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HomeMy WebLinkAboutMiscellaneous - 118 SECOND STREET 4/30/2018 -118 SECOND STREET J 210/014.0-0047-0000.0 I I Location No. Date �oR7M TOWN OF NORTH ANDOVER f R % Certificate of Occupancy $ • i cHUsE<� Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # W 11r f , y Building Inspector TOWN OF NORTH ILD ANDOVER O BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING T OTHER THAN A ONE OR TWO FAMILY DWELLING /v ��_'J .�.w�>''.o°.?';., "Y-'K-� Section for Official Use Onl � � � BUILDING PERMIT NUMBER: DATE ISSUED: E-6 Z SIGNATURE: BuildiU Commissioner/Inspedor of Buildings Date 1.1 Property Address 1.2 Assessors Map and Parcel Number: 11F-1,2e Sez;o,� S7' j,/ AlM4 Number Prarcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Area - Frontage It - m 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided f 1.7 Water Supply M.G L C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: (� Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 11, 2.1 Owner of Record 73)Nt D A I32. LOav e•vr 31 9, A AJdUe- Mk b N pef t} Address for Service 07 /) 981 ;SIX _ M Si a n Telephone 2.2 uthorized Agent (� e rint Address for Service: z 14A s 6 Si a re Telephone z 903.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number O ry e? t^J, Licensed 5o u so Expiration Date _ ature Telephone 3.2 Registered Home Improvement ContractorNot Applicable ❑ 4e 44 409 h&4*06w;�Iwl - ,Vv Company egistration Num m w? f #ks 61(vae5reg, ok Ada s5 f—0y— ©l r FOO ���y1 �-7��( Expiration Date z i store Telephone ((f� Y, SECTI(?x a '4VORI c. FYSA ©1' G. 2 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 Yea......)Q No.......❑ SECTION 5-VROFESSIQ DW&,N AN f ONS RUGTI<o S V1iCIS FOR 1i1 D4-GS AND M�T S.SfJ1t tT T+B CONSTRiTCTI©N Ct)]�I;tI PBf TAI+iT TO 7S�IR 1.16 MOS TTrIAIs 35,OA9 C 7C OF F.+f+CT.OSED Si'A j 5.1 Registered Architect: I Name: I Address Signature Telephone .3.2 RegfstLn'ecI`)P�f�stena� �$� .�, Name: Area of Responsibility Address: Registration Number Signature Total Expiration Date Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 1 r �l"h�}' zq-6 L '°�'r"'1"'s S" M" Not Applicable ❑ Company Name:� �- ��N Responsible in Charge of Construction * r�, ,0"i�rd!,!1�ir;R�T�Q���' Q New Construction ❑ Existing Building 0 Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ft,4-r rmh ( -rputA APO fid USE GROUP Check as applicable) CONSTRUCTION TYPE AAssembly ❑ A-1 0 A-2 ❑ A-3 ❑ 1 ❑ A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ C Educational ❑ 213 0 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft 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 ,as Owner of the subject property Hereby authorize I M � ll�l2-. !1� �� L V f �4 to act on My behalf,/kip all matters relative two work authorized by this building permit application Si ture of Owner Date 1��,��_. eK or- t ,a&Qwfter/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 ame � a Si tore er/Agent Elate Item Estimated Cost(Dollars)tobe =� i'j Completed by permit applicant 1. Building (a) Building Permit Fee �P "V Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a)x(b) 9/ 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number r�xst^y3- NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2ND 3RD SPAN DEMENSIONS OF SELLS 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 Date. .?./j./'U. .... . .. . TM pf NO o1H o? � TOWN OF NORTH ANDOVER 41 PERMIT FOR GAS INSTALLATION s io h SA US iQ This certifies that . . . ..��. ... . . . . . . ' /. . .`� .y. . . . has permission for. gas installation . . . .� . in the buildings of . .l!u. ./ L! . . . . . . . . . . . . . . . . . . . at . . . . . ` North Andover, Mass. Fee.? Lic. No.. .P. / GASINSPECTOR Check# 72 '/9 .J MASSACHUSETPS UNUORMAPPLICAPON FOR PERMIT TO DO GAS FITTING (Type or print) Date 7 h //t, NORTH ANDOVER,MASSACHUSETTS Building Locations C O'er Permit# Amount$ Owner's Name New❑ Renovation Replacement 0- Plans Submitted ❑ rA W a w w a o H x Q W Lr Q z �. W d W W per„ Q W r C7 F Z F. z x0 W > O W ? v cOq z O z W Cal a U a > D a O SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 87H . FLOOR (Print or type) — Check one: Certificate Installing Company Name C. -� / (*/c .1;-b - c Corp. Address �� t v k J� ,0 A_ Partner. BusinessTelephone 2 7 gf�6 Q, ® Firm/Co. Name of Licensed Plumber or Gas Fitter ,-So 46 5 4A e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes �� No If you have checked yes,please in ate the type coverage by checking the appropriate box. Liability insurance policy Mr Other type of indemnity Bond 13 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 El 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 in allatio performed under Permit I ued for this plication will be in compliance with all pertinent provisions of the M sachus s e Gas Co d Chapter 2 of the e al Laws. By: ature of License Plumber Or GasZtter Title E3 Plumber 7 City/Town [:] Gas Fitter License um er master APPROVED(OFFICE USE ONLY) Journeyman P The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations 600 Washington Street Boston, AL4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6' ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. . insurance 5. 9 ❑Building addition [No workers' comp. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions j3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.[]Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other applicant that cheeks box At" also nL out the SecRr"+beenu,en!?l nub f!:err l:Cr::='CCmw:-iSa�`JE p012Cy L^.f4r u`..:+CII. T Homeowners who submit this affidavit indicating they are doing allwork and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance a verification.Covera g Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Simature: Date.: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Is Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than#hree apartments and who resides therein,or the occupant of the dwelling house of.another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to si=gn and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding he lav,-or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0.2111 Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Revised 5-26-05 Fax# 617-727-7749 v mm,.mass._Dov/dia Town of North Andover � NaF?Th Building Department i'�off''-go ~�y'tio ' o _ ., 27 Charles Street North Andover, Massachusetts 01845 Z (978) 688-9545 Fax (978) 688-9542 �.q °R�Tca �Ps`y.t9 �'SAC�fl15�,S 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 c 1, sI50a: The debris will be disposed of in/at: Ali i2N�Y�. - Svc �e p-tftz,sr Facility location Si re o A.pp ant Date NOTE: A demolition permit from the Town of-North Andover must be obtained for this project through the Office of the Building Inspector. ' I i _ _ fire L�amrnu�u��C.�ut�e o�:-�lirJAarlt�c�d BOARD OF BUILDING REGULATIONS lw� License: CONSTRUCTION SUPERVISOR Number: CS 035741 Birthdate: 03/1811960 Expires: 03/1812002 Tr.no: 21772 -%nairnontinn-r.q Restricted To: 00 � EDWARD J SOPER 18 READ STREET WINTHROP, MA 02152 Administrator 1 i Z - a The Commonwealth of Massachusetts d Department of Industrial Accidents RQ Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name l„z ,� J �Q Please Print Name U�tiI� lQ1J lam/ Location: 3 kIVYWG ET6 City 6100esTe- C M4- Phone # I 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. ComDanv name: Address srlgT�G Ci : Phone#: �� J? d 77 ' Insurance Co /�/ >'r 1 Policv:# C�3 S V ffi `� Company name- Address CIw_ Phone..#: Lnsutanhe:Co. Policv.# Failure to secure coverage as required'u r Section 25A or MGL t52 can lead to the inlpasipon of cnm�nal(senalt�+es of a fine up to$1,6Ob.00 and/or one years'rnbprisenmentAs m"rna., ivil_penalties.ioSf e�mn � IDP 1luORK-S?RL�F 3.and_a�inrr:of $CD4 � #lay-againstme I understand that a copy of this statemeny be forwarded to the Office of Investigations of the DIA for Coverage vetcation. ” I I do hereby cert' th pains andltiesof pedury that the information provided above is true and correct. Signature.. i� Date a i Print name Phone.# 70/ /6 0�76� Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensinq Building Dept ❑Check if immediate response is required .0 Udensing Board E] Selectman's Office Contact person: Phone# O Health Department Ej Other 118-120 Second Street f No. Andover, MA "IF C�I�LLY V i v J, o 2 \\lc:)0 > _. :7 1, --1 - ' �AV1D I`. .TOIJ MORTGAGE INSPECTION PLAN DUYER: LOCATEDIIIII 10111E 1A0m'b'(*aE cop-p. OF THIS LAs-r ` dol?fr� /—\f V l�J V�� NIU IIS TITLE BISU11ERS 1,CERIMY MAT I(LAVE EXAIRIIED TETE Pa..,Al.111E IIUILUDICS glom!DO( ) MASSACHUSETTS COHFURM IU 111E 20111110 LAMS AIR)AMOIDMEIIIS,L. 1`110117,SLUE,k REAR YARD SEIDACK 0'N-Y,OF NOfzTH XNPC)VLF-R, m1EII C011SIRUCIEU, I FtIRIIIER CERT Y MAT 1 MS PROPERIY IS LOCAIED UI 111E ESTALISIIEU ILOW DEED -y DAZARU AREA. 2-5ooa8 0005 - f EXALURA11611 OF 111E RECORDS IS MAUE,OIELY SUDSECAWIT 10 1RE RECORIIED DALE OF 111E Lj7Q. LAIESI UEEO,AIN)DUES ROT IK7.UDE VMn1I10 11IE ACCURACY OF 111E UEED DESgID'11U11 PAI&: PRLVIOUS 10 ITS UA1E OF IIECOIW. CFIII.TIO. TINS COMPAIIY IS ROT RESPOUSUME FOR AIIY DIDE1l1URES MADE SUOSEOUEUT 10 111E RECORDED DAZE Of 111E LATEST DEED OF REOURD, NINUIEVER BUNONICS ARE E U M1l LESS MAR OIIE FOOT FROM IIIE PROPERTY/IIE,IT IS AUVISED IIAI TIN. PACE 11UT A MORE PRE05E SURVEY BE MADE TO VERIFY MESE MEASUREMEUTS. 1IQIL* I'Wl IF UAIEII TINS CERTIFICA11OA 15 BASE 011 111E LOCATION OF SURVEY MARKERS OF O11WM.NIU DOES JULY ZS 1.1101 REPHESEIIT A PROPERTY SURVEY. ,LBBB 11US CERIIFICMi011 TO BE USED FOR MORTGAGE PURPOSES ONLY. SCALZ 1'-Cc' OFFSETS AS SIIOWII ARE NOT TO DE USED FOR THE ESTAOUSIUAEN7 OF PROPERTY LINES DRADFORD ENGINEERING CO. P.O. Dox 1244 q IIAVERIIII-L MA. 01831 RO RLS. /10307 TEL,(508)373-1394 ft .��II I►ne-% — ol - - --- - j4 oll �t75 I NORTiy E Town . of - over 7 �A M,c1p dower, Mass., DRATED p'P�,��� S H E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ,.A ...... . ....................................................................................................................................... ......... . Foundation permission tote .��.wWYL buildingson ..&O—/00 SiedN� S40 Rough................ ....................................• c peat, Rr0�' 0 �� S Chimney to be occupied as... A.1.!r............................................................................................................................................ 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. ;y/ y7 q� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARS ELECTRICAL INSPECTOR C 1 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.