HomeMy WebLinkAboutMiscellaneous - 354 Salem StreetDate...... a.?.. �.1. f f�
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
'This certifies that -5 u.¢s f/t �t� two
..................................................................................
i�
has permission for gas installation ......(Y\c ,.-c . ...............................................
inthe buildings of...................:...............................................................................................
at :...... �.................................................... North Alqdover, Mass.
Fee.�!.:�:..... Lic. No ........................... ......:.......
GAS INSPECTOR
Check # f 4� 15—
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY �.i MA DATE ! D / 12014 PERMIT #
JOBSITE ADDRESS OWNER'S NAME
GOWNER ADDRESS I Same I TE FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES® NOE]
APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
Replace 1 Gas Meters x
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY E OTHER TYPE 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: OWNER ® AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in pliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. –�
PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 SI NATURE
MP El MGF Ej JP ® JGF LPGI ® CORPORATION # 3285C PARTN SHIP®# LLC ®#
COMPANY NAME: RH White Construction Co ADDRESS 41 Central St
CITY I Auburn STATE = ZIP 101501 TEL 1,S5081,832-3295
FAX 508-926-4347 JCELLI 508-832-4614 EMAIL JMarino@RHWhite.com
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Location_�J
No. ' `5 �'3 Date,
TOWN OF NORTH ANDOVER
p Certificate f Occupancy $ j%y
41
* > * Building/F ame Permit FMel
Foundat' n P r it F e
s�CMus
Other er ee er Co ection ee
r Connection Fee $
a TOTAL • U
Building Inspector
No 6391 Div. Public Works
Location
I A
No+ '
Date /-,-
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
BuildinglF ame Permit Fee
Foundatio Permit Fee ~
Other Pe e� a
Sewer o nec�Pon F
a�e Co bion ee
AL $ { !
Building Inspector
Div. Public Works
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Location
NG,. -IF Date
N°RT” TOWN OF NORTH ANDOVER
p Certificate of Occupancy $ - 516, J
° .�; Building/Frame Permit Fee $ %
SS F ndation Permit ee $'�
CMUS
th Permi Fee $
we Con ecti n e $
er Co nec Ion Fee $
TOTAL $
Building Inspector
Div. Public Works
in'�o,
Location �y
Wo' Dat
o?o. T;�tioo� TOWN OF%ORTH �ANDOVER
p Certificate oc $ v v
Building/Fram Permit F $
s Foundation P rm' e $
sACHuS
ther Permi F e $
wer Con a io Fee $
W ter Co ne n Fee $
TO
$ 0
21, A
Building Inspector
;;14-
12 -6'3 9 1 Div. Public Works
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TOPS FORM 3450 Q LITHO IN U. r5. A.
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.Propos
Proposal
al No.
FROM Sip�� 1/, t/
Sheet No.
{ , /
batei�� .
Proposal Submitted To
Work To Be Performed At .
.Name
Street
Street �-
City State
City
Date of Plans _
/l"ll`T
State
Architect
Telephone Number
We hereby propose to furn'sh all the ntaaterials and performallthe labor rhe essa for the co pletl0 : o ,-
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All -material is ' guaranteed to . be as specified, and the above work to be performed in accordance , with the drawings
and specifications submitted for : above work and .completed in a substantial workmanlike manner for thpspm, of
Dollars ($ U/(J )
witayments to be made as follo slyp:
AW 00 /qt,0tq
,t
Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public
Liability Insurance on above work to be taken out by
Respectfully submitted
Per
Note —This proposal may be withdrawn by.us if not accepted within days
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above.
Accepted Signature
Date ~" Signature
TOPS FORM 3450 Q LITHO IN U. r5. A.
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OFFICES OF:
APPEALS ;s.N; NORTH ANDOVER
BUILDING
CONSERVATION DIVISION OF-
C�.. ,:.
HEALTH
PLANNING PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover.
Massachusetts O 1845
(617) 685.4775 ,
0
In accordance with the provisions 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 e 111, S
150A.
The debris will be disposed of in:
NWN
of Facility)
Sig cure of Permit Applicant
S�')'3j / �-�
Date
NOTE: 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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FORM U .-LOT RELEASE FORM
'2q a I'JcQct'�T�ai�
C_ Fmri
} 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
APPLICANTCb O , 1 I, I L/ F�V�II �AfszN AyLr PHONE 4 °V -a o""1-0QR
LOCATION: Assessor's Map Number PARCEL 7 (�
SUBDIVISION LOT (S)
STREET S(a I eii i ST. NUMBER ' tDJ I
*****************************************OFFICIAL USE
ONLY***********************************
RECO E D�
CON RVATION
`r
COMMENTS
TOWN PLANNER
COMM
F TOWN AGENTS:
TOR
uA 1 t APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH DATE APPROVED
5,-e LU --C, DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMME
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 jm
TE
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
"ON,W
BUILDING PERMIT NUMBER: DATE ISSUED: .
SIGNATURE: '
Building Commissioner/12REtor of Buildings Date
SECTION 1- SITE INFORMATION I
1.1 Property Address:
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
v
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
_1,81gnature Telephone
Rear Yard
Required Provide
Required Provided
Rapired
Provided
Name Print
Address for Service:
Signature Tele hone
1.7 Wat Supply M.G.L.C.40. 54)
Public Private p
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.8
Municipal
SfZpne Disposal System:
On Site Disposal System ❑
SECTfON 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
0,HR15Ti
Name (Print)
Address for Service
_1,81gnature Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (MG.L C 152 & 2506)
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 .......❑ No ....... ❑
SECTION 5 Descri tion of Proposed Work check atl applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
cam. r ar.rGGe. W, +h 6T,1 (2 (2WA
J
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit a licant
n
jF�yIJ+}yx
(a) Building Permit Fee
Multiplier
1. Buildingr,
. f�
(� V
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
500
Building Permit fee (e) X (b)
f
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN _T
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ( l h n . &i -c/ LU W )y A r ow l l as Owner/Authorized Agent of subject property
Hereby authorizeKO'_ 1h �J = AfnOQ 14 to act on
If, in all matters relati_Am to ork au rued by this b ' g permit application.
Signature -of Owner Date -�
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, ) (1�5 na��)( �� ,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
Ohnt�nboe ju-i)q k,�-e&)_Aucr
Pr e
12,11
mature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TEVIBERS 1sT 2 ND 3 RD
SPAN
DDvIENSIONS OF SILLS
DM ENSIONS 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
D. Robert Nicetta
Building Commissioner
(978) 688-9545
...-1(978) 688-9542 Fax
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
HOMEOWNER !.!CENSE EXEMPTION
Please prink f //
DATE
JOB LOCATION 65 I
Number
"HOMEOWNER 1 I c
Name
PRESENT MAILING ADDRESS
01reet Address Map /lot
9A
Home Phone Work F
s14�-
A
City Town
0577-
) 1 I
Zip Code
The current exemption for "homeowners" 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 .
nat 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 procedures and requirements.
HOMEOWNER'S SIGNATURE
41
APPROVAL OF BUILDING OFFICIAL
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