HomeMy WebLinkAboutMiscellaneous - 76 MARTIN AVENUE 4/30/2018 (2)IN
Location
No. / Date
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
t
TOTAL
Check
1.
15V32
1
`% `Building Inspec
APPLICATION TO CONSTRUCT RE:
BUILDING PERMIT NUMBER:
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
R, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
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DATE ISSUED: 47" Poo' 4, O'
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SIGNATURE ^""'�1 w• ---
Li"•�-
Building Commissioner/Ips
for of Buildings Date - fl
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area
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 1-C.40. 54)
Public 0 Private 0
1.5. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSIiIP/AUTHORIZED AGENT
.2.1 Owner of Record , N0 f .�
MR MRS Rq Cgrr-�A(ir f�c���,%v Ave 4Aolover
,Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
ZGy L f3 /A"/c
+ Licensed Construction Supervisor: 3q 3
License Number
t Address Ll
0."A ,jr Expiration Date
Signatuk - 0– Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
���� Le /31�r•c
Company Name
A, �4-/A`7C' Registration Number
Address �/ d
9, A 3 �1! ` 3 — G6 Expiration Date
Si natu Telephone
SECTION 4 - WORKERS COMPENSATION (AML. 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 all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑
^ 1�
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify,% ;I 1 kN �1 E;1.,
• ,.-0 \ 1` . P„144-"; tee t'%\
Brief Description of Proposed Work:
S �6�o e a rvv Re 9A /'V
I gF.rTTON R - F.WYMATUD CnNCTATrf'TTnN rncmc
c
Item
Estimated Cost(Dollar) Dollar to
(
Completed by permit applicant
IAIISs
'
y
1. Building
d60 G 6
(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
�Xkl%'F1l is V VV1'gMX% nV1C1GH11V19 1V JD %'V1V1rLZ 1L'U WrMrN ,.
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i, .���% 46f 13,16,r as Owner/Authorized Agent of subject property
Hereby authorize L �� f3 to act on
My behalf, in all mattL#s klative 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
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
Signature of Owner/Agent Date
G
0
S
p � ✓ /G� �d%����%u (� ✓(UA.(ItIWNLU.OGLLIr •..
BOARD OF BUILDING REGULATIONS f
License: CONSTRUCTION SUPERVISOR .
Number' CS 056393` ;
Birthdate: 10/13/1963
Expires. 10/13/2001 Te. A: 7597
3 Restricted To.,.00
JAY J LEBLANC `
25 S LINCOLN ST
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BRADFORD, _MA,01835' Administrator. ='
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North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150A.
The debris will be disposed of in:
AGf4), es S+ *W A
(Location of Facility)
LV, ae, ,
Signature of Permit Applicant
IF g%zil Q
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
1
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI
(Print or Type)
Qp
_' �Ib cJlmtJ� Mass. Date g Or 19CL Permit #
a
_
Building Location -a-LA Owner's Name
" J('c�Li �el� Moe A i�� of Type of Occupancy Eesi r a
New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ 1,40
(i
Installing Company Nameon I
,' ?k y"6 L-1 y1c . Check one: Certificate
Address ( &dGA Corporation
rQ ❑ Partnership
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter Po�.
INSURANCE COVERAGE:
I have a current f bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes GY No ❑
If you have checked ves, please . dicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑
YP Y 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:
Owner❑ Agent ❑
Signature of Owner or Owner's 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 the permit issued for this ap lication will be in compliance with all
pertinent provisions,of ttaeMas ch setts(St to Gas'Code and Chapter 142 of the eral Laws
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B p Y r
I k r , r = - -- — _ ITpGas'ter
cense:
p I ber Signature o nsed Plu b or Gas Fitter
Title Ai !r 2 ! i r License Num (Df.�City/Town eyman
APPROVED (OFFICE USE ONLY►
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SUB—BSMT.
BASEMENT
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1ST FLOOR
2ND FLOOR
I
3RDFLOOR
4TH FLOOR
I
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Nameon I
,' ?k y"6 L-1 y1c . Check one: Certificate
Address ( &dGA Corporation
rQ ❑ Partnership
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter Po�.
INSURANCE COVERAGE:
I have a current f bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes GY No ❑
If you have checked ves, please . dicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑
YP Y 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:
Owner❑ Agent ❑
Signature of Owner or Owner's 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 the permit issued for this ap lication will be in compliance with all
pertinent provisions,of ttaeMas ch setts(St to Gas'Code and Chapter 142 of the eral Laws
+;
�/ Y
B p Y r
I k r , r = - -- — _ ITpGas'ter
cense:
p I ber Signature o nsed Plu b or Gas Fitter
Title Ai !r 2 ! i r License Num (Df.�City/Town eyman
APPROVED (OFFICE USE ONLY►
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Date .......� .. ... .... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
H
LL
-'9SSACMUSEt�, �`
This certifies that J. � : � %� f.. � .l.... f . �. � .......... .
has permission for gas installation S
f
in the buildings of .,:.. '::....'... !. �..:...................
at ...... ........ , North Ner, Mass
Fee..:.... Lic. No /(.� .,r{ .. '�,. r^✓!co�!d'�'... .
' GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Date .... .....
-*-� xx
.'VON
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .....................
has permission for gas installation
in the buildings of ......................
at North Andover, Mass.
Fee.OK 0 Lic. No. .................
GASINSPECTOR
Check#
4
4900
C
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
_MTA A i\MOVFL, , Mass. Date /U 2 2 Permit # rd
Building Location , `G LIF -11.0 AVE Owner's Name SWTT HACACHa L
UC Type of OccupancyS l f? hiT) A t_
New ❑ Renovation ❑
Plans Submitted: Yes[] No ❑
Installing Company Name BAY STATE GAS COMPANY
4ddress 55 MARSTON STREET
LAWRENCE, MA 01840
3usiness Telephone .68,7-1105
Vame of Licensed Plumber or Gas Fitter Francis X. Corkery
Check one:
X7 Corporation
❑ Partnership
❑ Firm/Co.
certificate #
1862
ASURANCE COVERAGE:
hive a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
It Yes K No ❑
f you have checked yes, please Indicate the type coverage by checking the appropriate box.
k liability insurance policy D( Other type of Indemnity ❑ Bond ❑
IWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
'.hapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
signature of Owner or Owner's Agent
hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu%e to the best of my
nowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all
,ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S.
h Tg of License:
Plumber Signature of Licensed Plumber or Gas
itle Gasfitter 3-145
, 4
Master License Number
Sty/Town Journeyman
aO ICSOD Y
I
f
Y
Nonni
NONNI
• ..
l����������i��t�����ili■«O■
••
■���������������NNOME■
SEE
Installing Company Name BAY STATE GAS COMPANY
4ddress 55 MARSTON STREET
LAWRENCE, MA 01840
3usiness Telephone .68,7-1105
Vame of Licensed Plumber or Gas Fitter Francis X. Corkery
Check one:
X7 Corporation
❑ Partnership
❑ Firm/Co.
certificate #
1862
ASURANCE COVERAGE:
hive a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
It Yes K No ❑
f you have checked yes, please Indicate the type coverage by checking the appropriate box.
k liability insurance policy D( Other type of Indemnity ❑ Bond ❑
IWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
'.hapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
signature of Owner or Owner's Agent
hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu%e to the best of my
nowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all
,ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S.
h Tg of License:
Plumber Signature of Licensed Plumber or Gas
itle Gasfitter 3-145
, 4
Master License Number
Sty/Town Journeyman
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