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HomeMy WebLinkAboutBuilding Permit #5302 - Exception 2/11/2009Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION l/t 1 Pri t d l � PROPERTY OWNER A22:1 ,� -]'an n `/ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE E.~/ Residential. IMPORTANT: Applicant must complete all items on this page LOCATION l/t 1 Pri t d l � PROPERTY OWNER A22:1 ,� -]'an n `/ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Residential. Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: / Commercial V Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print OWNER: Name:% a o i Address: f(I5S PO R'P k A TE S C early) Phon G 1 CA / L4t "rl /2A go CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Date: Phone: 6lDv Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ /,�) C) -- Check No.: % l � Receipt No.: 2«.2 `- NOTE: Persons contracting wit regi eked contractors do not have access to the guaranty fund Signature Age caner Signature of contractor r 6 �i C 7( (�/ i 'n/ Location—7- No. Date TOWN OF NORTH ANDOVER f F s 1 i " Certificate of Occupancy $ �'�s' •° E<� Building/Frame Permit Fee $ JACHUS Foundation Permit Fee $ Other Permit Fee �' d f v$ 1061"— TOTAL 4d"— TOTAL $ Check # 2►E/'-2 Building Inspector i 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED 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: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT -Temp Dumpster on site yes t_ocated 384 Os ood Street Located at 124 Main Street Fire Department_ signature/date COMMENTS Revised 2.2008 t t Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions./ -5'6' 7 Total land area, sq. ft.: SGS. ,4T 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department 4 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) z ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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) ❑ 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 DEPARTMENTMIZORM07 Revised 2.2008 fire COMMS_ NTS f ,40RTH 1 Town of North Andover Office of the Planning Department '°•;�•° ��'` Community Development and Services Division �gSACHUSFt Osgood Landing 1600 Osgood Street Building #20, Suite 2-36 North Andover, Massachusetts 01845 P (978) 688-9535 F (978) 688-9542 Kathy Jannino-Faino Passport Pilates 567 C�g_Read North Andover, MA 01845 Re: Waiver of Site Plan Review January 14, 2008 Dear Ms. Jannino-Faino According to the North Andover Zoning Bylaw Section 8.3.2.c.i, Waiver of Site Plan Review, your request to renovate the commercial space located at 567 Chickering Road, will not require an application for Site Plan Review. The waiver request is granted based on the following information: • The property will be used as a Pilates and Spin Studio. This use is an allowed use for the General Business District, according to the Town of North Andover Zoning Bylaw section 4.131(1). Additional renovations will also be made to the interior of the building. • There will be no changes to either the existing building footprint, to the exterior of the building or to the existing parking area. There is no requirement for additional parking spaces since you are estimating that there will be no increase in foot traffic from the prior use. If there are any questions, please let me know. 7own rds, Tymon, CP Planner cc: Jerry Brown, Inspector of Buildings BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Commonwealth of Massachusetts /Official Use Only Department of Fire Services Permit No. � Q A Occupancy and Fee Checked% BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] 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 PRIVT W INK OR TYPE ALL INFORMATION) Date: _ ; fG City or Town of: To the Inspector of Wires: By this application the undersignea gives notice of his or her intention to -perform the electrical work described below. Location (Street & Number) 1--�{--2 -2-1 Owner or Tenant ���'JC, 5'�/14s- Owner's s -Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building Utility! Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. (Check Appropriate Bos) .uthorization No. Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Completion o%the r-Howiro table— d b h No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans may e waive v t e Inspector of ?Ytres. No. of Total Transformers KV A No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimmina Pool Above ❑ In- ❑ !No. o mergency ig nn; und. zrnd. 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 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices 5 No. of Waste Disposers Heat Pump Number Tons I KVV No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW ❑ Other o cdo1 No. of Dryers Heating Appliances KW Security Systems: No. of Water No. of No. of No. of Dev' or E uivalent j Heaters KW Sins Ballasts Data inner No. of Devices or Equivalent— uivalentNo. No. Hydromassage BathtubsNo. of ,Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: i ,Attuch udditionui detail it desired. or us required by die lnscec:or INSURANCE COVERAGE: Unless waived by the owner, no permit for the-,-.--,or-mance of electrical work may issue :r.ie;: the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. Tike undersigned certifies that such coy rave is in force, and has exhibited proof of same to the permit issuinv office. CHECK ONE: fNR SUAvCEBOND ❑ OTHER ❑ (Specify:) (Expiration Datei Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NIEC Rule 10, and upon completion. I certify, under the pains and penalties of perju that the in formation on this a plication is true and complete. FIRti1 NANIE LIC. NO.: Licensee: Ae�e 167G e2 Signature LIC. N0.S�Q a04 7a`� (If applicable. enter-e-emet" in the licen number l e.) —� Bus. Tel. No.70S/y3 Address f e fir /, Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lk,------ oes nor 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- Signature Telephone No. FPTI�V-11T FEE: S This certifies that has permission to perform_ wiring in the building of A'2* Date .... /�� ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING .............................. ............. ate........ ::1 ....... ....... f(. .... i .................. . North Andover, Mass. Fee... ....... Lic. No/ ..... . n ............. il�l .................................... CAL INSPECTOR Check 0 I t5302 " MASSACHUSHITS UNIFORM APPUCA (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations �- 11/7 � t g"wneTs Name New ❑ Renovation El Replacement ❑ FOR PERMff TO DO GAS FITTING Date 7 Z Z — OLI Permit # �o y Amount $ Plans Submitted ❑ (Print or type)j j/J f Chec one: Certificate Installing Company Name l � a A cam- � `' Li Corp. Address � Z S ° "�v �"' L ❑ Partner. Business Telephone '?7A 6X--7 3 0 & 3 ❑ Firm/Co. {Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond ❑. Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information 1 have submitted (or entered) in above appncation are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Iss ed for this application will be in compliance with all pertinent provisions of the Massachuse7Sta Gas , ode a d 7a7/e 1 of the General Laws. ICity/Town OVER (OFFICE USE ONLY) Signature of Licensed Pkimber Or Gas Fitter ❑ Plumber L) U % ❑ Gas Fitter License Number © Master ❑ Journeyman x Ij w 9 rA (40 U x W P.' O H Imo'. x E-4 cn w z o w e a z O O F' W F4 W z O F. O cn a0 C4 Q U C4 F cn Z Z H U z , C4W W W U �, O W H W C] H F U ra I a O A a a A a F x w O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. F L O O R 3RD. FLOOR 4 T H. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)j j/J f Chec one: Certificate Installing Company Name l � a A cam- � `' Li Corp. Address � Z S ° "�v �"' L ❑ Partner. Business Telephone '?7A 6X--7 3 0 & 3 ❑ Firm/Co. {Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond ❑. Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information 1 have submitted (or entered) in above appncation are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Iss ed for this application will be in compliance with all pertinent provisions of the Massachuse7Sta Gas , ode a d 7a7/e 1 of the General Laws. ICity/Town OVER (OFFICE USE ONLY) Signature of Licensed Pkimber Or Gas Fitter ❑ Plumber L) U % ❑ Gas Fitter License Number © Master ❑ Journeyman Date..".��. �`�...... ..o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that>... G^u'...`' :.'...... . has permission for gas installation ��'... ........ in the buildings of ... ... . /.. l- ................... at ................. , North_Andover, Mass. el Fee.' .... Lic. No.l`:° �-"-GAS-INSP,EC;,;R Check (J 4684 0 t MASSACK'USETTS UNIFORM 80PLICATION FOR PERMIT TO DO PLUMBIN( (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 5-� 7 611 4- 1 R �7( F�z�j��?.� ame �1 t- t Ah o L i S "r L -U a J"Vf f'-" Date 3 '- 2 Z- O Y Permit Amount o% New Renovation Replaaent Plans Submitted Yes No FIXTURES (Print or type) �11. Check one: Certificate Installing Company Name 1 V d LA, (� ' - Corp. Address Z So j L -i " Partner. a Business Telephone g 7 C4 i a 3 Firm/Co. Name of Licensed Plumber: 'r .411 ( 7 Ph. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® 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 ri I hereby certify that all of the details and information I have submitted (o: best of my knowledge and that all plumbing work anIstations a on compliance with all pertinent provisions of the Mass Stat unit By Signature oT 3icense ur Typ� u bing Lic Title (� City/Town rcense um er APPROVED (OFFICE USE ONLY application are true and accurate to the Issued for this application will be in mer 142 of the General Laws. ense Master � Journeyman ❑ Date.n.?V "0R,r:�ti TOWN OF NORTH ANDOVER 60 PERMIT FOR PLUMBING SS't US� This certifies that ............. has permission to perform.. .!`.� .... . plumbing in the buildings of ......'. ^.J;.- :................. . at. �: �.....� f..............�� --.. , North Andover, Mass. Fee. ...Lic. No..... ... ..... ,,..` / PLUMBING INSPECTOR Check !i-��/� J v G' 5k, 51 CD CL cn co D m m r m Z Z C7 r m m D r D z r z O co m D 0 0 m 0 m 0 OT CDocD.. o o cn fn (no -0 W c� °po-0w =a C.)3 in m o° CD-�� -a (n � c CD cD 5 cn c� CC CD ° rz co O y CD `Vm v cn O �2 cnO 0 Z aD c cD m ° n :1- c o -0 CD o -0 C) (c) = - n CD = vz p3CD- O Q 0 =(o � 0 (=/)r "o = U) O Cl) J 0-0 CD U N p iU O CD 5 p �• =CD p CS N —v (D CnCD o E. CD CCD O c J c= en cD O n O 'a CD -« -, � t= o � O O CD CCD �. O Er cD W" sv =; v O l _ T O cn _0 CD UD 3 v = =NCD 0- --�� o=rcr cn _ CD v�=SCD �`n3 SCD p (D 0- -< - CD <. cD p < CD p CD O CD - (D 3 J CD CD L1 (n 1 cn C cn O 1 = CD = O �. cD a v CD CD cn = O a � � � a � T rn cD c ED rn o o 0 O c OO CD sll -1 o cn n J O CD c O cD O Q 0 ro ,.r CD rn adv o 0 c --t',= o Q=.CD OO D DQ -1 o cn 1 , O J O CD c O Q c. Q ro ,.r CD U I v c M Z� v CD v' l 0 sv X Z C— CD ° CD -� = � v E 3 ?. (D vCD 0Q I MW TQ, \1 C rA N (D O 0 0 U) rn 0- cn ►m (7 • iv cid i O z O m z O 4 z 0 O m Cl) c CD cD DQ O + rn ro U I I MW TQ, \1 C rA N (D O 0 0 U) rn 0- cn ►m (7 • iv cid i O z O m z O 4 z 0 O m S d -D r 1-e P-AICI ti �- - � fC &,- /'! �'/ a 5 �' Yb- Property Owner Business Name SIGN PERMIT WORKSHEET —ax -Srleule Property Owner Address Sign Location Address J lv („yoac+e) cry x!� Zoning District // y o2 �� Allowed Area a Proposed Area Allowed Height /1%% Proposed Height Allowed Setback AIA WA l ( Proposed Setback Map Lot Estimated Cost $ Fee $ Permit Application Received / a 7� /,:�p z— Permi Approved /a — —e�-2 a _ Inspector --P d CD W O aq O � . CD '�04•NCD d CD CD O CDS N lD CCD CSD C) Q, O uq zMn N u CD a CD A� O vukCL L7 CD CD •.. CD H O S; aro M CCD v' C. " CD D (D y "i G CD d O 0 a. o o tz (Di CD dQ En O C1. E'ft r * CD 5 L� to En .. . CD CD P. Location �✓ a � r ` 11",e /,b p 4"` No. �a-aoiL3 0516 N S Date off' ID -0.2 HpRT�y TOWN OF NORTH ANDOVER 9 Certificate Occupancy $ of s�CHus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee SIGN $ 30— TOTAL 0_._ --TOTAL $ Check #16665 / Building Inspector MAR -11-2004 09:04 GCE ANDOVER BRANCH VERSI-POLETM VERSI-POLETM 1, 2s 3 POLE WSTRIBUTION BLOCKS co P.01/01 CATALOG CONNECTOR RUN TAP AMPERE,R ' OPTIONAL RUN TAP WIRE RANGE WIRE RANGE' .NUMBER RATING PER POLE COVER ORDER I PER POLE ALOCU AL9CU 20-12 4-14 195 21, 901K*V62 -3: BDB-26-210-1 EXIS-2400-2 ## 1 9@0 =(o 20-14 2-14 390 2, 609covm �BDE -2103 13, W13 -112 -WO -2 moose 350 kcmQ -6 4-14 360 2 BDOCOVERI geese* 350 kCM9 -6 WO 14 360 2WSCOVER1 3 -8M14-5W2 ISO 'I 50 *M* -4 20-14 430 2 BOBCOVEM .500 kcrnil -4 2/0- 14 430 2 WWOVERI BOB -16400-3 I 3 'BAB -f 621 PM10400.2 500 koMll -4 2-14 I 430 1 1 2 800GOVER2 Dp-16240" 3 0DO-26-356- 350 kcmll -6 2/0.14 700 1 2 BDIBCOVERI 3 2-600-9 F@7 To @a 5w k=H -4 4-14 `t` . ODOCOVERI lb&212-500-3 a, —7a9,, Bob -29-50" 9004#600-3 Sm kCMil -4 2J0 -14 ow 2 808WVERI a 9PB*4450" LB-,-)tu So kc;mll -4 4/0-6 wo 2' BDSCOVEnt -60" 31, -7 u TOTAL P.0.1 7,;,£ em&7&M 2 5Xd7,?1 07 DgGauix a 4 P -O& S*ty BOARD OF FIRE PREVENTION REGULATIONS 527 APPLICATION FOR PERMIT TO All work to be performed in accordance with the (Please Print in ink or type all information) Town of North Andover Official Use Only Permit No. S FIs Occupancy & Fee Checker� 6 R 12:00 ELECTRICAL WORK Electrical Code 527 CMR 12:00 Date 2 V To the Inspictoif of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number �w 7 C��e'G `-e -e - Owner or Tenant lei *I c, S f t,, k S4"/") , ", Owner's Address Is this permit in conjunction with a building jpermit Purpose of Building (. 6 wrsvt. e) Yes,v .S /P e, C -Z- Existing Servic Y 0 d Amps 2-,Y Y Voits New Service • Amps Voits Number of Feeders and Ampacity, a "-w Location and Nature of Proposed Electrical Work No 0 (Check Appropriate Box) Overhead' Overhead 0 ✓ C� r., ac, e Utility Authoriz No Undgmd 0 No. of Mete / Undgmd a No. of Meters INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the OfficeS NO - If you have checked YES please indicate the type of coverage by checldng the appropriate box. INSURANCE - BOND - OTHER - (Please pecify) (Expiration Date) Estimated Value of. lectrical Work$ Work to Start Z / > Inspection Date Resquested %f77 Rough Final Signed under the lbenadies perjury: FIRM NAME/ // G%� / UC. NO. Licensee C A el le Gt"1 D G G� � �1lk Signaturer—ylll� LIC. NO. 6 /L�1t Qx S+ La.- �.� P� L� Bus. Tel No. & &S = 6j e / Address Alt Tel. No. L o Ile J' P J - 2— OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ J (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units 7� No. of Switch Outlets ` No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and / Total C No. of Ranges No of Air Cond f Tons ✓ Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices Nol of Self Contained p No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal a Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the OfficeS NO - If you have checked YES please indicate the type of coverage by checldng the appropriate box. INSURANCE - BOND - OTHER - (Please pecify) (Expiration Date) Estimated Value of. lectrical Work$ Work to Start Z / > Inspection Date Resquested %f77 Rough Final Signed under the lbenadies perjury: FIRM NAME/ // G%� / UC. NO. Licensee C A el le Gt"1 D G G� � �1lk Signaturer—ylll� LIC. NO. 6 /L�1t Qx S+ La.- �.� P� L� Bus. Tel No. & &S = 6j e / Address Alt Tel. No. L o Ile J' P J - 2— OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ J (Signature of Owner or Agent) Name: Location: City Phone F-1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing. workers' compensation for my employees working on this job. y' Company name: t Address City: Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policv # r 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 k understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' 0 Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone A Health Department Other FORM WORKMAN'S COMPENSATION Date.. �//;/ -Y TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... �-&A/A­f .... f. �140 ............................ has permission to perform ........... Tp.na"../ .... :.�. CI .................. ...... ... .... ... S? ... wiring in the building of ....... .................. // ........................................ 7 z at ....................... U ......................... ... North And ver; S. ............ ...... ....... ........... Feej.e� ......... Lic. E ECTRICA NSPECTOR Check # 50'19 TOWN OF NORTH ANDOVER BUHDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING MN- s Section for Official 27R Use OWYEM- WELDING PERM[rr NUMBER: DATE ISSUED: C2 - 0 (�� SIGNATURE: # Buildi< Commissioner/ or of Buildings Date , G 1.1 Property r, eW: 1.2 Assessors Map and Parcel Number: /Z Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage (R) 1.6 BURDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReqIIired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner of Record + Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Nam l Address for Service: Signature -11, Telephone Not Applicable 0 3.1 Licensed Construction Supervisor Address License Number Licensed Construction Supem'911:-. . ........... . ........ .. ... Expiration to 7 25Cy - /to :?- Signre Telephone 3.2 Registered -Home ImprovemenJContractor Not App cable ❑ lea '.2 Com ame,( Registration Number Address x Expiration Signature -;x Telephone 0 M 6P 0 1 X M X z z M 90 0 -n M r - Ir, z G) "CT ON A Vt�1 RS 1t 11 ©N a-tiltCf ► z 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. Sign affidavit Attached Yea ....... El No....... ❑ :PALDM0CNMUC1IONSIM, .1 5-Ra$SUG 1 Al p CONSTRTJCTiffN Ct3N)i#LUI.�i` ib lllf �+vNT't� MQ"IDr35,11 F,,O�TCI?S%t? s1PAt'E) 5.1 Registered Architect: Name: Address Signature Telephone 5.2 Regfstere�'Pfe>c� ���i s Area of Responsibility Name: / Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Nai'pe Registration Number Expiration Date Address Signature Telephone Area of Responsibility Name Address Registration Number Expiration Date Signature Telephone L Not Applicable ❑ Com�pan Responsible in Charge of Cfi ruction New Construction ❑ Existing Building " Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of oposed Work: A Assembly 0 A-1 ❑ A4 ❑ A-2 A-5 Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ lA IB ❑ 0 B Business 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory 0 F-1 ❑ F-2 0 H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional 0 I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R -I ❑ R-2 0 R-3 ❑ 5A 5B ❑ 0 S Storage 0 S-1 ❑ S-2 0 U Utility M Mixed Use S Special Use 0 0 0 Specify Specify: Specify: COMPLETE TRIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date el A �•�?. ^yp5 k'.y�' �� .tee L ,,,,qq �< qie �S�'4z r.A �1, V A �tT1 1 ti<� as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury 1 - Print N �� U Signa of Owner gent Date Item Estimated Cost (Dollars) to be �, xOman Completed by permit applicant m 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of o'r'b Construction from (6) 3 Plumbing O71"fi Building Permit fee (a) x (b)�'-� 4 Mechanical (HVAC) 5 Fire Protection ,.0 6 Total (1+2+3+4+5) ..D Check Number ll tµ5,$�P..ni�f .-�.>•$ 11S >.I Yt .? 33k{�(fi( h f aF rv''f t J _{}%tn .b�t�eYiH}Ta✓kj, �:J 'Yl 71-.. ��t -�t�v/ S�,S t"i � N 1. N� (' hv,<. J S,w Y.�� � �t�u� f 5i' �- `{ � � i th f,%-1�..'t'.� ,S . _�7>a ,. � . i�r.. tiiif �j 1 '� ik✓, Tf�a� :rvY, jS u�„-v��/�k h t Y.�'F,1 3 r P � rS� .):;,� SFj �33 '�tA .: NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIv1BERS ] 2 N RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE L £ t U. r._'S.k.:1111Fse� ``s, v, _ Location % Chi Ic k No. tY77 Date S '� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # �as� 1% 5 i M A f t C -a- -.- Building Inspector Name Name: Location: { The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers-' Compensation Insurance Afdavit Please Print City Phone # 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F i am an employer providi ng workers! compensation for myy employees working on this job. Company name: Insurance Co. 1: s:Va ld lV" ce— Policy # W6G 3 3 U Company name: Address Com: phone* Faikireto secure coverage as required under Section MA or tiltGL 152 can lead tathe irrVasition of erfrrminat penalties or aKfihe into 51,51 and/or one years' imprbc rrmwLas 7 penalt�s�o16e1ama ��?S?P fioesi€ ($1ffiOOj ..,,� understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage veri kation. I do hereby c&W under flue paL and penal ofpedwy bW the AnrornreUw provided above is true and correct Print Official use only do not write in this area to be completed by city or town cfficiar city of Town ti. + Lit►ild1 C7 ng Dept. []Check,V immediate response is requred p L.icensira Boat Q Selectman's O contact person: Phone # Q Health Uepartr, Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 c11,S150A. The debris will be disposed of in: ' (Location of F Signature of Permit Applicant / A ; -''/o; , , Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 048040 Birthdate: 10/29/1955 Expires: 10/29/2005 Tr. no: 8109.0 Restricted: 00 TADEUSZ DOWGIEERT 171 BRADY AVEC SALEM, NH 03079 Administrator FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that allnecessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. '..............■r..........■r........./...........■.............'...........■ APPLICANT�� vD �� �� ��PHONE 1- rte,. ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREETS E> % c TSTREET NUMBER J- ) ...*....■..............a.....a-....... ............... OFFICIAL USE ONLY RECOWAENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADNIINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMDENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONRVIENTS PUBLIC WORDS - SEWER / WATER ONNECTIONS D Y PERMIT �5 �A� Jv XDATE APPROVED FIFEf)EPAk*VH§T DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR _ DATE O z 17 x p w� v w° " N� C/)w° U r-4 z A ►-a w a ° c w°' U .a w p w w a°G w a p w `� •� w cn � w a p U w d w z A a G CQ cn v cn c c goo � L O y C O C3 CJ C cc R c 19, �Q O L c v*v w .� E• �C.2 cm .1= Q cc:IQ ail wE I'll: cm • � o •s� f tw N = G 0 '"Wo O y O m D tt O CM • act � CJ! w mo' v H O . c o c o 2 N .r yLai -W COD t r-. c .y -o.t tv S Z o, o y O uj cm ca _y a m - C2 = tyv 0 O Ay'� a� s o .O.. m :IN z 0 w a 0 IS 2 CD a, coj o— yO O •E— cm m co a_� CD O O R O d CLco �a C V = Z ai Q CL V H c _c d 0 Name: Greg Smith Company: GSD Associates Location: N. Andover, MA FAX #: (978) 688-5717 WaMe: Company: Loc ,tion: Office k: FAX `: i rrne: 5:20 p..m. Bob Brecknock S W & C Engineering Man Nester, NH (603) 645-1392 (603) 645-6586 Re-., Sandie Ela; tai an Photo Studio lao1 S Cp . n9i Aee. ingii ' P.A. Date: 1.0.20/04 The lightest-. P'oll joist available in the 1960'sand 1970's was a 2 _ os. `chis , - ction wi,f be usc-d in cornjunction with information, shove¢,, r;,3 your sketch (taxed earlier- tachy) tc,. eterrnine whether existing joists at E �,r! r-eG ereneed project are rapable of a new S tori HVAC Unit that wei fit+ k P n�xirnately Soo 1b.s., The rOOf �Yste r, as your described it consists of rirrretal gI, rigid insulation ae>; an Ahered membrane)`Chat supports a hunk Ceiling. The r��� �wls�g roof dead 'RSC,' is approximately 11 psfe snow load required by the AaGS-8 Usefzts-Building ;amide for Andover is 30 psf. �vasts are spaced. �t 79�, *.which s:: a MaXIMuM. total load of 270 pounds per lineal foot (cif). �� I OS ois�ts Vanning Piave an . allowable total load of 330 lair. If the dead is as described abo,.,e and if the callateral foaid is 5 psf or less, the I existinc-1,foists will be able to supi.ri: the SOO lb. HVAC unit 1 -he unit should be kk� ` uppo ted equally betw6en two joists. The dead and cols°iteral loads should be verified. Tease tali if you need anything else: I AUTHORITIES AND OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA). e M•�xr'` a=„ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number y 1o711-7Date—Y–/c2 –D THIS CERTIFIES THAT THE BUILDING LOCATED ON - Q (f h MAY BE OCCUPIED AS i 0 �o �0 w" d IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO cf)z S j `e a- / �y -7-/,? (,S Building Inspector