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Home My WebLink AboutBuilding Permit #015-2011 - 151 HILLSIDE ROAD 7/1/2010 BUILDING PERMIT o`NORTHq,�, TOWN OF NORTH ANDOVER 02tb'+,' APPLICATION FOR PLAN EXAMINATION Permit NO: �S �1Oi Date Received ��SSACHUS Date Issued: l U IMPORTANT:Applicant must complete all items on this page LOCATION I S ` � V Print PROPERTY OWNER 1 1 Z 2.A - Print MAP 210 11.1? PARCEL: _ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' tial Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, eplacement Assessory Bldg Oth s: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: S--r _ R�q� Identification Please Type or Print Clearly) ,,/ OWNER: Name: �!Y1 C-, f- Phone: et� — moi*,— Address: CONTRACTOR Name: Phone: Address: 1 Supervisor's Construction License: Exp. Date: Home Improvement License: ` Exp. Date: ho ( `r f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT: 12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ � Check No.: L/�� Receipt No.: v2 303 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnature of Agent/Owne-rz-a::f Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp:Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,-sq. ft.: e.x. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application I - I Doc:Building Permit Revised 2008 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK W191,11 CITY Pek*k Atjbovv, — 1 MA DATE] al//Zp/y PERMIT# JOBSITEADDRESS' /$f Hla51057 tb OWNER'SNAMELJIMISa, r,N CiR,"r OWNER ADDRESS TYPE OR OCCUPANCY TYPE COMMERCIAL( ( EDUCATIONAL ( I ` RESIDENTIAL D( PRINT CLEARLY NEW: RENOVATION:X REPLACEMENT: PLANS SUBMITTED: YES( I NOI I FIXTURES I FLOOR— BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ! DEDICATED SPECIAL WASTE SYSTEM ! DEDICATED GAS/OIUSAND SYSTEM } a DEDICATED GREASE SYSTEM j DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM i DISHWASHER DRINKING FOUNTAIN — FOOD DISPOSER ��'I j' ; r•, E j FLOOR/AREA DRAIN _ I INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN — — — SHOWER STALL SERVICE/MOPSINK TOILET ---I - --- —1 I f URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING -i OTHER I INSURANCE=COVERAGE: I have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYOTHER TYPE OF INDEMNITY( I BOND I. 1 OWNER'S INSURANCE:WAIVER:I am aware that the licensee does not have the'insurance coverage required by Chapter 142 of the Massact et . eneral Laws,and ti signatttre on this pennit application waives this requirement. I 7 CHECK ONE ONLY: OWNER I { AGENT { SIGNATURE OF OWNER OR AGENT I hereby certify that all of[lie details and Information I have submitted of entered regarding this application accuralp to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this applicalion will be in co ar vn a Pertinent provision of The Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME(/NIGNA4L tp f;Tfe6D1J LICENSE#IIfj,321$4-1 IGNATURE— MPI { JP CORPORATION{ {ll! JPARTNERSHIP( II{; �LLCI lit� COMPANY NAME ADDRESSD1� ¢�7 CITY4 � atD6jt.Jt c;j . . . 1STATE{14A, �ZIP � MIS-+ 1 TEL1Ct'01�� '' 33grl FAX CEL-/1'1 KI�N4.t P>✓-t�i6Lso�lo ��\��s�. �/rT f i ROUGH PLUMBING INSPECTION NOTrS BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES i� Yes Na THIS APPLICATION SERIES AS THE PERMIT ❑. ❑ FEE: $ PERMIT 9 -- PLAN EX�VIIEWNOTES b r 4 I 4 I i I I I I lyre Cnt Brio ipefifif,bfmassrrcfingeia j -� De�fr��futeitlgjlitrlrtscilcrlElccirlei�is 'llt,,�lc�'afXti*esfi�irlr'ous - 6p0#Vrsltfrtg�orrSYr��e� BOSIorr;MA02fif 1 • ,tvittt�.trursrSor/dirt � '��ro>_iftcrs�Contttt:►isntbt�>Ett$�rr<=n.►��ficltt�'ft:Bt�tttctslL�ainfint;tors�3'letfrfcin�#slBiJittti�et��; � �ty1 Itaauflltfot�etuttrdti ... .. - P7etisi::t'r nf);�' tf :: ' I ftttit;�l3itSuresir0ighiiiratio r irCd j: [�.�J' all 1 A(lEl'resk, 4}tat/ itife iii W�S� � l>f t t0ltff �� /b� q.. ' Atcy:otrttneitti�[otirr2CtrecTrthenpt►loprfatebox. .. _..... . . ., .. 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A&besuretoslgnAnd Ilatetht:Affidavit. Ttiecftidavifshottid � be retul-lie l to tlts city or town that the application for the permit or license is being requested,not file Delmaluent of Fndasirtt!liccidents. Sltotitd yon htit any gttest�gtts regar�Pingthc lam 6c ifyoii Are required to obtain a workcrs' i;ag(pt Mation policy,please cal!the"J ;dpattine(rf:rjt tltenumUer.tisted Uelovu.=Self-insitr£ti,compati ies fltoulcl enter their felt=itisucnnce license numberonthe Appropriate line Qs or Toisit Oflichiis ! Please bv:etre 1liatthe atfiitavit is cotiipletd ottdprinted..iegibly. 71ie bepaitiiient 1tasltroYidetl u space At the bott6m oft-he,aftldavit foryoft-Mfill bifla theeventtheOffimOf Investigations-has to cwttncE}�oureg trcli,(giheapplicant. ' Please be Sure to fill in the pennifdlicensei�umUer rv]uch�vi(I.be used AS A:refcreuce iiptitbzt:In addition,An applic.iut ttlat muststibinit multiple permit/ticense applicatio»s in attygiven seat,nee(lvily sublilit one affidavit indicating current �olicy�Infonnation(ifnecessary)mid widei"Job SifaAd`dress"the applicant'shouidwhe"alflocations in • (clwor i laivh)!'Acopyoflhe.atlidavifthatbasbegii9fficiallystatnpedormarkedby tliecityostoituuiaybeprovidcdtothe a1iplicantasproof thaeavafid.WidavitisotitiloforfulureperiiiNoflicenses.AtiecvtiQldavitntustfie filled old each 4 year.lWierea Monte owner or citizen is dbtaining.a license oi.pernvit not related to anybusiitess oreomntereial veritilte F a dog license or-lierniit to burn leaves etc.)said person is NOTrequircd to contplete tills effidaAL 'flie b)f fcQ ofIIIAki Dations would lilt to tleankybir ill advance for y9lit•cooper'4ti0ii aitct 3?t6pla 1,ottltavo ai y questions, � ptEase do not hesitate togive its#i calf_ t lite bepattutbiit'saddress.teleplioite acid fax litnttTier; The ConitngmiYe4lt o l �s r,6fittsetis - j i D61iaa_-lntent of fjid is€ri I Accfctpiiis Office.ef•Im'e;Vgfit(014 600AVashingtofi Strut Boston,IIA ON 1.1 Td.0 617-727-000 e9t.406'of 1-$77-IVIASSATIB • i evtfscd 2G-oS P419ytGiI-W-7749 ' 1�1�►i��,iiiass,goc'tiiia Commonwealth of Massachusetts Official Us.Only - Department of Fire Services PeinntNo, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(AMC),527 CMR 12.00 (PLEASEPRINTN NK OR TYPEALL.WFORMATION) Date: — City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&N�u-m,,b�er,)n�/��— �� s Owner or Tenant t 4,h Telephone No.GCS-> Owner's Address -S&MC Is this permit in conjunction with a building permit? Yes — No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Servic Amps �]� /� Volts Overhead Undgrd R' No.of Meters ewService Amps / Volts Overhead ElUndgrd E] No.of Meters Number of Feeders and Ampacity �-- Location and Nature of Proposed Electrical ork: tr ^ 1 Com letion off e ollowln table m be waived b the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)FansNo.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires �;L-- Swimming Pool Above ❑ In- ❑ o.o mergency ig ng nd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No,of Switches No.of Gas Burners No.ofDetection and Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons...._KW No.ofSelf-Contained Totals: "'"' "' "' Deteettitont/AalierttiinLY.Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:'• No.of Water No.of Devices orEquivalent Heaters KW No.of No.of Data Wiring: Si ns Ballasts No.of Devices orE uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent �,/r� Attach additional detail ifdesired,,or as required by the Inspector of Wires. Estimated Value of Electrical Work: -�_ (When required by municipal policy.) Work to Start:;?SI-)- Inspections to be requested in accordance with AMC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) X certify,under a pains an penalties of erjar,that t. informafion on this application is true and coo p etie FIRM NAME- LIC.NO.: License Signature_ _ LIC.NO.: (Ifapplicable enter`exem t"in thelicense umberline,,I Bus.Tel.No. Address: 1��/1�1(, yL/ /frdY, ti!f d�S/ Alt.Tel.No.: '�PerM.G.L c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE.$ f r BLEMACAL PERMT NO, ]CCAaGWSFECTOP, _ �_ • . Fassec -n Nailed--j ] Re-iuspectzon xequized'($50.00) 3�uspectQ s'camtne�ufs: - .-/ Z � 6r. (Xnspec Ore Signa -•xto r tzars) Date - L Fassecl L Xhifecl7 j ] u to inspection xequired($50.00)�[ .Titspectarig co encs: ' -41 ti (Xxis iectors'ui atu e 0 initials) Date passed—j 1 +ailed—j ] ? eSnspectzonxequixecT(�s0.00)�j ] Inspectors'comments: (Imp ectors'Signature-no initials) Date .INFl�1CTXON--�E3 1�JCC ': Passed--[ ) Failed--j � �e-fnspectzonxequirec�(�50.00)�j � Inspeetbrs'Comments: (Xuspectors'aigaature•-uo initials) bate 'assed j 1 I+ailed j ]_ ate-inspection required($50.00)--j , asp ecto.re cobamen.ts: @hSp ectors,Signatuxe-no initials) Date D 0 O TA.QS.AM TO BE ITMED ORT AM X.EFT ON SITE IF TM AREA TO 3E INSPECTED 19 NOT ACCESSIBLY,AND.A.3E WSFECTION OF$50,00 is TO$y,CHARGED. - . The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Invesfigations UV 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): t/J Address: V�(s2U City/State/Zip:- id) f S� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ' ❑ * have hired the sub-contractors 6. New construction ' employees(full and/or part-time). 2.Mian a sole proprietor or partner- listed on the attached sheet. 7.�Remodeling ` ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Al— f I 1 A , Job Site Address--/9,1-1:16f 1 t t� lZ c,L City/State/Zip: k of-6 6r&l}(t— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certio under the pains and penalties ofper'u that the information provided above is true and correct. - Si ature: Date: Phone#: (� j Offccial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance ' requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials w Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CommaoRwealthofMassachosetts Department of Industrial Accidents Office ofIavestigatlons 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax#617"727-7749 www.mass.govfdia • r � s NORTH Andover Town of Q yG. `-�,.tf r.rNy��M. r.: VIA No. F.� W A� over, Mass.,/'� / 191, COCMIC �ADRATE D P'P�\ '9S H E� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ..a... .. wr BUILDING INSPECTOR THIS CERTIFIES THAT.. � ..•..• Foundation has permission to4sWA& .O44/.,4111............ buildings on l.fl... ......... Rough ' f.to be occupied as...��.ri,��.�..a�►.t...�••��•�►6�•••l�•••0�� Chimney provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL d,?Ot- CONSERVATION FINAL Street No. Smoke Det. 6r%AI[7n MIATCD PIKIAI (5'—P2 ' nRIVFWAY FNTRY PERMIT _._- OPFICrZS Ott. .• 'x ow a Of 124 M ORI Sween i. ARlvz--LLS . • NOR.T14 AIS D6VER iv►t�Jt/�usth,vtr. ' ►ua:a�srrn t,ivs.,a�nr�N� ,. ttlu-lt e�tr:.�.^. tx 3N �Kt it`J"lUN He-A LI'Hrr fj 2-4 �✓t3 PLANNING & COMMUNITY DEVEL0prv%F.NT KARC—N H.P. NE1.SON.D1115C'1'01t . In ac=daaca with tho pmvislom of MCL c 40, 5 $4, s Eonaisl9A 9( Svil'ttth6 P941411t, Number is that tAa debris ttai,lung trvm WS Wvtk Shall Lt: dlsposcx 0f in a prcpcfty liccww satin "Sig dbpo"l lAcitlf- a,. +vcnncd 0?' SOL 0 3i1. S ' l"A. 7&;/debris Will bt dlsposcd of ir: „�' _,�(,� Lc,•e o c,Q �t S��rrr�r.. Gv/// � �t��oy�( d� • .c�`'""�s (i.A�croa of Fari�tY) U �� • � • .'S t 66 iyM�ui of Pat,�t Appiiraat elS.�on perm- from th• Tsvn cf North :+aao�•at twat hn ebi:airt:id, fat- this �rc_Rcr through chs vtC.-may of tht Suildrrit3 teo*pacco.r.: : * TOTAL PAGE. 002 TOTAL PGE . 001 BM 03-31-93 1c: `'T-1 FL112:30 ^ ' ` � � . � � March 3i, 19�� "Cl CONTRACTING, INC. � ' 220 Plain (�"t'rept ` Stoug�t�m~ MA 02072 ' � Patrick Budden ' M*rpdzth [u/ ��.atto» 29 Crafts Street / Surto 3OO NewLun, MA 02158-1255 RE151 Avr N. Aw�mve/" MA � Dear Patrick: ; - ' Tr)e Cost to remuvel a"d I t|1e oil saturateU fr*Mi.np und p*nelinp is \��s znclu�ec U.� Yo] lnwznq items . � , Demo $1, O40 Carpentry 250 Electric J60 Plumh,ng 300 Drywall 150 pa.1nt i z�O � --- � TOTAL $2,220 i � TUis prouu��l not i``c\vdc the cu,! Of the permit ft--.. cal) begio th1� work a� �onn as I hmve ym�� approval upd �ionature ' h�luw, ` ' Pleasc cuxtact we if ,uu |ave an �tiy qx� oot�. , ' �incerel.y Robef-t Mrinni� ` ' j_ /rk4wM r.snv�,��- ��vr�� P+trick nn�uen AS /46ON-r r&K - 1 Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only E OF CITY/T9WN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration,renovation,repair,modernization,conversion,inprovement,removal,demolition. or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. n Type of Work: p,joVij �?if i, ✓r OJ11 ' �l U✓c��I Est. CostJ Address of Work /`7 / I/�i df. �� Owner Name: Afew4i /4' 1191 t1&1.11 ?� Date of Permit Application: Zd-1� rt �r I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ob under 51,000 Building not owner-occupied _Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Na Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name OFFICES OF: . ' ' ° Town of i 2O htain street APPEALS � NORTH ANDOVER North Andover, BUILDINGw�'.;'"'Y�•� M:1SS:)<-11USCllsOIti4 i C:UNSL'1tVA'1'tUN DIVISION UI' �'"�w, ((i 1 7)1 i85-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECI'O11 • In accordance with the provislotls 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. 'Ile debris will be disposed of in: ZL( (Lo tion of Facility) Signa a of Pcr zu-t Applicant D t NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. •PERMIT NOA D O' APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. L.,/PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. 1-1 LOCATION1 URPOSE OF BUILDING +' f�EI.0 i �� ?y C �` rlr?JvtwPr F E) l3ii17►9 11 r3 f OWNER'S NAME r ��)[ NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB 2Tf`r��s � t'.�New �'�`►) .�� ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME A/1L f Or,i SPAN _— DISTANCE TO NEARS* 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 INSTRUCTIONS s PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST q n PAGE 1 FILL OUT SECTIONS t - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ' ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLAN ST BE F__( ILED AND APPROV9 /9 1 ED BU LDING INSPECTOR D1 7 A E L D c BOARD OF HEALTH t SIG ATURE' WNfd OA AUTHORIZ96 AGENT F E E OWNER TEL.# « /(1~�C;x-� PLANNING BOARD PERMIT GRANTED n i CONTR.TEL.# �� d/ 19 CONTR.LIC.# J'L-7 11 f BOARD OF SELECTMEN y � 7 BUILDING INSP[CTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES ITHIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION ) 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 I CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT il AREA FULL FIN. B'M'TAREA _ V, 1/1 1/ FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMC:N VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR 1y ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ F-ATJ A SHED 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 I 11 HEATING I WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS IL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING { T FORM U - LOT RELEASE FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** Z-"PLICANT: �' Igm4 ry p�4 Y Phone Gr /7 3`1' 67-9T /LOCATION: Assessor's Map Number Parcel Subdivision l Lot(s) 11 Street / f /� �ls�,Jc �'Ij e St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway pe it L//Fire Department -"- Received by Building Inspector Date 3 OF DEPARTMENT OF PUBLIC SAFETY '1 MASSACHUSETTS 1010 COMMONWEALTH AVE. B - EXPIRATION DATE OSTON,MA 02215 07/31/1994 CONSTR.LICENSE RESTRSUPER ICTIONS O P E R V I S O R NONE EFFECTIVE DATE LIC-NO. �5 1071311, 992 052111 ANDREW dMCINNS� Q oSS # 034-54-9674 PLAIN > = STOUGHTQN ST PHOTO(BLASTING OPR ONLY) FEE: m MA 0 2 0 7 2 100. 00 m HEIGHT. NOT VALID U SIGNED BY LICENSEE AND OFFICIALLY STAMP -O -SIGNATURE OF THE COMMISSIONER DOB: 03/01/1961 THIS DOCUMENT MUST BE CARRIEDON THEPERSONOF OTHERS-RIGHT THUMB PRINT THE HOLDER WHEN EN- - GAGEDIN THIS OCCUPATION. _�O SIGN RE OF LICENSEE O • COMMISSIONER Location fro. Date NORTp TOWN OF NORTH ANDOVER . p Certificate of Occupancy $ 41 ' Building/Frame Permit Fee $ �' �°'•^°•'�� Foundation Permit Fee* $ CHU _ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ Tdi, � $ Building Inspector Div. Public Works pORTii O',t •e y�tio F } * NORTH ANDOVER BUILDING DEPARTMENT * •' - ''-�, + 400 Osgood Street S=1cHwu Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: NAME: Ut MS L` c72 ADDRESS: ZONING DISTRICT: TYPE OF BUSINESS: r7� /C?0/71/? BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: =YES ) NO BUILDING INSPECTOR SIGNATURE c Revmed 11.5 04 BUISMESs FORM FOR TOWN CLERK Location 1st �� //✓�� /ms 's No. =;� j Dates I • ' ' TOWN OF NORTH ANDOVER 76 • . .. Certificate of Occupancy $ Building/Frame Permit Fee $ '" Foundation Permit Fee $ !_ r, Other Permit Fee $ TOTAL $ Check#—T—bz— Z` f!) 25001 Building Inspector Location �� !/s��t f RVI No. 0 /3'— Date X / /v MORT„ TOWN OF NORTH ANDOVER 3t � • OL Certificate of Occupancy $ �'�s'•^� E<�' Building/Frame Permit Fee $ /2 s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # M_ 26' 0b ; Building Inspector e"'''