HomeMy WebLinkAboutMiscellaneous - 98 MAIN STREET 4/30/2018N
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Date. 7.127.6'.-j
�'<«•� :'tio TOWN OF NORTH ANDOVER
PERMIT FOR PLUMLW G
♦�,SSACHUS�t9
This certifies that ... J.0. r.� ........ .
has permission to perform ..PCN. r..`' : '.................
plumbing in the buildings of ... S'i... At-. <.#.l.r.............
at ..C7%? !y...s`!............. , North Andover, Mass.
Fee. 4k ... Lic. No., may` /t/
FUMBING INS CTOR
Check 9 /�f /�
6528
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
s Date
Building Location / Owners Name ��� /'/ C !f� %O `Permit It
Amount q. -
Type of Occupancy
New Renovation Replacement ❑ Plans Submitted Yes No ❑
FIXTURES
(Print or type) ^ Check one: Certificate
Installing Company Name ���� //1 ❑ Corp.
ElPartner.
11 Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El 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 El
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 Plumb* ode and apter 142 of the General Laws.
By: ign u o is nse u
Title
Type of Plu b' g License
City/Town License um"q Master Journeyman
APPROVED (OFFICE USE ONLY `J
_ _ ..
-\ htASS"'AC HUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
UuildNORTH ANDOVER, , Mass, Date_ /r — /�{ Ig
B
ing permit #
Location
I
New / Renovation ❑
Owner a !I1
Name --,1PA �f (,tie
Replacement ❑ Plans Submitted: Yea ❑ No C7
Installing Company Name -0
Address /3 0 /4,0,14.1 . (X
Business T
E'
—'.�-d —
Name of Licensed Plumber or Gas Fitter
Check one:
Q Corp.
U Partnership
Firm/Co.
INSURANCE COVERAGE: Chek no
I have a current liability Insurance policy or its substantial equivalent. Yes No D
K you have checked yea, please Indicate the type coverage by checking the appropriate box.
A Ilabllity Insurance policy ,1 Other
type of Indemnity D Botx! O
Certificate
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:
%nature of Owner or Owner's Agent Owner D Agent D
'=hereby certify that ail of the details and Information I have submitted (or entered) In above application are true and e
knowledge and that all plumbing work and Installations performed under the perm s for this application will be
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the '!��� Lon, _l
By J
T of lkense:
Plumber rLkensme
u er or
Gasfltter
Master m
L� Journeyman
THte
Cfty/Town
NTn0VE0 (OFFICE USE ONLY)
Me to the best of my
opllance with all
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Installing Company Name -0
Address /3 0 /4,0,14.1 . (X
Business T
E'
—'.�-d —
Name of Licensed Plumber or Gas Fitter
Check one:
Q Corp.
U Partnership
Firm/Co.
INSURANCE COVERAGE: Chek no
I have a current liability Insurance policy or its substantial equivalent. Yes No D
K you have checked yea, please Indicate the type coverage by checking the appropriate box.
A Ilabllity Insurance policy ,1 Other
type of Indemnity D Botx! O
Certificate
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:
%nature of Owner or Owner's Agent Owner D Agent D
'=hereby certify that ail of the details and Information I have submitted (or entered) In above application are true and e
knowledge and that all plumbing work and Installations performed under the perm s for this application will be
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the '!��� Lon, _l
By J
T of lkense:
Plumber rLkensme
u er or
Gasfltter
Master m
L� Journeyman
THte
Cfty/Town
NTn0VE0 (OFFICE USE ONLY)
Me to the best of my
opllance with all
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Date... '.... .
pORTH TOWN OF NORTH ANDOVER
FO�Oy tt`ED anti OA
PERMIT FOR GAS INSTALLATION
�SSACHUSE�
This certifies that .. % l•? 91 , �r�r �. . _ ... .
has permission for gas installation,'1d
in the buildings of .� ...................
at .....�.,!f: `!' i. ;..... , North Andover, Mass.
Fee. �c. No.A."�' ... ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
//�71�3
Bay State Gas Company
GAS INSTALLATION AUTHORIZATION
Dhte //-/ `(-9
Issued to
Address /0 D
For Installation of
BTU Input
Restrictions
BSG Representative
PERMIT ISSUED _ BY
INSPECTOR
11�-711e3r
This Portion of Authorization To Be Returned to BSG.
Inspection Has Been Made of the Following Gas Equipment:
❑ Heating System (BTU Input ) ❑ Range
❑ Water Heater ❑ Clothes Dryer
❑ Room Heater
Location
All Work Has Been Done In Accordance With The Massachusetts
State Gas Code And Is Ready For Use.
INSP
NECESSARY
IF MAILEO
IN THE
UNITED STATES
NO POSTAGE
BUSINESS REPLY CARD
FIRST CLASS PERMIT NO. 721 LAWRENCE, MA
POSTAGE WILL BE PAID BY ADDRESSEE
BAY STATE GAS COMPANY
ATTN: SALES DEPT.
55 Marston Street
Lawrence, MA 01840
NECESSARY
IF MAILEO
IN THE
UNITED STATES
Location
No. I�
Date
U
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Faundati(on Permit Fee
_. , — 9P 1 ''' - �Otrier 'Perinit Fee
Sewer,Connection Fe
e
Water Connection Fee
`TOTAL'
$ �
/$�,,r� GU_
C Building Inspector
Div. Public Works
Location
No.
Date
TOWN OF NORTH ANDOVER
p
Certificate of Occupancy
$
�° .� „'
Building/Frame Permit Fee
$
s Eta
sACNUs
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
'
TOTAL
$
Building Inspector
Div. Public Works
1311T NO. 2/1 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
7
PAGE 1
P +40.
LOT NO.
I
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.
�—
LOCATION /
PURPOSE OF BUILDING
`7
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES — SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
cT INSTRUCTIONS
ar
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
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 �fj /r/+� / g/
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E
PERMIT GRANTED %
CONTR. TEL,
CONTR. LIC.
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST Q
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
6p--
BUILWING INSPECTOR
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