HomeMy WebLinkAboutMiscellaneous - 95 PHILLIPS COMMON 4/30/2018Date.,. . . .......
or TOWN OF NORTH ANDOVER
X PERMIT FOR GAS INSTALLATION
�9SSACHUSEtSy
This certifies that.. ......................
has permission for gas installation jf,.r/ ...................
in the buildings of .............................
at North Andover, Mass.
J .. ......
Fee. ... Lic. No..C.:,),.3
SINSPECTOR
Check
5879
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING
[Print or Type)
AL_," Wev,-Mass.fie 1Z114 20,0% Permit I �^
Building ovation Eaam
Type of Occupancy
New❑ Renovation ❑ Replacemeritte,Plans Submitted: ' Yes
❑ Mo ❑
•Installing Company Name
x"
Address -01
Business Telephone
- k �'3
Name of Licensed Plumber or Gas Fitter
a/)0?0(6-Check'one: Cer4ficate -4-
q_ ❑ Corporation
❑ Partnership
INSURANCE COVERAGE:
I have a currentli bllltq Insurance policy or its substantial equivalent; which meets the requirements
Yes No p of MGL Ch 142.
if you have checked yes/ please indicate the type of coverage by checking the appropriate box.
A liability insurance policy+ Other type of indemnity n Bond
OWNERS INSURNACE 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 s -perml ication Waives this requirement
S 19113tUre of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and Information i have submitted for entered) In a application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the pe t B ued for this apo9cation will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of thVniare
ws.
Type of license:
By ❑Plumber o L ed Plumber or Cas Fitter
Tide ❑ Gasfitter
C'ry/Town [9 {er License Number
APPROVED (OFFICE USE ONLY) 0 Journeyman —
i
i
•
49J. -I. -Mu IMMMMMMMMM
MM������®
vMMMMMM/MMM
MMM
MM�®
r s •
MMMMMMMMMMM
M
F8121115r • •
I!:
5MMMMMMMMMMMMMMMMM®
rr•
•Installing Company Name
x"
Address -01
Business Telephone
- k �'3
Name of Licensed Plumber or Gas Fitter
a/)0?0(6-Check'one: Cer4ficate -4-
q_ ❑ Corporation
❑ Partnership
INSURANCE COVERAGE:
I have a currentli bllltq Insurance policy or its substantial equivalent; which meets the requirements
Yes No p of MGL Ch 142.
if you have checked yes/ please indicate the type of coverage by checking the appropriate box.
A liability insurance policy+ Other type of indemnity n Bond
OWNERS INSURNACE 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 s -perml ication Waives this requirement
S 19113tUre of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and Information i have submitted for entered) In a application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the pe t B ued for this apo9cation will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of thVniare
ws.
Type of license:
By ❑Plumber o L ed Plumber or Cas Fitter
Tide ❑ Gasfitter
C'ry/Town [9 {er License Number
APPROVED (OFFICE USE ONLY) 0 Journeyman —
r
Location �f-� ` / `4/'
No. 7 i Date
NCRTh TOWN OF NORTH ANDOVER
Certificate of Occupancy $ t
tp
Building/Frame Permit Fee $
�'�s "�•° • E�� Foundation Permit Fee
SACMUS f�•� . .�
a
-)AID .,Other ,Pprmrt Fee $
Sewer Con 4ation Fee $
G G'�
'V ; 5lonnection Fee $
i
�y� TOTAL r $
Building Inspector
Div. Public Works
`oration �i/LU�"'t����rrlt��1 ,C - 12 -
No. Date
f -
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ SQ? 00
Building/Frame Permit Fee $1`1 t `
Foundation Permit Fee $ / /10 �-
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
IZOI
P�do Building Inspector
Div. Public Works
�, 4,6Nil
L tlon l/ AJ
r
No. 2- G Date 49 Y z -
NORT„ TOWN OF NORTH ANDOVER
O? 1 t• •e O0A
Certificate of Occupancy $
Building/Frame Permit Fee $I/I
Foundation Permit Fee $°
s�CHU
Other Permit Fee $
' Sewer Connection Fee $
�QQ�►/i Water Connection Fee $
G'�45�TAL $ Za op. 00
OF A
B`" ilding Inspector
_` Div. Public Works
v
PERJtIT N( Z 2 kAPPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.r��—(�
PAGE 1
MAP a40.
I LOT NO. 1 -2
TNNO.
2 RECORD OF OWNERSHIPDATE
BOOK 'PAGE
`ZONE SUB DIV. LOT
12m&
LOCATION ��---N_ ���Jl
—
PURPOSE OF BUILDING
\
OWNER'S NAMEk7t3�-
NO. OF STORIES L SIZE �7
C-�lJ
�1Y�2
J
OWNER'S ADDRESS
_ Gp S1 � ? i I W • �Vi JM)
ASEMENT SLAB
ARCHITECT'S NAME `,�OO� /1 SJOc1
`a
SIZE OF FLOOR TIMBERS IST n 2ND
`' (.,Z� 3RD
BUILDER'S NAME , „oma- a
SPAN
DISTANCE TO NEAREST BUILDING
/
DIMENSIONS OF SILLS
DISTANCE FROM STREET ,\ 0
V
POSTS -
jn
---
DISTANCE FROM LOT LINES -SIDES1 0 REAR +i/1
GIRDERS 5- r -z-
AREA OF LOT �f J�u� G1� FRONTAGE�CC�J)/� 1
AREA
1 (
HEIGHT OF FOUNDATION � THICKNESS
SIZE OF FOOTING « 2-2 X
v
IS BUILDING NEW[.^ f I
IS BUILDING ADDITION" t
MATER:AL OF CHIMNEY
IS BUILDING ALTERATIONIS
BUILDING O SOLID FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE es
IS BUILDING CONNECTED TO TOWN WATER
�S
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER c9�lS
IS BUILDING CONNECTED TO NATURAL GAS LIWE
INSTRUCTIONS
SEE BOTH SIDES PERM MR FOUMMMON ONLY
-' REGULATED BY PARA. 114.8-S. B.C.
PAGE I FILL OUT SECTIONS I - 3
PAGE 2VILL OUT SECTIONS 1 - 12 `v � �� 'n'
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIN PATE ,FEE PAID
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED d 3= I9 `--
SIGNATURE OF OWNER OR A
F E E / 2- (D 9, o-0 V
PERMIT GRANTEln
Ll C
19 ('
PERMIT FOR FRAME/BUILDING
DATE: EEE EAI: /// --6 av
OWNER TEL. h� a
CONTR. TEL. # G
CONTR. Lic. #
BLDG. PERMIT FEE S /2 6r, mo
LESS FDA FEE..._. goo. o 10
DUE FRAME PFWAIT //6,F,o o
C- U • -t- 5� . w
3 PROPERTY INFORMATION
LAND COST 01006
G`
EST. BLDG. COST
EST. BLDG. COST PER Sq. FT. sr/S-
EST. BLDG. COST PER ROOM / I)r) n
SEPTIC PERMIT NO.
4 APPROVED BY �T
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
OCCUPANCY
SINGLE FAMILY
CLAPBOARDS
STORIES
•,
MULTI. FAMILY
1
OFF)CES
3
—
APARTMENTS
> 'S
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
CONSTRUCTION ,.
1
2 FOUNDATION
f
�Jf
8 INTERIOR FINISH
CONCRETE
PINE
3
2
_
I3,
'
CONCRETE BL K.
BRICK OR STONE
BRICK ON MASONRY
BRICK ON FRAME -
HARDW D
CONC. OR CIA1bE'R BIK.
WIRING
STONE ON,MASONRY `.
J
_
PIERS
PLASTER
DRY WALL
_
_
HIP
_
UNFIN.
3 BASEMENT
MANSARD
SHED
w 411111
1
1--;
BY, ILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOTANDC (STANCE FROM
LOT LINES- AND- EXACT 6)MET1510NS._6F 13UIJL' DINGS lATITH.410446HES. GA-
RAGES. 'ETC. SUPERIMPOS•ED;.TH1S, EPLACES PLOT PLAN.'•,
r-
t: •..J. .i t..
r
AREA FULL I FIN. B'M'TAREA-. _ J
FIN. ATTIC AREA `
NO B M'T FIRE PLACES -^''r - +' _ _ U
HEAD ROOM _ MODERN KITCHEN
4 WALLS
1� j; ' r FLOORS
CLAPBOARDS
•,
B
1
2
XI_
3
—
DROP SIDING
WOOD SHINGLES
> 'S
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARDW'D
COMfACN
ASPH. TILE
VERT. SIDING
STUCCO ON MASONRY' �"
STUCCO ON FRAME
_
BRICK ON MASONRY
BRICK ON FRAME -
`AT.T'IC STRS. & FLOOR _
CONC. OR CIA1bE'R BIK.
WIRING
STONE ON,MASONRY `.
STONE ON $RAMEX
�•• i ,
_
5 ROOF
SUPERIOR POOR _
ADEQUATE s� NONE
10 PLUMBING
GABLE
GAMBREL
FLAT
HIP
BATH (3 FIX.
MANSARD
SHED
TOILET RM. (2 FIX.(
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
_
TILE DADO
_
6 FRAMING
11 HEATING
WOOD JOISTPIPELESS
FURNACE
TIMBER BMS. & COLS.
FORCED HOT AIR FURN.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
_
_
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
_
11r`top W01F."JIM � i felMR711
,t
1
7 NO. OF ROOMS OIL '
«... �. w-....� ...:.
B'M'T 2nd _ ELECTRIC
1st 13rd I NO HEATING
• s
r
s
FOM U
TOWN OF NORTH ANDOVER
LOT RELEASFt FORM
go
SUBDIVISION Y Y—i U 1) S
ASSESSORS MAP
SUBDIVISION LOT(S) U+ * IZ
PERMAyE T ADDRESS (ASSIGNED
STREET.
APPLICANT PONEH
' f d
DATE OF APPLICATION j Eq lq 2 -
TOWN
TOWN USE BELOW THIS LINE
PLANNI G BOARD
A 1 . ,.off
TOWI—PLAN
CONSERVATION COMMISSION
CONSERVATION ADMIN.
BOARD OF HEALTH
HEALTH SANI1'
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY P
SEWER/WATE
FIRE DEPT.
,DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTION
DATE
z
This form shall be signed by the agents of the Planning and Health Boards,
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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