The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - Exception (85)rm Date .. 7h ..... . f ,°Krry 1 4,0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... &.v.. �TkX ... ... � .......... i 1 � has permission for gas installation in the buildings of .... ra .*-.— ., f ...... at . ;? ...�!�?!r?....S ?L ..... , North Andover, Mass. Fee g' .e-�,. Lic. No..: �yS! ,��%,!�.. e .... . GAS INSPECTOR Check # / 6042 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 1JOR-7/{ p1J??ISVEfL , Mass. Date ll, Permit # G Building Location _ (oq OA q j S fr11c. iD Owner's Name ('Lt / SC PPF MOU1 A I)DYE fps, OA Type of Occupancy 5-IAJ&LF New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone g 71B-68,7=1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Corporation ❑ Partnership ❑ Firm/Co. Certificate # 1862 INSURANCE COVERAGE: have aYes rrenntt liability ins ra❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability insurance policy D< . 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'sAgent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in ab pplication are true and accuwe to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. T e of license: Plumber Signature of censed Plumber or Gas Title Gasfitter Master License Number 374-5 City/Town Journeyman AP O IC SE O 40 N c W N j N y V z Q N rn W W OC O U m F- = x n V c z o u F' Qt! Q Cc Z o}w o Q 47 N W H d= W O t- O uz a O ' Q W cc W N ,� J tl Z Q= It U) a Z W CC cc W O.W f' W F' _ W W ~ cc W 1r Q Q W> '.= W W O Z. Q D: Q Z O 2 a: O pN x 4 LC O tl= LL O G tl J V C> p a F- O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RDFLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone g 71B-68,7=1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Corporation ❑ Partnership ❑ Firm/Co. Certificate # 1862 INSURANCE COVERAGE: have aYes rrenntt liability ins ra❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability insurance policy D< . 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'sAgent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in ab pplication are true and accuwe to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. T e of license: Plumber Signature of censed Plumber or Gas Title Gasfitter Master License Number 374-5 City/Town Journeyman AP O IC SE O Z - O r W a N Z N N W cr O O (L a z O F- U ' W Z, JI Q Z LL a n O a w m a a n o r z• w F z � r a a n N J n z O O N � r w !' o n W m z_ o X a. Q a ¢ J O O w U. X to O U, O W Q w J r IL a w � w a U X z O F- U ' W Z, JI Q Z LL a n O a w m a a o r w CL f z � a n Location /,g U t S S f No./9Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 59,— Foundation 9, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3) Colo Building Inspector v TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING rad m 1.3 Zoning Zoning District Proposed Use BUILDING PERMIT NUMBER:DATE ISSUED: A A// J7 SIGNATURE: 1juilding Commiss'o er/I to f Buildings Da JEU1101V 1- VIE nk'OKMA LOIN 1.1 Property Address: 6�'QU�s f {�A4 `c` C /Information: 1/ 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Simply M.G.LC.40. 54)> ' 1.5. Flood Zone Information: Public 0 Private 0 i pone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2A Owner of Record G ; vsc- , / (7Ufs s�- Name (Print) tl Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SER CES 3.1 icensed Construction hpes, r: � � �� LkAnsed Construction Sitpervisor: �► Iry e Addre /// C �h l% � {) �J (lid f Signature Telephone 0, ASUI�3 Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c(6) 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 au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l Si Ni 6-K ace_P.C1)'1f �5p] SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be C m leted by permit applicant ON, { I. Building(a) V Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) V 00 �- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CON CTOR AP LIES FOR BUILDING PERMIT rr I, Aga;�� , as Owner/�4uthorized Agent subject property (/ Herebuthorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Si ahue of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS IST 2 ND3RD SPAN DIMENSIONS OF SILLS DUvIENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f `Ixe karnmo w*ald cl ltawzrftG" BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR .Number: CS 059233 Birthdate: 12/08/1961 Expires: 12/08/2001 Tr. no: 12249 Restricted To: 00 y JAMES A GALLAGHER _ 352 HOWE ST METHUEN, MA 01844 Administrator ✓At T'UM1=iMa9t([KRIIJF G�iZQ..:[IfI*a3['ill _ 7c HOME IMPROVEMENT CONTRACTOR Registration 111863 Type - INDIVIDUAL Jif Expiration 02/05/01 JIM GALLAGHER CONSTRUCTION JA ES A. GALLAGHER HOWE ST ADvMsTRaTOR METHUEN MA 01844 R ACORD..CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 11/22/2000 PRODUCED FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DeAngelis Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 283 Merrimack Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Methuen, MA 01844 INSURERS AFFORDING COVERAGE INSURED ,James Gallagher Constructions INSURER A: Arbella Protection Ins. Co. 352 Howe Street INSURERB: Legion Insurance Company Methuen,, MA 01844 COVERAGES INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRTYPE _TR OF INSURANCE POLICY NUMBER POLICY EFFECTYVE DATE MM/DD/Y POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY 8500004519 06/10/2000 06/10/2001 EACH OCCURRENCE $ S00,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR j I FIRE DAMAGE (Any one fire) $ S0,000 MED. EXP (Any one person) $ 5,000 A I PERSONAL & ADV INJURY $ S00,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 { PRO - POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCS0025570 05/07/2000 05/07/2001 TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate is issued in the interest of the above named insured and the certificate holder below Certificate is subject to all company conditions and exclusions CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: Town of Methuen Attn Building Inspe-:tor 41 Pleasant St Methuen, MA 01841 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Seaal /ICC ACORD 25-S (7/97) ©ACORD CORPORA' O z LISP w O� u 0 w° C/)w° 0 w z A 9 o � ao' G U cd w o w a z wo' CdW w a a U w P-4 X wo' uu c� w O a C7 ao' w w w a w oj W zu ci) v Q o cn c o as c C*ts c ` ca caO 1 �. c =oma y � J X Ea CDm5 it O CLc 3 : tj � e c V.� y m `O O' y N nn(tl y m 3 v m o i mo ce W y O O y +�+ m 9► � : = r o os J C O Q m V , :MsZ p y;� coo am v O C c e m •sm= �co. _ CD N CLO O ti +� �0 0 m W 0 �r-.�Z ..� So «- Om .y O V .`m p O ; C M_ COD O' m O _ ` y•� O_ 4.4 � c cm o•— V� Q 'C O� M E m m CD 0� O CD Q O L 00. ca C Q Occ c vCc J= CZ O ,co c Z CL C.) H c Cc_ c cv CO)CL Q C U) U) crW W ccW LLJ U) e Location c� Avts �al�oy � No. A Date T;— &ORTN TOWN OF NORTH ANDOVER • O. 9 Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ C s uMU 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (? ?o i 7 5 9 5 L -3, --- Building Inspector 11 TOWN OF NORTH ANDOVER WELDING DEPARTMENT APPLICATION TOCONMUCTREP OR 0 A ONE OR TWO FAMMY MILING IMOVATI - BUILDING PERM NUMBER w'' IMF I DATE ISSUED: A) SIGNATUREBuil . diggCommissieskeszoMwId-M Date SECTION I- STICK INFORMATION 1.1 Property Address: q i4VIS S. 1.2 Assessors Map and Pared Number 5— (a Map Number Parcel Nam IV� 14AI.00 VICK IqJ4 olf4_5"" 0 13 Zoning Information: 1.4 Property Dimensions: Lot A. (d) hTtay- MU 1.6 L:;!:AING SETBACKS (M Front Yard Side Yard Rear Yard -- ReVired Provide ReMATed Provided Required Provided 54) =,CA013 Public 13 .200 13 13 DbposilSyst- 1.5. Flood zona00 Sits Dispoul sydan a 0uW6FlwdZcw 0 Muniow SECTION 2 - PROPERTY OWNERSMIAUTHORIZED AGENT 2.1 Owner of Record 61 USEPPF- '81CO(4cy1 (,g 9 04 VIS S7 - Address for Service: 2z I S�T 2.2 (*a fttluW! 'Phv'W 1q, XN & Tdvhone I — Dllwls Sr,. AV xrw X"o vc-1c, A11q e Address for Service:/ 4 SECTION 3 -CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor Licensed Construction Supervisor Address Signature Telephone. Not Applicable 0 LimseNumber Expiration Date 3.2 Registered Home Improvement Contractor -&-Iq &IL16 Not Applicable Cl Company Name 4pvt S#vRIII40,504 0 Registration Number Expiratioh Daft I Address Signatuic Telephone W L-10 0 Z M 0 ic MUMM rw M r MMMMr z a SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2544) Workers Compensation Insurance affidavit must be completed and submitted wide this application. Failure to provide this afltdavit will result in the denial of the issuanot of the building it. Signed affidavit Attached Yes .......0 No ....... 0 SECTIONS Detcri tion of Pro sed workclue& a de New Construction- 0 Existing Building )K Repair(s) ❑ Alterations(s) Addition ' 0 - - Accessory Bldg. 0 Other 0 Specify Demolition 7fl Brief Description of Proposed Work- AX W Ki re,/ it% -CA &AAS rJ- 1 d/c tN AWRY C/XTy.K s rfcSj�trK Vlie , ;rt)L5 t-St)XXQ0 c�D / 11EA.); GAA! 6/' C- E + 6.4-rhl WIK F a 4HAS SECTION 6 - ESTIMATED CONSTRUCTION COSTS , Item Estimated Cost (Dollar) to be Completed by permit applicant SM L Building • -' (a) Building Permit Fte Multiplier 2 Electrical (b) Estimated Total Cost of Construction O ' 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 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 SECTION 7b 5WNEWAUTHORIZED AGENT DECLARATION I 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 andbelief Print Name Si afore of Owner/Agent Date NO.S SIZE BASEMENT OR SLAB SIZE OF FLOOR T11vMERS I 2ND 3RD SPAN DUENNSIONS OF -SILLS DRAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover R Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. (/ DATE b ,6 JOB LOCATION //!✓ ' /4/, 4901I"20 R. / / Number Street Address Map / lot (/�.S6PPE i3RoGc�/ ` G Q .I "HOMEOWNER i'n 4UI- ! S i B A)a S l FC2 Name Home Phone Work Phone PRESENT MAILING ADDRESS �- L'� City Town State The current exemption for "home6wners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said prOCedure mnA rcniiircman+e HOMEOWNER'S SIGNATU Zip Code APPROVAL OF BUILDING OFFICIAL North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: - - -..__ _r r- - (L NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Home Improvement Contractor Look Up • ?nter Search terms separated by spaces. Search terms can be Town/City, Name, or License number ;elect Search type: C AND r OR Search ;earch Results Reg. No. Applicant [StRFZ—ipli Name Title Expiration 114272 BOB'S FIX -IT DURAND 8 APRIL DR NASHUA NH 03060 DURAND, ROBERT OWNER 8/19/2005 Total of 1 Records matched. 3ack to. Home_P__ag_e BBRS Private Statement EE h h A q v a w U) C4 w A o w2 w2' v U w x w a w w c7 90U)cn z p. C O CL o L rt+ 40: v CL J •: z W R - .40 N` c + Aw o m :... GO � E c s o C CA m E i� o z CD � a y =0 0 Zm IRSp � m - �: �•Z 4=0 > O pf y-. 'D C c ix.pQ : � m V y O c r: •Z z o : IICK, c o► c � p Q o :2 m c 'c _ a'='' o O H C 'v = NJ O 4- o Is •� dt O C uiZ CLW •E V fp1 y O COD Co CD a •= O= 2 = Go m O 1- .c $ a O. m M v 4.4 • P.1 �CM o� MO O O 'E m m CL F- �3 0 0 a ca �v 910 d ow C Z V y O C C — '� C cc a y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 71 1 am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone # Insurance Co. Policv # Company name: Address City: Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of•a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civil_penattiesinthefarmda..STOP WORK. ORDER..and..a.fine.of (.$100.00)..achy against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin Building Dept ❑Check if immediate response is required Licensing Board E] Selectman's Office Contact person: Phone #. E] Health Department O Other