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HomeMy WebLinkAboutMiscellaneous - 66 BOXFORD STREET 4/30/2018 (3)/ 66BOXFORD STREET 210/104.D-0007-0000.0 II 8798 Date? Via. HORT►1 ?0.,, °„•.�+ TOWN OF NORTH ANDOVER ` PERMIT FOR PLUMBING 11 ,SSACNUSE� This certifies that . . . .111.-710! .! L.l�. . . . . . has permission to perform . . �.� .t. .-. /? . . . . . . . . . . . . plumbing in the buildings of . . . .P a.,Y. C. . . . . . . . . . . . . . at . .lee. �iL .� . . .` . . . . . . , North Andover, Mass. Fee. . . .Lic. No..!.? . . . . . . . �!. �L . . .�-� . . . . . . . PLUMBING INSPECTOR Check # k/.('-.Cf MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /t / ate a( Building Location �(p <' (I_p-.Owners Name Permit# _ Amount X ® d Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES z Q H a o z > W x a s v z o w F w v z z 3 F U w G Q a d z c °' V a� F U 3 z x a O Q z z w O Q x > O � o o m a d x as o . � suB$svtr. BASEVENr ISr f oOR M ftOOR 3Mfffio"M aux Ft" 5M ROOK 6M FUM 7tH FLOOR 9fliRDM Installing or ing Company y \"- C /yI� � '� Check o Certificate Installin Com anName G�°� Co .�! Ca 3fi Address 79 E] Partner. 0.3"J3ZI-6?07 Business Telephone / Firm/Co. Name of Licensed Plumber: /` Insurance Coverage: Indicate thetyp nsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information ave submitte or entered)in above application are true and em to to the best of my knowledge and that all plumbing work install performe der it Issued r is ap tion be compliance with all pertinent provisions of the M achusett SW 1 b' Cod Cha t ws. By: Signatcale o (cense umer Type of Plumbing License Title 1 23 910 City/Town icense N-7 777-r Master Journeyman APPROVED(OFFICE USE ONLY 7 5 t 6 Date x/22��/. ° . ... .. NORTH °•° TOWN OF NORTH ANDOVER ...;. PERMIT FOR GAS INSTALLATION ,SSAC HUSES This certifies that . . .��1.4.�. . . ./�Irh. /�. �*! . . . . . . . . . . has permission for gas installation . . . : . . . .�. . . . . . . . . . . . . . in the buildings of . . . .R �. ' 5: C?�.F. . . . . . . . . . . . . . . . . . . . . . . at . . . ./13 o Y.Fv-./J.j • . .1 Z• � . • . North Andover, Mass. Fee??-.�. . . Lic. No./i.3:�. . . . . . . . . . . . . AAS INSPECTOR Check# /C S MASSACHUSETTS UNUMMAPPLICATON FORPERM TO DO GAS FITTING (Type or print) Date © '�� NORTH ANDOVER,MASSACHUSETTS Building Locations az4zPermit# If Amount$ As, '170 Owner's Name New❑ Renovation ❑ Replacement Plans Abmitted c� Q x z o a > w w z Q z w�Iw a v �a w w wCi x x z d w a F F > m z o z w o x wx o wo ¢ x ¢ ¢ o o w '� o w F 3 c a x > c a H o e SUB-BASEMENT BA SEM ENT IST. FLOOR 2ND. FLOOR y 3RD. FLOOR 4 T H . F L O O R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) I Q ,Q /►�� (� LI CheKo . Certificate Installing Company Name 1 / '' ` 0 r Address / "�--Q%t% � " '�� /y/'_ oT� ❑ Partner. Business Telephone ® - - ¢�� r - q�-, ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance cy or it's substantial equivalent. Yes No❑ If you have checked yes,please' icate the type coverage by checking the appropriate box. Liability insurance policy 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. : B ature of Licensed Plumber O Gas Fitter By: Title Plumber City/Town ❑ Ga r License Number 0-1 aster APPROVED(OFFICE USE ONLY) ❑ Journeyman a Location No. Date t►ORTN TOWN OF NORTH ANDOVER " Certificate of Occupancy $ cNuEco Building/Frame Permit Fee $ _L s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 36 �- e ' Check # 97z�_ A ✓ Building inspector The Commonwealth of Massachusetts State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: / Date Issued: L/o /a U 3 Signature: Building Commissioner/Inspector of Buildings Date SECTION I-SITE INFORMATION 1.1 Pro Ad 1.2 Assessors Map and Parcel Number: r r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: � '511/Z11'ey Lot Area(so J Frontage(ft) Zoning District Proposed Use 1.6 Building Setback ft Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 107 Water Supply 9M.G.L.CAOA 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private Zone a Outside Flood Zone Municipal Q On Site Disposal System 2.1 Owner of Record ec,v,V6rN C IVq;ve y � Name(Print) ��lz - /� zee-111d9- 9. l e11` /J (9j Signature Telephone C% /Jl� �/�T 2.2 Authorize gent: Name(Print Address Signature Telephone SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q, Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable 10 Company Name Registration Number Address Expiration Date Signature Telephone Revised 1997 JMC w 4 SECTION 10b-OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to Official Use Only be completed b permit applicant 1. Building (a) Building Permit Fee Multiplier 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee(a)x(b) 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 1+2+3+4+5 Check Number �N i SECTION 6-DESCRIPTION OF PROPOSED WORK check all applicable) New Construction Q 1 Existing Building Q Repairs Q Alterations Q Addition Accessory Bldg, Q I Demolition Q Other Q Specify Brief Description of Proposed: SECTION 7-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly A-1 A-2 A-3 lA Q A-4 A-5 1B Q B Business Q 2A Q E Educational Q 2B Q F Factory Q F-1 F-2 2C 0 H High Hazard Q 3A Q 1 Institutional Q I-1 1-2 I-3 3B Q M Mercantile Q 4 Q R Residential a R-1 R-2 R-3 5A Q S Storage Q S-1 S-2 5B U Utility Q Specify: M Mixed Use Q Specify: S Special Q Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index(780 CMR 34) Proposed Hazard Index(780 CMR 34) SECTION 8-Building Height and Area I BUILDING AREA Existing(if applicable) Proposed Number of Floors or stories include basement levels Floor Area per Floor(sf Total Area(sf) Total Height(ft) SECTION 9-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION I Oa-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,As Owner of subject property hereby authorize to act on my behalf,in 11 matters el ive to work authorized by this building permit application. .s_ /lo3 Signatu a of Owner D to revised bldg form/state 7MC • 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 Y APPLICANT /\� II q� 3 a 1 9 4 0--� �_tzL'L� HONE-12EJn Ob �1 LOCATION: Assessor's Map Number-1601D. PARCEL SUBDIVISION LOT(S) �a STREET Gk�0►- S�-re e± ST. NUMBER lop lI ************************************OFFICIAL USE ONLY***** 111******** RECOM NDATIONS O T AGENTS: CONS RVATION ADM DATE APPROVED (j 7 DATE REJECTED COMMENTS s' TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR— DATE— Revised NSPECTORDATE_Revised 9\97 jm A6r'1..�..8a'i _SLTN 1U;28 FAX C,A.RLSON N.ANDOVER P, B9zT4A0Ltb Aja aIEA.0lAX, ,MA.-,r -CALF 1',40' ' _ T d 441 Oso . rr Cps b5� 65 4�c�U 1 Y TO a Q 5 Ito 'A ,.-. IL lob- "" ppPpsE►� __ w t GC- awrtivar� oar-, ALES - a f '908 r. Za' AerA 1.16, _ 'Ak4f.#ddal.L llyt7,. T r tffY' ta! I - i fi Idles.�O NpRTH E 4 over own of �l No. G(� y dover, Mass., �,o� l A A- COCHIC WIC^\� �J AOASATED PP � BOARD OF HEALTH Food/Kitchen Septic System PERMI BUILDING INSPECTOR y Foundation .....7e................................................................................. THIS CERTIFIES THAT ..... ..... Rough �........ r° ......... .... ... buildings on ............. v �1 ._...•.. . Chimney has permission to erect... .• 0,«�. N• �v to be occupied as......... this permit shall in every respect conform to the terms of the application on file in Final provided that the person accepting p PLUMBING INSPECTOR provisions of the Codes and By-Laws relating to the Inspection Alteration and Construction o this office, and to the p /� Buildings in the Town of North Andover. ! Rough D � � VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS - Rough • Service / ................. BUILDING INSPECTOR Final Building GAS INSPECTOR Occu ancy Permit Required to Occupy g Rough P s Place on the Premises — Do Not Remove Final Display in a Conspicuous FIRE DEPAR"F'MENT No Lathing or Dry Wall To Be Done and Approve by the Building Inspector. Burner- Until urner Until Inspected PP Street No. Smoke Det. SEE REVERSE SIDE