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HomeMy WebLinkAboutMiscellaneous - 71 JOHNNY CAKE STREET 4/30/2018TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: .1 -0 'STEM OWNER & ADDRI ltu,�V�! Ve SYSTEM LOCATION (example: left front of house) rc I k� 4CA- b-� vous(7 DATE OF PUMPING: QUANTITY PUMPED t 50-D GALLONS CESSPOOL: NOy YESEPT S IC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: l ��\bA r�L� COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: G, -L- ) , N r _ Location,ft No. �� ' Date `� -z- ►il &ORTPI TOWN OF NORTH ANDOVER af„•n :•,h•G • 0. 9 Certificate of Occupancy $ o •. s,CNusE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ [7 Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ' fix; • ,s �'� %z fns .. Z%` eY,«tra+,u 'K�^°r`'yab"`a, 'a?x BUILDING PERMIT NUMBER: DATE ISSUED: a V- tv SIGNATURE: Building Commissioner/IREEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l l TC401AO10Za � W Map Number Parcel Number 1.3 Zoning Information: �f (� 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSEUP/AUTHORIZED AGENT 2.1 Record Name (Pri Address for Service Wq— SignAllre Telephone 2.2 Owner of Record: 1 Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (XG.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 ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Pro sed Work: OF W �� Cr SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ;(}FFiCIALUSE QNLY. k 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of%7� Construction 3 Plumbing Building Permit fee (e) X (b) ' 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNE13S AGENT ORtONTRACTOR APPLIES FOR BUILDING PERMIT I, 7a , as Owner/Authorized Agent of subject property Hereby auto act on My be t, Al "sLk authorized by this building permit applicatiy�t. 700Si nature f Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name Sip -nature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3 SPAN D9%4ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 11 CAWk US To ST I r 43 JDHNYYCA KF < LLEV VA F ArfOUNbAl I D At WAI AT 7-AtIK IRLE-F - - - - AT" 7 -A -/V K ou rar. - - AF blSl- BOW IAILF1-- - AT ibl-SFBC)X otl7zc7-. 0 F 7WAlcl-I FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner fro5i compliance with any applicable requirements. �r■■■rrr■■■rr■■■■rrr■r■r•r■■■■•■■■■..■.■■■■■■■.■■.rru■.rr■_•■■■■■■■■■.■■.■ APPLICANT PHONE ASSESSORS MAP NUMBER % 7 LOTNUMBER /f/. SUBDIVISION LOT NUMBER t STREET�W�{C-pt STREET NUMBER ` �r■......•■..■rr■■.■.■r■r■■■.■■.■■■r■■.■■r■■•■■■r■■.■■r■■■.rrr■■■.ago r■■■■r■ OFFICIAL USE ONLY .■ass ..■.■■■...r■■..rseen son r'.SON* .■■. sun .■■■.. ass Noun .■■■r■...amass ..■.■■■. RECOMMENDATIONS OF TOWN AGENTS �.... r...r■r■■.r■■■.■■r.■■r■.■rr■■.■■■■.■■■•.............................. N "- DATE APPROVED'.')'( Ito TION A CONS VADMINSTRATOR .DATE REJECTED COMMENTS �� c v• L j Cal •s DATE APPROVED TOWN PLANNER DATE REJECTED COMIAENTS DATE APPROVED FOOD INSPECTOR -HEALTH DATE REJECTED �✓ DATE APPROVED SEPTTC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE, HOMEOWNER LICENSE EXEMPTION Please print DATE I�MI+, 2 - JOB LOCATION I 1 Number "HOMEOWNER i Name PRESENT MAILING ADDRESS City Town Street Ad(�70)0— ress Home hone cv State Map / lot C) 2�6- Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does . not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)' DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, , The undersigned "homeowner" certifies that he/she u nd e No. Andover Building Department minimum inspection procedur e i m n d that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFICIAL I Town of North Andover Building Department 27 Charles Street . North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 ....1978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE I�MI+, 2 - JOB LOCATION I 1 Number "HOMEOWNER i Name PRESENT MAILING ADDRESS City Town Street Ad(�70)0— ress Home hone cv State Map / lot C) 2�6- Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does . not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)' DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, , The undersigned "homeowner" certifies that he/she u nd e No. Andover Building Department minimum inspection procedur e i m n d that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFICIAL I 141 6 z cz r� Z c r- 00 o C 0 o 0 C L O_ N G o t : Ea m CO C h•Ec� ti CD ♦: �v �: u r m c N O Ct L L At:M-o N C N A :DQE" .40D CD 0 b: Q' c Vc o a i- m �Hcmc a m Or :L. O W O WaD% O C LU E v�vN C.) m o m = c a m.5 0:5 2 A .0oN .O f- c s a � m E CAN H O N c 0 cm CD cc a c CID `o cm c �c N CD t r.+ O Z 0 O Cn 0 C/) W 0 rS a1 CO O O O Z O G co O .y O L O C 0 O V _m CL COO) 0 V .Q CO2 C 'O+ V O 0 CD �O 0 0 O � 5. Q C cc ca J .wq O O Z C) O O. CO) C LLJ C) U) LLJ Ccw LU CcW p U UW W W W A4E., W ow U w z d � A z � z o cz OQ o c7 i v w z p O °�° m A. m m �"� W "Go0 ro �+ y O v O O G p G 7 O G a O G G E I U iiA a! u. w y cn z o: u: cc co cn Z c r- 00 o C 0 o 0 C L O_ N G o t : Ea m CO C h•Ec� ti CD ♦: �v �: u r m c N O Ct L L At:M-o N C N A :DQE" .40D CD 0 b: Q' c Vc o a i- m �Hcmc a m Or :L. O W O WaD% O C LU E v�vN C.) m o m = c a m.5 0:5 2 A .0oN .O f- c s a � m E CAN H O N c 0 cm CD cc a c CID `o cm c �c N CD t r.+ O Z 0 O Cn 0 C/) W 0 rS a1 CO O O O Z O G co O .y O L O C 0 O V _m CL COO) 0 V .Q CO2 C 'O+ V O 0 CD �O 0 0 O � 5. Q C cc ca J .wq O O Z C) O O. CO) C LLJ C) U) LLJ Ccw LU CcW J J.— J Date..// .....'.... r. � .. . HORTry TOWN OF NORTH ANDOVER 1 �ao ,sa ti0 L p PERMIT FOR GAS INSTALLATION This certifies that ... , 7.!� .... S........ ......... has permission for gas installation .... ,` .`.. �..�� ........ . in the buildings of ....�� ...� !.� :....................... . at .... �. / ...,� :. /; �, . `...... , North Andover, Mass. Fee.. Lic. No...) .... ........... `...... \...:. . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) vep,-- . Massachusetts Date % -/ 6x) Permit # Permit Fee Building Location %/ 1,Ae rt u 00e- sr Owner's Name n C Type of Occup New Renovation [j Replacement L) P ns Submitted: YesE] No ❑ Installing CompanJName y1 Address-//, 1116 e C S S r V—Aike-Ak L4 MA- D 1 Wl Business Telephone *W -d Vs- I7 ,20 Name of Licensed Plumber or Gas Fitter Check one: Certificate [ 7 Corporation [4—flartnership ( 1 Firm/Co. INSURANCE COVERAGE: I have a current Ilab Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No [7 It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy LST Other type of Indemnity f J Bond O 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: Owner,' i Agent [J Signature of Owner or Owner s Agent I hereby certify that all of the details and information I have submitted (or entered) in ab e applicatiorlAr ue and accural to the best of my knowledge and that all plumbing work and installations performed under the permit i d foIts �jnill be in cplia a Ilh all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ral La T o of License f lumber signature oT L ceased iiTitle G tter. aster License Number Cit /Town Journeyman -- Inspection Date Requested N N W 0 N Y U Z ¢ ¢ h vi x W W J ¢ W O ~ U to H x ¢ z 0 Q Z 'o �' 1 w < ¢ ca n F 4 y ¢ W F. O a O C ri a 00: W Z W UW a O W r Q ¢ O O > W W W N J Q = ¢ W ¢ ¢ W W f' U _ rA Cr Z 6 W Z f H W r 0 0 W > Z W O F Z � J O j+ (A W Z ¢ Z O C7 S t1 3 O 0 J J ¢ > o a (^ O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR tt Installing CompanJName y1 Address-//, 1116 e C S S r V—Aike-Ak L4 MA- D 1 Wl Business Telephone *W -d Vs- I7 ,20 Name of Licensed Plumber or Gas Fitter Check one: Certificate [ 7 Corporation [4—flartnership ( 1 Firm/Co. INSURANCE COVERAGE: I have a current Ilab Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No [7 It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy LST Other type of Indemnity f J Bond O 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: Owner,' i Agent [J Signature of Owner or Owner s Agent I hereby certify that all of the details and information I have submitted (or entered) in ab e applicatiorlAr ue and accural to the best of my knowledge and that all plumbing work and installations performed under the permit i d foIts �jnill be in cplia a Ilh all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ral La T o of License f lumber signature oT L ceased iiTitle G tter. aster License Number Cit /Town Journeyman -- Inspection Date Requested 9 z > M z 0 I" m m N2 2612 Date.... ............ ...........'..... 0 TOWN OF NORTH ANDOVER 0 I va PERMIT FOR WIRING i ...... This certifies that .......... has permission to perform'.—. --2 . .................................................................... wiring in the building of ....... at ...... .............................. North Andover, Mass. Fee ........ Lic. No/.fit..`. ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer The Commonwealth of Massachusetts W1140 "'• onty 9 , DeperTment of Public &fery 1`0061900619 %*.-` 612,— BOARD /?/BOARD of FIRE PREVENTION REGULATIONS SV CUR 12000e6ppo"T ` r" aws"a ]/90 (Lan 610a) .APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AU weh a be performed Is accordance With the Masaachusens f]scrrtui Code. SYf``,�� R It -00 (PLEASE PRINT IN nM 08 ITP INFORMATION) Data `"I �© City or Tova of k To the Inspector of Wiress The undersigned applies for a permit to perform the electrical work described below. Location (Street h *.=bar)— Sj)tlrh\l c04 ' 4H4 Owner or Tenant W W K -WI Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Sox) Purpose of Building Utility Authorization NO. Existing Service bps / Volts Overhead ❑ Und d ❑ gs No. of Meters New Ge bP= / Volts Overhead ❑ Uadgrd ❑ No. of rioters Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Iotal No. of Lighting Fixtures Swimming Pool Above la- ❑ ❑ 1CVA d, grad. Cenarators ENA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Bat te Units rim. of Switch Outlets No. of Cas Burners F= ALA;W No. of Zores No, of Ranges No, of.Air Cond. Total tons *No. of Detection and No. of Disposals No. of Heat Total Total Initiating Devices Pumos r I RW No. of Sounding Devices No. of Dishwashers Space/Area Heating gx No. of Sel� Contained Detection Sounding Devices No. of Dryers r Basting Devicu EW mal ElMunicipal ❑Other Connection[]Other Water Heaters iii No, No 0 0. o , Low Voltage a Ballasts Wiring No.,Eydro Massage Iubs OTM: No. of Motors Total HP INSURANCE CflYERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabili Insurance Policy including Completed equivalent. TES* NO [ I have submitted valid proof of same torthis ofatifice j offige or ce. YES NOuQtantLl If you have checked T=S, please indicate the type of coverage by checking the appropriate box. INSURANCE J3 BM ❑ ITM ❑ (please Specify) MFRC'HANTS TNS17RANr l Estimated Value of Electrical Work S l-00 lac Prationace Work to Start ��v Inspection Date Requested: Rough 1� Final Signed e,.4ar the penalties of perjur;: FIRM NAME LIC. NO. Licensee GR . ,ORY TAYT.nR Signature M LIC. 3.3??F,RF Address 4 SAN MATEO DR.CHELMSFORD MA 01824 Bus. Iel. No. 50A-?50-nn17 PER'S INSURANCE WAI Alt. Tel. No. 1►ERs I am aware that the Licensee does not have the insurance coverage or its au - stantial equivalentas required by Massachusetts Cenral vas an that my signature on this permit application waives this requirement. owner Agent (Please check one) Telephone No. PERMIT FEE S5� Signature of Owner orAgent l T Location J� �' CA/ No. '630 Date �� '��r f- NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ E�� JACHUS Building/Frame Permit Fee $ S' 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check # J" 7 Building Inspector TOWN OF NOR'T'H ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: O DATE ISSUED: ♦a-�Y-oma SIGNATURE: C 602 Building Com"m'lss_ioner/I2EREt6r of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 7A) A tAUP- 5_�qe 1.2 Assessors Map and Parcel Number: p �r ap Nlutiber Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided Z05 t'5 3& r (0 3 1.7 Water Supply M.G.L.C.40.` _ 5`4)' 1.5. Flood Zone Information: Public ❑ Private ' ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 7er Record `( ^� � I I :YcO CA ^II// 3 I ' !pp Name (Print) Address for Service Signature Telephone Ct pI �+zz 0 1 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - r.ONSTRUCTION SERVICES o 3.1 Licensnj c ' Supervisor: Uetc Licensed C�nsttion Supervisor: ILicense Addr s �� jt Signatur Telephone 181F341W Not Applicable ❑ Number Expiration Date 3.2 Regied ome Improvement Contractor q\J�}(&Jl) �1 s Not Applicable ❑ 1 Company Na e Registration Number Address OZ-00 Expiration Date Signature Telephone 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. Si ned affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations( #) U Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Spgcify t c Brief Description of Proposed Work: + s: I SECTION 6 - FSTIMATF.D CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 2 (a) Building Permit Fee Multiplier 2 Electrical /' /! V�v (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) �i 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, PA?-V� dl CQ' \ as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matt s rel tive to work authorized by this building permit application. Z ��` O lJ Signature of Owner Date SECTION 7bOWNEPJA��/UT RIZED AG NT DECLARATION I,PK`Y ( A \ k.. 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 bel* f Print Na l I -cP Signature of Owner/A ent Date Jill 1111111111�11111111-p NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2 ND3 PD SPAN DIMENSIONS OF SILLS DROENSIONS OF POSTS DIlVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUH DING CONNECTED TO NATURAL GAS LINE _40ME IMPROVEMENT CONTRACTORS REGISTRf�I"zialy Board of- Building Regulations 'And Stanela, 0 - One Ashburton Place — Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 107083 Expiration 07/29/00 Type — PRIVATE CORPORATION ENVIRONMENTAL.POOLS INC. Andrew C. Everleigh 20r0..Tur npi,ke. ;Road Unit t 10 Chelmsford MA 01824 "— - HOME IMPROVEMENT CONTRACTOR = Registration X01083 Type - PRIVATE CORPORATION Expiration 01/29/00 ENVIRONMENTAL POOLS INC. Andrew C. Everleigh G�ce�co7� 6 Q Turnpike Road Unit 10 ADMINISTRATOR Chelmsford MA 01824 0/ �WCIo$al6607 l ra.ns aTT0,410n , ns P ;�/fe >%onrmo�ru�cal/� of �.��r.y'rrclurel� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 035353 Birthdate: 04/18/1945 Expires: 04/18/2002 Tr. no: 18551 Restricted To: 00 ROBERT F BACON 110 STAGECOACH DR MARSHFIELD, MA 02050 e Administrator 1 d PNNIVYCAKF IMIRT PIPF ' FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT ,l�lC, a Wi PHONE 110 I Z ASSESSORS MAP NUMBER LOT NUMBER SUBDN LOT NUMBER S��' STREET NUMBER71 �...... ......... .... ...... ...............................M■ . ........ OFFICIAL USE ONLY .......................... 0 .......................... ................... . RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR " F -C t TOWN PLANNER COMMENTS FOOD INSPECT - HEALTH C `�,d3�IS OR -HEAL DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENIS P,.,n ` Z-- R r PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE O F=4 x w A.. �L�y .Yw �` (� U 0 z A c o .T v Cd wa°' a w a W a W °�° a°' cA �+ w a a Ca W W A Vfy v G O z V)cn v o uj am 5 0 oLZ1 :i6 C H we O C O Ula Q•C� 4 mC 0 E Q W' o m ts fA �Ec (DID _ C.3 $ CL.msE y �V �mm cE Cr: � � O y C",CD y ,a R C m ry C aO CM 0 y C C O — E m L O - :go . CM = �x�'--� OI Qua s H o � m r: 45-Itv Zo` ' ow .. c a o cc ~ m . y O C = m W.CIO O 3 O rte.•. H r0. y as F- m W O 4��Z y=.. w •w O C a.L W •E f� V Z O CM C.2 C O' � O g V! m Z 0 y'p O - CL0. K? .A 001.1 CD O CD z O C y CD y .CD L- 12 - CD O O CD V '.7 L 0 t5 a� CA C rF Cn crW w w 0 Location J �d %lti�/ C,A ,SCE V- Nb. yy Date NORTH TOWN OF NORTH ANDOVER . 09 Certificate of Occupancy $ Building/Frame 9(Frame Permit Fee $ C;? J' 1 si a JACMUS c�' Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector i %15/99 14:47 25.00 PAID Div. Public Works M U-1 m x III O z sm s, Z w Z W F , W U c w N � O z z u L w U W 0. a W c O f- c O � � d � ;z 74 U Z Z i i z p w Ci O m e O p C [V z z Z y w a a y W N i Z m fn v] G A c w c F� W O z 0 F d ` z F PLO d � V Z O O i F ? . w 4-7 in ca F z � .• p z � W � — � caa f f r w ►-� Z t F ti ca. O u u u _ z W z z z o° r_l L C „V VF_7 tFi—] fs7 0] CO III O z sm s, r 1 Z w Z W F , W U c w N � O z z u L w U W 0. r 1 Z w Z c w N � O � L w U W 0. W a. f- C in � � d � fA L Z i i z p w r a e O C [V — LA W — a y r 1 Z w c w N � O � a. f- C in � � d r 1 T0'd 000000000000 " " " " 0 Wd 0Z:60 nHl 66-20-Nnr Z -C)7 4,3 , j 1 `i Lp pr°?Og w - P! -I NN YCf4 K k S Tf Aj WUN,bIXI lDIV WALL - • �p�'��" AT- T N K 00 raT... .. .17 /'l L./IJ/ go, I!TZ 1 AT Ai.ST 13DX OV7Z C;" Ai fWh 0 F 7i rNcH co O x 0 Q Q .m 0 d w O t ; I" a IIIIINIM gl■nrlkilm cn z � ^W c W 2 U uJ Q g U -I' C C - C U w w c = W U � M \ /\ Z w C U I" a IIIIINIM gl■nrlkilm cn z � c U -I' C C - C U w w c = W U � \ Z w C U Y � N c � z 5 � a L a G _ i c w a Z C O= L ¢ U m F Li „' ❑ N a w ` O 7 _ z 7 �s n r ` � r � c f..r � Z m mom.] � ❑ ¢ Z � _ Z Z c m v� v> ❑ ❑ q .. in c n z ` 0 U _ _ r .. Z n - J w w v � Z 2 � C QuJ C w w w rt F Z F p a N N w U w U w CL � z U z z I" a IIIIINIM gl■nrlkilm a cn z � c U C C - C U w w c = U � \ Z w C U N c � z 5 � a L a G _ i c w a Z C O= L ¢ U m F Li „' ❑ N a w ` a 3L � C C - C V V = G 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. ***********************7*Y*APPLICANT FILLS OUT THIS SECTION APPLICANT LOCATION: Assessor's Map Number SUBDIVISION PHONE PARCEL - LOT (S) STREET . �CNu� �\ ST. NUMBER *****************OFFICIAL USE RE 0N1MEN AT NS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS i IQ J tk,- Js l o o/ TOWN PLANNER COMMENTS FOOD SE -9 IC R -HEALTH P CTOR-HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197jm DATE NORTH O 9 SSAOMUS� Date./- `.- o L.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. Ax .../,V ! .-.r:.�/'..'y............. . has permission to perform ......................... . plumbing in the buildings of.. y .................... at ... . �.. ;1 c �, �.< &A t .............. North Andover, Mass. Fee. Lie. No.. /X 7 � .... ........ . . ! .-' :. a !t ...... . ,. PLUMBING INSPECTOR Check # W, t j 51 U2 IN 'L.w MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) A0 h ddvC'. v Mass. Date 113 19 d 1), Permit # 02 Building Location _ �) O Vl h C (5vtint:r's Name. ` G� Typel0 =ccupancy New ❑ Renovation ❑ Replacement UK Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name M & R PLUMBING Check one: Certificate Address 16 Princess St. El corporation Wakefield, A u' ❑ Partnership Business Telephone a 5- 1 � 1. _ Name of Licensed Plumber r C Ill Q �j��' -� t J ❑Firm/Co. INSURANCE COVERAGE: I have a currenUability insurance Policy or its substantial equi:z;c-,nt which meets the requirements of *,AGL Ch. 42. Yes No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sionnturp mi FA.— — K-7. e,.e..r Owner ❑ Agent ❑ 'hereby certify that all of the details and information I haves Omitted (or entered) in above application are true a accurate to the best of my knowledge and that all plumbing work and installations pert ed under th ed for this ap at' w be in compliance with ali pertinent provisions of the Massachusetts State Plumbing de and ha r 42 t General law BY Title_ Signature of Licensed umber -- ----- City/Town Type of License: Master (�^ Jo neyman _ APPROVED (OFFICE US ONLY) License Number—P_` NONE SOON Ifl2w. - ■EMEMEMOM 0 M mono MEMEMEMME Now .. - ■ENOM■OMMn 0 ONE .. Enos In .. ■ENE■ ME������������������ Installing Company Name M & R PLUMBING Check one: Certificate Address 16 Princess St. El corporation Wakefield, A u' ❑ Partnership Business Telephone a 5- 1 � 1. _ Name of Licensed Plumber r C Ill Q �j��' -� t J ❑Firm/Co. INSURANCE COVERAGE: I have a currenUability insurance Policy or its substantial equi:z;c-,nt which meets the requirements of *,AGL Ch. 42. Yes No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sionnturp mi FA.— — K-7. e,.e..r Owner ❑ Agent ❑ 'hereby certify that all of the details and information I haves Omitted (or entered) in above application are true a accurate to the best of my knowledge and that all plumbing work and installations pert ed under th ed for this ap at' w be in compliance with ali pertinent provisions of the Massachusetts State Plumbing de and ha r 42 t General law BY Title_ Signature of Licensed umber -- ----- City/Town Type of License: Master (�^ Jo neyman _ APPROVED (OFFICE US ONLY) License Number—P_` Date. .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . „ ! ? .'. / .... f.'.�. 5 ..................... has permission for gas installation ....(.�...................... in the buildings of ......./.......................... at ..... ....!....`.... `:...`......... , North Andover, Mass. Fee.... '�/.... Lic. No.. L l.. .'.. . Check # -, I'-- -1-7 .. . -.c. } GAS INSPECTOR f ti r� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Town of 1 fdf; Massachusetts Date 19 Permit # Permit Fee Building Location %h) n hc,a.-LoOrV's Name e0L t Ala ndo U c,y- Type of Occupancy R a Q New L] RenovationRe D Replacement [U/ Plans Submitted: Yes(] No p Installing Company Name M & R PLUMBING Check one: Certificate Address 16 Princess St. I J Corporation Wakefield, MA MEW— (��a _ rtnershlp Business Telephone_ _ 454770 I 1 Flim/Co. Name of Licensed Plumber or Gas Fitter rif LPL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. I-t>� Yes No [ J If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy LJ Other type of Indemnity f 7 Bond U 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, i Agent [-1 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 the permit Iss d for thi opwll be in compli ce II pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the G .ral Laws T n of License' Plumb �ignalu e o Licen (gas c., Title _ Gasfitter aster License Number �� q Cit /Town Journeyman -- At�I�owE6�F>•t�t'��t� ------ Inspection Date Requested 1-0— N W ¢ W N N X U Z ¢ vi N ¢ h ¢ O W W touj cc O U tD F S n =Lj4 O Q M n ►- Q y ¢ W o rs � o~ 0 ¢ 0 O = W U W X VI Z I, < n ¢ O ~ p > w W W n J Q Z ¢ ¢ ¢ W W f' U _ ¢ Zf W W O > LL I,- J W Z 6 W — Q C Q Q 0 m Z O Z O VI Z Q ¢ W X > 0 2 0 W Z :)Z LL. 7 3 O 0 Q J o U O C W > d O a MS H r O SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name M & R PLUMBING Check one: Certificate Address 16 Princess St. I J Corporation Wakefield, MA MEW— (��a _ rtnershlp Business Telephone_ _ 454770 I 1 Flim/Co. Name of Licensed Plumber or Gas Fitter rif LPL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. I-t>� Yes No [ J If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy LJ Other type of Indemnity f 7 Bond U 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, i Agent [-1 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 the permit Iss d for thi opwll be in compli ce II pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the G .ral Laws T n of License' Plumb �ignalu e o Licen (gas c., Title _ Gasfitter aster License Number �� q Cit /Town Journeyman -- At�I�owE6�F>•t�t'��t� ------ Inspection Date Requested 1-0— Q Z -v ' ._.Lila.;,}S.-i:...,a;..l: •. - '. ....:; ':'. t�•t::..h1r ^+:.:t....7„w...... � � .-.. k. qj -Z 'L ��- -- 0- 43, 6 I( EAS: l NG - JN NN YCA K k ST k. E ET INVERTELEE n ArfOUNbA 1 oiV WALL TA -ti K AT U51 BOW I NIL -i 3 P. • i • 2. 'L ��- -- 0- 43, 6 I( EAS: l NG - JN NN YCA K k ST k. E ET INVERTELEE n ArfOUNbA 1 oiV WALL TA -ti K AT U51 BOW I NIL -i 3