/Sounding Devices
No. of Dryers I Heating Devices KW Local ! Municipal
Connection E Other
No. of No. of Low Voltage
No. of Water Heaters KW I Signs Sailasts Wirina
No. Hydro Massage Tubs I No. of Motcrs Total HP
OTHER:
I
INSURANCE COVERAGE: Pursuant to the requirements of 'Massachusetts general Laws
I have a current Liability Insurance Policy inclueing Comeieted Operations Coverage or its substantial equivalent. YES NO I
have submitted valid proof of same to the Office. YES = NO 7,_If you have checked YES. please indicate the type of coverage by
checking the appropriate box.
INSURANCE — BOND = OTHER = (Please Scec:fy)
— (Expiration Date)
Estimated Value of Iectrical Work S 0 2
Work to Start0 Inspection Date Recuested: Rough ��` AM Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO. pct
e �- .-r `� Signature LIC. NO. o�g�oti
Licensee .� f :
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
auired by Mass cnusetts Gen ral Laws. and that my signature on this permit anplic ton,tNa es this requirement. Owner Agent
(P!ease ch one L-M
Telephone No. — PERMIT FEE S
(Signature of Owner or Agent) x 55c5
r
4 7
NORTh
"o°� TOWN OF NORTH ANDOVER
•
° p PERMIT FOR WIRING
SA US CL.
'7
This certifies that�,.of--".C4:..t ........ n:4.,.1. F tp . ................................
has permission to perform .. :. 't. ....................................................... r
wiring in the building of �� '�� .i`. ":. ?
at ?.:. . c~ ...�. 1............................. .North Andover,Mass.
....w...r......... ......Mwv..
�. Iw .I r 4J'2c ..:
Fee..`S: ........... Lic.No. . ......... �.... . ...................................................
ELECTRICAL INSPECTOR „^
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t
(Print or Type)
NORTH ANDOVER Mass. Date
4uilding Location (oW s21empy �� Permit # l-
Owners Name o(?FV 1 L. L f �✓►rD
• Y News Renovation ] Replacement Plans Submitted n
FIX7UI?_c
N Cf U a F- C
N rG oI tL
.0 N =
W
2dQNWO ,rW}Qu2t. 2to NGW
G1 _ UA
o
Nw;; . W>O
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a = W
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O O U. QOiU 1QC�
1
1
1
t'! SGNW
O
1 1 1 1 1 1
Su$—asmT. 1
BASEMENT I if
ISTFLOOR
2MO FLOOR
3RD FLOOR I
4TH FLOOR
5TH FLOOR
6TH FLOOR I
7TK FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name �Ai�� �� vQ Corp.
Address -7djn< 12Gt (.,c/F� iU,�t� �tS.�S 6!'&a f Partner.
Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy 0 Other type of indemnity Q Bond
Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of
this plication does not have any one of the above three insurance coverages.
Signature of owner/ag�ent of property Owner 0 Agent F7
I hereby certify that a!!of the details and information I have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing worst and installations performed under Permit iuced lo.- this application will-be in compliance with all pertinent
provisions of tho Massachusetts State Cas Code and tiapter 1S:of Uw Genual Laws.
BY
TYPE LICENSE:
Plumber
Title Gasfitter Signature of Licensed
City/Town: Master Plumber or Gasfitter
Journeyman A / ----
APPROVED (OFFICE USE ONLY) --License Number
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t
(Print or Type) _
< NORTH ANDOVER Mass. Date - 9S�
Building Location 60Z S/i107 S71c-f7— Permit # (_O,i+ I�IK
• s
Owners Name l06P17 //0JZ19,Ap -EZ
'
New Renovation II Replacement Q Plans Submitted D
N _
of
uj m G O V O H t of
US i= a r = o i- u
o W < c c Q � a W
Z m N 1- W w O — a C W �-
t= > 4
W Z l.7 W W 4 C OO W
W Ul N J < — G t7 Q W W p G
O h S. J 1" .'� p.. W W O ? It
> C til C < G < < O Q CO 01
W O W F-
O Q a t- 0 4
SU$-3S?.IT• I I ( I T-7-7-1-1 i 1 I I t I 1
BASEMENT I I ( I 1 I I I I I I I
IST FLOOR I I I I I I I I I I I I ( I
2ND FLOOR I I I I I I I I I I I I I I ! I
r3RD FLOOR I I ( I I I I I I ( I I ! I ( I
Ty 4TH FLOOR I I ( I I I I I I I I I I
STH FLOOR
6TH FLOOR f I I # f ( I
7TH FLOOR I I I I I
8TH FLOOR ( ( I
(Print or Type) Check one: Certificate
Installing Company Name gf/�Jh/lj1,1 ,41,y e9C Q Corp.
Address L3 70 5",7 / S'7leP j Q Partner.
O w r& ,/yz� O/ S"// Firm/Co.
Business Telephone: --of
Name of Licensed Plumber or Gas Fitters
f
Insurance Coverage: lndicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy z Other type of indemnity Q Bond Q
Insurance Waiver: I , the undersicned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Q Agent Q
I heteby certify that all of the dettils and information I have submitted (or entered)is above application are true and accurate to the best of my
knowledge and tisat au plumbing work and tnstadations perforaed under Permit irsced fo: this applicationwit!be in mpliance with all pertinent
provisions of the!Harsachusetts Slate Cas Gude Ind C�tptes L4Z of the Cencai Laws.
By TYPE LICENSE
zweo�_
Plumber
Title 1 Gasfitter ignatu of Licensed
Y Master Plumber or Gasfitter
C'`t /Town: 1 Journeyman
APPROVED (OFFICE USE ONLY) License Number
- ,rsr- ,�.,;,C`1`..X,,,.w;.Kf c_ e,*-�.l .:.✓+'•_.{-.'iS'.SF:�4-si.�'ir ...--•. .r ...r�r;L�ff';.s:•.F-�+cxy:+rC^.cs�
Date..{.f. !::.. �. ...
NpR*� TOWN OF NORTH ANDOVER
AL
PERMIT FOR GAS INSTALLATION
s � a
SACMUSEt .
This certifies that . . f!. . . . . . . . . . . .
has permission for gas installatio �r` %: . _ . . . . . . . . .
in the buildings of ,! .!':; . /*` �?.�f�� r�IL . . . . . . . . . .
at t(. �. .:1� ,�3.J. . ` . . . . . . , North Andover, Mass.
Lic. No'? % i)';/7 13:53. . . . . . fi . . . . . . . . .
GAS NSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File