HomeMy WebLinkAboutMiscellaneous - 83 HEWITT AVENUE 4/30/2018J
Date.. ..1.-.()3 .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
S
This certifies that,x�./� ...........
has permission for gas installation
.......... ..........
in the buildings of ..........................................
at .4. . C/ �). � ............ North Andover, Mass.
Fee�-P ..... Lic. No��'7.q,�-
GASINSP&TOR'
Check # -yy
41-459
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Lei
_1 nun ANDbUEl2 , Mass. Date 9 1 A0700. Permit # t%
Building Location , A 3 (-�F_f , l j� ,t� - Owner's Name_ R.�i I�Tf� S C R L
NO R'f u A N b Ovs✓ iZ Type of Occupancy P -Es t o ►jTI A L
New ❑ Renovation ❑ Replacement ZPZ
lans Submitted: Yes❑ No ❑
Installing Company Name BAY STATE GAS COMPANY
Address 55 MARSTON STREET
LAWRENCE, MA 01840
Busin<,ss Telephone -68,7-1105
Name of Licensed Plumber or Gas Fitter Francis X • Corkery
Check one:
X7 Corporation
❑ Partnership
❑ Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy X 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 abo plication are true and accuWe to the best of my
knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S.
T of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter _
Master License Number �1 4
City/Town Journeyman
APPROVED O FICE SE ONLY
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Installing Company Name BAY STATE GAS COMPANY
Address 55 MARSTON STREET
LAWRENCE, MA 01840
Busin<,ss Telephone -68,7-1105
Name of Licensed Plumber or Gas Fitter Francis X • Corkery
Check one:
X7 Corporation
❑ Partnership
❑ Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy X 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 abo plication are true and accuWe to the best of my
knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S.
T of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter _
Master License Number �1 4
City/Town Journeyman
APPROVED O FICE SE ONLY
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Locationy—,"
No. Date
40*TN TOWN OF NORTH ANDOVER
0-.4, 00
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # /b -/0
6 7 4 1
Building Inspector
1.1 Property Address: \
(�
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel 14umber
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Regaired Provide
Rapired Provided
Reqttired
Provided
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
JLl;11VINZ-YKVYlmK1Y VWPIEKJrilY/AUlriVlu4LllA(sLrlvl I Historic District: Yes No
2.1 Owner of Record
G\- 4z PA
Name (Print) Address for Service:
Signature Telephon
2.2 Owner of Record:
Name Print e , Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
i
Licensed Construction Supervisor:
Address
Signature Telephone
3.2 Registered Home Improvement Contractor
Company Name
Address
Not Applicable LC /
License Number
Expiration Date
Not Applicable 8/
Registration Number
Expiration Date
SECTION 4 - WORKERS COMPENSATION (nG.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 all
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
Completed by pern-dt applicant
OIFFICIAL VSE ONILY x
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
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
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/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlvIBERS OT 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CH ANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Note: This drawing is an artistic 81101526 Dwg no.
interpretation of the general TME premier
appearance of the floor plan. It is HOME DEPOT john & roberta scali
not meant to be an enact rendition. 1 83 hewitt ave
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All dimensions & size designations THE This is an original design and must 81101526 Scale: maximum Dwg no.
given are subject to verificatijohn & roberta scall on on HOME DEPOT not be released or copied unless premier Designer
job site and adjustment to fit job applicable fee has been paid or job cheryl terry,asid
conditions. order placed. 83 hewitt ave Wall/C Line # 4
north andover, ma
1294 '
' 101 T16 ' 27156 �5V
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All dimensions & size designations THE This is an original design and must john & roberta scall o8110premier
Scale: maximum Dwg no.er i
given are subject to verification on HOME DEPOT not be released or copied unless Designer
job site and adjustment to fit job applicable fee has been paid or job jhewitt ave the I ter .asid
conditions. order placed. north itt aver ma Wall/C Line # 2
Oct 16 03 10:27a NORTH ANDOVER 9786889542 p.2
�Ys
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordanc ith the provision of MGL c 40 S 54, a condition of Building Permit
Number 02-1 is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
tAJus4<Lvoo� Stil-e�, H
�. (Location of Facility)
VIA `"` L�` Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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No 4. 11
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
n
it his certifies that
has permission to perform P. ............
plumbing in the buildings of .... 1),,,. �'. ( �. 7-f . . ( .
at I -Ir. .................. North Andover, Mass.
Fee. Lic. No.. �7. .. ........ -.0. . ...........
PtUMBING INSPE6T'OR
Check # b 7
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Zv _
(Print or Type)
Lel'e ✓ , Mass. Date gOd Permit'# W y
,���IAe- /
Building location eLy � ,_ Owner's Name,///G�/��1�✓� .��n 1A//lPl��/
Type of Occupancyt5t 5 i D E Iv Ti rA L_
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB-BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
i 4TH FLOOR
STH FLOOR
t 6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name ktlEeT P(rM A TAef) Check one: Certificate
Address �� r' l f: RC H r1
Mt,) /I Pi ❑ Corporation
�Y) E % N i ' Fn) Y} l A ❑ Partnership
Business Telephone Z - i97 9-Aire/Co.
Name of licensed Plumber ��( r3 r ,i' 7- fr' �A mm req P -O c.
INSURANCE COVERAGE:
1 have ayes ent Ijabildy inspura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If you have checked ve, please indicate the type coverage by checking the appropriate box
A liability insurance policy ld 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:
Owner ❑ Agent ❑
1 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
knowiedge and that all plumbing work and installations ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum de and apter of the oral Laws.
re of Licensed Plumber
Title VRO
City/Town Type of License: Master % Journeyman ❑
APPROVED O FIC U ONL License Number 133 1
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