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HomeMy WebLinkAboutMiscellaneous - 34 Johnson StreetC 4 7-- '1c�1 O t\ W rte►►,, V R i M� I+y O .4 L /y� C •O N V) O O > ti 7 O I M O O •� Q C ¢ Nt w O � oon b w 3 ry � a u v on 2 o 0 ° o N 0C3 > d 0 NCd ° U CS�C++ 0 E cn ^C ^' ❑ c C 0 - Gn7 L Cf)ca r C ami O F U U O V G d W uQAuuaou us W c 1 rO I p O Q M F w 0 v cz o. U C 0 O 7 O Q �U rn a� .j cc J N N 0 LO O N O m 0 75:4 Date /? ! . /.Z b P ....... i 3j '` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SAC HU This certifies that A! T...? .�!.''. .?....�'� .......... . has permission for gas installation ... ?:k 0 V .e ................. in the buildings of /t./.... Z'./?.� 0 t.... . at�?.(-i L ......... North Andover, Mass. Fee ZW . v 0 .. Lic. No.. GAS INSPECTOR Check # FIXTHRFR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: -)41 (/�,GhlN'A MA. Date: 1 / t) Permit# y Building Location: 3LiJaw, A— (� n l - Owners Name: 7F Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ©� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ FIXTHRFR INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91'FIo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy E]� 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Siqnature of Owner or Owner's Aaent Owner ❑ Agent El By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and dccurdw ro me uum or my nnowieage ana tnat an piumomg worK ana mstali ions performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State PlumbingC ode and Chapter 142 of ttte General Laws. Tyf License: By 0 Plumber ' Title El Gas Fitter Signature of Licensed Plumber/Gas Fitter ©- Master v City/Town ❑Journeyman License Number: APPROVED (OFFICE USE ONLY) ❑ LP Installer CO IX W W Y Cd IX N = W mLu = O W W v CO) W F N O W o: O O Z q W w w 05 W Z g m 0 F.a W I— o O X Z 0 W LLJWW 0 = LL > W w z O Z >- W a O a m z -1 C7 W O z L O F wWM � W w 1— v o o LL C9 0__ O a W F>>> O SUB BSMT. BASEMENT 1 FLOOR y 2 FLOOR 3 FLOOR 4 TH FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 1H FLOOR Check One Only Certificate # Installing Company Name: /� `� � S ����z�� �' /'? �" �"� • , �� El Corporation Address: S 7% is : X �' t- I ViGity/Town: "� U • <7 ���- Mate: lyI ✓� ❑ Partnership Business Tel: 7-0 Fax: [}firm/Company Name of Licensed Plumber/Gas Fitter: 9'' (:31 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91'FIo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy E]� 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Siqnature of Owner or Owner's Aaent Owner ❑ Agent El By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and dccurdw ro me uum or my nnowieage ana tnat an piumomg worK ana mstali ions performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State PlumbingC ode and Chapter 142 of ttte General Laws. Tyf License: By 0 Plumber ' Title El Gas Fitter Signature of Licensed Plumber/Gas Fitter ©- Master v City/Town ❑Journeyman License Number: APPROVED (OFFICE USE ONLY) ❑ LP Installer Date .��..�U. D/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S 5 � 4 This certifies that ,................. "... ....... has permission to perform ............. i plumbing in the buildings of . ?� ......... . at `3`,� . ..'ho ............> North Andover, Mass. Fere 50 ..... Lie. No.1.1f PLUMBING INSPECTOR Check #'� 4381 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location /Owners Name Date lO Permit #S -r Amount t5D' °!!r— Type of Occupancy New Renovation ,� Replacement Plans Submitted Yes No (Print or type) Check one: Installing Company Name �_��c Ari w (A Corp. _ Address P6 6ex -7`— Partner. Business Telephone 9 � 8 — g 37 -- / V 5— -7� Firm/Co Name of Licensed Plumber. Ad cc_r "oeo / /uo R C d a �c Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity 11 Bond 11 Certificate 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 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 Stat Plumbing Cqde h ter 142 of the General Laws. By:Signa re o um er /t Type of Plumbing License Title `© g / 7 � City/Town icense Numoer Master1 Journeyman ❑ APPROVED (OFFICE USE ONLY �L� • I off$ • �------------------- ---. (Print or type) Check one: Installing Company Name �_��c Ari w (A Corp. _ Address P6 6ex -7`— Partner. Business Telephone 9 � 8 — g 37 -- / V 5— -7� Firm/Co Name of Licensed Plumber. Ad cc_r "oeo / /uo R C d a �c Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity 11 Bond 11 Certificate 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 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 Stat Plumbing Cqde h ter 142 of the General Laws. By:Signa re o um er /t Type of Plumbing License Title `© g / 7 � City/Town icense Numoer Master1 Journeyman ❑ APPROVED (OFFICE USE ONLY �L� Vit° 3-J Date ..! v �S/ oo� tJa .a'ry TOWN OF NORTH ANDOVER v104 ' 10 PERMIT FOR WIRING This certifies that ...... 2 i` t'' `y� c�, f= �f� • .............�............................... has permission to perform ...... i� « 1 ra (+`f' ....................................................................... wiring in the building of ....... 7 i� ' � e2 ...................................................................... at ................................................... - ,North An ver; plass. ........................ . Fee t1.j 0.......... Lic. No. ........ ........ ..... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4 The Commonwealth of Massachusetts Office Use Only Department of Public Safety Permit # Board of Fire Prevention Regulations 527 CMR 12:00 Occupancy & Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date October 15, 2001 City or Town of No. Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 34 Johnson Street Owner or Tenant Mr. Griffen Owner's Address Same Is this permit in conjunction with a building permit: Yes 0 No F7(Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead F]Undgrd =No. of Meters New Service Amps Volts Overhead =Undgrd =No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers No. of Lighting Fixtures 25 Swimming Pool Generators No. of Receptacle Outlets 34 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switches 23 No. of Gas Burners FIRE ALARMS No. of Ranges 1 No. of Air Cond. Tons No. of Detection No. of Disposals 1 No. of Heat Pumps kw No. of Sounding No. of Dishwashers 1 Space / Area Heating kw No. of Self Contained No. of Dryers 1 Heating Devices kw Local No. of Water Heaters No. of Signs Municipal No. of Hydro Massage Tubs No. of Motors Low Voltage Wiring ther: (1)100 amp sub panel INSURANCE COVERAGE: Pursuant to requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES L! NO [7] I have submitted valid proof of the same to this office YES No If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND F-71 OTHER [7 (please specify) 2/2/02 Estimated Value of Electrical Work (Expiration Date) Work to Start /0/s/0 / Inspection Date Requested: Rough Upon Request Signed under penalties of perjury: Final Upon Request FIRM NAME Dumais Electric LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E Address 8 Newport Street Bus. Tel. No. 978-683-9438 Methuen, MA 01844 Alt. Tel No. 978-685-4553 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or it's substantial equivalent as required by Massachusetts General Laws, and that my signature on this perm' application waives this requirement. Owner Agent (please check one) Telephone No. Permit Fee U� (Signature of Owner or Agent) ter, M, 0 W� z� Jaz 0 UA W `� CL V ° v zz H 0 a 2 06 UJ U. o 0 Z � � Q W y Q woe � w LL z �zz A o C ui a A Vag V CSA owa ter, M, v 0 b cn two \ O z d W W \w '\' - \ " C" o a W y w C7 . �,• � co% z A o LZ V ' 9pd W z Q _O C U w v V cit cn z 0 W w P-4 6 O a LAE O L CLL O CD ca _cc CL y O v CLy C 'O V cc rm� 0 U) cr w o m c o LZ _O C v V C Wm cm o: II EE c v o M 3 m CM mo O C C C42 O O ca SE CD CDCLUCDC m o n M's O Q n(�,�: W: ,: N : o,cs ' 5 O Ci•�z r. O n 00 0 5 Q o :cmcMo_ CO 3 = CD r0+ : :n o N m S ~ N 07 �. M .o � "r o •N O Ci o0 CO2 S n o� o� Now, y'� C 1- typ t $ a. .. m 9 z 0 W w P-4 6 O a LAE O L CLL O CD ca _cc CL y O v CLy C 'O V cc rm� 0 U) cr w Location No. Date - U� t NQRTq TOWN OF NORTH ANDOVER 2 Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �S Check # _ ,z 6 Q0 CyN _ 1 C " 3 4 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE. C Building Commissioner/I for of Buildings Date I & l,11VII 1- ally, 11VrUK1YlA11UP1 1 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: 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 Required Provided 1.7 Water Supply M.G.1-C.40. § 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ NEU11UN L - YKUYEKl Y UWIVEKSffW1AU'1'1101(iZED AGEAT 1 2.1 Owner of Record [ ] f �,�n. �-�a- �`el4 ��y �T"l11.S�'C �<eylw �+'1���,N� �y �U►1 N fu`s �-'t"PrS� Name (Print) _ Address for Service 6? )- 63 Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: l cr- Licensed Construction Supervisor: 2 r. , 4e- Pw r o/ Address Signature Telephone 3.2 Registered Home Improovement Contractor ( (6 �e- 4 � J R �' l-6 ;4 Company Name � 6 car' Arlrl— A Not Applicable ❑ 6SeJ,s License Number &-)b -- v�— Expiration Date Not Annlicable ❑ Registration Number y— s'- o Expiration Date SECTION 4 - WORKERS COMPENSATION (MG.L. C 152 § 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 rmit. Signed affidavit Attached Yes ....,..0 No ....... 0 SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: C9 � L'i � hJ el.✓ � �l'Vr � � r I SFrTTON 6 - F.STTMATF.n CnNCTRTTrTTnV 9-nc're Item Estimated Cost (Dollar) to be (._Completed by t applicant I, t (a) Building Permit Fee Multiplier s� 1. Building n 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVACJ 7fes; 5 Fire Protection 6 Total 1+2+3+4+5 CL`/`T7/1N 9.. 111777►TL T A TTTiTAT1T.9 . --1 Check Number OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ., 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 r Name: Location: City Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer prtovidin`g, w' orke/rs' compensation) for my employees working on this job. Company name: )r �C 011 -------4- City: Al, {I ✓e,h, Phone #: 1 ��� ��✓ I nGr irnnrt- rn I /? { dy1 Pnlicv It Company name: Address City: Phone #: Insurance Co. Policy # 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 penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Print name t� 11/��. /�'� ��. Phone # Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax. (978) 688-9542 DEBRIS DISPOSAL FORM U StLao , .Y � y�•� a d o 4 0 y yy� Gac•Mc� 'QtSn 'ITEn /�PR`���j i In accordance with the provisions of MGL c 40 s 54, and. a condition of Building permit-# the debris resulting from the work shall.be of in a properly licensed sodislid waste disposal facility as defined by NIGI; sh I, sI50aposed The debris will be disposed of in /at: , K-IJ0, Facility location Signature ofApplicant _5� aid j Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 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