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Miscellaneous - 107 OLD FARM ROAD 4/30/2018
/ 107 OLD FARM'ROAD J 2101035.0-0031-0000.0 Location 'AP a12 ©oaf TA12 k� �.. No. Date MORTN TOWN OF NORTH ANDOVER Of �ao ,a,h0 AFEW 9 } ° Certificate of Occupancy $ �'�S' •'��' Building/Frame/Frame Permit Fee $ � swCHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 116 C/ Check # a 6 ,1 —� Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MtAM RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING seeied"a fro* BUILDING PERMIT NUMBER: DATE ISSUED: rn t4 ic SIGNATURE: "'I Building Commiss"i"oner/InELWor of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 31'3 ! b9 00 `aWMap Number Parcel Number � 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage 8 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zane Information: 1.8 Sewerage Disposal System: ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ PublicSECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT "i'"i'i'i% ip3tr!Ct: yes P,!,O M 2.1 Owner of Record NJ fly Name(Print) Address for Service 0 Signature Telephone 2.2 Owner'of Record: 0 Name Print Address for Service: z A ature Telephone 90 SwCTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: A��1 \ c>� �� J A /a J�� License Number Q S 7Addres 9 ) b c z V Expiration Date 41010101 Signature Telephone 3}"2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r r Address z Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(N.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.......0 No.......❑ SECTION 5 Description of Proposed Work check ad. ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ckd (e(2)-Ac-k- ► Q,r a 5l.t L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 160 5 Fire Protection / 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject K property Hereby declare that the statements and information on the foregoing application are Lrue and accurate,to the best of my knowledge and belief Print Name Sipnature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS7 2Na 3 RD SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS t� SIZE OF FOOTING X MATERIAL OF CHIIVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 at: dl 01 a ryn Ko - 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. 6"a S Low I I The debris will be disposed of in: s-G Alt (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date t 71. [oommo9uuea�t a�/�aaoac/u�aetld BOARD OF BUILDING REGULATIONS } License: CONSTRUCTION SUPERVISOR ! Number: CS 072892 Birthdate: 09124/1964 Expires:09/248006 Tr.no: 2539.0 y Restricted,, 00 1 FRANCIS J MARR JR f 253 APPLETON ST N ANDOVER, MA 01845,, PATRONS MUTUAL INSURANCE COMPANY of CONNECTICUT GLASTONBURY, CONNECTICUT ARTISAN CONTRACTORS POLICY DECLARATIONS = Policy Number: CTR0005705 NEW Effective date: 10/20/04 .. _..... _..... . __ ........ _. _._..._._.... __.. .._ ... .._...... _... .._.. ............................................................................................................................................................................................................................................................................................ ::NAMED: FRANK MARR T A SULLIVAN INSURANCE AGCY, INC 253 APPLETON ST 369 MERRIMACK ST NORTH ANDOVER, MA 01845 METHUEN, MA 01844 (978)681-8200 Policy Period: from K10/20/04 10/20/05 12:01 a.m. Standard Time at your mailing address shown above. Insured is: INDIVIDUAL Business Classification: CARPENTRY- RESIDENTIAL Code: 10030 LIAB)CC,ITYCO VERAGE .. COVERAGES LIMITS OF INSURANCE L. Bodily Injury and Property Damage Liability $1,000,000 Per Occurrence $2,000,000 Aggregate M. Medical Payments $5,000 Per Person N. Products/Completed Work $1,000,000 Per Occurrence $2,000,000 Aggregate 0. Fire Legal Liability $50,000 Per Occurrence P. Personal and Advertising Injury Liability $1,000,000 Per Occurrence ..................... EROPERTX VE E DESCRIPTION AND LOCATION OF PROPERTY Loc. 1: 253 APPLETON ST NORTH ANDOVER, MA 01845 COVERAGES LIMITS OF INSURANCE Loc. # Building# Limit ACV A. Building B. Business Personal Property 1 1 $2,500 C. Loss of Income ACTUAL LOSS SUSTAINED, NOT TO EXCEED 12 MONTHS. WAITING PERIOD: 72 HOURS Increased Property Off Premises: Automatic Increase—Coverages A&B: 0% ANNUALLY Property Deductible: $500 .. .. SUB E T;TO.Tit FOLLOWING.FORMS ANll ENDORSEMENTS AP-100 Ed. 2.0 AP 0611 01 99 AP 0643 12 99 AP-432 Ed. 2.0 GL-895 Ed. 2.0 AP 0700 12 02 AP 0740 12 02 AP 0688 06 02 AP 0690 06 02 AP 0692 06 02 PREMIUM AND BILLING INFRMATI01tiL ANNUAL POLICY PREMIUM: $483 $450 Minimum Earned Premium Regardless of Term ENDORSEMENT PREMIUM: BILL TO: Direct Bill To The Insured TERRORISM PREMIUM: $11 NON-CERT TERRORISM PREMIUM: $0 l ORTGAGEES PRINTED: 10/25/04 AGENT COPY THIS IS NOT A BILL �..o a.vnsrssurswcusin UJ jyjassacnitsens 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 Pie_ Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Nc� n M; Phone#: ���'�J�i�—' 37 c)' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employee's(full and/or part-time).* have hired the sub-contractors 6 ❑ New construction 2\Efl I am a sole proprietor or partner- listed on the attached sheet: t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. o workers' co 9• E3 Building addition [N comp. insurance 5• ❑ We are a corporation and its . required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11-0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12• Roof r insurance required t employees. ❑ �� �1 ] [No workers' ���-�, comp. insurance required.] 1 j�J OtherS°� :w� *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infotmatioa t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.Policy inforntation. I am an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year smprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and instructions conMassachusetts General Laws chapter 152 requires all employers in theservice of another under any contracto provie workers' npensation for their et o lhire� ` Pursuant to this statu ' te, an employee is defined as ...every P express or implied,oral or written"' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged m a joint enterprise'and including the legal representatives of a deceased employer,or the receiver or trustee of ah individual,partnership association or other legal entity,employing employees. However the or the nt Of the owner of a dwelling house having not more than three maintenance,� cconstructionnd who eorthrepair�wok on such adwelling house dwelling house of another who employs persons to d or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employee•" MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." s"Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chapter 152,§25C(7)state enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along wittthhe their other than the insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance co �so�sure to sign usbeing requested,not the Dcpdate the affidavit. The arlment of avit should ��n forthe be returned to the city or town that the app permit or license i Industrial Accidents. Should you have anyt the regarding the sted below.You Self-are insured companies should enter their compensation policy,please call the Department self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affi4vit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia NORTH Town of Andover No. O ..mv,.r.rar".... Oaft �, - dover, Mass., 0 LAKE A, COCMICMEWICK V 7,95 RATED PPFi ,�GJ BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................................... p !5..................................... ...... ...................................... ......... . Foundanon has permission to erect....Rr. �!�'.!..... buildings on J #7 P/� .......................... ....... Rough to be occupied as.... s M � p.. ................ Chimney r....................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws elating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 3r131 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N T S ELECTRICAL INSPECTOR lRough .......... ..... ........................................A......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. �1 n U ? Date.. r...... ............. NORTFI °�t�``°;•�"o TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ,SSACHUS� This certifies that " .....:............................ ......................................................... has permission to perform :....:........ .: �a ..r-.:... ...:. ...........::: �-' ........... . 1 ' wiring in the building of..... ....: .�. �'............................................................ ' rte / / at... -.............................................................. .North Andover,Mass. Fee.? 5............. Lic.NO.':. .; lf......................:p.::......... ":r................... ELECTRICAL INSPECTOR Check # �� 7 Official Use Only Permit No. _ �Cr Occupancy&Fee Checked_L��?— BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 7- 30 •- O . To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number _-1-07 r41n nASOwner or Tenant Q C 44a * c4x�S Alsf Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service _q0 O Amps Voits Overhead ❑ Undgmd ❑ No.of Meters / New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures S Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets 20 No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of%ater Heaters KW Signs Bailases Wirin No.H ro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalen01 .1�_-rage NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the typby checking the appropriate box INSURANCE W BOND = OTHER (Please Specify) Expiration Date) Estimated Value of Electrical Works Work to Stant Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. Lkensee OsegQ Signature J�IAi ./d +�'kil+kQ LIC.NO. ? 99 0 1(e T �1 r r Bus.Tel No. Address a0 ( Cr4d�cti�� c r�u�"T �Nr �^�rN�(o� Alt Tel.No. OWNER'S INSURANCE WAIVER: I 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) crr+ Telephone No. PERMITTEE $ (Signature of Owner or Agent) �x t I s NUMBER + ° S88024133 DRIVER'S LICENSE DATE OF BIRTH CLASS REST HEIGHT SEX 04-05-1950 D EXPIRES 5-05 5-05 M 04-05-2003 . . SALEMME JOSEPH EPH M �- 201 CARDINAL CT '' Ar WILMINGTON,MA 01887.4580D4ast�o' COMMONWEALTH oFVAssACHUSETTS DIVISIONOF PROFESSIONAL OF ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIAN ISSUES THIS LICENSE TO i t JOSEPH M SALEMME v Is , 201 CARDINAL COURT WILMINGTON MA 01887-4580 r 39961 E 07/31/04 337501 i Fold,Then Detach Along All Perforations UIIC UUUlUlU11U1fUllll Of 1001111HEIIUS(till Permit No. r '7 BrpnNment of public Fnfein occupancy A Fee Checked 3Y BOARD OF FIRE PREVENTION FIEGULATIONS S27 CMR 12:b0 3/90 Qe9ve blank) --� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to bo performed in becordance with the (Massachusetts Electrical Code, 527 C)MR 12:00 PLEASE PRINT IN INK OFj TYPE FOFiMATION) bele ZO 05* or Town of_ 4 y�,� to the Inspector of Wires: The uderslgned Applies for IN permll to perform the electrical work des ed below. Location (Swael IL Number) _ /0 7 016 G�iQ� 4P Owner or Tenant ywr ./Aip,Vd-S Owner's Address _ 5 I;1'7 e- is this permit in conjunction with q building permit: Yes El Wo (Check Approppriale Box) Purpose of Building _ C S Utility Authorization No. 60,7 y S Existing Service x200 Amp; /?0 ayv 'v'otis Overhead ❑ Undgrnd 9)1 No. t); rviel'rr� � New Service Amps —J Volts Overhead El Undgrnd 1l No. of Meters Nurnber of Feeders and Ampacily �^ Location end Nature of Propose Electrical Work �.n 1C V_ J ' UAl.D A:1 /f _5-Pl�iG No. of Lighting Oullets No. of Not lbbs No. of ltenstormers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators kVA No, of Emergency Lighting ►Jo. of Receptacle Outlets No. of Oil Burners �anery Units No. of Switch Outlets No. of Gas 8urnerb FIRE ALAnIMS No. of Zones No. of Ranges No. of Air Cond. Tbial No. of Detection and tons Initialing Devlcei No. of Disposal@ No.of Most Total Total Pumps Ton! KW No. 01 Sounding Devices fJo. of DishwashersNo. of Sell Contiln6d Spece/Area Heating KW D61ection/Sounding Devices No. of Dryers Heating Devicel kW LocalMunicipal _ ❑ Connection ❑Oihar No. of Water floaters Kyy No. of No. of Low Voltage Signs ballasts Wklnd No. Hydro Message Tbbs No. of Motors Tblal NP OTHER: iN$UnANCE COVERAGE:Pursuant to the requirements of Massachusetts general Laws I have a current ala ilitypro fatInsurance ms Policy Ih6 Ihcciii. y Corn of Operations Cov6r@ge or Its subbtantlal 6qulvatent. YES have submitted valid proof of isms to the Ofllei. YES b,-NO C If you havb check Y S. pless6 indlcat6 the typi of eovsOraye by eheCkir.g the ippro�lata box. INSURANCE LX 8oND C bTHEn t7 (Plbasb Sp6c11y) — Estimated Velma of Electrieif Work A-7 (Expi aeon Datsl Work to SIeH In6pectlon Dale hiwested: hough h ii 1Q 1G—992 Signed under the Pe tlelt of patio n '� FIRM NAME ' Ltcerisee • LIC. NO. - Signblurrf LIC.NO. � Address buf.lbl.Ido. INSURANCE WMVER:t snt twat•%hit thi t_ic6nsair does not hi vtL the insuraneiit oe tag6 of hi ubstintlai aqu;valanl t,i•a_ qulred by Massachuselti�3aneral Llw;,ind that my 1{gnslur6 en this pstmrt ippiteallon"Ives this tiquitament.Ownit Apsnl 11010699 check one) ISignsture of Owner a Agent) lbtephon6 No. PERMIt kbE ! eW Date.../J// A(o 521 NORTH 4, 0, 0 TOWN OF NORTH ANDOVER PERMIT 0,,,,,WIRING $A 4b This certifies that ........ .............. V7, .p has permission to perform .......... ........ wiring in the building of....la.Rz�.f.n5.................................................... at..... .............. ,North Andover,Mass. Fee..30—.d.d.... Lic.Nol'/.Y '7'�............................................................ ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Date.�... . . . . . . . . . 0q 40RTN-4 .... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ;13 gACMus This certifies that . .`��.h���.`. 'r . . . . .I�!t• .W. . . . . . . • • • . . . . . . . • • has permission to perform . . . .P.0 A. . . . . . . . . . . . . . . . . plumbing in the buildings of . . f ' /9�?'.l/� .� . . . . . . . . . . . . . . . . . . . at. . U.!. . . ()Z. ). .r/i!' `d `t • • • - • , North Andover, Mass. Fee. Lic. No.. . . . . . . . . . .} . . .1 y�. . . . . . . PLUMBING INSPECTOR Check # 5326 �1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J� ,� Date %�' Building Location ,z� �'7�/ Permit# —3z "3 L Amount ^) g Owner New ri Renovation Replacement Plans Submitted Yes No ❑ FIXTURES CrH w cc .1a xCn F d ai A F 2 SLIMM msgvty f M Hi" 3*Q MOM 3MHfM 4IH Hj" SII3HA" 61H Hi" 7MH1"A gII3>h7�C�2 (Print or type) , Check o Certificate Installing Company Name � 7 Address J , El Partner. Js� 74- Busmess TTeJep one 7—JF-I <A;"q S yj .7 Firm/Co. J r Name of Licensed Plumber: 'faf—.S Insurance Coverage: Indicate thetype insurance coverage by checking the appropriate box: Liability insurance policyEl Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under PermitJR ed for this application will be in compliance with all pertinent provisions of the XignTa husetts St to Plu in/C e anapter-1 2 of the General Laws. . BY re o icense um er ype of Plumbing License Title / jQ/) City/Town iL�euse'1Muniver Master El Journeyman ❑ APPROVED lorFjcE usE oNLY K ''Location 7 No. Date �oRTN TOWN OF NORTH ANDOVER y 9 ° Certificate of Occupancy CMBuilding/Frame Permit Fee $ � ;J US Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 15769 /,/7 - Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s BUILDING PERMIT NUMBER: DATE ISSUED: -c217 —00 0 aZ SIGNATURE: f Building Commissioner/Inspector of Buildings Date z SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Af O A01,] FA ?,M �Z D � 3 I v, X► ������ �n f 0 1 gzn Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: \ Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.5. Flood Zone Information: e tion: 1.8 Sew tem: 1.7 Water SupplyM-GL.C.40. 54)J, % �S l System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service: p� Signature) Telephone i S 2.2 Owner of Record: � L4 to 7 o-to 1:,A �' O Name Print Address for Service: z i �/ ���- ZI 91 m Si natureTele hone SE*CTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: - Not Applicable ❑ Licensed Construction Supervisor: 03858 0011 ,ql O 93 yN boiv � �,,t 6� N- License Number Ade ss J �? D 60S,!xJ —�/ Expiry on Date Signature I Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name / �� M ,5� /n� �� f Registry n Number r Ad!ns / �✓ E ion Date A� Signature Telephone G) SECTION 4-WORKERS COMPENSATION(NLG.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.......0. No....... SECTION 5 Description of Proposed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s). ❑ Alterations(s) ❑ Addition - AccessoryBldg. ❑ Demolition' ❑ Other ❑ Specify Brief Desc9ptiln of Pr sed Work: Aw �o 4 r r r � - ' ,r SECTION 6-ESTIMATED CONSTRUCTION COSTS /� ✓N :9ti. ., 5`ioh oXE"3 }. .V4 Item Estimated Cost Dollar to be �FIF �+ Completed b rmit a licant � ... � TIN Yr 1. Building �C.� (a) Building Permit Fee 00 4 Multiplier 2 Electrical • � (b) Estimated Total Cost of 46 Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 70 A �- 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHOR12ATfON TO BE COMPLETED WHEN ;(? OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT • 1, �" / as weer/ thorized Age Hereb orize of subject property t; , 1 (� ®v i GO" to act on My hall in a matter ive t ork thor b this' uil & pp tion. S- 26-02 - �,� SIature of Owner ate SECTION 7b OWNER/AUTHORI, )ED AGENT DECLARATION f`\ 1, Ay by66 ,as Owne Authorized A e of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief _ v t Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB NDRD SIZE OF FLOOR TIMBERS 1 O 2 3 SPAN DIlvIENSIONS OF SILLS DINIENSIONS OF POSTS DlTv1ENSIONS 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 `- FORM U LOT RELEASE FORM pcl4`aa I wa INSTRUCTIONS: This form is used to verify that all necessary approvals/permits Boards and Departments having jurisdiction have been obtained. This does not from Boards the applicant and/or landowner from compliance with any applicable or requirements. *************************** *APPLICANT FILLS OUT THIS SECTION APPLICANT R ich Y j PHONE LOCATION: Assessor's Map Number -3 J1'"' 3 PARCEL SUBDIVISION f � . STREET_ G� 0 10 rA RM LOT(S)ST. NUMBER OFFICIAL USE eCROECOM N ATI OF TOWN AGENTS: NSE 'VATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS Z(? av G� ZDy� led CC roved s/s U,� b TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS . DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9\97 jm The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phones am a homeowner performing all work myself. 01 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. Company name A �v Address ✓� Ci Phone# r insurance Co v Com2gMf 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 andtor one years`imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($1 woo)a day against me. t understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. !do herby certify under�pa alties ury th t e i ation 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' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Ca-rtact person: Phone# ❑ Health Department ❑ Other R�9 WORKMAN'S COMPENSATION • North Andover Building Department Tel: 978-688_954; 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 Facility) Signature of Penni Applicant Date NOTE: Demolition permit from tt�ie Town of North Andover must be obtained for this project through the Office of the Building Inspector to� (�ln;.3-i 4ct�d h vT --Of-r-*f t 1 G b ' � o m � � � ►. h � � J Q � W o o� � � o fi Nrj , kit fj bit � 1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 001141 Birthdate: 05/25/1958 4 Expires:05/25/2002 Tr.no: 24295 Restricted To: 00 RAYMOND J HOULE JR 93 AMESBURY RD ""'�' NEWTON, NH 03858 Administrator � �++� �iooriuzon�u.-all�i oy°✓�ueaac/u�oelta i 3 HOME IMPROVEMENT CONTRACTOR ` Registration: 105709 y = ? Expiration: 07/20/2002 TYPe: OBA RAY J. HOULE CO, Ray Houle Aaesbury RD ADMINISTRATOR Neatoii NN 03858 o-7 o i g f:�AR m P- D 20= Op �� — 3 ate-VA� � i f OPE{ s t (one �t F t D to ©.c» � t 084 Om t-,G�-O p to r-ARS d PIV iy x ' - - Au pN TOZTsZ. � b kx 6`- to" cAsCD OP6N it4G � � — CUT rRSP06tt � W ALC, WINDOW � P I -aX � 6 ° �` Ux ntziLk, tL-SVAT I ON W7 010 ' f P (l P0- C Y4 CUT VIGLd V dl'L t C,RO4-AId x w Gro .. . _.� 1F __ �. •._..�_ �` s5 e~as� -- ?A vend _ y .T-p P MCA Qstz t I R-19 zx6 sT 16`'a.�. zx�a Rei►`) ---- 2�c 1-00—P DOW) 00 vt►�l E Lc- V MIA .•. . ootINGS Iz" kZoos ftej t n(O RICH &CHRISTINE KARELAS RAY HOULE CO. 107 OLD FARM RD. 93 AMESBURY RD. N.ANDOVER,MA.01845 NEWTON N.H. 03858 TEL. 978-794-2191 TEL. 603-234-5129 FAX 978-794-2154 CONTRACT SPECS 1. 20' WIDE X 24' DEEP 1 STORY ADDITION WITH FULL CELLAR : A. COST OF EXCAVATION TO INCLUDE DIG AND BACKFILL TO GRADE FOR 20 X 24 ADDITION---USING FILL ON SITE, DOESN'T INCLUDE REMOVAL OF FILL EXCESS OR LOAM 1F NEEDED--- ----------2,140.00 B. COST OF FOUNDATION TO BE FOR FULL CELLAR WITH FOOTINGS ONE STEP DOWN 1/2 WAY DOWN SIDE OF ADDITION TO ENTIRE REAR (for kneewalls and windows rear)ONE CELLAR POUR IN WINDOW INCLUDED-- --- ---------–--------------------–----------------------2,880.00 C. COST OF PERIMETER DRAINAGE WITH STONE AND HAY(connected into exisitng system )---–____—----–----–------_ ___ __ _–---–---------------450.00 D. COST OF STONE FOR CELLAR FLOOR 10"THICK APPROX----------- ------450.00 E. COST OF INT. SLAB TO BE 4"THICK -- --- _ --__1,440.00 F. COST TO CUT OUT THROUGH EXISTING FOUNDATION WALL FOR ACCESS INTO NEW CELLAR---------------------42"------------------------------------------745.00 G. COST OF MATERIALS TO FRAME TO ROUGH STATE------CATHEDRAL STYLE WITH DECOR PINE BEAMS 4X8=2----STAIRWAY TO CELLAR---------- --5,965.00 H. COST OF LABOR TO FRAME TO ROUGH STATE ______-4,845.00 I. COST OF FRAME MAT. TO ROUGH FRAME WALLS IN CELLAR IN FRONT OF FOUNDATION FULL HEIGHT AND HALF HEIGHT WALLS, WITH CLOSET AREA, STRAPPING FOR CEILING----ALSO FRAME HALLWAY WALLS IN OLD SECTION WITH OPENING FOR 5 DOORWAYS-----------------------725.00 J. COST OF LABOR TO FRAME CELLAR FOR RM.---------------------------------------------975.00 optional K.COST TO ADD WALK-OUT DOOR IN INSUALTED STEEL 9 LITE OVER 2 PANEL ENTRY DOOR....TO HAVE P.T. LAND-TIE RETAINER WALLS WITH 2 STEPS AT 8'OUT END ---------- ---------------------- -------2,135.00 L. COST OF WINDOWS TO BE ANDERSON PERMA-SHIELD TILT-WASH DBL.HUNGS SAME SIZE AS HSE. =4 UNITS WITH SCREENS, BUILD-OUT, AND GRILLES=4 INSTALLED @ 415.00/EA= 1,660.00---------AND ONE 8' BOX BAY WITH 3 DBL-HUNGS MULLED TOGHETHER AND UINT BUILT OUT FROM HSE. 12'WITH SHED ROOF AND TRIMWORK= 1,780.00-- 3 DBLHUNG WINDOWS CELLAR @ 365.00/EA= 1,095.00-------------------------4,535.00 M. COST OF SINGLE FLUE NATURAL BRICK CHIMNEY ON GABLE END OF HSE. WITH BEAM MANTEL------------------------- ------------–----------6,250.00 N. COST OF ROOFING TO BE ARCHETECTUAL 25 YR. SHINGLE WITH ICE AND WATER PROTECTION, PERIMETER DRIP, RIDGE VENTING ----1,925.00 O. COST OF SIDING TO BE 1/2 X 6 VERTICLE GRAIN CEDAR CLAPBOARDS WITH TYVECK HSE. WRAP, STAINLESS NAILS------- -- --5,775.00 P. COST TO MOVE AND RE-ROUTE SPRINKLER SYSTEM–--------------–----------575.00 Q. COST OF ELECTRICAL TO INCLUDE BASEMENT AND 1ST LEVELS WITH STANDARD WIRING-----CEILINGS LITE SPOTS=3 ( new stairway to cellar, hallway in exisitng cellar, new 3/4 bath area), FAN LITE SPOTS= 1 RECESS CAN SPOTS= 12, OUTSIDE FLOOD SPOT= 1 ---TO INCLUDE PHONE AND CABLE -- 3,740.00 R. COST OF HEATWORK TO INCLUDE 2 ZONES OFF EXISITNG SYSTEM BAEBOARD HEAT IN CELLAR AND 1ST LEVEL------------------------------—3,420.00 S. COST OF INSULATION TO BE R--19 WALLS AND R-30 CATHEDRAL TO INCLUDE BASEMENT LEVEL WALLS------ --1,970.00 T. COST OT INT. FRAME WORK 1ST LEVEL TO INCLUDE COST OF REMOVAL OF ANGLE LOAD WALL AND RE-FRAME FOR NEW STRAIGHT WALL APPROX. T TO RT. OF OLD WALL AND FRAME-THROUGH FOR ACCESS DOORWAY INTO 1ST LEVEL NEW RM.–(cellar framing of 2 walls making new hallway to new basement with framed opening for entry door, three doorways for access into exisitng basement, water meter, and electrical box., plus opening for coat closet after doorway to exisitng cellar=675.00----FRAMING FOR 1ST LEVEL ANGLE WALL= 1,400.00)---2,075.00 U. COST OF BLUEBOARD AND PLASTER WALLS ANS CEILINGS IN BASEMENT LEVEL, 1 ST LEVEL, AND ALL AFFECTED AREA'S WITH PATCHWORK PLASTER IN 1ST LEVEL OLD SECTION -----------------6,075.00 V. COST OF TRIMWORK TO INCLUDE 6 PANEL PINE DOORS ENTRY=5, CLOSET BIFOLD IN PINE 6' UNIT= 1 , CLOSET PKG=1, WINDOW TRIM= ( 1 BAY UNIT, 7 REG DBLHUNGS, 1 CELLAR ) , BASEBOARD TRIM, OAK SPINDLE RAILING AT TOP OF STAIRS AND ONE SIDED OPEN SPINDLE RAIL DOWNSTAIRS–INSTALL CHAIRAIL TO PERIMETER OF 1ST LEVEL NEW RM.,CASED OPENING FROM KITCHEN HALLWAY TO NEW RM. SIZED TO ACCEPT 5' FRENCH DOORS, BIFOLD 48" UNIT FOR CLOSET IN EXISITNG CELLAR NEW HALLWAY WITH CLOSET PKG.------4,625.00 optional W.COST OF WALL AT BOTTOM OF STAIRWAY WITH DOOR SAME PRICE AS OPEN SPINDLE RAILING IN"V"ABOVE OR 775.00, SO YOU CAN HAVE WHAT IS ABOVE"V"OR THIS"W'.�----- --------------- X. COST TO MOVE OIL FILLS TO OUTSIDE WALL OF HSE.------ 775.00 Y. COST OF CARPETING TO BE BERBER WITH PAD @ 25.00/YRD INSTALLED FOR 1ST LEVEL, BASEMENT LEVEL, STAIRWAY TO BASEMENT LEVEL, BASEMENT LEVEL HALLWAY IN EXISITNG, ADD BERBER TO EXISTING STAIRWAY TO CELLAR (doesn't include cost of affected area 1 st level original,wasn't discussed )-----3,910.00 Z. COST TO ADD 2 VELUX 4'X 4' FIXED SKYLITES WITH LOW"E" GLASS FRAMED, INSTALLED, TRIMED-------750.00/EA-------------1,500.00 AA. COST TO CONSTRUCT TWO TX 6'OPEN FACE BOOCKCASES FROM OAK VENEER PLYWOOD, ADJUSTABLE SHELVES=4 EA., SOLID OAK FRONT TRIM-----------------------475.00/EA------------------950.00 BB.COST TO REMOVE AND MOVE EXISITNG BEDRM. WINDOW INCLUDES INT. TRIMWORK, AND PATCHING HOLE WHERE WINDOW WAS----------315.00 CC. COST TO INSTALL A.C. DUCTWORK ONLY IN NEW RM. ---ESTIMATED UNTIL VERIFED----------------------------_-------------------------------375.00 DD. COST TO CUT UP CONCRETE FLOOR FROM EXISITNG DRAIN TO NEW FUTURE BATH LOCATION NEW MAIN DRAIN AND BRANCHES FOR TOILET, VANITY----SHOWER-------INSTALL HOT AND COLD PIPING AND LAUNDRY SINK ONLY -----1,285.00 EE. FRAME WALLS FOR BATH AND DOORWAY IN BASEMENT LEVEL--------375.00 optional FF.COST TO INSTALL STEEL BEAM IN NEW CELLAR INSTEAD OF HAVING 2 LALLY COLUMNS FOR SUPPORT BEAM---(this would delete out cost of wood carrier and sallies in above framing cost)COST ABOVE AND BEHOND ABOVE FRAMING COST ------- --475.00 2.TOTAL COST OF ABOVE WORK(doesn't include cost of permit,finish paint or stainwork inside or out,doesn't Inc.optional above-------71 ,540.00 3. COVERED UNDER"MASS CONTRACTOR LAW"--------------REG#105709 BUILDER'S LIC.#001141 4.PAYMENT SCHEDULE: 10%DOWN PAYMENT6%AFTER ROUGH-IN----- 25%UPON COMPLETION.... ------------------------------------------------------------- -------------------------_-------------------- CUSTOMER SIGNATURE 3-19-02 RAY HOULE CO.3-19-02 I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # MAScheck Software version 2.01 I I Checked by/Date I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 3-26-2002 PROJECT INFORMATION: KARELAS RESIDENCE 107 OLD FARM ROAD NORTH ANDOVER, MA. COMPLIANCE: PASSES Required UA = 185 Your Home = 157 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 560 30.0 0.0 20 WALLS: Wood Frame, 16" O.C. 589 19.0 0.0 35 BSMT: Conc. 7.5' ht/6.0' bg/7.5' insul 285 19.0 0.0 14 GLAZING: Windows or Doors 123 0.320 39 SLAB FLOORS: Unheated, 24.0" insul . 64 10.0 49 HVAC EQUIPMENT: Furnace, 85.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 3-26-2002 Bldg. l Dept. l use I CEILINGS: [ ] I 1. R-30 Comments/Location 1 WALLS: [ ] I 1. wood Frame, 16" O.C. , R-19 Comments/Location I BASEMENT WALLS: [ ] I 1. Conc. 7.5' ht/6.0' bg/7.5' insul , R-19 interior cavity Comments/Location I WINDOWS AND GLASS DOORS: [ ] i 1. U-value: 0.32 For windows without labeled U-values, describe features: i # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I SLAB-ON-GRADE FLOORS: [ ] I 1. unheated, 24.0" insul . , R-10 Comments/Location Slab insulation to extend down from the top of the slab to at least 24" OR down to at least the bottom of the slab then horizontally for a total distance of 24". I HVAC EQUIPMENT: [ ] I 1. Furnace, 85.0 AFUE or higher Make and Model Number I AIR LEAKAGE: C ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no i more than 2.0 cfm (0.944 L/S) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. I • I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing u-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 LOW temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NfNJ-CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): . RUNOFF-FS 071" ( 0-1.25" 1.5-2.0" 2.0+" I • I 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ,----NOTES TO FIELD (Building Department Use only)------------------------- NORTH Town of4 Andover No. tj I �( o O C A dover, Mass., T -' COCHICMEWICK I- ADRATED p5 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... . 4.. ........... .. !r...I.+.. .............................................................. .......... ...... Foundation �' �'g a y I 1 0 1 0 1 A......F�.1'w�....... .. has permission to erect...�................................. buildings on ........................ . .. ................. Rough t0 be Occupied as..... ..'.'..�.M!1.l..t.. . rr� a J A 1+to N N►/ �iiw►ti /►INS . .. . . . . .. . . . . .. . . .. .................................................... .........................0...........Sawahimney provided that the person accepting!-Xi is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to he Inspection, Alteration and Construction of Buildings in the Town of North Andover. 35/31 5/3 A/ .4=0w PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU N S ELECTRICAL AINSPECPOR .. 6�� Rough ......... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Location No. _ Date g-1y, 6o f &ORT" TOWN OF NORTH ANDOVER 41 9 + Certificate of Occupancy $ • ,SJACHO*. Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3s) Check # ` J Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING MOM BUILDING PERMIT NUMBER: DATE ISSUED: " M yao � 00 SIGNATURE: Building Commissioner/I or of Buildings Date Z SECTION 1-SITE INFORMATION 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 10-1 OBD `FARM X35 00 3l �V, _/0 Ver) Ate, D�o l Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: M v Et f Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided ReqWred Provided v 1.7 Water Supply M.C.L.C.40. 54) 1.5" Flood Zone Information: 1"8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Qwner of Record PSI cid /0-7 n1c--�M P-d Name(P tj Address for Service Signa re Telephone 2.2 Owner of Record: (�hnnioe- &6aj J6 ''J told FafM ,Rod Name Print Address for Service: z (97S) 794)-Igl m Si ature Te hone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number Mn Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable Vv Company Name Registration Number r Address r Expiration Date ^z Signature Tele hone G) SECTION 4-WORKERS COMPENSATION(NLG.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 unit. —Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descrin of Proposed Work check au applicable) New Construction Existing Building ❑ Repair(s) I-❑ All ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: tez 1 67 1.14 T,rrJ /D 6-661 pec/< SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be �� F'ICLlti#TSE ONLY 31 a'x 4 M" Completed b permit a licantAN r., ,�� 1. Building ¢ubD (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number t SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT j as Owner/Authorized Agent of subject property 1 ��ss � Hereby authorize �an l '('edGCz to act on MyfF in all matters relati a to work authorized by this building permit application. ri 1 ^,4 n/3 ! /6O Si a e of Owner Date T SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Pch&GL-4 Y&A- ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print N 1113 ��aa Si atur of Owner/A ent Date NO. OF STORIES SIZE, BASEMENT OR SLAB SIZE OF FLOOR T M BERS 1ST 2 3 SPAN DRVIENSIONS OF SILLS DM,ENSIONS OF POSTS DRvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTif Town of North Andover F R Building Department - p 10 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE L3ilao JOB LOCATION 16 q Ot D 90 Ai> 1JAv1>oV 2 f d Number Street Address Map/lot "HOMEOWNER _ki C Aieb s rla`q—.:�IQ I -Iqq—,-I j Name Home Phone Work Phone PRESENT MAILING ADDRESS 167 Q i.d, 'f N."Ytjr., arYi City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiremen HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL k � d o IN So NX IN � � ti � e oo� W � kh � QQ � � � � o Q o �CD � � � W � �' � WW m `` ►, � � Q �'� o Town of North Andover t%ORTH do Building Department o 27 Charles Street North Andover Massachusetts 01845 2 ti (978) 688-9545 Fax(978) 688-9542 �9SSgcHus���y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Q /�re.�ta�4' /�✓e�l� ignatur of Applicant /d d/b lie+-w• . Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. BID (service and materials) July 30, 2000 TO: Richard and Christine Karelas Daniel Crevier 107 Old f=arm Road PO Box 694 North Andover, Ma. 0?845 330 Campbell Rd (978)794-2191 North Andover, Ma. 01845 978-794-3956 978-771-3127 We are pleased to submit the following bid: Job Description: Remove old deck, replace with elavated 20'x16'deck. MATERIALS QUANTITY DESCRIPTION UNIT PRICE TOTAL .. ..... ... Materials total. 2,375.00 SERVICE HOURS DESCRIPTION CHARGES TOTAL remove old deck-la out for new 16'X 20'deck 2,500.00 install deck frame;batlast railin s`stem, ate, stairs, floor, enclose the under side as discussed, bench as discussed, ;' � ;; all buildf n.will tie Ono:0meet or'exceetle current state and local code. and will comply with the minimum ms 666n;Orr ure Service total: __ 2,500.00_ Total bid price:11 4,875.00 House -- 20 e2isting c,ec.k (retained) 11.8 16 s I 7.4 House 20 existing deck (retained'.) 11.8 14' 16 7.4 support 6 x 6 posts (3) 2 x 8 support beam �4' 12" tubes at 4' House 20 existing deck (retained) a 11.8 14' R 16 i i 7.4 2 x 10 joist @ 16" oc (3) 2 x 8 support beam 12" tubes at 4' 6x6posts House 20 i emstitg deck (retained) 11.8 r railing posts 16 x r i � 7.4 not to sole 6 x b post �y 3- 2x8 support tubes-12" 48" deep e�'Ustzng declti ballast railing 3.5 inch oc screen porch ?' House 20 existing deck (retained) 11.8 16 Bench or 7.4 House �— 20 emstir deck (retairied) �i s 11.8 16 7.4 I r T FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary 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. 44 APPLICANT K I(_i')Af2D KttkEL f}S' PHONE ' qq q ASSESSORS MAP NUMBER 6315- LOT NUMBER 0031 SUBDIVISION LOT NUMBER STREET 10-1 00 rA f-i✓1 01-d2. STREET NUMBER /07> NONENougge�.......................... OFFICIAL USE ONLY.........................�.�-, ................................................ .. ......... ■.M.NN■ MONO RECOMMENDATIONS OF TOWN AGENTS 1 �✓� f"� DATE APPROVED O CONSERVATION ADMINISTRATOR f` c /� DATE REJECTED CONffVTEN S Q l� nl - �- N !V© r• �• C�(�P� Nb DATE APPROVED TOWN PLANNER DATE REJECTED CONUVIENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE NORTH TONNM Of Andover No. 420 = Ao dower, Mass. goo CoC HICHEWICK ADRATED S 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System eAs%ailou.0 � BUILDING INSPECTOR THIS CERTIFIES THAT. 1. .......a.r.............................. . ..... .... .. .. ..�'.�..�A..S.......... Foundation buildings on .... ... ...... . Rough has permission to erect...,/►..� .� 40 7.......�� �� A4&M to be occupied as.............................&.. ............�7. AC..C..I y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. m a tr #03/ # 3a#� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ' Rough .....................:............................. Service BUILDING INSPECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 1 i �t �•/O7 W h ti O Q .mor -Of-Of t a v 1 � Area Code 508-872-3529/20 iai-ls5-i�4s Fax 508-626-4255 B&F Associates Inc. Mass.Only Toll Free 1-800-33222-88818818 Adjusters and Appraisers P.O. BOX 904 FRAMINGHAM, MASSACHUSETTS 01701-0204 Established 1968 Form of Notice of Casuality Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 313 TO: Building Inspector or Board of Selectmen Board of Health Type of Loss: Windstorm Town Hall Andover, MA 01810 �� 18 RE: Insured: Richard & Christine Karelas Property Address: 107 Old Farm Road N. Andover, MA 01845 Policy No. NBSM85235 Loss of Sunday December 17, 2000 File or Claim No. 41543 Claim has been made involving loss, damage or destruction of the above-captioned property,which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appro- priate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date a loss and claim or file number. John A. Barone Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. John A. Barone 1/16/2001 Signature and date Date. . 597 4130 TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING ,SSACHUSEt This certifies that . . .,/.,... . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .�. . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . �. -?r . . . . . . . . . . . . . . . ... . . . . . . . . . . . . Ngrth Andover, Mass. Fee. . . .Lic. No. G JC. . . . . . . . . X1-. . .1-,-1c �z. :. . . . 11" UMBING INSPECTOR V WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MAP PARCEL MASSA HUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ype or print NORTH-ANDOVER,MASSACHUSETTS- d'q 0 & �� Date i� / .S rn7it#_ /? Building Location n A) wners Name Pe Amount 'k L Type of Occupancy New ET__� Renovation El Replacement Plans Submitted Yes No FIXTURES tiLn rRH-OOR 3M MOOR 4M IMM sM Hj" sTR mit 71H HJ" sn3FLOW 4d— (Print or type) Check one: Certificate Installing Company Name � � S/�} Corp. /� nn Address �� �.! D X �D y r Partner: Business Telephoned jry S l9�� ✓u ut 2 a-Fium/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type,of insurance coverage by checking the appropnate box Liability insurance policy Other type of irideinnity Bond ,D `> Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature -Owner Agent I hereby certify that all of the.details and information I have submitted.(or.entered)in above.applicationare.true and-accurate to the best of my knowledge and that.all plumbing work and installations p ormed under Perrpit.lssued.for this application will,be in, compliance with all pertinent previsions of the Massachusetts State b e hapter 142 of the General;Laws. By: 1gna e ot Liconseclum e ' Type of Plumbing License Title _ City/Town Jce _ er `1Vlaster'.," Jrniney�nan .. �._.. APPRHVEcE USE ONLY