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HomeMy WebLinkAboutMiscellaneous - 66 LONGWOOD AVENUE 4/30/2018 210106.0 h Location C(o Ca L CNU e-r co O Q-6 A U E No. 5Jr 6 d�O 1 ? fi J Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-9-6 , = Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1230 Building Inspector R ~ OCT 2 4 2016 1OWNOF tJORTN AN00\1ER HEALTH DEPARTMENT j IIF MMM 0 XM9T °� 2HM= r Environmental/Demolition Contractors r Commercial/Industrial/Residential October 17, 2016 Town of North Andover Health Department 1600 Osgood Street, Suite 2035 North Andover, MA 01845 RE: 66 Longwood Avenue, North Andover, MA Dear Sir/Madam: Please find enclosed a copy of the Notification filed with the MASS DEP regarding the above captioned project. We will be at the location on October 26, 2016. Kindly review and contact us with any questions or comments you may have. Very truly yours, Susan A. Pappalardo /Enclosures I 7 Puzzle Gane, Unit 2, Newton, NN 03558 Office: (603)97q-2503 FAX 603 974-2877 Massachusetts Department of Environmental Protection 100252865 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision r" [ Project Cancellation A. Asbestos Abatement Description 1.Facility Location: RESIDENCE 66 LONGWOOD AVENUE Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTH ANDOVER MA 01845 5085099430 must be completed in order to comply with c.City/rown d.State e.Zip Code f.Telephone MassDEP notification MARK RAE OVMIER requirements of 310 CMR 7.15 and 9•Facility Contact Person Name h.Facility Contact Person Tile Department of Labor i p Worksite Location: OUTSIDE,BASEMENT Standards(DLS) i.Building Name,Wing,Floor,Room,etc. notification requirements of 453 2. Is the facility occupied? r%_0 a.Yes r b.No CMR 6.12 3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? W a.Yes 17, b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 E&F ENVIRONMENTAL SERVICES LLC 86 CAROtAN AVE a.Name b.Address HAMPTON NH 03842 6032345581 c.City/Town d.State e.Zip Code f.Telephone AC000767 h.Contract Type:r 1.Written 2.Verbal g.DLS License# 7. GUILLERMO A MARGARIN FRIAS AS060373 a.Name of Contractors On-Site Supervisor/Foreman b.DLS Certification# N/A 8 a.Name of Project Monitor b.DLS Certification# ASBESTOS NOTIFICATION LABORATORY AA00208 9 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 10/26/2016 10/28/2016 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYY`) 7-330 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r a.Demolition 1- b.Renovation c.Repair r, d.Other-Please Specify: REMOVAL Revised: 11/13/2013 Page 1 of 4 Date. . . .1!' ;?Il Z'. .. . ... NORTH 3j 0ry`,sae ,+�,ypL TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION 9SSACMU5Et This certifies that . . . . . . . . . . j Q has permission for gas installation in the buildings/of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . ../ . . � ref '. . . . North A do er, Mass. Fee. �� Sv. Lic. No..•.�. Z. ?T GAS INSPECTOR i��� Check# .3 z ll 8125 w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS _,OWNER'S NAME �O I►' � / GOWNER ADDRESS TE FAX TYPE OR OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL® RESIDENTIAL PRINT CLEARLY NEW:E] RENOVATION:© REPLACEMENT: PLANS SUBMITTED: YESE] NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 T6 7 8 9 10 11 12 13 14 BOILER - -- - - -- BOOSTER CONVERSION BURNER COOK STOVE E DIRECT VENT HEATER _I __ - - -- - - DRYER FIREPLACE - - -- - - - - -- - FRYOLATOR - - - - - - - -- - - - -- FURNACE -- - s ' GENERATOR -_-- GRILLE -- - -- - - - - - INFRARED HEATER — LABORATORY COCKS MAKEUP AIR UNIT OVEN - _ - -- POOL HEATER ROOM/SPACE HEATER -- - -- _f - ROOF TOP UNIT _ - --- - - --- TEST -- - ' -- - _J UNIT HEATER - - - - UNVENTED ROOM HEATER - WATER HEATER --' - -- OTHER I - - - I INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ]NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW \ LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNERS ' INSURANCE WAIVER:I am aware that the Ii ensee 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 E3 AGENT Ej SIGNATURE OF OWNER OR AGENT -Thereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the es y knowl and that all plumbing work and installations performed under the permit issued for this application will be in compliance with I Pertin t p /b t Massachusetts State Plumbing Code and Chapter 142 of the General Law—s. �`- PLUMBER-GASFITTER NAME f�� I I _ __ �I LICENSE# _ y� S A R MP 0 MGF E-1 JP JGF E] LPGI® CORPORATION[:]# PARTNERSHIP O# LLC Q# COMPANY NAME: __ __� ADDRESS . CITY — STATE I_/33 ZIP TEL FAX CELL EMAIL 9383 Date. 4niv. . . TOWN OF NORTH ANDOVER 0 0 PERMIT FOR PLUMBING ss�CHUS� -�' f f This certifies that . ./.!���/-� . . 1"�. . . . . . . . . . . . . . . . . . has permission to perform plumbing in the buildings of . . . . . . �9.U% . . . . . . . . . . . . . . . . . . . . at . . .�P. .[a �.� . ?"v��. . . . . . . . .., No :hh}Andoveei, Mass. PLUMBING INSPECTOR szla Check # J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY MA DATE __-. _-:_. _,!a_--------, PERMIT# JOBSITE ADDRESS OWNER'S NAME�—t.l.0 J_fy 5r, POWNER ADDRESS " ._ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIALE]i EDUCATIONAL El RESIDENTIAL f PRINT CLEARLY NEW:E] RENOVATION:El REPLACEMENT:M PLANS SUBMITTED: YES NOM FIXTURES 1 FLOOR— BSM 1 2 3 4 5 1 6 7 8 1 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ___. . DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM— DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR _ .. KITCHEN SINK - - -- - - - - - - 0 - - - - -- ---- -- LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET - URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i WATER PIPING OTHER r -- {- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESP NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 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 E] AGENTE] 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 es of m wledge and that all plumbing work and installations performed under the permit issued for this application will be in c pliance with all P ' nt ovis' ofthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. oL,726 �, PLUMBER'S NAME �" _ _- ,LICENSE#MG ATURE MPD JP CORPORATION S# PARTNERSHIPFJ#OLLCQ#� COMPANY NAME _1.� TJ U_M ADDRESS1 CITY -CIY�_. _�1.__. --_ - _ - STA E _ ZIP _d (� --- TEL Cj 2-0-a.L FAX CELL EMAIL �� '`� �`1 S�(' W)'1 TS ,f7 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/lndividual): —� Address: /Ok Lila City/State/Zip: -��e#: , Are you an employer?Check the appropriate box: Type of project(required): L❑ 4.I am a employer with ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. �Iarn a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling p and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' � y p � comp.insurance.t 9• E]Building addition [No workers comp.insurance P required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:_(' \ ' _ VCity/State/Zip:V &_J_t 61W Attach a copy of the workers'\�§mpensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi under lite pains and enalties o er'u that tl:e in ormation provided above is tare and correct. Si ature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f�10R7/r� -W. • "° Zoning Bylaw Review Form t Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Sys°.r."..•'j,�9 s"`Husx Phone 978-688-9545 Fax 978-688-9542 Street: X Ma /Lot: C Applicant: Request: /& K '3 -t — Date: '-711S 0 Y' Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning it'-3 a 3v00LI-zja5 rNv4/3r>1�0 - 30 i` s 1-,Q- Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting Lj r- 2 Frontage Complies 3 Lot Area Complies 3 1 Preexisting frontage e 4 1 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area A) .a 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 1 Complies 4 1 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient Act oN 2 Complies 3 Left Side Insufficient 3 Preexisting Height e 4 Right Side Insufficient 4 1 Insufficient Information 5 Rear Insufficient I I Building Coverage 6 Preexisting setback(s) S A a oea r- 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting Lf -e 1 Not in Watershed L e 4 Insufficient Information 2 In Watershed j Sign fV 3 1 Lot prior to 10/24/94 1 Sign not allowed 4 1 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district S 2 Parking Complies e 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parkin Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit -a Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housin S ecial Permit Special Permit Non-Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit 1�: -jA Special permit for preexisting Watershed Special Permit nonconforming- The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to Provide definitive answers to the above reasons for Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new permit application form and begin the permitting process. ✓ Building Department Official Signattfae Application Received. Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: fiM• d"' 1 �yWl a (i � ! s t ,s 2 Y^P _s�s'V�7Yt, nc a q a .y. cV Vz a .. tr n S+�s t F4 7<..-: 5d r N:?C .,�`;'}'...s, �''s,.�: ;�Sn M4:.: 't•Y 33�{�.d�.t< _ A So e c 143� ��r�n�c T ICU o" d 10r,e ' c F�677 o,v rm SJ�rvc ort q- �1/ CvNlbrMr:� �t9 /S r� Utr o� VV0 ® IC A RPF/A /S a na seal d2 .14 t1,4 R!AV<<e Zv— i-c,-4 Ac k S r—C 401L) i`j st 'T-4- Referred To: Fire Health Police Zoning Board Conservation Department of Public Works Planning Historical Commission Other Building Department IF NORTH ANDOVER ZING DEPARTMENT APPLICATION TO OR DEMOLISH A ONE OR TWO FAMILY DWELLING Sedim f6T fleC tlai' BUILDING PEINI.0. DATE ISSUED: M _ X SIGNATURE: Building Commissioner/Ingwor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Ej g LoNCs woo� tom, Coo C S t P(of AA- �r acN�+( -1,A P 0�2 L1 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: f02So Zoning District Proposed Use LA Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Reqwred Provided v 1.7 Water Supply M.G L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT l: r C L I I : C-5 2.1 Owner of Record C 4US r'rt —5 qVA, LG-1USL PP1Ar t SAV1 Name(Print) � ) Address for Service 7 --7 4 —3/-8.0 St Telephone 2.2 Owner of Record: O Name Print Address for Service: Z Le.o. q -78- 1qct—368 v Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES 9" 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number r Address r ^ z Signature Tel Expiration Date hone G) 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 permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check su applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Multi lier 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 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject g J property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3Ku SPAN DD64ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHD4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � Uie On WELDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/12EQmtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: L©N CT Woo-1N N-J, ' (DO C _ s � AA' 1`r a�` P `'$ [�r Map Number Parcel Number 1.3 Zoning Information: 1.4 Properly Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard ReqWred Provide R red Providd R red Provided 1.7 Water Simply M.GL.C.40Zone1.5. Flood Zone Information: 1.8 Sewerage Disposal stem: D Public ❑ Priate ❑ v Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record �y� L " LG- PP IA(A sAvl _ Name(Print) Address for Service l� r1 4 /-;9 u St Telephone 2.2 Owner of Record: 4co ``��-, ,v,-- CLEEn f=oRooH.A(L7 Name Print Address for Service: O Z Signature Telephone R{ SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: _ 0 • License Number Address Expiration Date Signature Telephone r.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r AddressWORM r Expiration Date n Zz 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.......0 No.......❑ SECTION 5 Description of Proposed Work checkapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 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 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A SUN 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 G i U 5 PP, 1\)f- S I PHONE q O LOCATION: Assessor's Map Number 6 C PARCEL SUBDIVISION L Q+ LOT (S) 1 STREET 6� DOMLT"�®(�L� ��� ST. NUMBER .**********OFFICIAL USE ONLY * *********** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED. DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR _DA E Revised 9197 jm rDate. ...4141............. MORTM Of<•••'��,�O TOWN OF NORTH ANDOVER o PERMIT FOR WIRING Thiscertifies that ............................................................. ................................ has permission to psrform --/°•I.-.1- I.Y-�' :,. .:.s ............................................................ k wiringin the building of..::.... ........................................................................... at -� ';�, . ... ... ........... .North Andover,Mass. Fee.�U..... I .No:� -. . ...... . /L: �c/........ ELECTRICAL INSPECTOR Check # � 5515 N J d MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date d ' /' 19 Permit # ✓ J Building Location�L 4L,0ygU_;P"nl. *Ja Owner's Name Type of Occupancy 'Tri New ia--Iol Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No pg� V) rn uj x Z CCvi W N U �- r w W ¢ o o m F y rx Oct r Z ' 9: x n o U ~ a ¢ z D o ~ Cr a ca a Cr o o F 0 w — a c m oc vt o w a x zL) W r- n< ccp > w W W N J z Q = ¢ ¢ W Cr W r W F- S Q v H z — W0 z W W o > LL F U -j h W Y a wF— F r NM z o z a o rn x a W > ¢ W D z a ¢ ¢ = O C7 0 W X LL 7 3 o C7 J U > q a 1- O SUB—BSMT, BASEMENT r IST FLOOR 2ND FLOOR BE 9110 FLOOR 1E 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR eTH FLOOR a Akio Qr—rlv!�L Installing Company Name 215 BOSTON ST,,P ® BOX 999 Check one: Certificate Address TOPSHEW,MA ©1283 ❑ Corporation ❑ Partnership Business Telephone-, (� Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ • No ❑' If you have checked yes, please Indicate the type coverage by checking lire appropriate box. A liability Insurance policy ❑ Other type of Indemnity❑ I Bond ❑ I ' 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. 'I r t _ I Check one: LSrgnalure of Owner or Owners Agent Owner❑ Agent ❑ I . I I hereby certify that all of the details and information I have submitted.(or'enlered)in above appli ion are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for IN application w' be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge era aw . By T pr,of Ucense:GasliUer Title Plumber Si'gnat o cense P m er or Gas ilt j - City/Town Master License Number ' APyFiONE OF C .ON Journeyman ; t'I 111E(,'UMMUIV Wt ALI H UP' JACHUNW I N' Office Use only D+ OFPUB CSAFEIY permit No. BOARDOFFB?EPREVF1V770 RBGIIIAT7OWrCW 12:010 Occupancy&Fees Checked APPLICATTONFOR PERMIT T PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant S Owner's Address �/� Is this permit in conjunction with a bui ding permit: Yesimm No (Check Appropriate Box) Purpose of Building vt�;L �/ 5 `/ S �' 'Pee�� C.JU/kJG GSM. Utility Authorization No. Existing Service 1= Amp '2�Volts Overhead Underground No.of Meters New Service ✓ Amps �?U/ /Z2eNolts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4r _.G {fl/!n 1�► No.of Lighting Outlets / No.of Hot Tubs No.of Transformers Total (� KVA No.of Lighting Fixtures U Swimming Pool Above 0 Below Generators KVA round eround No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners /20 vo /7S No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Plumps Tons KW Initiating Devices Of No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal � Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• b=anceCc)WrW-Phalantoothe►eWmxx>tsdWi%mdvseasGaiaW aws IbawaamerALdxUyh>u o=PohcymchdTCoplee Covaaworitsakst chalegtuvalart YES NO Ihayssubrniwdvalidptcofofsametot rOffi=YESM Ea Y)wha%wire Ed YES,pp=mdc rethetypeofoovaageby dvda<lgthe brut INSW� ANCE BOND r7 OrIIEZ (f�f� (P1ea9eSpecity) IJ Estimated VahleofFbddcal Wolk$ �j U U d WOJIDSW kq)ectimEkiteReque9ed Rough Final Sigrwun rTrPaVffi sOfperjury: FIRMNAME LioffWNo. C1*p2&'- � LicerwNo 0 3 BusirmTelNb. A l V CJ ///h` t Alt Tel No. `1''-7Sr— OWNER'SINSURANCEWAIVFR;IamawmetridieLiowdoesnothawthemrdnceeovaageoritsmbstx leqrivalartasWmedb,Nha xu GalaalLaws andthazmy . Onthis' 'applicati«Iwaivestfrislagtlrtanai ' (Please ec e) r f Agent d(.N 7�&- a a� Telephone N PERMIT FEE$ �V� signature of Owner or Agent a Date. . . Of NORTH TOWN OF NORTH ANDOVER .'QED 'a9ti0 PERMIT FOR,GAS INSTAhLATION T 29 3SNCHUSE This certifies that . . _16. . . . ... . . . . . . �J has permission for gas installation . ..t.�+�;:!v in the buildings f at , North Andover, Mass. Fee. -r� Lic. Nq�� .2.7 S.1 . . . —. . . . . . .t. . . . . ,T . GASINSPECTOR WHITE:Applica RtZ;Rit�ANARY: Building Dept. PINK:Treasurer GOLD: File