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HomeMy WebLinkAboutMiscellaneous - 7 COPLEY CIRCLE 4/30/2018 (2) 7 COPLEY CIRCLE 210/059.0-0087-0000.0 Datel a . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . .,I,?� . . . . . . . . . . . . . . . . . . has permission for gas installation . .�,,f,z,�;i,f - . . . . . . . . . • . . . in the buildings of. . . . . ' i' r�'�Cl'1 I>•-/ 'j L' at . . .�. ! , ' . . . . . . . . . . . . f; • << • •t ..L , North Andover, Mass. Fee .-: ,:s Lic. 1o. GAS INSPECTOR Check# , �, 5 ��1 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DAT PERMIT s�JOBSITE ADDRESS l OWNER'S NAME GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL -- PRINT /_ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER f ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY R( OTHER TYPE INDEMNITY ❑ 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 ❑ AGENT ❑ 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 best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp fence with all Perlin t p otrision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Michael H. House LICENSE# 7173 'S4&ATURE MP❑ MGF❑ JP❑ JGF❑ LPG[❑ CORPORATION❑# 3377C PARTNERSHIP❑# LLC❑# COMPANY NAME MERRIMACK VALLEY CORP. ADDRESS 15 AEGEAN DRIVE, UNIT#3 ] CITY METHUEN STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-815-4523 EMAIL Vt' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ G� FEE: $ PERMIT# PLAN REVIEW NOTES i The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information ,,/� Please Print Legib Name(Business/Organization/Individual): f//�,"1 n,// 411e Address:_- /�_ i, //,8111 e,3 City/State/Zip: Z�FleZ/ V, �/? Q/��f Phone#:_ Are ou an employer?Check the appropriate box: Type of project(required): 1.WI am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).` have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.# �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10F]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repas4 insurance required.]t employees.[No workers' comp.insurance required.] 13. they !J�_ / tJl-•u� .G� .l *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they hie doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.#:/��//t7�[��//9/p �J�Q?/ �j�/J Expiration Date: &crz Job Site Address: G r City/State/Zip: /Y/f9 ew,y Attach a copy of the workers'compensation-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. I do hereby cerci nd the p ins a V;�6fpel� that ie in or�ati i provided above is true and correct.��K `` ,tel Signature: �J/��P�° Date: hn/-a Y�/ 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMjAoRwealth of M—assacl?use is - Department ofladustr.al Accidents Office ofIimstigatfons 600 Washin&n Street Boston,MA 02111 Tel,#61.7-72.7-4900 oxt 406 or 1-877,MASSABB Revised 5-26-05 Fax#617-727-7749 www-mass,govfdia V 'COMMONUVEALTH OF MASSACHlTSETT3�� �' REUtS FRED ANordim D PLUMBING CORP ISSUES THE ABOVE LICENSE TO: I MICHAEL H HOUSE MERRIMACK VALLEY CORP S3. MAR3H LN EEEEMEE TWP ME 04414-6137 3377 05/01/14 159880 bATE SERIAL No. 90UUl: Dateu0�,'J-1 ! TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING ,SSACNUSE� e This certifies that . . . . . . . . . . . . . . . has permission to perform . . . .-. . .t. .SAkk-C (z .. . plumbing in the buildings of . . . !pc4 -.1 .... . . . . . . . at . .7. .G.9.Pj!' A C. . . . . . . . . . ., North Aq�ndover, Mass. F �:S cv.Lic. No.. . . . . .. PLUMBING INSPECTO Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Cit Town. A0. AL'(�l�l ,MA. Date: Permit# Building Location: 4 ��L��lo,/ Cl,`1Owners Name: f;'N� tt�� 1c,i.%✓1✓tAb�� Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ ResidentiatEr New:❑ Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No 0 FIXTURES DEDICATED LU Z SYSTEMS I- z W r v W z H O Ln to C Z F- Y Q N J U H w 0 ' O W W •� W Z I.Q.. Q VI Z O Q Q = W LU O Q Z (� � C' C' Z � _N ~ Q LL F- 3 Ln 4: W p O D W W z W U I- x C. O U Z Q LL - a Y Q x W W w or! O h W Q a y h O O > > O O O z Z v� H F' x O I a y Q m m i] o LL x Y g S W _j 0 u a a SUB BSMT. BASEMENT 1sr FLOOR 2ND FLOOR 3RD FLOOR 4r"FLOOR Sr"FLOOR 6r"FLOOR 7TH FLOOR } 8r"FLOOR Installing Company Name:& 'r,,^ elC Check One Only Certificate# l Q Corporation Address:6 1*4 L41?41 City/Town: /,.,(,?ilu'11,-111 State•411�. ❑Partnership Business Tel:,- � l p�j Fax: f^e�i}�)' C7?CCS ❑Firm/Company Name of Licensed Plumber: c; -j •'t�i4S INSURANCE COVERAGE: I 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 ind'cate the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted(or entered I regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Lawd/ By Type of License: / Title ❑Plumber iSitu're fq ice`hsed Plumber City/Town ❑ of .� APPROVED(OFFICE USE ONLY ❑,Journeyman `License Number: kl�,� �j `COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER'PLUMBER ISSUES THE ABOVE LICENSE TO: JASON W THOMAS 13 JACKMAN RIDGE RD WINDHAM NH 03087-1670 ! 10315 05/01/12 795950 �C• � �Ql L- � 3 No J :3 Date...... HORTM ' 3?°;�;�``. ;•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 i # �,SSACHUS� +� rCC " �� This certifies that .......... .....11..:.. ..:....... .. ........... ............. has to perform ....... wiring in the building of + at........ �.�.s.....�.�'.�.. ........'.. ................................. .North Andover,Mass. _. Fee...%j..(A).... Lic.No....;....... 1............. .. � `hLECTRICAL INSPECTOR o Check # � { 1 I I ./ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Nlassachusetfs Official Use Only Department of Fire Services - Permit No. �vy .. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked v.11/99] (lea,e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(IV ECI 527 CMR 12.00 (PLEASE PRINT 1N NK OR TYPE ALL WFORMATION) Date: -9 1306 City or Town of: 001°•-TY 14Nlt3 Uee—To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant `7?j oml4s --c5,ber,Ce Telephone No. -79 Owncr's Address Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Boz) Purpose of Building Utility Authorization Na Existing Service Amps / Volts Overhead❑ Undgrd❑ Na of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ Na of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a r�L�Qr sarin Completion ordte following table may be waived by the Inspector of Wires. Na of Recessed Futures Na of Cell.-Susp.(Paddle)Fans Na of Total Transformers KVA Na of Lighting Outlets Na of Hot Tubs IGenerators KVA No.of Lightina Futures ISwimmina Pool Above ❑ ❑ a o me bcncy Lighting �rnd. �rnd. Battery Units Na of Receptacle Outlets Na of Oil Burners FIRE ALARMS Na of Zones Na of SwitchesNa of Gas Burners tNa of Detection and Initiatine Devices No.of Ranges INa of Air Cond. Total Na of Alerting Devices Na of Waste Disposers (Heat pump Number I Tons I KW INa of Self-Contained 1 Totals. Detection/Alerting Devices Na of Dishwashers ISpacelAreaHeating KW . Local ❑ municipal ❑ Other ection Na of Drvers Heating Appliances kw Uri %stems: o evices or E uivalent Na of Mlater K,W Na of Na of Data Wiring: Heaters Sins Ballasts Na of Devices or Eouivalent Na HvdromassageBathtubs No.of Motors Total KP Telecommunications Wiring: Na of Deices or Equivalent OTHER Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless wah ed by the owner,no permit for the performance of electrical work may issue unless the licen=provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CIMCK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Dau) Estimated Value of le,^trical Work. (When required by municipal policy.) Workto Start ��� 0 d Inspections to be requested in accordance With MEC Rule 10,and upon completion. I certify,trader the pains and penalties ojperjuy,that the information on this'application it true and complete FIRM NAME: ADT Security Services 111 Morse Street,No o MA 02062 LIC. NO.: 1533C Licensee: John S.Bassett SignaturLIC. NO.: 1533C (If applicable,enter"csmtpt-in the license tntmber line) / Bus Tel. N o.: — Address: Alt Tel No.:603-594-59 lresi OWNER'S INSURANCE WAIVER I am air, that ilte LfLensee does not have the liability insurance coverage normally ONLY required In-law. By ml•signature below.I hereby«'sive this requirement I am the(check one)❑o«vner ❑ owner's agent. Owner/Agent PERI111T FEE: �� Sirttst rc Telephone No. rJj LJ / Location =< No. 10?5 Date d NORTFr TOWN OF NORTH ANDOVER p Certificate of Occupancy $ u 1 y `►b «, Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ "S Ci �4 Sewer Connection Fee $ -P-r) rd, 4 Water Connection Fee $ '^ `- TOTAL $ &' �/� 0,0'77� . Bullding Inspector -.� (a/ '-�--�. Div. Public Works Location ,7 _ ! _� (� ,s'% r%• /�//i No. �r Date r- r "ORT" TOWN OF NORTH ANDOVER o mmwdlk p Certificate of Occupancy $ S 1, •a U * Building/Frame Permit Fee $ �'ss�cMu,tc Foundation Permit Fee $ 4 • e) U Other Permit Fee $ r_ Sewer Connection Fee $ Water Connection Fee $ TOTAL Is Building Inspector leen f — U Div. Public Works ,Lbcation 7�4-1!No. Date Date NORTH TOWN OF NORTH ANDOVER F � „ Certificate of Occupancy $ # Building/Frame Permit Fee $ SAC sFoundation Permit Fee $ MUS S Other Permit Fee $ _ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �_ Buliding Inspector Div. Public Works V PEL''.' Ivo. �pZS APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 l MAP KVO. I SUB DIV. LOT N LOT NO. r-� 7� 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE i ZONE- 3 1 f LOCATION t`��f. PURPOSE OF BUILDING 5 i I OWNER'S NAME j i l • NO. OF STORIES 7 SIZE OWNER'S ADDRESS 1rb?? •J f !N' /� JJ !� G/ J,j L�/�,��Co l T / ASEME TOR SLAB ARCHITECT'S NAMEZd SIZE OF FLOOR TIMBERS IST E7�N) 14 2ND 7�/�v 3RD BUILDER'S NAME mL4)�4 4� SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS L/ Lo / ___�,t DISTANCE FROM STREET q_ / POSTS Vly DISTANCE FROM LOT LINES-�fS� ��IOES ( REAR ( GIRDERS AREA OF LOT ZS"�,�. FRONTAGE f e� t ,F HEIGHT OF FOUNDATION (� THICKNESS IS BUILDING NEW ./ yJ SIZE OF FOOTING u X 2-o tf IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION 'A `O IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATERA4 Q BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROP RTY INFORMATION LAND COST !d SEE BOTH BIDES - (9 °(R MIT M EST. BLDG. COST � PAGE 1 FILL OUT SECTIONS 1 - 3 X11 / � j `J a EST. BLDG. COST PER SQ. FT. j'N PAGE 2 FILL OUT SECTIONS 1 - 12 /�f�/� !�� EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS f PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR Z DATE FILED BOARD OF HEALTH SIGN URE OF OWNER OR AUTHORIZED AGENT O 1 FEE A.5y'g 'd PERMIT GRANTf0// Q OW%ER TEL.# !V j ,� PLANNING BOARD CON R. TEL. #-4j,?:.L_ jZ$_ C0NfR.LiC, 9 BOARD OF SELECTMEN k&; � Bul INo INSPECTOR ��63 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY ,` STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BIL'K. PINE BRICK OR STONE HARDW D PL — _— PIERS ASTER _ DRY WALL UNFIN 7 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/,. /Z 1/1 FIN. ATTIC AREA N_O B M FIRE PLACES _T HEAD ROOM MODERN KITCHEN t 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD��J'D - ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME _" ....".`""v '!. `� ' •� _J �✓�aT CONC. OR CINDER BLK. ^ ♦t�". STONE ON MASONRY WIRING '""" ""`"" ""� ♦i• G' STONE ON FRAME SUPERIOR POOR ADEQUATE ADEQUATE / NONE 5 ROOF 10 PLUMBING GABLE IF BATH Q FIX.) "L GAMBREL MANSARD TOILET RM. (2 FIX.) L FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY ' WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING — e TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. L HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS L OI 8'M'T 2nd Ti ELECTRIC 1st 3rd I NO HEATING 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT. / Phone LOCATION: Assessor's Map Number Parcel Subdivision +An., (' gs ",,,4 Lots) Street St. Number 7 Official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Date Approved Date Rejected Comments T wn Planner Date Approved - l91-3 - Date Rejected Comments Health Agent �� Date Approved Z Z 3 Date Rejected Comments Public Works - sewer/water connections zp_� 3 - �� driveway permit &AW `?04P_ F3 Fire Department r r(= "" Received Building Inspector Date b tS/rE SEE//�7ET6.2 ,,� Lor*14 le,sd/s ,:, tK 00 D �uvo a ri o.v_ n C=27.40 r1� / �S fm\ a /08. 32' -- 6-Y 4 iAec 1-E /Yyr�c-,• /��tiao rias/!A4�/ON F.Lown . ! ° ' e."AY - 61994 's ,y�eEaY cE,cr�Fr ro ryE rir�E/,vsa,�nrgvo �L o T �OL.4.4/ TU T,yE B,oN,r T.f�gT T,SiE 0a'E[G/•cK/S LOCAT60 o,V TiyE GoT,/S Jlq�wyv A,vD TiiGIT?Oafs GO,i/FGtPAf /N !Y/T// T.S�E row"� Of.uD..vctco�E.2 ZON/NG •�E6�/LAT.I�,t�S iQLr6rI.e0/A4'a SElZAC�t'S FEOA1 STPEET,S !LOT ZlmeS."' /vD, 0v00YE�/ :S F(/.�TJYE.0 GE.�T/fY Tif/iIT TiIU.S OArLrLL/N6 /S'NOT eooe LOG4TE0/� T•YE FEGtE,P,OG fiCAOO iy,9Z4.00 A.PEA. O,PA/>✓it/ FO.P SiyQlvit!OiS/�EM�'COMMt/N/TY/�.�NGL '� �OCBG6�T'o.vE' C.2o3si.v6 l>avE J �P.L.S. oATE Boavo,PS��E �o _. BG'U,VOA,PY/.f/FO.POf- �E�•P/r�f.9G!'E-,v6itiEE.P/.t�6 SE.PI�/�'ES ,4T/O.f/ j;4A .S/ F �X/STivc .ee-co,Pos. 6G �q.P�,ST,PEET A.t/ODYE.0 /�Jr4S.�4Gs///SGr7TS O/8/O CERTIFICATE OF USE & OCCUPANCY Building Permit Number 125 Date Tllt.y 27, 1994 THIS CERTIFIES THAT THE BUILDING LOCATED ON 7 COPLEY CIRCLE (Lot #14) - TYPE D MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAG$N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Cobblestone Crossing Realty Trust urnpik ADDRES 400007 r _ ng Ins Town of N.- No. 12 5 r �;'� ,��.•.qtr}' , ' ' �� North Andover, Mass., /�/�il�I 19 UILP BOARD OF HEALTH PERMIT TO B Food/Kitchen SSeptic System BUIL I INSPECTOR THIS CERTIFIES THAT. �Q.. l►! !r y� �.�.. ...... Foatio� ►Lb✓ C j 17 has permission to erect".I..40f,V~.. buildings on f a `'. ..�.ri�.� r� ..... Rough 41h l-7 } !�/� • y hi� to be occupied as S�./ .! ► � �.. w1 ,�.'�.+S.�Jr�M11f .f /IM1i1' . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in > P P Final� Y27j� 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. PERMIT FOR FOUNDATION ONLY � GIN PECTOA_, VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. o y S a,/ r a PERMIT EXPIRES IN 6 MObAf ,r FEE PAI 0, 6 UNLESS CONSTRUCTION S T AR CS 4,�0�/��.o U �/ EL ICAL INSPECTOR PERMIT FOR FRAMEAUILDING . Rough ^'-1 Service BUILDING INSPECTOR L / DATE:` ° 9 FEE PAID• ' Final , /� _ i 11-cl11)ti)1PCnnit l\c',qllire(l to OCCltj1)' Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Coal o Lathingor Dr Wall To Be Done y FIRE D PARTMENT l L Until Inspected and Approved by the Building Inspector.CONSERVATION Burner �►i.r, �� ,�L�� �, 11 �1 �1 IF,NUA'L` • I Street No. PLANNIN G1i0 - `��� TRY PERM IT � Smoke Deter' SEWER/WATER FINAL DRIVEWAY EN Date.. . :. .�. . .. . .�... . . Of HORTM 1't' 3� TOWN OF NORTH ANDOVER R O 9 • PERMIT FOR GAS INSTALLATION SACMUSEtS This certifies that . . . . . . . . . . . has permission for gas installation .;.. . . . . . . . . in the buildings of . .? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . ... . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .? . . . .. . Lic. No.. :. . . . . . . . . . . . . . . . . . . . . . . . .�.7 . . . . . . GAS INSPECTOR Check f. j MASSACHUSETTS UNIFORM APPLICATON FOR PERNHT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS ` 7/ / ' �- Building Locations t Permit# � 3 6 Amount$ 2 Owner's Name S C J 4- N,V New Renovation ❑ Replacement ❑ Plans Submitted ❑ v� v,a U GG a C �a z o a -4 ,]j O A C�7 a A 0 SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR I 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH . FLOOR e or type)) c\y t �1+�' �JGGC lilt� /''d' L I �k one: Certificate Installing Company Nams Address SZ i7o X (7d /L J S T ❑ Partner. fit,(7. ►/�'�✓e( U ✓-?� /' "'�'i��i Business Telephone rl� ff Z Firm/Co. Name of Licensed Plumber or Gas Fitter �)�Q vy /�(�� —p a INSURANCE COVERAGE. Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes f_ No❑ Ifyou have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑f 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 installati perfo under ermit Issued for this application will be in compliance with all pertinent provisions of the Massa chuse to ode and apter 42 of the neral Laws. Com--------` By: ignature of Licensed lumber Or Gas Fitter Title Plumber () 5 r City/Town ❑ Gas Fitter (cense Nurfter Master APPROVED(OFFICE USE ONLY) 0 Journeyman Date. .. ..:... .. ... ..... Of NORTH 1ti or 0 TOWN OF NORTH ANDOVER ti D 41 PERMIT FOR GAS INSTALLATION a This certifies that . /. . . . ... . ... . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . ... . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . !. . !: :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .`. .... %t. . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. .'. . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPUCATON FOR PERNU TO DO GAS FTITNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations [ ���E�( . /���� Permit# Amount$ Owner's Name New❑ Renovation Replacement dans Submitted � w x z d a Hz C F a0i H p p W ww z z a w a w N A U x z z � o z c c w O O A C7 a U a A a F 1-01 j. SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR = 3 R D . F L O O R 4 T H . F L O O R 5TH . FLOOR 6 T H . F L O O R 7TH . FLOOR STH . FLOOR (Print or type) /� �y Check one: Certificate Installing Company Name {/F� 0/,/0, ��6= 9D, , /�('_ Corp. —12�/ �'— Address Partner. usmessTelephone Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on .' I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked Les,please i icate the type coverage by checking the appropriate box. Liability insurance policyr 13 Other type of indemnity Bond 13 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 Gasode and Cha r 14 oft General Laws. ignature of Lic ed Plumber Or Gas Fitter By. Plumber Titleq,5�' City/Town [—:]I Gas Fitter License Numner Master APPROVED(OFFICE USE ONLY) E] Journeyman