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HomeMy WebLinkAboutMiscellaneous - 65 MARBLEHEAD STREET 4/30/2018 65 MARBLEHEAD STREET Z• �p� 210/009.0-0027-0000.0 Date.. . . e"s .�� e- . . s. NpRTM F? °p TOWN OF NORTH ANDOVER -� PERMIT FOR GAS INSTALLATION •�,SSACMUSEt�ya This certifies that . .� . . . . . . . . . . . . . . . / N? has permission for gas installation . .4 � � r in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. North Andover, Mass. Fe6�. . . . . . . Lic. No�//r.g, A U GS N ISP *CTOR Check# 60V 6333 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Locations Permit# Amount$ �O Owner's Namev New D Renovation Er Replacement ❑ Plans Submitted E4 � zwz vy� o C � �a G z w C7 w < w y a C w C H z d m w W w F x z Q w d z .H. H z o H vv '� FG w x o x fi 3 0 a o 0 > c off. COD N o SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) G Check one: Certificate Installing Company Name a C C? �S `�O�-} _ � Corp. _- Address C y Business a ep one d, 6 13Partner. �� Finn/Co. r Name of Licensed Plumber'or Gas Fitter 3 INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes 0 NoO If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ©/ Other type of indemnity13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Cha ter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. p Check one: Signature of Owner or Owner's Agent Owner 1:3 Agent hereby certify that all of the details and information I have submitted13 (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 ode and�-�hAQ of the General Laws. By: gnatur f Lice d Plumber Or Gas Fitter Title Plumber Cit /Town, � Gas Fitter License Number ° Master APPROVED(OFFICE USE ONLY) Elljoumeyman Date. TOWN OF NO-R`TH ANDOVER '.' ? •. oo PERMIT FOR PLUMBING SSACMUS� f This certifies that . . . . .. . . . . .. . . . . . • • • • has permission to perform . . '`. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . s . . . . . . . . f. . . . . . . .at . . . . . . . .:. . . . , North Andover, Mass. F . Lic. No. Fee. s / PLI;M ING INSPECTOR Check x 6 7 658 P MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ! 1 Date Building Location Ic�`'� �, �rs Name 1 pelt# -6 Amount 3( Type of OccupancyS New Renovation �(/ Replacement 0 Plans Submitted Yes No FIXTURES o a � a K a c W W A A 4 A A w F to U a q A A 0.47 A Q a as STSS�E RkIEV NT M FUXR j M RLOQ2 3M FLOCIt 4M FL CI[Z 51H FLOCR I -T 6M HDM - 7M FL CR 9M FZOCIZ P---+� I I T-14f (Print or type) Check one: Certificate Installing Company Nam Corp. ���r t��,c,r� :c � r Address ❑ Partner. br � usmess Telephone irtn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of irtsurance coverage by checking the a'�ppr�ate box: Liability insurance policy r7^ Other type of indemnity Bond Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance 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 with all pertinent provisions of the Massachusett Plumbin e d Chapter 142 the General Laws. By: SignWare o ense r Type Plumbing License Title City/Town icense um a Master ❑ Journeyman APPROVED(OFFICE USE ONLY �1 0"/ PE=RMIT NO. O APPLICATION FOR PERMIT TO BUILD*** I"NORTH DOVER, NIA nt u'NO. I OI.N(1. 2. It E(ORD OF OWNLRSBB' DATE BOOK PAGE S , Sr M, a. ' POO �- UISIl11'. LO-r No . C ��) (� ��`e tke f1 J PURPOSE*Of BIM I)IN(i ()\VIv�R'S NAt IE e 1F�+i-}6"Ck eP-,A LC y)Q N().C)1 STl>rtIES t✓ SIZE OWNER'S ADDRESS / r f CL - BAST;NIENf Oil SLAB AMIIII ECI'SNANIF lV „ '✓ SIZE OF FLOOR IIMBERS I ST 2 HD 3 RD [it 111 l)ER'S NAMES C � �/ mto�, SPAN DISIANCE—IONEARESI BUILDING q® O ` DIMENSIONS Of:SILLS DIS FANCE FROM S IM-1:1' Cp 1 DIMENSIONS(N POS I S I)ISI'ANCE FROt.I LOT LINES-SIDES (5^0 REAR ` DIMENSIONS OFGIRDEI(S AREA OF LOT 10. FFROMAGE /D t 1111161IT(A FOIJNDATI(NJ THICKNESS IS 13111LDIN(i NEW SIZE OF.I("IING 1 a X IS BUILDING ADDIIION KIAIERIAL OF CIIININEY IS BUILDING ALTERATION IS BUILDING ON SOC.ID Of(111 LED LAND WB 1.BUILDING CONFORM TO REQ JI REMENI S OF CODE IS BUILDING CONNECI ED I O TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING C(NJNECTED TO TOWN SEWER I i BUI LDI NG CONNECI ED TO NA I IJRAL GAS I.I NE INST11('TIONS 3. PROPER fl'INFORNIA I ION LAND COST EST. B1.1Xi.COS r PSAGE I FII.I.OtIT SECTIONIS I-3 EST. BLDG. COAT PER SIT FT. ES 1 BI Ixi.COS I I'ER 1100M EI WrRIC MEI LRS Nit BE ON 00-1 SI DE 04-BUILDING SEI'lIC PERMI I NO. AI-IACIIEDGARA(3L'SL.11)STC(NJFOtivl root-ATEFIRERE(HILAII(NJS a. APPRO)VEI) BY: - - -- 7 - PLANS MUST BE FILED AND APPROVED 13Y IIIIII.DING INSPECTONt . BI II HANG INSPE=CTOR l DAM_FII f;1 �r � � OWNERS TEl k. / � �� 80-5-3 11GNA111RG1NO\\'NIiRORAlfUlt IZ1iDA(;1141 III° t PI RNIIT(ii(AN11-D (P /� 19 — • _ _\ The Commonwealth of Massachusetts ( Department of Industrial Accidents — Mics 911VYesUgatluns 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city ohon # I am a homeowner performing all work myself. [i I am a sole proprietor and have no one working in any capacity l-7 [ am an employer providing workers' compensation for my employees working on this job. cltmoanV rase: addrEss: citynhonc#- in�arance co: Policy# I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' com ensati n polices:: comnanvname• _) G v ,nue- Po-- o k)t-k k-C"I City: P pt 0 i >til G M fr S S phone#- imuranre cQ, P, /'r ' policy'# companyname: a.ddress_ ;; _... city phanc#- insarane~cn. s o'ic.t" Failure to secure coverage as required under Section '_5A of NIG 15�can lead to the q d imposition of i g criminal Hallie of a fine u to 51.500-00 And/or P Pe P S 00 n one yean' imprisonment as well as civil penalties in [he form of:i STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA far coverage verification. 1 do hereby cerrify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license.a L7 Building Department C]Licensing Board Q check if immediate response is required Selectmen's Office CiHealth Department contact person: phone q; COther I (r--i]i95?;A) I 32 w S He p i - 27S "�v Fe retl) � _ * NOTE: No record plan s client. Due to vaguenes r, available, certification is �-R,�du ♦ _ and shed. No determina location of abutter's garz a a locus and abutter's drivf k,�. . a mentioned garage: and: di J,Qp -Olt , in close:-p.roximity:,to pr( location; of above mentioc be ascertained by .a mor VAR. 71 Ch Sr� A�rtok rcDc'G o� Ac+so•rER'S AgP�lk .r ' 1.I.F•17• 02J¢voL� . (i S 1P SO r�rH7 ' APPr=oX 'LsoG& of MARBLEHEAD STREET FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT �� "� C�'P� L �p �0 PHONE LOCATION: Assessors Map Number / PARCEL C;2 r' SUBDIVISION LOT (S) STREET �I AA L v k� A4 ST. NUMBER OFFICIAL USE ONLY*" i�xag O'V4 6^4 Pwf RECOMMENDATIONS OF TOWN AGENTS: _ � �� q CONSERVATION ADMINISTRATOR DATE APPROVED b (OM DATE-REJECTED COMMENTS 1 `� �/" �f `mss \A/k TOWN PLANNER DATE ,APPROVED r1� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS I PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY EUILDING INSPECTOR DATE NORTH Town of No. CAST 0 : f � °�A CoCN Q dover, Mass., ORATED PPI S 5` BOARD OF HEAL Food/Kitchen PERMIT T Septic System �, BUILDING INSPECTOR THIS CERTIFIES THAT...............� C01V Y/......... ........ ...0 ....... . ' ..... .. .. has permission to erect. x � � A /� �� Foundation .. ! d ....... P ......... buildings on ......40 Aj^ Rough A to be occupied as... .......6009 f�AO v N� pOm� /N /'�w ^ 4 R� Chimney . . . . ............................................................................................. ......................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 1 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. 1Y)A 1N M IN AWA) /b Cat 134 CA PLUMBING INSPE R VIOLATION of the Zoning or Building Regulations Voids this Permit. Fr& M J.vl- Ai N 19 S Rough Z C* PERMIT EXPIRES IN 6 MONTHS Final qUNLESS CONSTRU S TS ELECTRICAL INSPECTOR Rough a ........................ ...................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. N Date....lD. ". "" ...... NORTH °�t"`°;•'"° TOWN OF NORTH ANDOVER 10 PERMIT FOR WIRING cMUSEt This certifies that .� .44.P..'�......Lr:. �...��.X4.4 i .................... .......:... ....:... .. has permission to perform ... .....f' 1! ...f......................................... wiring in the building of....... :e..............�1v.. ...!..�1- at.... n5....... rth Andover; ass. Fee.... . Lic.No. A)(� ......\ `:rp ..: 1..'.:.......... ! ELECfR1CALINSPECTOR hR �4 W108199 14:19 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer r`\ (Ililcr Use Only �.. The Commonwealth of Massachusetts Permit xm. 17 (, Q$� Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONSoccupancy i ret checked 52T CMR 1200 3/90 (1aaee blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance with the Massachusetu Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INR OR TYPE ALL INFORMATION) Data 5., a -1- q t City or Town of OIZT-11 ANL1MlI:2 To the Inspector of Wires: The undersigned applies for pa permit to perform the electrical Work described below. Location (Street & Number) Owner or Tenant �F Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building G- �� '(^ Utility authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �( , N(e� �fi d0L_ No. of Lighting OutletsTotal No. of Hot Tubs No. of Transformers KVA No. of Lighting fixtures Swimming Above In- Pool grnd. grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat Total Total a Pump s Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. o f Self Containeding DDeteceviees No. of DryersHeating Devices KW Local ElMunicipal Connection❑Other No. of No. of Water Heaters KW No, nsf Ballasts Low Voltage No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO I have submitted valid proof of same to this office. YES❑ NO C]If you.have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S xpiration ate Work to Start Inspection Date Requested: Rough 1 Final Signed under the penalties of perjury: FIRM NAME LIC. NO. . Licensee StL--1�f•li_�•I �f�s�}���'��� Signature LIC. NO. 0-260 2 Address7\,-,/i 1 f .Q J�1� �b �(� . IC�J�J�bt Aft ��/� Bus. T No. 1 (-,rj)i{-(� Alt. Tel. No. q-Za_ 6C1L4- Qig , OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub— stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit app) tion waivthis requirement. Owner Agent (Please check one) � Telephone No. PERMIT FEE S JAS Signature of 06ner or Agent) C 1.�14�,,- 4 II