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Home My WebLink AboutBuilding Permit #Exception - 16 MEADOW LANE 5/1/2018 BUILDING PERMIT �,�J CTED °� N°RT►� q Ott LlD kb• �O TOWN OF NORTH ANDOVER °32,4 _ op APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received p0AATfD �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page l.r LOCATION I i' E 19 Oow W E int PROPERTY OWNER �5L n 0 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes K5o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: i Identification Please Type or Print Clearly) OWNER: Name: Siqrvo2f Phone: Address: CONTRACTOR Name: Sift= Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ /d 1000 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner 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.: 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 2008 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 ❑ Copy of Contract ❑ 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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) ❑ 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 ❑ 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Zoning Bylaw Review Form f N°orN 1 Town Of North Andover 3a� e!,d. •_^.':a pL F ; p Building Department �o 1600 Osgood Street, Building 20, Suite 2-36 North Andover, MA. 01845 9ss"` Phone 978-688-9545 Fax 978-688-9542 Street: 16 Meadow Lane Map/Lot: 45.G/44 Applicant: Sandra Beland Request: Family suite Date: November 12,2008 Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning District: R-4 Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting X 2 Frontage Complies X 3 Lot Area Complies X .3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area NA 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required X 3 Preexisting CBA 5 Insufficient Information 4 'Insufficient Information C Setback H Building Height 1 All setbacks comply X 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies X 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient I Building Coverage NA 6 Preexisting setback(s) 1 !Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed X 4 Insufficient Information 2 In Watershed j Sign NA 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district X 2 Parking Complies X 3 Insufficient Information Remedyfor the above is checked below. Item# Special Permits Planning Board Item# Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non-Conforming Use ZBA Large Estate Condo Special Permit B-4 Family Suite Special Permit ZBA Planned Development District Special Special Permit Use not Listed but Similar Permit Planned Residential Special Permit Special Permit for 2 NLI Unit R-6 Density Special Permit Special Permit Pre-existing, Non- Conforming Watershed Special Permit Supply Additional Information The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled'Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.Y u must file a new building permit application form and begin the permitting process. Building Department Official Signature Application Rec ived Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following.narrative is provided to further explain the reasons for denial for the building permit for the property indicated on the reverse side: Review Reasons for Denial & Bylaw Referelncea Form Item Reference B-4 A Special Permit from 4.122.22 of the Zoning Bylaw (Family Suite in the R-4 Zoning District) is required from the Zoning Board of Appeals Referred To: Fire Health Police X Zoning Board of Appeals Conservation Department of Public Works Planning Historical Commission Other BUILDING DEPT ZoningBylawD enia12000 Date..7-.a.......!:�.l..... � � pORTM of 0-.e -;� 0 TOWN OF NORTH ,ANDOVER PERMIT FOR WIRING CHU 1 l This certifies that . ..... .......................... has permission to perform .. ... !!CSR-. �. �^��1..� ��,�-r................ wiring/in the building of.:: ....., ... � ............................... at ...... --:� ............... . .North Andover,Mass. Fee.. . ............ Lic.No..�!lr�..EO ......... . ` LECMIC iNS Check # --2�7-7� 8 C\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 25?94 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 71N�� 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&Number) Owner or Tenant s�Q , / ��,� No. Telephone Owner's Address /�. /Y1 e.�r•�,�� p Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: MIA- Completion � ry (� Com letion of the followin table may be waived by the Ins ector oWires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total . Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o.61 Emergency Lighting d• d. ❑ Battery Units — No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Co d. TotTons No.of Alerting Devices No.of Waste Disposers Heat Pump NumberTons KW�- No.of11 1 elf-Contained Totals: -_ _......_.__. Detection/Alertin Ply Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Dryers Heating A Connection No.of D E] Other iY g ppliances KW Security Systems: No.of Water No of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. " Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: - LIC.NO.: Licensee: ly'A-,r,! I�- Signature LIC.NO.. (If applicable, enter"exempt"in the license number line.) Address: Bus.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.L cl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ' urance coverage normally required by law. y signatur,�below,I hereby waive this requirement. I am the(check one) owner ❑ owner's agent. Owner/Agent �/'L Signature Telephone No. 17f' '`j PERMIT FEE: $ S� r The Commonwealth of Massachusetts 41 f Department of Industrial Accidents Office of Investigations � /� 600 Washington Street V Boston, MA 02111 "` r 1 www.nzassgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: City/State/Zip: I,�-.__ '�/�Y F one#: _'�78 ? p�,131 Are you an employer?Check the appropriate box: P7. ED f project(required: t.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors New construction 2.�I am a.sole proprietor or partner- listed on the attached sheet.t Remodeling ship and have no employees These sub-contractors have Demolition working for me.in any capacity, workers' comp.insurance. g El Building addition [No workers'comp, insurance 5. El We are a corporation and its required.] officers have exercised their 10.4WElectrical 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 required.]t employees.ees. [No workers' . .�/ comp. insurance required_] 13. Other *Any applicant that checks bore#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. 4cormactors that check this box must attached an additional sheet showing the name of the sub-contractors;and their workers'comp_policy infotmx*on• lam an employer that is promding:workers'compensation insurance for my enw1ayeaL Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under 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. Ido hereby c der the ns d pe allies of perjury that the information provided above is tate and correct Si tune: .''lat, 17 7HCl Phone#: l / 3 Official 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#: 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 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(.if necessary)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 bum 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Sheet Boston, MA 02111 Tel.# 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-QS Fax#617-727-7749 www.mass.gov/dia LAWRENCE H. OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 cell: 978-502-5921 November 5,2008 Mr. Chris Cesati 16 Meadow Lane North Andover,MA. 01845 RE: Beland Residence, 16 Meadow Lane, North Andover,MA. 01845 Dear Mr. Cesati As you requested I visited the project 11/3/08 to review the LVL members used in the framing of the addition to the above residence. These are shown on drawings prepared by Martha MacInnis dated 7/29/08 with the framing sheets and certified by me 7/30/08. Based on these site visits I can certify that to the best of my knowledge the LVL members utilized in the above structure are acceptable and meet the loading conditions required by the 7t'Edition of the Massachusetts State Building Code. Should you have any questions please do not hesitate to call. Yours truly, . / LAWRAD _cn 11 (J J 0 � ''ULD r„ tawrence H. Ogden,P.E. Stnactural 27765 CDSte .o 65 4 j4 S�V�OIVALL V eadow-Lan�, North Andover, MA 01845 October 28, 2008 Bruce Thibodeau Director of Public Works Town of North Andover 384 Osgood Street North Andover, MA 01845 Dear Mr. Tibodeau: This letter is to notify you of a public safety and infringement of land use issue that is caused by water being pumped both into the street and into our front lawn fronxt"kmdow Lane. The home owner is adding an in-taw apartment to her existing home and has apparently run into a water problem. Since the foundation has been put in, there is consistent intermittent pumping of water both day and night into the street and onto my property. This water flows down the street and across my front lawn and drive-way. This is a public safety issue because there are a number of students and residents that walk on the street and when this turns to ice it will definitely develop into an ice slick. This is of great concern to us because winter ice will cause a problem for our vehicles using our drive way. We are concerned about sliding out into children and persons walking or into motor vehicle traffic on the street. Moreover, school buses drive up and down Meadow Lane. In addition, a portion of our yard which is used for winter parking is currently becoming a mud•pit. We are also worried about any visitors, mail carriers and newspaper persons who will attempt to enter our residence. My husband has two replaced hips and we really do not need to have an avoidable accident happen this winter. We have taken photos that show the swift movement of this water and the width that it extends on to the street. Should you need copies I will be happy to supply them to you. Yesterday, October 27, 2008, 1 tried in good faith to talk with Samuel Caliento (home resident with estate interest) about the situation; however I was met with irate resistance. He told me to take this issue up with the town if I had a problem. I then spoke to the town Building Inspector, Jerry Brown, and Tim Willett in the Department of Public works to alert them of the problem. Tim Willett said he went out there to inspect the site and address our concerns and he did agree that there is a public safety issue. Please let us know what steps are being taken to correct this dangerous situation before the winter season. Thank you for your help with this serious matter. Sincerely, cc: Sandra M. Beland, Owner of Record Mark Rees, Town Manager Jerry Brown, Building Inspector Timothy Willett, Water and Sewer Superintendent Attorney Thomas Urbelis, Town Counsel Attorney Jennifer M. Shola Date .i . "oRTM TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING o SSACNUS� This certifies that . . . . . .1-r. .Te t. . . . . . . . . . . . . . . . . . . . has permission to perform . . . !^.. `. .. .. . . . . plumbing in the buildings of . . . -3 c C o ,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .C. . . .L. '" , North Andover, Mass. Fee. . . . . . . . .Lic. No.l. �5. ' PL WING INSPECTO Check # G '7 7900 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMB]NG (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location / rq /� J� , 1 — D 9��!� ��l Owners NameS a"►d Date /J E'/ 7y Permit# o Type of Occupancy e S Amount G New Renovation Replacement Plans Submitted Yes ❑ No FIXTURES F D O rM • U W q O � O U fi4i4+A,II+SII' ISTROCR o 21nFLOCR 3MELOCR 41H FLOCP, SMFLooR s>EIFLOCR 9MFLOO[Z { (Print or type) Installing Company Name Cr f G G, - Check one: Certificate _ QAddress Corp. � � d P � R(/rr �/ i�3d ("� J Partner. Business elephone MFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tyVof insurance coverage by checking the appropriate box: Liability insurance policy r NIZ Other type of indemnity 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 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 Issile for this application will be in compliance with all pertinent provisions of the Massachuse State Pl Ch 42 of the General Laws. By. ignature t Licens um er Title Type of Plumb* g License City/Town "cense u oer APPROVED(oFFtea usE oNLY Master Journeyman Dater o °,/` �'�... .. Of NO oTM ,ti TOWN OF NORTH ANDOVER • -3 PERMIT FOR GAS INSTALLATION R Sy SAGMUSEt This certifies that . . . . .1/14 F T . . . . . . . . . . . . . . . . . . . has permission for.gas installation ."P. . . . . . . in the buildings of . . , .>.. . . . . . . . . . . . . . . . . . . at . .lxl� . . ,l�J.l.!�crc `... . . . . . . . .. North Andover, Mass. Fee. .3 Z Lic. No..2.3 75-.>. . . . . . . . GAS INSPECTOR r Check# )) 7 f 6593 MASSACHUSETTS UNwoRM APPLICA'TON FOIL PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASS Date MASSACHUSETTS Building Logations Cyd Pe �o rinrt� Owner'sName Amount$ New Renovation Replacement Plans Submitted w �C Cnv' u ro w m a o rn G� a O U q a EW„ w e a z z14 w x � v w � � a a W d V F Z F Z x W w 0 q Ems„ Z d w Q C .E. F, W Z p Z W .a Z O CO ID x ice. 3 a a > a 0 F p SU B -BASEM ENT BASEMENT 1S, . FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . .FL00R. 8TH . FLOOR (Print or typ Name (G Check one: Certificate Installing Company _ r 0 Corp. Address -s�o Partner. Business Telepnone �rm/Co. Name of Licensed Plumber'or Gas Fitter INSURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Check one' !f you have checked yes,please indicate the type coverage by checking the appropriate box.Yes No0 Liability insurance policy Other type of indemnity D D Bond Owner's Insurance Waiver lam aware that the licensee does not hie the Insurance coverage required by Chapter]the Mass. General Laws,and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 13 It 9 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 Massachus State G Code and Cha r 142 of the General Laws. By: D Signature of Licensed Plumber Or Cjas-Fitter Title Plumber City/Town: E:] Gas Fitter Lic .s- Number 0 Master APPROVED(OFF)CE USE ONLY) Journeyman Residential Property Record Card PARCEL ID:210/045.G-0044-0000.0 MAP:045.G BLOCK:0044 LOT:0000.0 PARCEL ADDRESS:16 MEADOW LANE FY:2008 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 05994 Road Type: T Inspect Date: 08/2512005 Tax Class: T Sale Date: 01/30/01 Page: 0006 Rd Condition: P Meas Date: 08/25/2005 Owner: Tot Fin Area: 1410 Sale Type: P Cert/Doc Traffic: M Entrance: X CALIENTO,SAMUEL P&MERINDA LT Tot Land Area: 0.42 Sale Valid: F Water: Collect Id: SGC SANDRA MARIE CALIENTO BELAND Grantor: SAMUEL CALIENTO Sewer: Inspect Reas: M Address: 16 MEADOW LANE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RN Tot Rooms: 5 Main Fn Area: 1410 Attic: NBHD CODE: 6 NBHD CLASS: 6 ZONE: R4 Story Height: 1.00 Bedrooms: 2 Up Fn Area: Bsmt Area: 1410 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: H Full Baths: 1 Add Fri Area: Fn Ssmt Area: 705 1 P 101 S 18160 0.420 193,457 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1410 Current Total: 373,900 Bldg: 180,400 Land: 193,500 MktLnd: 193,500 Foundation: CN Bath Qual: T RCNLD: 180414 Kitch Qual: T Eff Yr Built: 1975 Mkt Adj: prior Total: 401,500 Bldg: 187,400 Land: 214,100 MktLnd: 214,100 _ . Heat Type: HW Ext Kitch: Year Built: 1964 Sound Value: Fuel Type: O Grade: A Cost Bldg: 180;4b0 Fireplace: 0 Bsmt Gar Cap: Condition: A Att Str Val1: Central AC: N Bsmt Gar SF: Oct Complete: Att Str.Va12: Att Gar SF: %Good P/F/E/R: /100/100/79 Porch Type Porch Area Porch Grade Factor E 476 P 30 SKETCH PHOTO _. ; E 14 476 Sq.R 14 s s; 4034 .5 i 4 14fi FM 6 1410 S .Ft 322 Sq. Sq .Ft 23 32a 28 , E 3 16 MEADOW LANE Parcel ID:210/045.G-0044-0000.0 as of 7/25/08 Page 1 of 1 Date...... ..... �.... {� NORTH °`< °;•1"° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING � - 1SSACMus� This certifies thit ......... L. ?................................ has permission to perform ....... ..�. � .................................................. wiring in the building of......... .+ / 1................................................ ` at..... ...........................�North Andover,Mass. FeeLic.No..?..4.?410/4E........ Ei CMCAL INSPECMR f Check # amu?7 6661 i mi� Commonwealth of Massachusetts Official Use Only Department of Fire Services Per N°. °a 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(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: ),11710 9 City or Town of: NORTH ANDOVER To the By this application the undersigned gives notice of his or her intention to perform the ele electrical workpector idescribed below. Location(Street&Number)_I L I Owner or Tenant C'• S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above [IIn- o.o melt u ig g r d• rnd• � B ittery Units -- No.of Receptacle Outlets No.of Oil Bwraerg I4I1tE tt.I.AF�l'riS No. of ZonesNo.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiating Devices Tons No.of Alerting Devices No.of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained Totals: Detection/Ale. in Devices No.of Dishwashers ( Space/Area Heating KW Local❑ Mymcipal A Connection El Other No.of Dryers Heating pphances ICS' Security Systems; No.of water No.of No.of Devices or Equivalent Heaters I Si s Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC 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:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: Licensee: LIC.NO.:Signature '� I applicable, - LIC.NO.: 9 (� (f pp e e;, tt 'in t license nu er lin Address: fs j 1�rd� (vCt4 r1ng.) � Bus.Tel.No.: *Per M.G.L c. 147,s.57 61,secunty work requires D Alt.Tel.No.: eparttnent 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 [I owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ • i F f tj The Common wealth of Massachusetts i Department of Industrial Accidents A �� 1 Office of Investigations 600 N,ashing ton Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insetranee Affidavit: B iiders/Contractors/Eiectricians/Plambers Applicant Information Please Print Le�bly NaIIie (Business/Organiradon/Individual): Address: City/State/Zip: Phone#: . Are you an employer?Check the appropriate box: 1.❑ It am a employer with 4. ❑ I am a general contractor and IF1. ype of project(required): employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.7 I am a-sole proprietor or partner_ listed on the attached sheet t ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demoiition working for me.in any capacity, workers' comp.insurance. [No workers comp.insurance 5. 9• ❑Building addition ' p ❑ We are a corporafion and its required.] officers have exercised their 10- Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGG 11,❑ Plumbing repairs or additions myself [No•workers'comp. c. 1.52, §1(4),and we have no 12, Roof insurance required.]t employees. [No workers' ❑ repairs comp. insurance required_] 13.❑Other 'Any applicant that checks bout l must also fill out the section below showing their workers'compensation policy information t 1 homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Corttractors that check this box must attached an additional sheer showing,the name of the sub-contractors and their wor?c►R'com,;•poticJ i;ter=anon. lam an employer that is providing workers'compensation innsurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date, Failure to secure coverage as required under 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 certify under the pains and penalties of perjury that the information provided above is tme and correct Signature: Date: Phone#: Offxial use only. Do not write in this area, to be completed by city or town ociaL City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. plumbing Inspector 6.Other Contact Person: Phone#: 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,.assooiation,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 tnrstee 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-contractor(s)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,notthe Department of i 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 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(if necessary)and under".lob 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 bum 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 Commonweadth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7745 Revised 5-26-05 www.m.-iss.gov/dia Date... /..�1....... .......... I f NO DTM A . 3:°•,;�`` "�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �7Sg,,CMUSEt r ! This certifies that ....':!�;...,.......... �....... '. :/.' -c ...................... has permission to perform ' ...........�......................................... wiring in the building of...... •.............:,...................................................... at.`A �? -a- ,North Andover,Mass. Fe�3/-S ... Lic.No 6 Gj ............. .1 ELECTRICAL INSPECTO Check # 8332 I � +, l.ommonwea&o f/i'lamackwe Official Use Only / c� Permit No. 43� 2.partment of Jire Serviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO. PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code rQ,5 7C 12.00 (PLEASE PRINT IN INK OR TYPE L INFORMATION) Date: or City or Town of: �• V\zdUe, - To the Inspector of Wires: By this application the undersigned givesnoticeof his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant S Q Q I Telephone No. to 5 Owner's Address 6Q vl�e— Is this permit in conjunction with a building pe�mit? Yes 21, No ❑ (Check Appropriate Box) Purpose of Building �M Utility Authorization No. S3 X 917 US 6 Existing Service /U d Amps told/a A(d Vplts Overhead Ef;-----�Undgrd❑ No.of Meters New Service Zgo Amps t /bLq Volts Overhead�Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires I � Swimming Pool rnd. E:i rnd. El Battery Units 1D No.of Receptacle Outlets, No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and O� Initiating Devices � Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump umber Tons I KW No.of Self-Contained No..of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of D ers Heating Appliances KW Security Systems:* �' No.of Devices or Equivalent No.of Water KWT No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or E uivalent " OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. y Estimated Value of lec ical Work: I ,10066 (When required by municipal policy.) Work to Start: IeK Inspections to be requested in accordance with MEC 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' surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true anj complete. FIRM NAME: .NO.: Licensee: ature C.NO.:p� (If applicable,a pt' 'n the licen number lIV-in n Bu Tel.No.: Address: 'jY3 i Oma• Alt.Tel.No.: *Per M.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 agent. 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