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HomeMy WebLinkAboutMiscellaneous - 95 BARKER STREET 4/30/2018N IN Date . ,,�•�' •`,��`!. . 8846 TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING NS� This certifies that ...� �c ..�.� _..6�, �..�. �.� `• ........ has permission to perform .....0 ..(... .................... . plumbing in the buildings of ..:D....A.1f .A �.., ............... . at ...���.. fyrt.,!f. r(:.. .............. North Andover, Mass. Fee.2.o.Lic. No.jj/.. .3.. ......�-ILUMBING INSPECTOR Check /rte MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location �� , i9�'/�t. S'% Owners Names rl �Nt:: �V t�ft!�'` 0 Permit # Amount Type of Occupancy New 0 Renovation 0 Replacement ® Plans Submitted Yes No FIXTURES (Print or type) C �p Installing Company Name {�." L Lo RA') Pz t)M 1J ! 416 heck one: Certificate Corp. Address iRtJ-4l.tF' ST- Partner. 14A11)o 0e -t— Business Telephone j 7& r '�;�� _ �-� c� Firm/Co. Name of Licensed Plumber. 70 IV hjl //®/! • f �'✓ Insurance Coveraee: Indicate the type 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 rgnature Owner 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State �li bin Code and Chapter 142 of the General Laws. �. r By:sign01 Ucensea Plumber Type ofPlumbing License Title k3_ APPROVED �i ecense um er Master Journeyman APPROVED to�cE usE oxt.Y t�.7 7 5 f 4 Date. ....... . TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ',sSAtNUSEtS' 1 This certifies that.. � < < U %�: �?.`.'..... .... ........ . has permission for gas installation ... hl ................... in the buildings of . .,y � 1 (.`� G ......................... . at . c?.} .. Del'�. h. f .... ....... , North Andover, Mass. Fee.. Z.... Lic. No..?.`4' -23. C.L) ...... AS INSPECTOR Check MASSACHUSETTS UNIFORM.APPUCATON FORPEiMT TO DO GAS FrFnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations ���� ST S �e.P1l�/� 0 " R%,' Owner's Name Date /—oZ %—// New 0 Renovation 0 Replacement Plans Submitted 0 Permit # Amount $ (Print or type) Lv� Name of Licensed Plumber or Gas Fitter �vj hl�!'�/G Check_ one: Certificate Installing Company 0 Corp. ® Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No13 If you have checked des, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity Bond ED 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 r" 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter .Plumber ,;tL DGas Fitter License Numoer Master ® Journeyman w � U U aca ¢ ca y a a > < w w z z a z cc y V W F aI- x z C4 F+ 4 ki > rq O > Z L'w O [zl F z s o �'`� e Q a o w > a O SUB -BASEMENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Lv� Name of Licensed Plumber or Gas Fitter �vj hl�!'�/G Check_ one: Certificate Installing Company 0 Corp. ® Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No13 If you have checked des, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity Bond ED 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 r" 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter .Plumber ,;tL DGas Fitter License Numoer Master ® Journeyman Location 9,5— S -f - No. // Date v c�o -61 i No�TM TOWN OF NORTH ANDOVER F ? • . L9 # Certificate of Occupancy $ cMuE4� Building/Frame Permit Fee $ s�S Foundation Permit Fee $ Other Permit Fee $ ate' r TOTAL $ Check # (/4 Sf- Building Inspector TOWN' OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING It ._ BUILDING PERMIT NUMBER: 3117 n DATE ISSUE SIGNATURE: z* //// -Building Commission tor- of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: �.� a fit. L4 a 1.2 Assessors Map and Parcel Number: f �lU Map Number Parcel Number nQ n_ cD) q / � Y� A 1.3 Zoning Information:: Zonin District Proposed Use 1.4 Property Dimensions: Lot Area •Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Re4Tjired Provided Re red Provided 1 1.7 Water Supply M.GL.CAO. 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 Owner of Record D. $a AitooLi/L- Name (Print) Address for Service Signa4ltre Telephone 2.2 Owner of Record: _ 44 '10 C Name Print Address for Service: l Si nature Telep one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Rzw Ss Company Name / 03, �t 3 /1111 Registration Number— '1 /J Address I -0 1 ml naturExpiration Date e -g Telephone 0 edj'655 �fh$ . SECTION 4 - WORKERS COMPENSATION (XG.L C 152 § 25c(6) 0 0 G%, j')e; ql--�' 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 0 �4 Repair(s) ❑ Alterations(s)� 0 f o Addition 0 Accessory Bldg. Demolition Other ❑ Specify, Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Pollar) to be Completed by permit applicant {OFFICIAL f7SE i?l.Y r 1. BuildingO @Q (a) Building Permit Fee Multiplier 2 Electrical _ _ (b) Estimated Total Cost of Construction 3 Plumbing ...-- Building Permit fee tat x tbl I 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 p da 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 12�%-hull io vW1'MK/AU1nVK1GELAtiBN1 DEC;LARA110-N . I 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 of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 sr 2ND 3 RD SPAN DlIvIENSIONS OF SILLS DMIENSIONS OF POSTS DIlNIENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ 'THICKNESS SIZE OF FOOTING X MATERIAL OF CHlNfNEY i IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ti FORM U -LOT RELEASE FORM IC) x1(40 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT�VJ ahP /1 PHONE LOCATION: Assessor's Map Number V / PARCEL 1 0 SUBDIVISION( t / LOT (S) STREET `Z R= Ke 0- ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** REC)DWIMENDATIONS OF TOWN AGENTS: ATION ADMINISTRATOR COMMENTS N6 A-0 4( e TOWN PLANNER COMME FOOD INSPECTOR -HEALTH DATE APPROVED 1 Z11 6 — DATE REJECTED fr-,A/ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMM PUBLIC WORKS - SEWER/WATER CONNECTION DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm � D y ?'- .p C � fD Crf yV �'. so y CD az Co ar CL ato o p CD a� Q CD O ff-w Cos -o CD 0 7 M) -v, 0 CO) CD 0 CD m CD CCDO) CO) 0 CD 0 CD A, 0 n: O -ca O C y s' ao5m . y m O m n CA C2 CLC.) 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TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that,/-/. r.I . . '.......... . has permission for gas installation ............................ in the buildings of . ... l .. r"�/`-!..................... at ..�-'?. x .%i. �? ... `." �..... . , North Andover, Mass. Fee. .:.. - . Lic. No.. .?. ? 1... . ��-� � ......... ASINSPECTOR Check # / 2c ' 3 %.0 O� 5X11sr-4 _r MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print)Dat€ 4 yr C 19 s�m� NORTH ANDOVER, MASSACHUSETTS Building Locations C� '-� u.('�CCy Permit # tO ��✓ Amount $ Owner's Name New R Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type Name �b_�1 �N to �. c c+�y S S►S �",tJ `. Address Q) \g k one: Certificate Installing Company Corp. C-- ❑ Partner. ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter v V4. J �-•4�5(U► INSURANCE COVERAGE Checone: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, ple a indicate the type coverage by checking the appropriate box. Liability insurance policy ImOther 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's Agent T I Iia, n.k: f.. 41...4 -11 ,-1 aL_ .1_-_•1_ _ I • _^_ - - w-�- »-- �� �•�-.�•�__� �.=u .,11V1111aL1V11 1 11a— ­1111uea kor enierea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse"te Gas `ode and Chapty 142 of the General Laws. ICity/Town 'L-1rrAkJ V MJ (OFFICE USE ONLY) I Signature of 1 ❑ Plumber Gas Fitter Master ❑ Journeyman ;ec Plumber Or Gas Fitter S -)3s License Number IMIRS • i 7TH. FLOOR 8TH. FLOOR (Print or type Name �b_�1 �N to �. c c+�y S S►S �",tJ `. Address Q) \g k one: Certificate Installing Company Corp. C-- ❑ Partner. ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter v V4. J �-•4�5(U► INSURANCE COVERAGE Checone: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, ple a indicate the type coverage by checking the appropriate box. Liability insurance policy ImOther 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's Agent T I Iia, n.k: f.. 41...4 -11 ,-1 aL_ .1_-_•1_ _ I • _^_ - - w-�- »-- �� �•�-.�•�__� �.=u .,11V1111aL1V11 1 11a— ­1111uea kor enierea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse"te Gas `ode and Chapty 142 of the General Laws. ICity/Town 'L-1rrAkJ V MJ (OFFICE USE ONLY) I Signature of 1 ❑ Plumber Gas Fitter Master ❑ Journeyman ;ec Plumber Or Gas Fitter S -)3s License Number