HomeMy WebLinkAboutMiscellaneous - 89 PHILLIPS COMMON 4/30/2018Date./.�.
o� �` °. TOWN OF NORTH ANDOVER
F ..... 9
• PERMIT FOR GAS INSTALLATION
�9SSACHUSEt -
This certifies that ... !�...``.....
has permission for gas installation ..C�`�f'
in the buildings of .. g. �� .. .� (j�<% ... CU. '! !'� `..... .
V.
at ....:...... ,North Andover, Mass.
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Fee. ..... Lic. No..
v GAS INSPECTOR" ?
Check # )'(F 3 7
r
6713.
} . MASSACHUSETTS UNIFORM APPLICATON FOR PERNll'I' TO DO GAS FM ING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
Building Loqations
Permit #
Owner's Name Amount S
New ❑ Renovation Replacement .
Plans Submitted
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SUB -BASEM ENT U C 5. p y F 0
BASEM ENT
r IST. FLOOR
i. IND.'FLOOR
3RD. FLOOR
4TH. FLOOR
STH. FLOOR
6TH. FLOOR
7TH. .FLOOR
8TH. FLOOR
(Print or type)
Name J / y,�_ �l—/f Check one: Certificate Installing Company
Corp.
Address ..5
ij 0 Partner.
Business Telephone
�E 7--J 0—Finn/Co.
Name of Licensed Plumber'or Gas Fitter
FINSURRANCECOVERAGE
t liability Insurance, policy or it's substantial equivalent. Check one:
ecked yes, please indicate the type coverage by checking the appropriate box Yes ED
No�nce policy � Other type of indemnity D
Bond D
Owner's Insurance Waiver [.,am aware that the licensee does _not�� the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent Check one:
er
t hereby certify that all of the details and information 1 have submitted (or entered) ed) in D application 13 a d
best of my knowledge and that all plumbing work and ins ions accurate to the
compliance with all pertinent provisions of the Massac etli Statep' ormed under Pe it Issued for this application will be in
as Code/ nd 7er 142 General Laws.
113y:
Title
City/Town
1APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
Gas Fitter License um er
Master
Journeyman
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ...............
has permission for gas installation ............................
in the buildings -of
at North Andover, Mass.
Feev)_...... Lic. No.
...........
/�-'-_GAS IN.0,ECTOR
Check #. 6- & 2 ? U
9wo"
MASSACHUSET, T. UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
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Installing Company Name'�Ar ;A (Z T A , :51m MA Tri r Q Check one: Certificate
Address 30 0-0A C N 1vt A ry -Kf, . ❑ Corporation
f 11 E T N U E fJ 01 rl 01 k q� ❑ Partnership
Business Telephone 691 —17 47-7 ( 2--'Firm/Co.
Name of licensed Plumber or Gas Fitter -,0R 1) jBE j. T A - SA 61-M ►9 7A jeo
INSURANCE COVERAGE:
I have a current (}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes &4' No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy 0"" ' 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 OwnerO Agent [I
I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the pe ued for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws.
BY T of, licebse: �3
Plumber n ure o cen u or ltter
Title tier
er Ucense Number X333
C7t own Journeyman
APPROVED 0
IC
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Y
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Installing Company Name'�Ar ;A (Z T A , :51m MA Tri r Q Check one: Certificate
Address 30 0-0A C N 1vt A ry -Kf, . ❑ Corporation
f 11 E T N U E fJ 01 rl 01 k q� ❑ Partnership
Business Telephone 691 —17 47-7 ( 2--'Firm/Co.
Name of licensed Plumber or Gas Fitter -,0R 1) jBE j. T A - SA 61-M ►9 7A jeo
INSURANCE COVERAGE:
I have a current (}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes &4' No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy 0"" ' 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 OwnerO Agent [I
I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the pe ued for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws.
BY T of, licebse: �3
Plumber n ure o cen u or ltter
Title tier
er Ucense Number X333
C7t own Journeyman
APPROVED 0
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Location ! C `�If r r�J �'e-I
No. Date �' I
NORTH TOWN OF NORTH ANDOVER
Certificate of Occupancy $-� f 12
Building/Frame Permit Fee $� r,
rigs',^° • Eta' �`' Foundation Permit Fee '
sACMUS
Other Permit Fee $
Pam G.V OjIMebtion Fee $
Water Connection Fee $
wo, YCBuilding Inspector . .
Div. Public Works
L-6—c-a"tion '7Z 71
f r j
No. 112-- Date�-
,;TOWN OF NORTH ANDOVER
Y Certificate of Occupancy $ -5-0,00
Building/Frame Permit Fee $
Fouindation Permit Fee $ /K)
Aer Permit Fee $
Sewer Connection Fee $
#Conaction Feed $
Ta���e $ �,� o DCS
Building Inspector
Div. Public Works
Location �i %h i l/%/1�✓1 /�1 til f
f No. `3- 4-z-- Date y A
I TOWN OF NORTH ANDOVER
NORTH
O?O• t`'O I•,ho �
p Certificate of Occupancy $
Building/Frame Permit Fee $
�' b'"•°'''� �' 'Mbundation Permit Fee $
1SJACMUSE� +
Other Permit Fee $
OQQy 4- Sewer Connection Fee $ lr-vi7
Water Connection Fee $ •t''�
1� AL $ d 00, ori
Building Inspector
i
�1 ,* Div. Public Works
PER31TTi '' . Z—Z2.-. APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. PAGE 1
MAP 440.
LOT NO. -
2 RECORD OF OWNERSHIP iDATE
BOOK 'PAGE
ZONE 4'
SUB DIV. LOT NO. T
I
1{,
�I
LOCATION�\
PURPOSE OF BUILDING
OWNER'S NAMEN( -19
NO. OF STORIES rf Z SIZE 1 f-
� L� (T' Z
t' l.�
OWNER'S ADDRESS Clv�
1�.`�^
ASEMENT SLAB
ARCHITECT'S NAME _A s_,5 I
V`,
SIZE OF FLOOR TIMBERS IST �7/tel IND % x N 3RD
C- (J t� O
BUILDER'S NAME
^''
SPAN I I /
DISTANCE TO NEAREST BUILDING c.y� I
II VV
DIMENSIONS OF SILLS
DISTANCE FROM STREET Zo
L -SIDES
POSTS
DISTANCE FROM LOT 'LINES
a)k REAR ?_Of
"' "' GIRDERS G^ )CIL
AREA OF LOT L I �W Cay �Lc�c� FRONTAGE IM (
�"� LiC J
HEIGHT OF FOUNDATION �icJ� THICKNESS
j}U
IS BUILDING NEW �c�
SIZE OF FOOTING O _ %
IS BUILDING ADDITION
MATERIAL OF CHIMNEY rI
IS BUILDING ALTERATION NO
IS BUILDING O SOLID R FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER V e5
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER i
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS iiJJ e{
SEE BOTH SIDES MIT FOR FOUNDATION ONLY
REGULATED BY PARA. 114.8-S. B.C.
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12 -
4 DATE 6/o/9 v FEE PAD /ODy"
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED 5� 2 1'Q
SIGNATURE OF OWNER OR
F E
PERMIT GRAN D c
19
PERMIT FOR FRAME/BUILDING
DATE- 69v FEE PRdD:-L/ (o 8_ %'-
OWNER TEL.
CONTR. TEL. # g
CONTR. LIC. # ' �c
BLDG. PERMIT FEE 9 / Z 6 �_ ""'
LESS FDA FEE / o -o. ao
DUE FRAME PERMIT $ //6S-, t
C'• 0 . f- ,571. rz
3 PROPERf"Y INFORMATION
LAND COST //1� C o0o
EST. BLDG. COST 7`
EST. BLDG. COST PER 94. FT. Sp
EST. BLDG. COST PER ROOM /� ry
SEPTIC PERMIT NO. A i
4 APPROVED B
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDIN sa�crne
r BUILDING RECORD
1 OCCUPANCY,
12 t
i.
SINGLE FAMILY
STORIES
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT -AND,DISTANCE FROM
MULTI. FAMILY := -I.--
OFFICES
LOT LINES'AND EXACT DIMENSIONS OF
BUILMNGS. WltK PORCHES. GA -
APARTMENTS
RAGES. ETC., SUPERIMPOSED.:THIS REPLACES PLOT PLAN: -,-
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
w
CONCRETE
d
1
2
3
I^4
CONCRETE BL K.
_
PINE
BRICK OR STONE
HARDW D
1;
PIERS
PLASTER'-•
_
_ DRY WALL
_
'
3 BASEMENT
AREA FULL
FIN. B M-TAREA `
'/, 1/7 1/1
_
FIN. ATTIC AREA
- '
NO BMT
FIRE PLACES
HEAD ROOM
_
MODERN KITCHEN
4 WALLS
, • ` '
t FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
'CONCRETE
�_
'
WOOD SHINGLES
?
I
ASPHALT SIDING
,EARTH
HODW'D
_
_
_
ASBESTOS SIDING
VERT. SIDING
_
COMIAGN
ASPH. TILESTUCCO
ON RY
STUCCO ON FRAMEBRICK,
{rl,}416F TWIN
ON RY ` .:
AT71C STRS. &FLOOR I_
J ry p n Y { i� i + ►.
$' I �i 7R4�
BRICK ON FRAME
CONC.ORCINDER-BLK�
STONE ON MP�SONRY
WIRING
STONE ON`FRA'ME
SUPERIORI� POOR _
.I •I 1 __ -...
'
ADEQUATE NONE
5 ROOF
10 . PLUMBING
GABLE
HIP
BATH (3 FIX.(
GAMBRELMANSARD
TOILET RM. (2 FIX.(
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
s
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
I
11 HEATING
WOOD JOIST
PIPELESS FURNACE
'\ i
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
1
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
" i1 `
'
7 NO. OF.ROOMS
GAS
%+ •"�+1
,
OIL.
�.
B'M'T 2nd
I
ELECTRIC
�.,.....�.,..��o.•�.,.. _. .._ .:�� t�
1st �I 3rd
NO HEATING
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP
SUBDIVISION LOT(S)
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET L� k-1 Q ; n c (� _ . _ _ --
APPLICANT
_
APPLICANT' ��� ,0094p PHONE
DATE OF APPLICATION 2 ��
TOWN USE BELOW THIS LINE
CONSERVATION COMISSION
NSERVATION ADMIN.
BOARD OF HEALTH
ANITARIAN
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY P
SEWER/WATE
FIRE DEPT.
DATE APPROVED Zj
llATE REJECTED _
DATE APPROVED
1,7,q
DATE REJECTED
DATE APPROVED /��%/� Z
DATE REJECTED
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and health hoards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or. Bylaw.
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