HomeMy WebLinkAboutMiscellaneous - 69 PATRIOT STREET 4/30/2018 69 PATRIOT STREET
210/013.0-0008-0000.0
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TOWN OF NORTH ANDOVER
O P
PERMIT FOR GAS INSTALLATION
SACHUSEtty
f
t This certifies that .tl . . . ( . . . . . . ... . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . .
- � �
in the buildings/f . -
at �� � � .-' � • . . • • •(; North Andover Mass.
Fee. Z . . Lic. No. - Gam.
r GAS INSPECTOR
Check#
6316
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date 113,1161
�3�!
NORTH ANDOVER, MASSACHUSETTS ,
Building Locations
Permit# �� w
Owner's Name Amount$
New Renovation Replacement Plans Submitted
a
U
W
OU x
z z F a
G Z , V U W x F o+ C > d
GW7 F z d x w w W ca zF
a x o x 3 c a ° °� Q
0
SUB-BASEM ENT 0>
BASEM ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . F L 0 0 R sf
5TH . FLOOR
6TH . F L 0 0 R
7TH . FLOOR
8TH . FLOOR 41
(Print or type) Check one: Certificate Installing Company
Name ` f t��Zl "� �p�-�
1 11 Corp.
Address i � �
c�� � (�✓ �,� �� �C Partner.
QY
B u si n—e—sS7 a I e h one10 Finn/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent.alent.
Yes ❑' No
If you have checked ❑
Y es lease'
�,p indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond ❑
k Owner's Insurance Waiver: l,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 ❑
1 hereby certify that all of the details and information 1 have sub or tered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and instal ions rf ed under Per it Issued for this application will be in
compliance with all pertinent provisions of the Massach tts e C nd Ch t r 142 of the enera aws.
By: Signature of Licensed Plumber Or Gas Fitte
Title Plumber
City/Town, ❑ Gas Fitter License Num er
aster
_ APPROVED(OFFICE USE ONLY) Journeyman
Location
No. Date
MpItTN TOWN OF NORTH ANDOVER
p Certificate of occupancy $
41
Building;rrame Permit Fee $
sA�N�s Foundation Permit Fee $
.` ?k-0
Other Permit Fee $ �2r—
Sewer Connection Fee $
Water,Connection Fee $
MAR 16130 �,.�.��.�.�
A' -building-Inspector
Mo. Andover Collector Div. Public Works
N I111
OI I I(a.tiv1 : � Tl) w1l of, 121) NI:►i►► tillc(•I
a
NORTH A NDOVI-At nlll► ;�►►(1 , ►.
lttlll.I)IN(i ,' NI;is,;"10it v;c•II';Ultia
S.S� �t
(:ONtiI'.I(VA ION \' I�I�'1.�I( )N(W 1(i17)(N 54775 p�
I Ilii\L I I 1
I'I_1\NNIN(; l'l,ANNIN(; R (;t)f�lf+lUNl l'�' UI;V1:LOl'1lil:N"1'
Hl:N 1 1.1 '. N1:I .ON• I )Il t1: I Ol t
CHIMNEY Al'I'L ICA i ION ANO PERt1I l-
LATE PERMIT # 3��C,-(Dl0
vcarlvN
� � 7 -
VNER'S NAME:
aI LDER'S NAME:
ISDN'S NAME:
ISON'S ADDRESS: �--
ISON'S TELEPHONE:-- �'y� - '! 5—��
ITERIAL OF CHIMNEY:
J1-ERIOR CHIMNEY: EXTERIOR CHIMNEY:
AMBER AND SIZE OF FLUES! — 72-
IICKNESS OF HEARTH:
�U cUbiney on. 6iAeneaee conomin to ,the. )tc-quiAerllelll-16 0() the code cold have nufm arld
igu,eatiou been uce-bed: - - — — -- - ----_--_-
JE: "IlkO _
'GNATURE OF MASON: /
:RMIT GRANTED: 3 - \la -cw FEE
)BERT NICETTA
IILDING INSPECTOR
ISPECTED:
MARKS:
SOLID BLOCK REQUIRED
THIS PERMIT MUST- BE U1SPLAVI=U 014 WE PREMISES
Location
No. Date
HpRT1l TOWN OF NORTH ANDOVER
F 9
Certificate of Occupancy $
�'�b'••° '<� Building/Frame Permit Fee $
SSA 14
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ < —
i r>
Check #
r
1 _
182125 ` Buitd'ing Inspector'
U
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUII DING PERMIT NUMBER. DATE ISSUED: NQ-)
M
Ifawic
SIGNATURE: �•` '"'`'
Building Cotltmissioner/I for of Buildings Date z
SECTION 1-SITE INFORMATION O
1.1 property Address; 1.2 Assessors Map and Parcel Number:
G/3,a 0009
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
v
1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑
Tone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
Cl1"; ��?:�
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 :1:77-17 �1•`;'tl!C; P ❑ M
2.1 Owner of Record
4RIC l/
Name(Print Address for Service
Gov e6Fv .�323 2
Signature Telephone
2.2 Owner of Record:
BUNROEUN CHHOUY
HOME DEPOT 0
As. Print 4 COBURN RD. z
T'i'NGSBORO,MA.01879 M
te bele none 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: 0
License Number
e�
Address
Expiration Date am
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
/�J) l 2 6 � 3
Company Name M
!31— J/ / Reg istration Number r"'
6/S �NLc�tJ}� % / l/VOL '/ �Z / r
Address 0010111
z
'57&1c, Expiration Date G)
Signature
q��Tehone
R
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 b ildin permit.
Signed affidavit Attached Yes...... No.......0
SECTION 5 Description of Pro sed Work check aH a cable
New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Addition ❑
Accessory Bldg. 0 Demolition 0 Other ❑ Specify Y
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY.
Completed b permit applicant _
1. Building (a) Building Permit Fee
2 Electrical Multi Tier
(b) Estimated Total Cost of
Construction
3 Plumbing
4 Mechanical HVAC Building Permit fee(.)x (b)
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
1, 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 t
Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
e
,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
�C ^• L"e,f i l/
Print Name --'
Signature of Owner/Agent 0 Date
NO. OF STORIES SIZE
BASEIVIENT OR SLAB
SIZE OF FLOOR T PvIBERS l' z. 3
SPAN
Ku
DIMENSIONS OF SlI LS
DIN ENSIONS OF POSTS
DINlENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS '—
SIZE OF FOOTING X
MATERIAL OF CHEANEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUU-DING CONNECTED TO NATURAL GAS LINE
%AoRTH
Town of - L Over
No. 9 Z __71
_
y dower, Mass., `r"��'��
T 0 - LAKE
COCHICHEWICK V
ADRATE D APS\
H BOARD OF HEALTH
PERM T T Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........... ... ......... ... ...................
......... 01-114-0.
.............................................................. Foundation
has permission to erect........................... ............ buildingson. .. ......... ................... Rough
tobe occupied as.... .. . ....... .................................................................................................................................. Chimney
provided that the person acceptin is permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions o 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
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPWMR
UNLESS CONSTRUCTION ST T�/r Rough
............................. ....................... Service
.A- T ................................................
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Fins
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.
AT-HOME Installed
Siding and Windows
Board of BuMall Regomfloas and Standards
HOME 111MOVEMENT CONTRACTOR License or registration valid for individul use only
p
Rsp!str�fiohj_J, 6893
before the expiration date. If found return to:
Board or Building Regulations and Standards
th" One Ashburton Place Rm 1301
r- _ ent Card
; T� m Boston,Ma.02108
THE Home Depot
BUNROEUN CHHJ
3200 COBB GALLEFt1Arf'}€iNl! #20
ALTANTA,GA 30339 Adadnistntor
Not valid without signatur
May 17 05 09: 45p Michael Bedard 1 -401 -246-2868 p. 7
May 12 05 07: 51a J. Trist:en FlOt;cher
9788872462 p- 6
HOME IMPROVEMENT CON'TRACf
branch Name: ��..- (js'"� Sold,Furnished and Installed by; `
Date; THD At-Home Services,inc
dlbla The Horne Depot At-Home Services
Branch?Number: / � / (j -345A Greenwood Street,Worceste,-,MA 01,607 %
Job *; 7 Toll f tee(8l)0)657-5:82; Fax: 508-756-2859 /
I'ede 7 JDJ 73-269946U A9E[.ie e!C()2434 RI Cur:.1_c6'i 6 27
Cr Lich X5522; 1IA Hon.c Impro4•crtant Contrarr.x keg f'164 .
Installation Address: � r'Oj
t-�— f-ttY Slate �iP
Purchnser(s); Driver'sLic,!t
&Exp.Unto 14' k Pbonr,
3 j!J Hone Phone:
� S� ) 11
(
homeAdd-ress _
(If different from Installation Address) City �-- �— State—
7 ip
Project laforntation: LAVe/You ("Purchaser"% tine owners o°the property located at the above installation address,cfft:r to
contract with Hoine Depot U.S.A.,[ne,('°Home Dep:t")to f�uriishh deliver and atrailre for the installation o ail materials as
drscribcd on the attached Spec Sheet tR;__ � incorporated herein by reference find mace a part hereof.
Home Depot reserves the right to cancel this contract if,upon re-iospection of the job,Home Depot determines that it
cannot perform its obligations due to a structural problem with tate(tome or because work required to complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS i
(Sul>iex is fund verification ard/arcredit opproval.) 411
CONTRACT AMOUNT S � 1. Chuck,Cashier`Chcckof Us Po_ta1 SuvicaMoney Ord.-
(Medc payublt to The Horne pcpot). Lti
*LESS DEPOSIT SZ-4 -�s 2Credit Carl°andior other payfricoi,op:ions•Circ[e One Setup
BALANCE DUE
Vi4a MasterCard Discover AmericonExpttss
"`
ON COMPLETION $ a S H
The oms;[)epos tinmc Improv rent Leon The I•lorne Depot r7edit ar
--y�—�_"-- t} ed t Cara
*Minimurn 25%of Contract Amnunt duc upon execution Avaihablc Credit:5 —(HIL&"I)CC ONLY)
f this contract,
_n Exp.Dare:__
aatc
h ars orc:rd: lr�4�
_ t as it eFF"
Indicate Payment M1tethod For •lit•rnyioar signatu*a below,I/wc a&rcC to
BALANCE DUE H s n �D-pot to chars l.u.at:ov,
1 O. COMPLETION: 'cferencec crcdu cord Ibr Oe depose ndic-ted. c
Di1co v Cardlu,lder's S cnaturu ---- — Dare
C6 2-702
HIL or HDCC Authorization.Codes _
` -- Deposit ^�__ — Fin:tl Pxymerrt
Purchaser agrees that; irlmodiatsly upon satisfactory completion of the work,Purchaser will execute a Coml),etloh Certificate
and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder.
Entire A reement: This agreement and its attachments,including any financing agreement,contain the complate agreement
etween t c parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE'rO PURCHASER
Pu not sign this contract before you read it. You are entitled to a completely filled-in Copy or the contract at the time you sign. Beep
it to protect tour rights. Do not sign an'Cornpletitrn Certificate or agreement stating Mitt you are sntistied with the entire project
before this project is complete. Lase pro ibits hams repair contractors from requesting or Accepting a Completion t.CrtirCate sil;ncxl
by the owner prior to the actual completion of the tirork to he performed under the contract.
You rnay cancel this transaction at any time prior to midnight of the third business day after the elate of this contract. See Notice of
Caneehlation fnr un explanation of this right. There will be a service charge equal to 25% of the contract arncunt it'the lob is
cancelled by Purchaser AFTER the third husintss day.
BY NIY./OUR SIGNA-f UR P D:ELOW,UWE AGRG£TO BE 80(J'ZN1D BY TI-IL rl?RNIS OFTHIS CONTRACT. I/VVE ACICNOV,rLEDG.
MCC IPT OF A COPY 0P TMIS CONTRACT AND TWO COMPLETED COPi SOF"'}il;NOTICE OF CANCELLATION.
RY MWOUR SIGN.ATLRI t3F.i.C)',j', t/wti LNI DERSTAND THAT T11F. AGRFF.%7N'r IS SL![3 r'.(:T i'O RI-Mi3t>!' 0r ,Y V.; UR
CRUDIT KISTORY ,hA1D 1rWl'.AUTH0R1"Lli HOti:.. DEPOT AtJTI-l01t1Y1:L;CONTR,1C"('GI:, 'i'Cl V??RiJ 1'::N!' RLVti•a�` n;;}':Gt'7:
CRtiDIT RL'COtD WITH ANINDEPENDENT CRE.DI'i'REPORTING AGL*siCY AND RLL'CASE THEN) FkONI ASI_ I.IA3ILITY
\'C IIRRFIi °Rout f*+.'AI}V!?(2T` IvflSSIONS OR.ERRORS. 00 NOT VGA THIS CONTRACT[F TI-tLRE:vlzE ANV 131,A.NK