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HomeMy WebLinkAboutBuilding Permit #294-14 - 332 CAMPBELL ROAD 9/9/2014 a I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received i Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION `P,rrit, "PROPERTY:OWNER _ - - 100 Year Old Structure yes`` no P-ririt :MAP;NO:, PARCEL _ ZONING DISTRICT Historic District yes nod _ _r . - . Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration N o. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other = f'❑Septic` 01WellL0'Floodplain` gWetlands.a x ❑ Watershed�DistnctT4 y Crrp a _ ❑FY Yater/VGw�r.haah �+mss � - ;';...'- .�.-... _ _ ____.. �.... _ _ . - DESCRIPTION OF WORK TO BE PERFORMED: i Identification Please Type or Print Clearly) Phone: OWNER: Name: Address: r R kName� a al?hone: te:- f Supervisor�s�Gonstruction License - . Exp .Date Home�Improvement:License. - - - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accessto the guarantyfund Si hature`of contractor Signature:of Agent/Owner g =- Dlnno Ci ihrtt niari F-1Plans Waived F] Certified Plot Plan ElStamped Plans ❑ t I I Locatio � Date k(-- No. f / _ 9 TOWN OF NORTH ANDOVER .` Certificate of occupancy �$ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#�/ 26825 Building Inspector I I f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ { TYPE-OF SEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑...1--Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.. ❑ . Permanent Dempster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted-_yes i Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW To`a : Engineer: Signature: + Located 384 Osgood Street FIRE DEP,4RT(ili:ENT - Temp Dumpster on`site eyes no Located at 124 Mair Street Fire Department signatureldate COMMENTS i II 0 NO°T BUILDING PERMIT oc TOWN OF NORTH ANDOVER ° p APPLICATION FOR PLAN EXAMINATION - Permit N Date Received °9, �•n--�- " �4ss�cr�us t� Date Issued: I ORTANT:Applicant must complete all items on this page LOCATION a► C" (I �a Print PROPERTY OWNER IQ�' L1�`�► t�Q UQ�(�e� Print MAP NOJ16 dPAR'CElJ4q(.v ZONING DISTRICT: Historic District yeno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P- ne 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 IGQi►13 aCS� jjAQ �OY..� - bewo of lSt., r /1 /L�?,I!C &6-0 W6 i ad ",:2j oaq- 4r00,1 X414a T C,"/,:2 .z Identification Please Type or Print Clearly) OWNER: Name: (°C�5 � ��i�i�, Phone: Address. l .. {1 kt Hkjmv nip& � � ARCH ITECT/EGI NEER Phone": Address: Reg. FEE SCHEDUL&SULDING PERMIT.$ ZO $1000.00 THE TOTAL ES71MATED COSH"'BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 7.3 Receipt No.: NOTE: Persons contr cti g with unregistered contractors do not have access to tK 5Wqrantyfiund Signature of Age �G '� Signature of contractor NORTFt � t E Town o : _ Andover O 0% No. D _ * � Z n oh . ver, Mass, COC q.9• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT 1.t6 .U.......� +^ BUILDING INSPECTOR has permission to erect . g .,3,,a,,,,, ,,r,,,�� ...ad Foundation ......................... buildings ....... ......... 9 4 Rough tobe occupied as ...... ..... 1.3#vet. ....... ... ..-............................................................ Chimney provided that the person accepting this permit s I in every respect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC -TARTS Rough Service ............ ............................ .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. I Smoke Det. h SEE REVERSE SIDE I Di C 03HOU1I UC ITHOKINC. Phone: 978-569-3519 Fax: 978-824-2319 E-mail: noel@fmcconstruction.biz Online: www.fmcconstruction.biz Mail: P.O. Box 92, North Andover, MA 01845 HIC Registration: 143050, Exp. date: 6/14/2014 Tax ID: 271 468 346 MA CS License: 86883, Noel Costantino, General contractor Date: 9/2/2013 Customer: Rob Obrien 332 Campbell Road North Andover, MA 01845 I I Description of labor for porch remodel project: 1. Demo existing screen panels and frame work,plywood on ceiling and battens from exterior walls (in porch area) and remove plywood from exterior walls 2. Install 1x8 beaded, knotty-pine to ceiling area 3. Wrap perimeter beam with knotty pine and install bedrail molding to cover gap at ceiling 4. Install approximately 200 sq. ft. of white cedar shingles (at 5"exposure)to walls in porch area 5. Wrap steel lally columns with knotty pine and construct(6)more additional columns to match 6. Install pressure-treated sill around perimeter of concrete porch slab 7. Install 2x4 fir cross rails (around 36"high, exact height to be determined by t homeowner) with 3-1/2" fir sill at interior and pine stop bead for eventual screen panels 8. Construct screen panel frame above new screen door opening and install new wood screen door with hardware and door closer 9. Install customer-supplied screen panels to porch (will need 12 individual panels with sizes to be determined after build-out) 10. Dig and pour four new concrete footings for landing 11. Provide framing for a 5' wide x 4' deep landing and stairway to ground level ending with a concrete pad on grade 4,W rJ,�yE� LICENSED View examples of our work at: BBB. INSURED www.fmcconstruction.biz PIAT-28333-1 12. Install(6)4x6 posts to landing and stair frame 13. Install approximately 40 sq. ft. of pressure-treated decking to joists and stair framing and construct railing and baluster system with pressure-treated stock to match existing side deck 14. Wrap exposed sides of pressure-treated stringers and risers with V primed pine stock 15. Remove and dispose of existing railroad ties between front of house and driveway li Payment Schedule: The cost to build the above project is$15,250. This is a labor and materials quote based upon the initial consultation and on-site meetings. A non-refundable deposit of $200 will be required to secure the start date*. The remaining payments will be made as follows: A First day of construction 6500 ➢ At the start of the second work week 6500 ➢ Completion of project 2050 *work will commence on Sept. 12"and should be significantly completed by Sept.27fl' i r i� i �C5�Nz 6EPA = LICENSED -�- View examples of our work at: BBB. F, INSURED www.fmcconstruction.biz NAT-28333-1 l i All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by Provisions of Chapter 142A of general laws,must be registered with the Commonwealth of Massachusetts. Inquires about registration and status should be made to the Director,Home Improvement Contract Registration, One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 TERMS AND CONDITIONS WARRANTY INFORMATION: The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of one year following completion and shall comply with the requirements of this agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after substantial completion of any job, including cleanup,the Contractor shall, at his own expense, forthwith remedy repair, correct, replace, or cause to be remedied,repaired, or replaced, such damage or such f defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the Contractor under this agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufactures' warranties, the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. The warranty gives the Owner specific legal rights, and Owner may also have the other rights which vary from state to state. Under Massachusetts law, sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. SPECIFIC TERMS AND CONDITIONS: • Any and all construction-related permits shall be the obligation of the contractor to obtain. Homeowners that secure their own construction- related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund • Permit fees associated with the project are the customer's responsibility and will be added to the final billing LICENSED View examples of our work at: L BBB. INSURED www.fmcconstruction.biz NAT-283333-1 i • FMC is not responsible for any existing defects, structural or cosmetic, that are undisclosed or undiscovered prior to the start of the project • Any such undisclosed or"hidden"damages could result in a project delay 0 If any existing defects arise and do hinder the projects progress a labor and materials quote to remedy the issue will be presented to the homeowner in a timely fashion • Any delays with permits or inspections could result in a project delay • Any delays with special orders of materials could result in a project delay • Any delays with payments could result in a project delay • All waste materials will be disposed of into an on-site dumpster, or removed off- site to a transfer facility • No assumed work beyond the specifics of this proposal will be performed • If additional work for this project is desired, a separate labor and materials quote will be provided and must be agreed upon by FMC and customer before additional work is performed • FMC reserves the right to photograph all aspects of the project from start to finish and may use the images for promotion • In the event of a project .cancellation, all project-related expenses (labor and materials) incurred to date will be applied to the most recent payment • FMC reserves the right to terminate the project if payments are neglected or ignored,without notice, for a period of seven days past due 0 Reasonable care will be taken not to damage any landscaping surrounding the perimeter of the home or property however FMC is not responsible for any minor damage that may occur as a result of the construction process • Homeowners shall not deposit anything non-project related into the on-site container unless permission has been granted by FMC • FMC contracting work will meet all state and local building codes • The customer reserves the right to reject any lumber or building materials deemed unacceptable or of poor quality • No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract • After a thirty day period,prices of this contract are subject to revision I,the customer, hereby understand and agree to the terms and conditions contained in this contract for FMC services. Do not sign this contract if there are any blank spaces. - r Customer Signature lam' f ', �`�� Date A/ f z-, Contractor Signature Date A;- � t.EPA.. 4� uc�. ENSED i e ' View examples of our work at: BBB INSUREDwww.fmcconstruction.biz NAT-28333-1 �� �� i NOTICE OF CANCELLATION You may cancel this transaction,without penalty or obligation, five business days after FMC Realty& Construction, Inc. receipt of the signed proposal and deposit. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instruments executed by you will be returned within ten business days following receipt by the contractor of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the contractor at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale; or you may, if you wish, comply with the instructions of the contractor regarding the return shipment of the goods at the contractor's expense and risk. If you do make the goods available to the contractor and your contractor does not pick them up within twenty days of the date of cancellation you may retain or dispose of the goods without any further obligation. If you fail to make the goods to the contractor and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice to the contractor at the following address: FMC Realty& Construction, Inc. P.O. Box 92 North Andover,MA 01845 I hereby cancel this transaction Buyer's signature —Date- LICENSED ateLICENSED + View examples of our work at: - BBB INSURED www.fmcconstruction.biz NAT-28333-1 t I� The Commonwealth of Massachusetts Print Form vii Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Em—c, &A t or f Li zQn Address: City/State/Zip: Qd/_5Z Phone#: `72J-5<p 9 3J%9 Are you an employer?Check the appropriate box: Type of project(required): 1.[gI am a employer with off• 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y P �'• t 9. Building addition [No workers' comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: [� ty eLl b /qi c k- Q Policy#or Self-ins.Lic.#: yc, "yD0 -]vel 7,70b o?0/4,14 Expiration Date:__0 f Job Site Address:�� CA,414& &d City/State/Zip: V 74,�d6 VV/- (J`J'�( 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 cErn&under tlLepa. an enalties ofperjury that thein ormation provided above is true and correct: Signature: Date /3 Phone#: 9�c9--sCo ��S(9 Official use only. Do not write in this area,to be completed by city or town offwial 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#: I �lassachu�ctt�- Dc{tartmcnt of Public Safety Board of Building- Re,,ulalions and Stantlartls Construction Supervisor License License: CS 86883 i NOEL L COSTANTINO 13A PAULINE ST WINTHROP, MA 02152 Expiration: 12/26/2013 ('nnmi>si neer Tr=: 7485 e G,",21nr arcucalf�o/ `a 3acfuNeff' n,_Office of Consumer Affairs&Business Regulation SOME IMPROVEMENT CONTRACTOR registration: 174628 Type: expiration 3/572015- Corporation FMC REALTY&CONSTRUCTION,INC. NOEL COSTANTINO 13 A PAULINE STREET WINTHROP,MA 02152 Undersecretary I i ACORDm, CERTIFICATE OF LIABILITY INSURANCE DATE /D 09 0099 22013013) I PRODUCER (617) 846-8600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John M. Biggio Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 399 Winthrop Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WinthropMA 02152- INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER&Harleysville FMC Realty & Construction INSURERB:AIM Mutual Insurance PO BOX 92 INSURER C: INSURER D: North Andover MA 01845— INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY _DATE MMIDDIYY LIMITS A GENERAL LIABILITY SPP 97481K 10/04/2012 10/04/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 'GE Ea oxurGE TO RENTED re".) ence $ 100,000 CLAIMS MADE a OCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY JECT LOC X AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMB $ ANY AUTO (Ea accident) ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG S A EXCESS/UMBRELLA LIABILITY CMB 47158P 11/05/2012 10/04/2013 EACH OCCURRENCE S 1,000,000 X OCCUR FICLAIMSMADE AGGREGATE S 1,000,000 DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND AWC 7027586012013 06/29/2013 06/29/2014 WC STATU- O R EMPLOYERS'LIABILITY TORY LIMffS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFACERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of Andover FAILUREDO SO SHALL IMPOSE NO 066TiON OR LIABILITY OF ANY KIND UPON THE INSURER, GrANTS O_R REPRESENTATIVES. AUTHORIZ R SE THE i Andover MA 01810- ACORD 26(2001/08) UU ©ACORD CORPORATION 1988 INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(8 D 327-0545 Page 1 of 2 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 21A=F and G min.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol;Lowing 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 o Workers Comp Affidavit o 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 o Building Permit Application o Certified Surveyed Plot Plan o 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) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include-Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 9 9 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ii 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 9235 Date. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS� This certifies that has permission to perform . . . .? ? plumbing in the buZ// . ngs of . . . a�. . 0/ rlm. . . . . . . . . . . . . . . S�. . . . . . . . . . . . . . . .. N Andover, Mass. Fee. ,Gr�� �`'• ,�!<< . . . . . . PLUMBING41N PECTOR Cheek # 3� i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� Date Building Location 3.3"9 Z Owners Name Pd 04r1-e J Permit# Amount ' Type of Occupancy �Gf�jJ New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES 1z rA d i z H x a U w cc Z F W H x ;To U A z a 0 F c x z x �" d rz a a w a s w SWERM IIi4,4OMM 3M if M HDOR sni>f sn><HDOR 7]R 1M sm HIM (Print or type) --� Q�f Check one: Certificate Installing Company Name l/�"i j (f- Z -11 Corp. Address 50 1:1Partner. /fW V'06 ifl��—�rv�/* c::,/ 12,-? Business Telephone L/01-3 Firm/Co. Name of Licensed Plumber: l �v Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance,policy Other type of indemnity ❑ Bond Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance I Signature Owner Agent I hereby certify that all of the details and information I have subm' eq(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati s p rformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett tit lumbing Code and Chapter 142 of the General Laws. By: Igna a oFFNENNATFum Der Type of Plumbing License Title 1��y` PPROVED(OFFICE USE ONLY City/Town License NumDer Master 0— Journeyman ❑ PRO Date.e .................... TOWN OF NORTH ANDOVER 0 I- • PERMIT FOR WIRING CHU ....... ..... ....................................... this certifies that .......( . ......... has permission to perform ..... ....... ............................. wiring in the building of.... .......... at....3-319 ..................... . ........................... North Andover AWass. Fee;, .............. Lic.No...../(T .. ...-... ELE CF.. INSPECTOR .. ...... Check # 0542 I TJ Commonwealth of Massachusetts Official Use Onl�y/*� Permit No. .1 5 'Z [ — Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FO.R 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: rL, 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) ,j (- b ell Owner or Tenant /`J I I Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Buildingp�1 Yv1 A/ V ,� Utility Authorization No. Existing Service Amps Volts Overhead ❑ 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: Completion e ollowing table 6y 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 El In- ❑ o.o Emergency Lighting rnd. rnd. Batte 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 Initiating Devices j No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I.NyTher].Tons IKW No.of Self-Contained Totals: Detection/Alerting Devices ,No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 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: z5)00 a (When required by municipal policy.) Work to Start: //J Inspections to be requested in accordance with MEC Rule 10,and upon completion. RANC C VE INSUGE: 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 WrdpFnalties of perjury,that the information on this app lic ion is true and complete. FIRM NAME: CJ f- C- G LIC.NO.: Licensee: I�1 $' t�5-lctcsL-2n Signature LIC.NO.: 16`2,j - (If applicable, enter "exempt"in the license number line) Bus. Tel.No . 6-2!J-2-q35 Address: T 3 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 Owner/Agent PERMIT FEE. $ S Signature Telephone No. 1 All 1 Alf 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 00 C6 o 4, C, I� Address:/I7 Ste_ City/State/Zip:yn_q n rb4 J��r &k 3/0, Phone#: j 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 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am 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. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.ElI 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.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are 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: `r, h Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: E 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 adv'Sed that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage erification. � I I do hereby certify under the pains and pen ties of Iury that the information provided above is true and correct. Si nature: Date: Phone#: O 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#: s Date.. 3.. b....... ° N°oT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHU This certifies that ... .��l.S. ..J...... ?.6:..L................................ has permission to perform yy..S n ........... ......... wiring in the building of.f--.fit. �.���.,.. i� . at.., ... '. ..b r. �........ .........:...... .North Andover,Mass. Fee....,r .:...... Lic.No.., 7.�y3 ?. ....................................... -......... - //__ ELEcrRICALI pECTOR Check # 2� 6 � 6 .0 Commonwealth of Massachusetts Official Use only Permit No. (10 Department of Fire Services Occupancy and Fee Checked s` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] 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: City or Town of: .�nd over To the Inspector of By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,3 J 2 C m Owner or Tenant p d' ice,a �� Telephone No. ]�-/•�"5,�- 6' Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Sert/iG e Upit*l{ Utility Authorization No. /06' Existing Service/00 Amps 120/ NO Volts Overhead 91 Undgrd ❑ No. of Meters 1 New Service 9,00 Amps / C{.fjVolts Overhead � Undgrd ❑ No. of Meters / ,. Number of Feeders and Ampacity /•YOAV,1`3oQnlp,/"kl0 comp, /3 -2!e l , /-/`-- -/6"94,Q Location and Nature of Proposed Electrical Work: t 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 El In- El o.o mergency ig mg rnd. rnd. Batter 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers eat Pump Number. Tons K No. o el - ontamed Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal [–] Other IN Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications irmg: No.of Devices or,Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: q00, 06 (When required by municipal policy.) Work to Start: ,Q Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of h bili insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force,and has exhibited proof of same to the permit issuing office. P CHECK ONE: INSURANCE BOND ❑ (Specify:) OTHER S I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: J M S / l0 r'G LIC.NO.: 31124 .3 r— Licensee: Signature > ,� LIC.NO.: (If applicable enter "exempt"in the i ense number line.) Bus.Tel.No.: 917-3 3—r- Address: Sf ^ I Alt.Tel.No.:ZV-Z24-26 T6 *Security System Contractor License required for this work;if applicable,enter the license number here: 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. Owner/Agent PERMIT FEE: $ Signature Telephone No. P Town of North Andover o �o oTM k f? bbd�- 46.0 OOH Office of the Conservation Department Community Development and Services Division i 27 Charles Street �4SSacHus`� North Andover,Massachusetts 01845 Telephone 978 688-9530 Alison McKay P ( ) � Conservation Associate Fax(978)688-9542 October 17, 2002 Mr. Robert O'Brien rr 332 Campbell Road j North`Andover;NIA 01845 Dear Mr. O'Brien: Thank you for taking the time on Tuesday October 15th for allowing Ms. Parrino and myself to inspect your property for potential wetland resource areas within the 100 foot buffer zone of the disturbed area that was sited on the property as documented in a letter dated October 8th Upon this inspection and as discussed with you on site, it was determined that work(tree clearing and grading) had occurred within the 100 foot buffer zone of a bordering vegetated wetland, but did not encroach into the 25-foot No-Disturbance Zone. Therefore, the submittal of a woody revegetation plan is not necessary at this time. However, we recommend stabilizing the area as soon as possible to prevent potential sedimentation into the resource area. As was also discussed, any work proposed within the 100-foot buffer zone of a resource area is subject to a Request for Determination of Applicability or Notice of Intent filing with the North Andover Conservation Commission. Please be aware that any further work within this buffer zone would require such filing. Ms. Parrino has decided to waive a filing in lieu of a$200 fine in this case. In accordance with the provisions of MGL c.40 s.2 1D and Section 178.10 of the North Andover Wetlands Protection Bylaw, alteration of any wetland resource area or their respective buffer zone is punishable by a fine of up to $100 per day. Please make the check payable to the Town of North Andover to accompany the enclosed violation ticket. I have also attached a list of local consultants, engineers, and surveyors if you intend to do any work in the future and need further assistance on these matters. i Thank you for your anticipated cooperation and do not hesitate to call if you have further questions in this regard. Sincerely, Alison E. McKay, Co rvation Associate BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i Cc: Julie Parrino, Conservation Administrator NACC DEP Mike McGuire,Building Inspector File i TOWN OF NORTH ANDOVER NOTICE OF VIOLATION OF WETLAND BYLAW 0125 DATE OF THIS NOTICE /I)—/7— NAME OF OFFENDER --� t Ids K fLePS'Ae. U)-'It € Mn Izd er+ Qf g","en ADDRESS OF OFFENDER ' CITY,STATE,ZIP CODE I DATE OF BIRTH OF OFFENDER Ao v D 8 MV OPERATOR LICENSE NUMBER MwMB REGISTRATION NUMBER i OFFENSE: Claw nG o,,� arac�lnu �tii �n '7�2 C-')d Q4zr a va(;d O(LJQ, ` Co�d;f;an.s TIME AND DATE OF Vt TION 101 20199, LOCATION OF VIOLATION 1 A'!! AT 3 a Q oA NOA vr?r,M SIGN fiE OF ENF CI P f�4FORCING OEPPTMENT i WY1 h I HEREBY ACKNOWLED RECEIPT OF THE FOREGOING CITATION X ❑ Unable to obtain signature of offender.Date Mailed NKCitation mailed to offender CO THE FINE FOR THIS NON-CRIMINAL OFFENSE IS.% JROO, YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER. (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:30 P.M.,Monday through Friday,legal holidays excepted,before:The Conservation Office.27 Charles Street,North Andover,MA 01845 OR by mailing a check,money order or postal note to the Conservation Office WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.This will operate as a final disposition of the matter,with no resulting criminal record. (2)If you desire to contest this matter in a non-criminal proceeding,you may do so by making a written request,and enclosing a copy of this citation WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE TO: The Clerk-Magistrate,Lawrence District Court 380 Common St.,Lawrence,MA 01840 ATTN:21D non-criminal (3)If you fail to pay the above fine or to appear as specified,a criminal complaint may be issued against you. ❑ A.I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ ❑ B.I HEREBY REQUEST a non-criminal hearing on this matter. Signature WHITE:OFFENDER'S COPY YELLOW:CONSERVATION COPY PINK:POLICE COPY GOLD:COURT COPY Town of North Andover o� «o RTH Office of the Conservation Department F- 9 Community Development and Services Division °gAT[D r�y.(y 27 Charles Street 9SSACHUSf� North Andover,Massachusetts 01845 978 688-9530 Telephone Tele Julie Parrino P ( ) Conservation Administrator Fax(978)688-9542 Ms. Katherine Wilk 332 Campbell Road North Andover, MA 01845 October 8, 2002 RE: Violation of the Massachusetts Wetland Protection Act(M.G.L. C.131 S.40) and The North Andover Wetlands Protection Bylaw (C. 178 of the Code of North Andover). Dear Ms. Wilk: On September 23, 2002 this department observed equipment on site and on October 4, 2002 the department further observed that alterations had occurred, specifically tree clearing and grading. Upon further investigation, the department's wetland maps indicate that the site may be located in the buffer zone of a protected wetland resource area. Please be aware that any work or land alteration proposed or conducted within 100 feet of a Bordering Vegetated Wetland is subject to a Request for Determination of Applicability or a Notice of Intent filing with the North Andover Conservation Commission (Sections V and VI of the North Andover Regulations). According to Section H(b) of the North Andover Wetlands Protection Bylaw, an "alteration"includes,but is not limited to, the placement of fill, excavation, or regrading. The North Andover Wetlands Bylaw also maintains a 25-foot No-Disturbance Zone and a 50-foot No Build Zone, which must be adhered to. Please contact me at (978) 688-9530 to set up an inspection so that I may accurately determine if wetland resource areas exist on the property and the extent of their boundaries. Thank you for your anticipated cooperation. Sincerely, y , f r� Alison E. McKay Conservation Assciate Cc: NACC members File Michael McGuire, Building Inspector BOARD OF APPEALS 688-9.541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535