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HomeMy WebLinkAboutMiscellaneous - 85 BEVERLY STREET 4/30/2018i Date. 0 q V4 RTH -1 TOWN OF NO ANDOVER PERMIT FOR PLUMBING This certifies that .I. ...... '... .'......................... . has permission to perform ................. ................. plumbing in the buildings of 2� at ,North.ndover, Mass. Fee. .... Lic. Nd'�.......... PLUMBIN13INSPECTOR Check # 7354 (rrifn�i �or j „I u e -Mass- Date Permit z— Building Location Owner's Name t' Type of occupancy C' (l`u' (�' 'tom I i.�'I u v►-� New ❑ Renovation ❑ Replacement" (` Plans Submitted: Yes Cl No FIXTURES Installing Company Name Business Tel-aphone 22L�1- -Name of Licerused Plumber — I' –1-1116 Check one: Certificate ❑ Corporation ❑ Partnership N' Firm/Co- INSURANCE COVERAGE I have a current liability policy or its substantial equivalent which meets tate requirements of MCL Ch. 142 Yes No ❑ If you have ed yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy, ❑ Other type of indemnity ❑ gond C OWNER'S INSURANCE WANEfi: I am aware that the licensee does not have the insurance coverage required by Cha�ier 742 of the General Laws, and that msignature y on this permit application waives this requin_ment Check one: Signature of Owner or r s Agent Owner/ Agent G 1 hereby certify that all of the details and information I have submitted (or entered in \above application are true and aerate to the best of my knowievlge and that all plumbing work and installations corrsp.[i2nce with allO1Td under the permit issued for this application will be Pertinent provisions of the � usetts State Piumoi ! \ re "ter 142 of the General. Laws. Signature of Type of Lice- Maser • W Journeyman C: License Number Date .. :/7/-. �° ...6.7... . �HOKrM 1 �1 TOWN OF NORTH AND ER • PERMIT FOR GAS I ALLATION This certifies that ......:...' has permission for gas installation in the buildings of ... � A-�- -, - r.-� i .................... at ..��.€ ;Lr.- ;�:� .. ,North Andover, Mass. Fee.?". .... Lic. No. �° .. ' ./. ��L%� -� . . GAS INSPECTOR' Check # 5958 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) _Q V Mass. Date L 19 Permit �u Building Location 1n Owner's Name L At 1 � el' UV Type of Occupancy `off [t( fJt Ll Y� New ❑ Renovation ❑ Replacement Pians Submitted: Yes❑. No (' x. t17 W' V7 W. U - N o p W. .. W N it Q U' m r Y m t W z.- a....�-.. IL d w ._ m z .` p .a ur tu s6B—asMT. _ BASEMENT 1ST.FLOaR ZND FLOOR 3RD FLOOR 4TH FLOOR < 5TH.FLOOR 6TH.FLOOR 7TH FLOaR 8TH' FLOOR ,QSC'� � U Installing' Company Name Address S' Q ❑ Corporation iT (I 1 '❑ . Partnership . Business:Telephone rl `� U do Firm .Name of Licensed Plumber or Gas -Fitter �� S INSURANCE COVERAGE: I have A current. lability .insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142_ Yes - No ❑ If you have c ecked Yes, please indicate the type coverage by checking the opiate box. .A liability insurance policy. Cl 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 ❑ Signature of Owner or Owner'l 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the C�e�eFa(-Lawsr� Ey T of License: t Plumber Signature of tensed umber or Gas Fitter Title Gasfttter Master License Number I [ J City/Town Journeyman APPPXN TD(OFFICE US ONL �� O t - v w a z N . LU a s CL 97 oil Q W .. U cLLp a < rr'. cC r [3 C ' W '02 LL ` ;:� . ,Z a '� - a.•. ami W .� .. �... La ,Q �• a :U O s sit f• "• ' ..J -}•" Q [r -;oil fit a m TV,. t z �° Location a ✓\sj No. E Date 6" -Z- TOWN TOWN OF NORTH ANDOVER O� F w a Certificate of Occupancy $ 'ss^cMusBuilding/Frame Permit Fee $ 17D t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f/ 5 �/ I ! i, U uilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissionerff for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 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 weer of Record a�7 & 4 Name ri t) Address for Service : 7M Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Addrels Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone v rn I 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. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ TAddition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRIICTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (e) 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 autho e to act on My beha, i mattersa-e�ive rk auth�thiiso 'building permit application. � G � Si ature of caner Date SECTION 7b OWNER/AUTHORIZED T 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/AQent Date NO. OF STORIES SIZE BASEMENT OR SLAB S17 -E OF FLOOR Tllv,MERS iST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D. Robert Nicetta Building Commissioner (978) 688-9545 978) 688-9542 Fax Please print DATE - al JOB LOCA Number "HOMEOWNER 'RESENT MAILING ADDRESS Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER UCFNSE EXr:xAr0 )pN ,-- (-, f Street Address Home Map -/lot Work City Town State f Zip Code The current exemption for "homeowners" was extended to include owner-cccupied dwellings of two units or less and to allow such homegwners to engage an individual for hire who does. not possess a license,. provided that the owner acts as supervisor. '(State Building Code Section 1 o8. a s.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_ cessory to such use and/or faun shixAures_ A person who constructs rrlore 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 drat she understands the Town d No Andover Building Departrnent minimum inspection p edures and requirements and that heJshe will ' comply with said procedures and requirem ts_ r HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance w. h 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 c11,S150A. The debris will be disposed of in: d , /UL�P�O (Location of F Signature of Permit Appl Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 3 5:' a, /7- 0 C;2 Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 0 d r.r."7# e x c ............................................................................................. has permission to perform ° 5 I?d ....... °. r wiring in the building of FDS �( .......... ,North Andover, Mass. at ........................................................... �1 6C/ 7 ' n......M...(.. Fee......... Lic. No.!.!.O ................... �` / {� ELECTRICAL INSPECTOR Check # 1! 3 Official U�e�1y Permit No. J'j X/40- 7�5 VOOV— `r 4 p"49` 'S`ddg Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date � -r b To the Inspector ofWires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location ( Owner or Owner's Address t;)Ct M e— Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Existing Service .1 C;0 Amps v? % 0 Voits New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Overhead Z' Authorization No. Undgmd ❑ No. of Meters Undgmd ❑ No. of Meters OTHER: d INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includ' ompleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Offic Y = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANC& = BOND = OTHER = (Please Specify) (Expiration tate) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested a Rough t� Final Signed under the Penalties of perjury:'�`� /—�j FIRM NAME i3 ctf,r — (t %- _ C&1 c_ LIC. NO. r 9 Ll NO. I�,:,. N"! p_ *zj L/! / Bus. Tel No. / � .3 / �� 5 �9 / Address ✓� tJ%1rr7fl % W-� y �—�nI � 4' • Alt Tel. No. S` OWNER'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ 5 (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiri No. Hydro Massage Tuds No. of Motors Total HP OTHER: d INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includ' ompleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Offic Y = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANC& = BOND = OTHER = (Please Specify) (Expiration tate) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested a Rough t� Final Signed under the Penalties of perjury:'�`� /—�j FIRM NAME i3 ctf,r — (t %- _ C&1 c_ LIC. NO. r 9 Ll NO. I�,:,. N"! p_ *zj L/! / Bus. Tel No. / � .3 / �� 5 �9 / Address ✓� tJ%1rr7fl % W-� y �—�nI � 4' • Alt Tel. No. S` OWNER'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ 5 (Signature of Owner or Agent) Date ....... .�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING jhis certifies that ................................... . has permission to perform .... �.,.....'.....�................ . -'plumbing in the buildings of ..C. 5-. ." l ..................... . at ... �.... �) .. . �.(:. (.. .............. . North Andover, Mass. r Fee. ..G.. Lic. No../. ....... (...` t'�..:-• ........ PLUMBING INSPECTOR Check # J 5 U 4 2 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING _.1 (Type or print) NORTH ANDOVER, MASSACHUSETTS S / �y� J Building Location � P ! N ��,J Owners Name i I New Renovation of Date u J Sc r Permit # Amount %o Replacement Plans Submitted Yes No (Print or type) Installing Company Namel Address �r Check one: Certificate ❑ Corp. Partner. b-'Fi:VCo. Name of Licensed Plumber: Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have su mitted (or entered) in above application are true and accurate to the *best of my knowledge and that all plumbing work a ons pert �td r Per ued fc� this application will be in compliance with all pertinent provisions of the Mas c us s State Pl b' Coe d Bier J of the General Laws. (OFFICE USE ONLY Tyle o y e Plumbing Lic rise icense INUMDer Master Journeyman ❑ / • EMI ' 1 ;;� iiiW��������iiiiiiiii (Print or type) Installing Company Namel Address �r Check one: Certificate ❑ Corp. Partner. b-'Fi:VCo. Name of Licensed Plumber: Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have su mitted (or entered) in above application are true and accurate to the *best of my knowledge and that all plumbing work a ons pert �td r Per ued fc� this application will be in compliance with all pertinent provisions of the Mas c us s State Pl b' Coe d Bier J of the General Laws. (OFFICE USE ONLY Tyle o y e Plumbing Lic rise icense INUMDer Master Journeyman ❑ Location No. Date /0 -/S -O/ f NORTh TOWN OF NORTH ANDOVER O ' 9 Certificate of Occupancy e P Y $ J+cMus `� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ of Check # C;� 6/ 'a �' S r / 1 J U u Building Inspector ." D—�*fa TOWN GP NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: i / DATE ISSUED: SIGNATURE: Uy�lrvtrs�'" Building Conunissioner/lEs 2ector of Buildings Date 0V,%- 1 acm 1- al l E I N VORMA ION 1 1.1 Property Address: e VC NEIUI'10.N 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.2 Assessors Map and Parcel �� Map Number Number: Parcel Number NjL4�6 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft SECTION 3 - CONSTRUCTION SERVICES Front Yard Side Yard Not Applicable ❑ Rear Yard Required TProvide Required Provided Required Provided Company Name Registration Number Address Expiration Date 1.7 Water Supply M.G.LC.40. § 54) Public ❑ Private 0 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 �f NEIUI'10.N 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. wner of Record i&OV4-4 Name (Prin) Address for Service Signature elephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature, Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date St nature Telephone �f 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. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ JAlterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: -- �� VVIr'3 �� i.�C.l'r'Gt11,f3-fJYi/\ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be�FFICIAI. Completed by permit applicant USE 1. Building 4 d (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, d , 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/AUTHAGENT DECLARATION __IZED ��OR 1> D c-. in i S� L CJ b Ci l/ ,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 C,' A_V_c� Signature of Owner/Agent U Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T NMERS 1 ST 2ND 3 SPAN DMIENSIONS OF SILLS DUVIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r C/) m M C/) 0 CO) .p CD CF CD O ar O d CL. =. a� o p CL Q�"C CD O ao O O tG CD CO) CSD O O CA O CO) cm C) CD O CD CD a CO)CD C C •?-mo d = O �•(A o Cr N CL o S m CD CD Cl) co C2 m Zo O CO)y=r-o co) _1 o, °: m -n a o Er 0� m d G y CO) moo: 2 o• Oto o = n o y: � cNo CO CL CD C d m V 1 0 r� d H *' Z i•..1 y d 0 � C cn cn 1 T 1Q cDCD 6 all fW a: O oCD " n = z ® o O W H 3 z •o o gi Acn CD. cn CD =r CD m ,o C=L v' Com 70d : g, 5• 0 dcn 7d ?I Ili r - O z '..rJ c 9 n Z �7 ',i7 tz ;79 n C o Cb � CL O o omi 0 9 0 c Location No. a Date 10 -61 -Cd TOWN OF NORTH ANDOVER Certificate of Occupancy $ cNuBuilding/Frame /Frame Permit Fee s�st 9 $ S a Foundation Permit Fee $ j Other Permit Fee $ TOTAL $ Check # l 411( } �� ` i; Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT. REPAIR, REFIOYATE, OR DEMOLISH -A ONE OR TWO FAMILY DWELLING IRS WIN r._, I r M, IN PWW�-Wftd BUILDING PERMIT NUMBER' a .a DATE ISSUED: Jf� SIGNATURE_:. Building Commissioner/I for of Buildin Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: C J �. Map Number Parcel Number , 1.3�Zanm nf0rmation: g 1.4 Property Dtntansions: - . Zoniig District Pr i5ed TJse, Lot Area Fronta a '$. 1.6 BLTH DING SETBACKS (ft) front .Yard. . Side YardRear Yard Required Provide R" red Provided R Provided I:S. Flood Zone Infomution: 1.7 Water Supply;;GJ—C.40. 94) 1.8 Sewerage Disposal System Public , 0 Private ❑ Zone Outside Flood Zone 0 - Municipal 0 On Site Disposal Systema 15 SECTION 2 PROPERTY OWN] 2.1 Owner of Record Name 2.2 Owner of Record: Name Print v -e r �✓ 0' Address for Service : Address for Service: ,Q .2 Registered Home Improvement.Contractor ompany Name ddress Not Applicable 0 Registration Number Expiration Date -V SECTION 4 - WORKERS COMPENSATION (MG.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 .......0 No........Q SECTION 5 Descri tion of Pib &W Work check ail a hcable . New Construction ❑ Existing Building ❑ Repair(s) ❑ Alerations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition. ❑ Other ❑ Specify Brief Description of Proposed Work: Pi SECTION 6 - ESTINIATED CONSTRUCTIONCOSTS Item Estimated Cost (Dollar) to besq, Completed by permit applicant 5 g, a.M., 1Z n I. Building .!1 V © O (a) Building Permit Fee Multi lrer 2 Electrical -(b) Estimated Total.Cbst of -:Construction 3 .Plumb.. .Building. Permit fee (a) x (b) 4 Mechanical HVAC�- 5 Fire Protection• 6 Total 1+2+3+4+5 _ Check l�Yiunberi SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 I SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION . I I, -L) tl f ,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 Na � /f �� ,� l Signature of Owner/Agent v Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THyMERS I 2ND 3RDl DMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a'w' C/) m m m 0 C= F C � CD 'O O 0 z y O CO) r c o.mc CO) � o � 0 CD CD o CLQ and CD CD o CSD w 9 C CD CO CD CL CO) CO CD S- CO) O 1 z CD O C o CD O CD < c ='� O 0 _ �• N O Cr VJ nc 5.0 -c C4 CD n n o yc�a� m Z ' � ?= h 010.� a NT ..n o W �OOO p y H O c ?CD m O m O ..r i7 O V+. o CL Cn O CD m y` 'b c a o n R cs o dCO) ( o y nff: C O W � d C/) a N C �O ? N * N co 01 m Zn ' c1 CO 0 0� 0 m o Cl) z H �m o ) o m cn ` a �- 0. r : � CD a.� O: n O Co 0 ►�nl : 1 y0 o C r v cn - cina ry� fD d � w- pGp H OAC O ?� o oGa z �... n o oGC o C z �^ o A.. d y �J W � 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 JOB LOCATION �-e "HOMEOWNER Number 55 Man / lot PRESENT MAILING ADDRESS City Town State 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 understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirement HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Code C. Town of North Andover t NORTH OFFICE OF ° ,-t ' ° •,� o. COMMUNITY DEVELOPMENT AND SERVICES � 1-1- 27 -27 Charles Street ; •� North Andover, Andover, Massachusetts 01845 WILLIAM J. SCOTT �\ �SSgcHusE�c Director (978)688-9531 cn Fax (978) 688-954:. i 2� COMPLAINT FORM DATE: COMPLAINTANT: ADDRESS: p 2 � �v �.�- l - 9 _ ,x/0 - 6 J ` - , S t'n o vL"i-�S 4�� _ ,� �� � � �- PHONE: _l I 1 ' S �( eN t e�cz� s o -p r?UAVerU6. • 7 O Q- n � y �c� to � w i J-�tr1�' �•2rrvt.i f5 COMPLAINT AGAINST: / ,,, I Ofd t S (!0 r e y ADDRESS: ;� _ V ler l PHONE: COMPLAINT: C Ll fiq Y2 oft `e o o e clay -� * i dj CY q k 'e- d rc) 0 W 1"q 'I ct -///, c- l� ccJ or k 1"4 '10�� . We asp � aJe h n h er- gja�� �y /p #,e CL�s s 1 r S• A o +>-'r er f rf'i Gi 1C 1 T l Ccs �7 i�►t �' f some fir` t` �- F�. �d iU � of re Oq �rac70� r pyjG� U u kc-ep s eis c r Jb /a s ; "c yj� r� s t` �� Il �� �e �t 0 I re c � L' t- �t e c v © r'c s yu ces f v� �ce?� f` U l � ° - 'BOARD OF APPALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 JDate.... ...........�...... rd f ORTN , TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION M � i This certifies that .....: ........... . has permission for gas installation .. .... %:.... ............. . �— in�the buildings of. .... ............................ at-%.. .:.. j ......... , North Andover, Mass. Fee.,'........ Lic. No. 1//1 �.... .:... ........ C"/�f7431 • .+ GAS INSPECTdR• WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UWORM APPLICATON FOR Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations �S / � " (I 1 Y2hJ ��/b/ / S 0 1-21^F V Ow er's Name New ❑ Renovation ❑ Replacement TO DO GAS FI MG Date 19 p�Q Plans Submitted ❑ Permit 9 34lNq Amount S /16d7-- (Print or type)�, ` ?I --Check one: Certificate Installing Com an Name �%2ijNW C /S I- J--2� �Sy� ❑ Corp 5 P Y Address C 21 ���%S� ❑ Panner. Busi ess TelephoneO ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �%G �� ��f2{2 / C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked veS• please indicate the lupe coverage by checking the appropriate box. Liability insurance policy [� Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coveraae required by Chapter 142 of the ?lass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sitnature 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 nd accurate to the best of my knowledge and that all plumbing work and instal lati s pertbrmed under Permit Issued for this ap ication wil in compliance with all pertinent provisions of the Massachusetts Chapter 142 of the Ge Laws. By: Title City/Town APPROVED (uFFicr- (ISE ONLY) Signature of Licensed Plumber Or Gas Fir= ❑ Plumber Jdy9 ❑ Gas Fitter Lictrise ivumoer ❑ ivlaster Journeyman i' i� (Print or type)�, ` ?I --Check one: Certificate Installing Com an Name �%2ijNW C /S I- J--2� �Sy� ❑ Corp 5 P Y Address C 21 ���%S� ❑ Panner. Busi ess TelephoneO ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �%G �� ��f2{2 / C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked veS• please indicate the lupe coverage by checking the appropriate box. Liability insurance policy [� Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coveraae required by Chapter 142 of the ?lass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sitnature 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 nd accurate to the best of my knowledge and that all plumbing work and instal lati s pertbrmed under Permit Issued for this ap ication wil in compliance with all pertinent provisions of the Massachusetts Chapter 142 of the Ge Laws. By: Title City/Town APPROVED (uFFicr- (ISE ONLY) Signature of Licensed Plumber Or Gas Fir= ❑ Plumber Jdy9 ❑ Gas Fitter Lictrise ivumoer ❑ ivlaster Journeyman ZONING DISTRICT R4 SUBJECT PROPERTY MAP 5, PARCEL 4 114 UNION STREET WILLIAM J & MARSHA DONEGAN BK. 3600, PG. 2 MARBLEHEAD STREET BEVERLY STREET X SITE LOCUS NTS MAP 5 PARCEL 5 122 UNION STREET JOHN J PATRICIA A MC CARRON DATE: NOVEMBER 9, 2005 REVISIONS: SCALE: 1 INCH = 20 FEET 0' 20' 40' IWION MAP 5, PARCEL 55 83 BEVERLY STREET COREY, DENISE M SCOTT L. GILES FRANK S. GILES SURVEYING 50 DEERMEADOW ROAD NO. ANDOVER, MA 01845 TEL: (978) 683-2645 FrankGilesSurvey@comcast.net FRANK S. GILES CERTIFIED FOUNDATION PLAN OF LAND LOCATION # 1144116 UNION STREET NORTH ANDOVER, MA WII.LLIAM J& MARSHA MACRINA DONEGAN I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NORTH ANDOVER, MA. AT THE TIME OF CONSTRUCTION. THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. C:\CLIENTS/DONEGAN BILL\PLOT PLAN.DRG F W F W W