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HomeMy WebLinkAboutBuilding Permit #463 - 834 CHESTNUT STREET 12/11/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 4- - IMPORTANT: Applicant must complete all items on this page LOCATION.. r� eb�>JJ1 S7 Print PROPERTY OWNER 2 Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ❑ Demolition ❑ Other R 64L�JG" ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: 214E114J Phone: 96 857 360Y Address: CONTRACTOR Name: L t I I ipon IRA 4,44\JT-Phone: 901 S95 100t r' Address:LY�� Supervisor's Construction License: /o( 61 A Exp. Date: -ly-an�y Home Improvement License: % yl '7') & Date: a"i 5 au 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: $ 9hQ FEE: U 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 ❑ Location��� No. Date Check #7q`/ 26031 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $_ Other Permit Fee 7F7' $� TOTAL ' / $_C51� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS r DATE REJECTED HE DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW T owp- ]Engineer: Signature: LOcatea 3M us 000 Street FIRE'DEPARTMENT - Temp Dumpster on site yes no Located at'124 MainStreet Fire Departinent 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, roast 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 ® 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 ❑ 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 o 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 submtted with the building application Doc: Doc.Building permit Revised 2012 12/11/2012 21:02 17815955820 AMBROSE INSURANCE ft EMU CERTIFICATE OF LIABILITY DUCER rose Insurance Agency, Inc. 56 Central Ave. Lynn, NA 01901 781-592-8200 Trahant Roofing Co. Willi= Trahant, Jr. Construction, Inc. 215 Verona St. Lynn, MA 01904 PAGE 01/01 INSURANCE DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A- First Niercur NAIL# 10 RE PREMISES Es occurenco INSURER B: Chartis MED EXP (Any Ona person) INSURER C: PERSONAL RADV INJURY INSURER D,. GENERAL AGGREGATE INSURER E: PRODUCTS - COMP/OP AGG "� r v�I' MO Ur IrvSUKANGE 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 19SUED 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE a OCCUR A NJCGL000017301 9/8/12 GEN'L AGGREGATE LIMIT APPLIES PER; POLICY F7 MOT I I LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNEDAUTOS GARAGE LIABILITY I A14YAUTO EXCHSSNMBRELLA LIABILITY I OCCUR u CLAIMSMADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATIONAND EMPLOYERS LIAarLITY ANY PR0PR1ET0RMARTNERIEXECUTME H OFFICER/W.M4LR EXCLUDEDT 51750679 4/3/12 hon.deacrlbaunder )ESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES/ Roofing Contractor Town of North Andover Attn.: Building Dept, Town Hall N. Andover, MA, 01845 Fax: 978-688-9542 CORD 25 (2001108) 9/8/13 EACH OCCURRENCEUAMADU S 10 RE PREMISES Es occurenco $ MED EXP (Any Ona person) $ PERSONAL RADV INJURY $ GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG Is 4/3/13 PROVISIONS COMBINED SINGLE LIMIT $ (EA aceldsnl) SODILYINJURY $ (Per person) BODILYINJURY $ (Paraccidem) PROPERTY DAMAGE 3 (Pernccldenl) AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC S AUTOONLY; AGG $ EACH OCCURRENOE $ AGGREGATE S E,L,EACH ACCIDENT I $ 500 000 EL. DISEASE. EA EMPLOYE S 500 QQQ B.L. DISEASE • POLICY LIMIT 13 sn n _ nn n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MA00 DAYS WRITTEN NOTICE TO THE CERTIFICATE BOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABII.nY^Y KIND UPON THE INSURER, ITS AGENTS OR ®ACORD CORPORATION 1988 The Commonwealth of Massachusetts Board of Building Regulations and Standards . Massachusetts State Building Code, 780 CMR, 7`" edition Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two -Family Dwelling Revised Aril 15, 2009 This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Commissioner/ Inspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Property Address: 819 r,¢sfnoT_ s % 1.2 Assessors Map & Parcel Numbers Map Number Parcel Number 1.1 a Is this an accepted street? yes no 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sq ft) Frontage (ft) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required IProvided 1.6 Water Supply: (M.G.L c. 40, § 54) Public ❑ Private ❑ 1.7 Flood Zone Information: Zone: Outside Flood Zone? Check if yes❑ 1.8 Sewage Disposal System: Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 �w►e-'ofRecord "m [ --f �, f" " — Name �in) Address for Service: qn Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORIe (check all that apply) New Construction ❑ Existing Building ❑Owner -Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other tf Specify: S-rA p c qd Brief Description of Proposed Work 2: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1. Building $ (, 6 00. o -a 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee ❑ Total Project Costa (Item 6) x multiplier x 2. Other Fees: $ List: 2. Electrical $ 3. Plumbing $ 4. Mechanical (HVAC) $ 5. Mechanical (Fire Su ression $ Total All Fees: $ Check No. Check Amount: Cash Amount: 0Paid in Full ❑Outstanding Balance Due: 6. Total Project Cost: $ ,�. 0 Ci SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) L. j t l+�t� 2P44A,0-r A 1Z_ License Number Expiration Date List CSL Type (see below) RF Name of CSL- Holder ,)-Isve�o� �yN�,m� �-�' Type Description Address U Unrestricted (up to 35,000 Cu. Ft. R Restricted 1&2 Family Dwelling J —h(� Signature M Masonry Only 1).91 s?I RC Residential Roofing Covering WS Residential Window and Siding Telephone SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor (HIC) ' LI l Will,p„ -r kA MtJt -hR CWS-feX+02 TAK— Registration Number HIC Company Name or HIC Registrant Name al'15, YfQrlc, S i` 1—.y my ;/YW Address �f /S /X11 Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER' AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, --'f, as Owner of the subject property hereby authorize NaA&rr NR ca"4Q )c-tiod to act on my behalf, in all matters relative work aut a by his building permit application. Si n tur@ of Owner Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. C) 111„ ar, -tAAN4-J —I Pri5t Name ia2-f/-a��2 Signature of O er or Authorized Age Date (Signed under the pains and penalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor (HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5, respectively. 2. When substantial work is planned, provide the information below: Total floors area (Sq. Ft.) (including garage, finished basement/attics, decks or porch) Gross living area (Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/ porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for "Total Project Cost" Page No. WIVI. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street LYNN, MASSACHUSETTS 01904 (781) 599-1211 e (781) 844-4551 * FAX: (781) 581-0855 PROPOSAL SUBMITTED TO PHONE DATE pc) SS -7 330 STREET JOB NAME CITY, STATE and ZIP CODE ) n- ,, , ) We hereby submit specifications and estimates for: SHINGLE ROOF Strip entire roof -- - ---- - ------ ---------- 12R _,,��Iace any bad boards up to 100 linear feet __ ------------ ____ —1-1 - - - -------- - einstall ice and water barrier first three feet up roof ---------- ,6nstall ice and water barrier in all valleys and along dormers ------------------- — --- - ---- Z Install 151b. felt paper on remainder of roof --------------- ------- - ,R] Install eight inch drip edge rylI ----------- Ep-'Install ridge vent -...5.._-_--------------- [ZFIash or re -flash chimney(s) El Install new pipe flanges M Install -30 year shingle Lei Mr3k" --------- --- - ---- ------ El Install gutters and downspouts ---------- ---- --------------------------- - - El Install trim coil ---------- ­_­ ___ — ___ I ------ ----- - ------------- - ----------- - --- El Install new fascia boards -------------- EJ Install new rake boards ------ ------ ----------------- ---------- 0 Install sky light(s) .­ ­ ----------- ­­­ ----------- -------- -- JOB LOCATION Of Pages H.I. LIC. #141778 We hereby submit specifications and estimates for: FLATZRUBBER ROOF ------- --- _ --- -- --- -- ----- ----------- ------------- El Sweep entire roof clean ­ ---- I ----------------- ---- ----------- ---------- 0 Strip entire roof ------------ ---- ------------------ 0 Mechanically fasten down ISO board insulation - -- ---------- ---------------- ------ -------- ---------- __ ------------ El Install 060 Rubber Roofing on entire roof --- ------ -- El Install metal flashing around perimeter of building --------- -- ---------- ----------------- ------- --- El Flash chimney(s), pipe(s) and wall(s) El Edge caulk all seams ----------- ----- EJ Install new copper center drain - --------- ------------- El Other: ----------- El Clean up all debris .- ­__. -_ _ ---- ----- ---- _ - ----- ----- ---------- ----- ------ -- El Labor and materials guaranteed 100% for five years ------------- ­_ I ------ ------- ------- ---- - — __ __ ---------------------- -------------- - -- ---- ---- ------------------ -- ------ _ -------- E:1 Other: — ------ - --- - -------- ---- ----- ---- Clean up all debris ---- ----- - -------- - ------ --- ----------- --- ----- -------- -- --- ---- Aabor and materials guaranteed 100% for five years --- ---- --- - -- ---- --- -- - ------ --- ---------- ----- -- Z All shingle roofs are nailed by hand. PejJrvVasje -hereby to furnish material and labor — complete in accordance with above specifications, for the sum of. Total Price ($ C�w - oo *IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS.** All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifica- tions involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. icrieptaure urf jJraposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: /2 3, Please mail yellow copy to above address. Authorized Signature —&.1 ID 14.0 bg /j Signature Signature— The Commonwealth, of M5msachuseti Deparieng of Indysti'ial?Accidents - Offtce o, f Inves;iigations 600 Washington Sheet / Boston, M4 02111 WWW.M ss.gov/ufla Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectsiciE.! s/Plu-mbyrs A>p�l�ewut Information 4 lease Print Legibly Name(Busir-iess/Organization/Individual): 1AJd1,An. 7QAaAWT -t2 0)M- VC-'*iJA/ r/VC- Address: 2US Vriea"P, s7'. City/Skate/Zip: 1,/A/&/ , MA (5 yid % Phone #: ?6Y S_S� Are on an employer? Check the appropriate box: 1. LTJ I am a employer with / C� 4. ❑ I am a general contractor and I employees (full and/or part-time).` have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and As officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ Nevi construction 7. ❑ Remodeling 8. [-].Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. oof repairs 13.❑ 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 state viliether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer Mae is providing workers' compensation insurance for nay employees. Below is Me policy andjob site igformastion. Insurance Company Name: CUAkjo — Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address 63.1 CI5+00-( 5-r City/State/Zip:,Ajp A J aoy`2- Attach a copy of the Workers' coampeusntaa n 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 ime 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. 1 do hereby cert fy aander�the pains and penaLdees of perjury that the information provided above is trace and correct. Phnne. #• 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 I A 46 cu CL U X C4 LU O. CL 4- 0 oIENp pn C-Oi WI -41 0 Z CO Q go 0 U � 0° 3Na I Fr- Z 4mo 0 E f x Q W LL o a O LL i-+ O_ Ln O W Z Z J c coo 7 LL W N C U _ LL O W CL Z Z a 7 110 K I LL O W CL Z V uj L j d' U Ln _ f6 LL O w Z L 3 K f0 LL �. W 2 a CL W LU ` a) c m Z N t Ln v O Ln != Q h = c a N �NGO4_A�' fir'O 4� C . N J d L m U) °�' M = 4) R L- w 0 N o� > t s o E o moz Com" N C O R C � r ?� al o O O O 1 -- CL Q. d CD ' O v O C 2 � Qy•� N W 'Cw 00 p � •� .V -a V O LLJ L V R C O H 70 CD CL 5E d .' 4- = J to -Q O O H t AM CLV > � F- T" ampow OMMEMP amom .- i SIV N '1 E 0 0 d z N i c N 0. N .C � �CD m m �i 0 �+ �a 0 O CL^ ii c Q 0 .2 CL �z 0 CL V i i CL U) Cl LLI N W W 19 W v/ R O O R o n. m m Q Avg V E n CD N .' w a cu o b != Q h = c a N �NGO4_A�' fir'O 4� C . N J d L m U) °�' M = 4) R L- w 0 N o� > t s o E o moz Com" N C O R C � r ?� al o O O O 1 -- CL Q. d CD ' O v O C 2 � Qy•� N W 'Cw 00 p � •� .V -a V O LLJ L V R C O H 70 CD CL 5E d .' 4- = J to -Q O O H t AM CLV > � F- T" ampow OMMEMP amom .- i SIV N '1 E 0 0 d z N i c N 0. N .C � �CD m m �i 0 �+ �a 0 O CL^ ii c Q 0 .2 CL �z 0 CL V i i CL U) Cl LLI N W W 19 W v/ Date .....�1..." .� ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....................:.? ............. .,.... .:. ..... 1......................... has permission to perform ....,.: ..�&7n wiring in the building of ................. ............................... at.f.. .............. F.........�.::�............. North Andover, Mass. Fee.?: ... ...... Lic. No:;�/�..`�l.-.?.F...... ............... I .......................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer \ The Commonwealth of Massachusetts (Mice 11.. Owlr Drporhnrnt of Public ScJcty p.relt 71.. o«wmne, a r.. ok.e►a BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 Uqt:..�. atae: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to bt periorened in accordance With the Mauachuseru Electrical Code. S27 CMR 12:0o (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -7)z C : 3..,_ � y I City or Town of ,t1lUtUU (��0091 To the Inspector of Wires: The undersigned applies for a Permit to perform the electrical work described below. Location (Street Ir Number) 0 C P S7 -AJ dl- 'V I Amer or Tenant r ri Eh w o r tyi Amer's Address x s 1 L.11 P S Is this permit in conjunction with a building permit: Yes [0 No ❑ (Check Appropriate Box) Purpose of Building au /07-7--70 /L' Utility Authorization 80. Existing Service V Amps a o)Q 1 /a0 Volts Overhead 1311"Undgrd ❑ No. of Meters_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No.'of deters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work S--? No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting fixtures g Swimming Pool Above 11In- grnd. grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners Batter Emergency Lighting U its No. of Switch Outlets C9 No. of Gas Burners FIRE ALARMS . No. of Zones No. of Detection and Initiating Devices of Sounding Devices No. of Sal # Contained Detection/Sounding Devices Local ❑ Municipal ❑Other Connection 'to. of Ranges h 6 Total No. of Air Cond. tons No. of Disposals No.No. No. of pumps Tons Total Total No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHERs 91)"7c4e -- / -- INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ MOO I have submitted valid proof of sane to this office. YES ❑ No If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please[ Specify) Estimated Value of Elec rical Work S J d 0 xp rat on ate Work to Start /a � Inspection Date Requesteds Rough g16 9 q Final Signed under the penalties of perjury: _ FIRM NAME / 41j.c�-� � 1JQE/��✓HN J� - �' �4;c/ i c'R�,t� LIC. NO. o2067, - Licensee �o y67E licensee kcIed- Ah��/�✓q�./ Sh _ Signature �g�� , Z-�- � LTC. NO. 076967 E Address :L-c/VE2/; f�f�ll�. p/9.23 Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I an aware that the Licensee does not have the insurance coverage or is sub- stantial equivalent as required by Massachusetts Cenersl, Laws, and that my signature on this permit appI s on� a this requirement. Owner Agent( (Pll�eaase check(�one) Telephone Nb97� e PERMIT FEE S Signature of Owner or Agent Location No. 61 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ I._ :: Foundation Permit Fee 7 'Other Permit -Fee 'S&�qonnection Fee ``• „�, �, Water Connection Fee TOTAL - .� Building Inspector Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP K40. * ;� LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZO(1w_ SUB DIV. LOT NO. w-wY)S-k LOCATION- ' PURPOSE OF BUILDING OWNER' AME C1 � he /) NO. OF STORIES SIZE OWNER'S ADDRESS 63q Ch K S� BASEMENT OR SLAB -- ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST 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 BO?RD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE ATURE OF OWNER OR AUTHORIZED AGENT FEE ASSN PERMIT GRAN D z S 19_ WHITE: Building Dept. CREAM: Assessors 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST �19V V EST. BLDG. COST PEA SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN i CANARY: Treasurer oL/• r�r .no�G4.�VR r /) J�� /� � �ff P r/7 ,l Y` J/vN WIC n V �� • t) �� /,/'J A L U C • 1-u � 01 � h ONIIV3H ON Pic I tsl A79 830NI:) 80 '5NO5 :)1 10313 _I PUL 1.W.9 3WV8i NO ADI89 110 SWOON 40 'ON L 80011 SVo '8 'SM X1111 Sa31d3H 11Nn ABNOSVW NO AD189 ON13OO8 1108 _ 0.1.H 1NVIOda ONINOI110NOD aIV 80dVA 80 a.1.M lOH— WV31S Nei aIV lOH GKMOd 3JVNani SS313dld — S831iV8 OOOM ' 8 13315 S1OD 0� 'SWOW9 a39W11 1SIOf DOOM _ 'JNIIV3H ll II ONIWViIi 9 �, � CVM �dSt�j�c� �U�LIS i.( fi%►fiN q6" 7 UL NO d 1� i0 �O aq Hell 'NV -1d 101d S30b-ld3U SIH1 'a3SOdW12l3df1S '013 'S30V21 -V9 'S3H0210d H11M 'SVN1a'11f18 d0 SNOISN3W10 10VX3 ONV S3N1'1 101 W02dd 30NV1S1a ONV 10'1dOSNOISN3W1a 10VX3 MOHS1Sf1W N01103S SIHl ZI CV033V JN1411n9 ON18Wnld 01 11 iooa. S ONINIM A8NOSVW NO 3NO1S A79 830NI:) 80 '5NO5 OOVO 3111 3WV8i NO ADI89 _I booli 3111 80011 '8 'SM X1111 334nlxli Na30OW ABNOSVW NO AD189 ON13OO8 1108 _ 83MOHS 11VIS ON19Wnld ON 9 13AVSO 8 811 31V1S _ ANIS N3HD11A S30NIHS DOOM O.MG8VH A8O1VAV1 S31`LDNIHS DOOM S310NIHS 11VHdSV 1080 13SO1-I 631VM 03HS1111 S1001i 6 II S11VM 17 1'X11 ZI 'W8 131101 08VSNVW 1389WVO 'Xli E H1V9 W008 OV3H dIH 3191`) ON18Wnld 01 11 iooa. S ONINIM A8NOSVW NO 3NO1S A79 830NI:) 80 '5NO5 3WV8i NO ADI89 _I 80011 '8 'SM X1111 ABNOSVW NO AD189 —� _ _ _ E L 9 3111 'HdSV NOWWOI 3WV8i NO o0:)n1S ABNOSVW NO O:):)n1S ONIOIS '1a3A ONIOIS 101131SV ONIOIS i1VHdSV O.MG8VH HAV3 S31`LDNIHS DOOM 313aDN0DS 1080 08VO9d S1001i 6 II S11VM 17 N3HJ11A N8300W W008 OV3H S3DVld 3813 1.W 9 ON V38V DI11V 'Nli %i 1A %, 1 11 IMMSV8 £ NIiNn 11VM A80 831SV1d 3NO1S bO If Y II—I31301402 HSINIA 101131NI $ NOI1VaNnoi Z r N0I.L:)nU1SN00 S1N3W18VdV A11w1i Illnw S3 81 o S — AIIWVJ 3105 AONVdf1000 I WOOD STOVE INSTALLAHON CHECKLIST D Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove (•._�` A. New -- ----- Used B. Type/radiant Circulating C. Manufacturer Hco A m -S I'd Ax Co 9 P. —Lab. No. TC 30 QC A 18 —6 Name/Model No. NCA t RV Collar size Dimensions/ Height Length 5/9 Width Chimney A. New Existing B. Size (flue area). iA C. Other appliances attached to flue (Number and flue size) ._ NO D. Prefab (Manufacturer—name and type) —_ E. Masonry/Lined X .Flue liner Unlined i lype 3 manulacturer) F. Height (refer to diagrams) Abut/(' AQxy cap CHIMNEY HEIGHT Hearth (non-combu 'ible A. Materials �� B. Sub -floor construction UM C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER 12t) hllf{, I2" MIN. 1$" MIN. ��i cy57ll:� HEARTH 3 It WALUCENTER 13 C5 z • z z 0 V) W I z .` cz r Im 0 oc OV J O Vf u p ne CL uaj W O. d d O H U. Z Z C LU c O ? —' u W6 o z H x N' .� Q E a m m L C J t W J m L V C u� m Y 01 E W` C O co C 3 C C ¢ U ii O C oC ii Q O m oC ch u a¢ ii m ro co • z z 0 V) W I z .` Vf p CL .� E O. i Q v C a� a 0 N' .� E a C O Q V i. Q .cm *00 to mi Location g3 7 0 ejyu� S4 No. Do/ Date ol3v9% TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ `5 a' yew �A'- Building Inspector i J : 40/06/99 16:08 52.00 PAUD Div. Public Works v Q O ©l i" Y L VI N Z T � ... Z z t^ _ T Z OVI G z � - ' Z C Z U U cI :J G^ r C to nw - c z - C j C - � r. z z 21 C O O C 1 _ CI L i c Q Q "' -- z ZZZ Z Z "- :J y Ul cn C O F - c c c Z Z zy to c rCr+ Y� z � U � Q to ,1 z ,\ Aj ellG W G. i4✓ — j. = MLj_ F M < C _ ? ? Z C C Z... Z 21 �:: _ Z Z Z _ — L C � - i" Kw - � Y L VI N Z T � ... Z z t^ _ T OVI G z � - ' Z rr1 Z cI :J VI r C Kw - � Y L N F T � ... 1\ FORM U - LOT RELEASE FORM Ii�ISTAUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. * ******* ***********APPI-ICANT FILLS OUT THIS U APPLICANT PL124 / ��l �/�'' C� PHONE -61 34 Of LOCATION: Assessor'sMan Number 10c PARCEL 0C)a 5 SUBDIVISION LOT (S) C ST. NUMBER STREET h eS 1:A1 J _ ********* OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: ' i/ 61,e ficlal i tiolu -/- Ke,4 2 L)a CONSERVATION ADMINISTRATOR DATE APPROVED Pt (S(I't5 DATE REJECTED COMMENTS�1 U✓/�S In ``�/ TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH S C/1fV CTOR-HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT / FIRE DEPARTMENT RECEIVED BY BUILDING iNSPECTOR_ Revised 919' jm OAQ q/t 71�� DATE V 4 O z x cQ w cn w ° U z w U w" w C Z to r� w r4 O w u a 0 w u '� ch � w O U � ~ O G w Q C � � cn sG O cn LLI om c c C H O C � O _V V n� 7: o o •- :� Ea 4b C V:5 V � a Eyc o v 2 cm si : " m c E •mm O: G ?-- CD m N m > A N O O CLCJ cm oC y CD �• act COM Z o o c C=2 F -®c Q m o W C Ow�t "r � •N � A A c � F- N GL LU •E 0 Z O C y a m 'C O � icy= C = eyv .2a m� 0' 4. U6 O CD O E CD Z O 0 W CD .y GD i CL CD C O CD V m ,as H O V .y C O U O C cy CL CA is CD 3� CD D 0 O C' Q •C � e J .O O O Z 0 CL CO) C LLJ 0 Cl) U) IrLU W w Lli Cn Na C The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Location i (-h QV) U7 Si City AJ6 , 4A106) iJZ-h Phone TA am a homeowner performing all work myself. F -1I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance Co. Policv # Company name: Address City: Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do herby certify under the pains and p naIti of perjury that the information provided above is true and correct. J Signature Date / 2 Print name %C' %l 11 4AI Phone # Official use only do not write in this area to be completed'by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Lincensing Board F-1 Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other Town of North Andover OFFICZ OF COMMUNITY DEVELOPMENT AN -D SERVICES 27 Charles Street North Andover, Massachusetts 18445 WILLLAR J. SCOTT Director (978)688-9531 \BCNU-G� Fax(978)683-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: k 0 Ute%) (Location offacilit`j) S:/a, ature of Permit Applicant 2 / Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project threuah the Office of the Building Inspector BOATR-D PPG: `S 623-9541 BGiLDONG 683=95.35 CONSLRV?TION 683-9530 HEA TH 633-95.10 ,7 °La',fNI 1G 68S-7535 CE 19 4� n CheS Nus' Ste' /yc 4&. ove 2 A9 -SS Def i`N Y/ 36/py 1�2,% G 19e d 0 rGa ®o � MA, +C N s rlwt If a dg o rA 146l iq I ' Ic i •'� C \ J► low ", �- t -40 R� d' r � R� �y G *4' A00/1" 2X9 Propaseoi Aa%�� io ✓� ,,i�s,d,n� Ply wood Sh�fing ef YP.5urn Drx\vo / p lro I- ►vood Flo r z "x /0 ":1 wstc l6"O-C 6 X /0 6EA" 6 z /o Do5r F q " 4 ' �' a '.o'•' 8 ; /6Dict " Sono -Tube 71 a. -' moi•' �• % :4 • ti: / 4 : C` J. 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