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HomeMy WebLinkAboutMiscellaneous - 88 WEYLAND CIRCLE 4/30/2018• �r:[�PrY r k This certifies that has permission for gas installation .T.!�,�f�.c o • • . . . . ...... . . . . . in the buildings of ... kc .............................. at .. Q • (A-) P., e -b ... , North Andover, Mass. 01U Fee . ?�? ..... Lic. No. 1 �. .................. ... GASINSPECTOR Check # i 8506 S'\_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY J��-�(� i l�U� MA DATE PERMIT # _ JOBSITE ADDRESS I OWNER'S NAME fk2 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 ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES4 NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � S SIGNATURE NAME(ct MP PO MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ #1 LLC [:1# ( COMPANY NAME Ma -4,04,C � " �) ADDRESS T 3 �v [7/�'LG/)4' O4 - e Se STATE r ZIP � ? TEL -7 CITY FAX CELL EMAIL �� �z ice, ,, � Q)-„fft--- , �„ r414 fib .'b F O z z 0 U W r� .a Q Gti . a Z ❑ z 0 H El w �- � ~ W wa O U w :a z a w a W C/3 pC p4 G4 w w N a d o 1:" a � U J a CL a � w = w H LL w H `( V z z 0 U w a a �a- d C7 Cx7 a O a 2§ Mo CAOa zOk- uj 2Z _0< L) ek22 54 g ■-tee \ =0 I («/© 2 §o 2 o U.-V)U. CL f\\U 3§§k LLS T 0: ul 6 LU 2 @ Ln o - � � LU _ m C7� o LLI D cy- co CL e m This certifies that ..� .!!Y� o C ...... �!k,� .�.(.�. /✓ has permission to perform .....�� , , , , , , , , , , , , , , , wiring in the building of ...-zt /�� , , ,, , , , , , , , , , at ..... �! .(;� North Andover, Mass. l � PHRICAL Fe.?•6.R.Lic. No.�.(441...EL INSPECTOR �. Check--# 11305 r Commonwealth of Massachusetts Official rrUse Only Department of Fire Services Occupancy and Fee Checked Permit No. I (� 0 U9BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATIOA9 Date: f a, 13 ' /ok City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inten ion to perform the electrical work described below. Location (Street & l nber) g W C' I c tt ou D L e. Owner or Tenant C UC14S' Telephone No. Owner's Address Is this permit in conjunction with abluilding Dermit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building�3NC Utility Authorization No. Existing ServicecXOD Amps 14-0 W16 Volts Overhead ❑ Undgr,dJ:J' No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fit tit ,. -4-s 4�—ieAJ49C C Completion ofthe followinje table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ce% Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ No. of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .................................................. Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances r Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under theme 'ains and penalties ofperjury, that the information on this application is true and complete. FIRM NAI &---�J i4 Af Z3 �C9 u-,/ 0 t,✓ -/`'( LIC. NO.: E Licenseer- dA)4 E -T f!�0V>-OL)rtTZ40 Sigaatkr-e ��` LTC. NO.: .f applicable a ter "exempt" in the license n r ber kne.) Bus. Tel. No., Address: 6 Z L-''�� P-0 • A G S � 6� Alt. Tel. No.: — *Per M.G.L c. 147, s. 57-61, security work requires Departmenf of Public Safety "S" icense: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent ,PERMITFEE. $ 'Z Z0 Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed Y on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: . Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 1fl Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: « Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: I Inspectors Signature: Date: FINAL INSPECTION: Pass Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: v:, Vi. Inspectors Signature Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Legibly Name (Business/Organization/Individual):",- J 7Pr N. g �0 v 7 0 V61-1 � A Address: b D L ©w C LA- City/State/Zip: W , �CmTfv& fiA - 0 64 Phone #: Z aC19-1 Are you an employer? Check the appropriate box: LEI I am a employer with 4. ❑ I am a general contractor and I ' mployees (full and/or part-time).* have hired the sub -contractors 2. m a sole proprietor or partner- listed on the attached sheet. t 'ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition ft,EFIM—ctrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site zformation. isurance Company Name: olicy # or Self -ins. Lic. #: ib Site Address: Expiration Date: City/State/Zip: Atach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 Cup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certi er the ins and penalties of perjitry that the information provided above is trite and correct. ,78 p C `?6 d - V�- ci- Official arse only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # 1d '13.1 oZ, 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 employer is 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-contractor(s) 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 may be submitted to the Department of Industrial Accidents for confirmation 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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1,$77MASSAFE evised 5-26-05 Fax # 617-7277749 - --- -- -- www.mass.gov_/dia Location �of 39 c -)g Ulmmit, G Q,— No. Date it 1 � ra Y? GL "OR*1y TOWN OF NORTH ANDOVER, q 0 p Certificate of Occupancy $ U' Building/Frame Permit Fee $ ��s',T•°''<�' Foundation Permit Fee $ �� e S�CHuse Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ a r TOTAL $ ra Building Inspector 7652 Div. Public Works :Location No. Date A o TOWN OF NORTH ANDOVEF Certificate of Occupancy $ Building/Frame Permit Fee $ w Foundation Permit Fee $ Other Permit Fee $_ Sewer Connection Fee $ -h�'Oewater Connection Fee $ ! TOTAL $ Buil Inspe>t /I /4/q 0429 Div. ublic Works Location jo)�3 y/E Yt No. Sy5 Date wa .� 40RTH TOWN OF NORTH ANDOVER p ` Certificate of Occupancy $ 4 * 1 Building/Frame Permit Fee $ sUS "° h �cNt Foundation Permit Feed $ ° Other Permit Fee $ Sewer Connection Fee $1'o: . Water Connection Fee $ TOTAL $ ell- C / Buil irg"rn-spector 7778 Div. Public Works PERIth NO. _ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAG 13�'AP hl0.LOT NO. I 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. T L,�CATION ►I PURPOSE OF BUILDING �� r� OWNER'S NAME / Ywoo d NO. OF STORIES SIZE aa3� OWNER'S ADDRESS 3 3 �� rh�� BASEMENT OR SLAB l 'JIST ARCHITECT'S NAME /� /J,J� n, t e/ A��� %l� 15UILDER'S NAME ,T~P L id d �! � ([ SIZE OF FLOOR TIMBERS 49X/ 2ND [ /lol0 3RD �I/l// SPAN �q DISTANCE TO NEAREST BUILDING JVD I DIMENSIONS OF SILLS -L��/ Z ,[�Jfi DISTANCE FROM STREET41t / "' POSTS //- DISTANCE FROM LOT LINES -SIDES 201 REAR i;a " "" GIRDERS �/ p 1/C1�r1 AREA OF LOT !J� FRONTAGE ✓ HEIGHT OF FOUNDATION THICKNESS (A�!{ IS BUILDING NEW •�/,gyp (' �1 SIZE OF FOOTING X ✓c IS BUILDING ADDITION ,vA/ vo MATERIAL OF CHIMNEY -Vn IS BUILDING ALTERATION �, /( 0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE J�p c Y L J IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY I it 'LJ IS BUILDING CONNECTED TO TOWN SEWER a /mss 7 IS BUILDING CONNECTED TO NATURAL GAS LINE y e p INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY LAND COST REGULATED BY PARA. 114.&& MC. EST. BLDG. COST EST..BLDG. COST PER SQ. T. F ' PAGE 1 FILL OUT SECTIONS 1 - 3 ! TPAGE 2 FILL OUT SECTIONS 1 - 12 / EST. BLDG. COST PER ROOM j -ATE l FEE PAID SEPTIC PERMIT NO. 5"e'f,1-,00 .ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING k ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPE MIT FOR FRAMUBUILDING DATE F ED 1 Lj% na r GKKT11RE OF OWNER IZED AG .EEE T .t S"D C/o PD PERMIT GRANTED : t_A# 19 WE F=E FM s OWNER TEL. # l( CONTR. TEL. # CONTR. LIC. #12R2 3.-jq NOV - 41994 P 4 ��� BOARD OF -.HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD • " 1 OCCUPANCY 12 SINGLE FAMILY - S�OkIES MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION CONCRETE 8 INTERIOR 3 PINE HARDW D PLASTER DRY WALL UNFIN. FINISH 1 2 13 CONCRETE BL K. BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL '/, 1/2 1/1 FIN. B M TAREA FIN. ATTIC AREA NO B M HEAD ROOM FIRE PLACES MODERN KITCHEN '4— 4- _ 4 WALLS I 9 FLOORS CLAPBOARDS A B 1 i 2 �_ 3 _ - _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARD"✓ D COMMON VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME, _ BRICK ON MASONRY ATTIC STIRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I:k POOR I ADEQUATE NONE 5 ROOF GABLE HIP GAMBFEL MANSARD 10 PLUMBING BATH (3 FIX.I TOILET RM. (2 FIX. WATER CLOSET _ FLAT SHED ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS 11 OIL B'M'T L 2nd I ELECTRIC to 3rd I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS -OF LOT AND DISTANCE FROM i LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, -WITH PORCHES. GA- ' RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.- . fA Ail 1 �.. ..� t imam- ID044 131AQ1WU ! w a v u w° E cn V)w° 004 z z A a a �a 0 U w 2o a ° r� C w a a a 0 H w w uu o c� v v� C w O w w d ° c4 w z w A w w M ci) Q o cn w O O EME4 W w, v m ... o O 5 zCD eF .� O = o a. E : 3 gcc co o m U -o COui CA E Q W 0 CEW ms m . = V C N ow O ++ �.V y0,. M' '� m = E C:a.S E m a O y t H CD rA � C m O := C co H O O H R CD m o cm _: t y mCD C: zs O ' m c m V H O G Z cc Q m HCD F=— � O ' Od CH N 4- y m r0„ Z W G �w.OZ ., c .. .H d.2 O.C Z r CL m J 0 z ECD 0 2 4-0 0 cc LU Z Q CL ?� I y v I 0 C z OC F- rr� CL-) CM C w ?� caCD ca .0 CD w J m m z CD 0= O Q T, co to 0 m h O C- a: � m.5 m HN O Z A H t ` y0-. CL..- Cm m J 0 z ECD 0 2 4-0 0 cc LU Z Q CL ?� I y v I 0 C z OC F- rr� CL-) CM C w ?� caCD ca .0 CD w J m m z CD 0= O Q T, co to 0 j CD 0 0 i Q O 0 Q CL �Q y -a vi 0 cw �i C5 J - a z Z C� Z �i U 0 V a ca w O C ;*r C cr- w CA 6 z � z � uj • w :4 a FORM U — LOT RErFnSE FORM • •r 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 Tout this section***************** APPLICANT: 6�Z /.t�Od -t 7V COrIe Phone LOCATION: Assessor's Map Number Parcel Subdivision 117 0 r1l Lots) J9 Street QSt. Nu. -icer bg **t*-k�ric*t�cttticotFtFtF�et�tOfilC�al Use Only**************ic*ic**W**** RECOMMEND ONS OF TOWN AGENTS: Date Approved nser-ation AcW inistratcr Date Rejected I Cc,:= er. own P14nner Conr,.er. :-_ 12/h, . - Fco.: 7nspect,._ - .ealth Pu -;-c ;Jcr*,:s - se;.er/water connect -ons driveway perrni Fire Departsent Received by Building Inspector Date Approved 11136Y Date Re j ec zed Date Approved Date Re'ieczed Date Approved Data Re; ec te_ Date 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 Tout this section***************** APPLICANT: 6�Z /.t�Od -t 7V COrIe Phone LOCATION: Assessor's Map Number Parcel Subdivision 117 0 r1l Lots) J9 Street QSt. Nu. -icer bg **t*-k�ric*t�cttticotFtFtF�et�tOfilC�al Use Only**************ic*ic**W**** RECOMMEND ONS OF TOWN AGENTS: Date Approved nser-ation AcW inistratcr Date Rejected I Cc,:= er. own P14nner Conr,.er. :-_ 12/h, . - Fco.: 7nspect,._ - .ealth Pu -;-c ;Jcr*,:s - se;.er/water connect -ons driveway perrni Fire Departsent Received by Building Inspector Date Approved 11136Y Date Re j ec zed Date Approved Date Re'ieczed Date Approved Data Re; ec te_ Date �S //ERF�Y GE,cT/FY TO Z, le T/TL•E /,VS!/,e0eA.VO PL or Jb THE O,4Me T•VgT T1lEOwECG/.u6 /S LOCATED O,V 4Orefs S,SG/YN AND rf/AT/r pews GO.dFG=Piff �N ,py/Tf/ Avan-E— , enwva c�E6�/LATiI�.tCS ,�� IRO/.t�Ys JETB.�C.CS FEOM STEEETS E LOT eTy' iONG�vE� � SJ, S F(/,n'y� GE.�T/FY TN.4T T•s��S O.Y'ELL/N6 /S �t/OT O.PA/�iV FO.P LOG4TE0 /N T.yE FEOE.PAL �Co+oO HAZA.CD A.PEf:. �SyCivN O/V /G'EM� • COM,�/t/N/TY P•INGL '� 0S25V 9,9 COO 7 COF MW k �'✓ao'D .a� ; y' �O�'r'? lee I�Ec�/9L �q�'cFS31O� iVOT FO.P ,47-1041 TA,rE.y Exrsrivc .eEca,Pos. 6G /'41el ST•PEET A.t/ODYE,� ifi.4S.S,4G%//SETTS O/8/O Location 3CA10b L� No. 5—b�_� Date �Z TOWN OF NORTH ANDOVER F : a p • Certificate of Occupancy $ • > Building/Frame Permit Fee $ 'I CHusE�� s� Foundation Permit Fee $ Other Permit Feee" $ y Sewer Connection Fee $ Water Connection Fee $ TOTAL G� $ Z,:g � Building Inspector Div. Public Works a ' iUXRE`�H.P. NELSON" �. �+� � r 120 Mair;st e�LPOI84J ' 1 Town Dimto► (508):682 fi83 • ; AND. DOVER' ti CO`SEM:aTIO\ ""j DIVISION of LTH PL PLANNING & COMMUNITY DEVELOPMENT PLANNING , DATE LOCATION OWNER'S NAME BUILDER'S NAME MASON'S NAME CHIMNEY APPLICATION AND PERMIT MASON'S ADDRESS MASON'S TELEPHONE MATERIAL OF CHIMNEY PERMIT # Gb5 - 0- -5? -9 wm &3 4%� V (Lik. INTERIOR CHIMNEY EXTERIOR CHIMNEY �yi� NUMBER AND SIZE OF FLUES 4el ��%� a4�ej� lJ THICKNESS OF HEARTH lo�d Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE SIGNATURE OF MASON �/ - '✓ CONTR. LIC. # i Kt'4oR y 't`fl t�Ctktt�lt EST. CONSTRUCTION COST/CONTRACT PRICE D� PERMIT GRANTED ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS I FEE SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES x 9 V m � m �r O ID00 a a D ;ocis-W :m = uj o a N 0 C C �fa � m m : � L N � m .m � L � N m ivyN m dV i J: 4D O L C2 N Z M= O CL F- Oa'�~ ++ {yj c H - ac E vC.3 CD v N COD a' •o O a " ca �+ CL -0- m' :a V)O a �Ra a W W 4- o E o A z � W co U w W W v CO CM ' C Oy co m m rj Q co ow u ~ 0 �ct .� N \ i m �• CD N O W c O y O a �r w N 7 7 o Z p G CMa w O U [R cn fs0. 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