HomeMy WebLinkAboutMiscellaneous - 119 MARTIN AVENUE 4/30/2018 119 MARTIN AVENUE
210/045.17-0030-0000.0
NORTH
TOWN OF NORTH ANDOVER
0 VIM M W- PERMIT FOR WIRING
MU
This certifies that ..... .................;..!7.......... ..........................
has permission to perform ... /. ........ ..............I
wiring in the building of............ ...... ...........................
......North Andover! ass.
Fee..3,�.... ...... Lic.No. .......lleloiez ...
.. . .......
RICAL INSPECTO
ti
Check #
Commonwealth of A7assaehusetts Official Use Only
.• iY
Department of Fire services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/07] (leave blank
APPLICATION FOR PERMIT 'TO PERS M ELECTRICAL ET
All work to be performed in accordance with the Massachusetts® �C a(MEC 527 C��O yY ORK
(PLEASEPRWflVAW OR TYPE ALL flWORNIATIO
City or Town of NORTH ANDOVER Date:
By this application the undersigned gives notice of his or her intention to pTO the erform the el�electrical w des abed below.
Location(Street&Number) l r t V
Owner or Tenant $ Lo
Owner's Address ITelephone No.
Is this permit in conjunction with a building pert? yes
Purpose of Building I , �� El No EJ (Check Appropriate Bog)
Utility Authorization No.
Existing Service Amps / _Volts
Overhead ❑ Undgrd❑ No.of Meters
New Service
Amps
Number _Volts Overhead❑ Undgrd❑ No.of Meters
of Feeders and.Ampacity
Location and Nature of Proposed Electrical Work:
Com letion of the followin table may be waived by the Ins ector of Wires.
No.of Recessed Luminaires No.of Ceil:Sus No.of
p.(Paddle)Fans Total
No.of Luminaire OutletsTransformers KVA
No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In_ o.o mergency lg
d• nd• ❑ Batte Units g
No.of Receptacle Outlets
No.of Oil Burners
F—M—E AJLA-RMS No.of Zones
No.of Switches No.of Gas Burners
No.of Detection and
No,of Ranges Total Initiatin Devices .
No.of Air Cond. No.of Alerting Devices
No,of Waste Disposers Heat Pump Number Tons ns KW
Totals: _�. .~- No.of Self Contained
No.of DishwashersDetection/Alertin Devices
Space/Area Heating KW Local❑ Municipal
No.of Dryers Heating Appliances fiances Connection El other
KW Security Systems:*
No.of Water No of No.of Devices or Equivalent
Si s Ballasts Heaters ' Na, Data Wiring;
_ .
. No.Hydromassage Bathtubs No.of Devices or E uivalent
No.of Motors Total HP Telecommunications Wiring:
OTHER; No.of Devices or E uivalent
Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires.
Work to Start: (When required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the lieensee.provides proof of liability insurance including`°completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER
I certify ❑ .(Specify:)
under the a'ns and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: 011 n*+
Licensee:_ !�ur I�APT LIC.NO.-._Z4_5—,/1�
� b Signature � ��
(If applicable,enter exempt 'to the license number line.) LIC.NO.:
Address: Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: fit'Tel.No.:
OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not have the liabili Lie.No.
required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner coverage normally
Owner/Agent ❑owner's agent.
Signature Telephone No. —
PERMIT
I
ELECTRICAL PERMIT NO, INSPECTION REPORT:
ELECTRICAL,INSPECTOR•-DOIUG SMALL
I.ROUGH INSPECTION:
Passed—[ j Failed—[ ] Re-inspection required[($50.00)-[ ]
Inspectors'comments:
(Inspectors'Signature-no initials) Date
2.FINAL INSPE TION;
Passed—[ Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors'comments:
(Inspectors'Signature-no initials)
Date
3.UNDER GROUND INSPECTION:
Passed— �
[ ] Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
4.INSPECTION—SERVICE:
DATE CALLED NATIONAL GRID: NAl"Y1T:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)
Inspectors'comments:
(Inspectors'Signature-no initials) Date '
S.INSPECTION-OTHER:
Passed—[ ] Failed—[ j Re-inspection required($50.00)
Inspectors' comments:
(Inspectors'Signature-no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO DE INSPECTED IS NOT
ACCESSIBLE AND A RE-INSPECTION OF$50.40 IS TO BE CHARGED.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office ofInvestigations
..600 Washington Street
Boston, MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant.Information
Please Print f,e ibI
Name(Business/Organization/Individual):
Address:
-----------------
City/State/Zip: Phone#:
FEFI-11
employer?Check the appropriate box:
em to er with 4, Type of project(required):
P Y ❑ I am a general contractor and I
yees(full and/or parttime).* have hired the sub-contractors6. ❑New construction
. 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.
[No workers'comp. insurance 5. ❑ We are a corporation and its 9' ❑Building addition
required.] officers have exercised their 10.El Electrical repairs or additions
3.[1 I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§44),and we have no F
insurance required.] f employees. T 12•❑Roofrepairs
[No z porkers'
comp.insurance required.] 13.[1 Other
a nY applicant that checks box#1 must also Cil out the section beton,shoring :heir w orkes'compensation;o?icy information
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:_ (". (f �-
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 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#:
FEOther
only. Do not write in this area,to be completed by city or town official.
n: Permit/License#
ority(circle one):
I. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector
son:
Phone#:
Gehna5 5hdural �Nineerinq L. C Phone 978.465.6436
Daniel L. Gelinas,P.E. Fax 978.465.5160
579A North End Blvd.
Salisbury,MA 01952-1738 email danlgelinas@comeast.net
June 22,2011
William J. Ferris [Back River Development]
28 Back River Road
Amesbury,MA 01913
SUBJECT: 4 Martin Road,N Andover,MA framing changes
Dear Mr. Ferris:
1. Per your request Gelinas Structural Engineering LLC (GSE)met on site with Brian Lynch on June
20th. Mr. Lynch requested GSE review the Pyramid Engineering May 11 letter and framing sketches
SKI, SK2, SK3. Specifically Mr. Lynch requested detailing changes,and several options where
discussed.
After review of these items the following is GSE's opinion:
1. GSE agrees with Pyramid's letter comments and framing plans/details concept
2. GSE suggests the revised details as shown enclosed as SKSG-1 & SKSG-2
3. GSE is willing to be the Structural Engineer of Record(SER)for this framing repair residential
project
4. GSE feels the SKSG-1 & SKSG-2 framing details satisfies the requirements of the IRC 2009 as
amended by the Massachusetts State Building Code 8th Edition One and Two Family Dwellings
5. Design criteria:
a. Ground snow 50 psf
b. Wind100 mph
Please call with any questions, cell 978.360.2562
A
DANIEL L.
GE H.,
Very Truly Yours, 4 3T1- tsT;�'?£AL t sr
No.33w,,-
Daniel L. Gelinas, P.Ep� '
D framing changes 114 Martin Ave N Andover job 11098
4LfVlV.CaL.�'�
,
�V
:�1NI97'f
3
1
I`
o
Co,4,o
v t d cmz
(—_
N �
tJ O^ N Q
GEUNAS 9RUe? M ENGINEERING Ile
o N - _
o LO V V Daniel L.Gelinas,P.E.
- � (I 010 a. Ae 579A North End Blvd.
o TIE I
ku 0 V Salisbury,MA 01952-1738
-Q St COON Phone 978.465.6436(Fax 5160)
o wl� Sfiw�p 2a
I- _.Ncu2-'u1 IL
�-T OF hLS.gS
CuLiNA:i m1
Rj1CT!3RAL N
NJ 33994
LI
Roh i o
Sb�
y & (fH o
GEUNAS STRUCTURAL EWNEEi W UC
Z o � j� -_ Daniel L.Gelinas,P.E.
579A North End Blvd.
HA4] AA Salisbury,MA 01952-1738
Phone 978.465.6436(Fax 5160)
Location
No. 2"r,, Date
NpRTM TOWN OF NORTH ANDOVER
H
.. 9
t •
Certificate of Occupancy $
y'•••°'E<�' Building/Frame Permit Fee $
�,wcNus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ b,D
Check # 17
16108 iY( AV
J Building Inspector
` a
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: m
ic
SIGNATURE: / t
Building Commissioner/1for of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
its ,A r+w Ave. . t F r. ,
Map Number Parcel Number W
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning DiAiic—t Proposed Use Lot Area(so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide R 'redProvided R red Provided
v
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
A
Name(Print) Address for Service
Si natu V Telephone
2.2 Owner of Record:
Name Print Address for Service: O
z
M
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
X
Licensed Construction Supervisor: O
ClLicense Number
� C 5;�,�Ip1LliTr�fcLy
A dress
� g
b, '– Eviration Date �
Sig'a re y Telephone r
3.2 Registered Home Imprrovement Contractor Not Applicable ❑ v
Company Name 2(G 62 1 m
7 Registration Number r
Address r
Z
!i1! Expiratioh Date ^
Signal re Telephone G)
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check allapplicable)
New Construction ❑ Existing Building Repair(s) Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition Other ❑ Specify
Brief�Description of Proposed Work:
J
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be
-L::: Ott
Completed by permit applicant
' 1. Building (a) Building Permit Fee
5G oo -!- Multiplier
2 Electrical (b) Estimated Total Cost of
(9 O 0<5 Construction
3 Plumbing 6Oo Building Permit fee(e)X (b)
4 Mechanical HVAC O d
5 Fire Protection
6 Total 1+2+3+4+5 d OO Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CO TRACTOR APPLIES FOR BUII,DING PERMIT
I, as Owner/Authorized Agent of subject property
HerVbelf
thorize to act on
My ;in all matters el iv to wor authorized by this building permit application.
A3
Signft of Owner a e
SEqTIPN 7b OW R/AUTHORIZED AGENT DECLARATION
1, 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 Name
Signature of Owner/Agent Date
IM��viqm MUM55-1-191 11,11-31
NO. OF STORIES — - SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TlTVMERS 1 Z.>( 2ND 2>< 3PD
SPAN
DHAENSIONS OF SILLS
DMENSIONS OF POSTS L U
DIMENSIONS OF GIRDERS 2l(
HEIGHT OF FOUNDATION y THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHINMY
IS BUILDING ON SOLID OR FILLED LAND (
IS BUILDING CONNECTED TO NATURAL GAS LINE ea
�l e TDo�re�maauuealC/ o���aoaac/auaplta
Board of Building Regulations and Standards License or registration valid for individul use only
x HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
4/8/%8/20
Board of Building Regulations and Standards
Registration: 20104 One Ashburton Place Rm 1301
Expiration: Boston,Ma.02108
Type: Individual
DENIS R. BARRETE..s J
DENIS BARRETE
24 WEBSTER ST '', GG 'i r� I -
HAVERHILL, MA 01830 Administrator Not va id without signature
z a The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
City 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..
Company name:
Address
City Phone#.
Insurance.Co. Policv#
Company name:
Address
City Phone#:
Insurance Co Policv#
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$1,5w.00
andfor one years'imprisonment-as well_as_civil.penattiesinShe.farm dA-STOP]1.11.ORKORDER md..a.fine af-($]11o.DD).aiday.againstme. 1
understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification.
I do herebyc der the pains d penalties of perjury that the information provided above is true and correct.
Signature • ��
Print name P_t>one.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensina.
Building Dept
E]Check if immediate response is required !] licensing Board
F1 Selectman's Office
Contact person: Phone A- E] Health Department
o Other
0
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 f
P p p Y facility as defined
p b MG
tY L
c11 S1 Y
50 A._
The debris will be disposed of in:
VWZ 33 Ail
(Location of Facility)
j Signature of Permit Applicant
i
Date
I !
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
FORM BR-7 AFFIDAVIT BY ASSURED AFFIDAVIT f/
I/We DENIS BARRE'l`l'E of Do hereby stair:that in AUGUST,2002,I/We directed CIRCLE BUSINFSS INS.A(ENCY My/Our Insurance
Broker to obtain insurance against certain risks as dcscribed herein. My/Our Insurance Broker ioformcd us that the required insurance could not
be obtainad from,or would not bo written by,companies licensed or admittod to trdnsaut business in the Commonwealth of Massachusetts.
I/We,the Assured,was/were informed that the type and amount of insurance shown below could be obtained from certain insurers not admitted to
transacx business in the Commonwealth,I/We was/werc further informed:
At the surplus lines insurcr with whom the insuranoc was placed is not licensed in this state and is not subject to Massachusetts
regulations.
l3:In the event of the insolvency of the surplus lines insurer,los&inolt jp - by the s!�teinsurancc guaranty fund.
Signature by Assured:
Print Name: DENIS DA
Dau: fQRt� Z3 ' um 2—
THIS
THIS PORTION.MUST BE COMPLETED AND SIGNED BY THE ORIGINAL BROKER
Name of insured:DENIS R BARRETTE
Address:PO BOX 1701 ANDOVER MA 01810
Location of Property:93 CHESTNUT ST HAWAHR,L MA 01830
Description.CA10ENTRY
Covcrage:GENERAL LIABILITY
Limit:S1,000,WO/2,000,000
Premium:1429.08
1/We.hcrcby verify that 1/We explained the foregoing to the insured and it was acknowledged the he/she uadarstood such.
SS/Fcd.Tax Id: 04-3068011. Signature: Date:
A copy of this affidavit must be kept in the original broker's file and a copy must be given to the assured at the time said copy was uumpleted by
him/her.
AFFIDAVIT BY SPECIAL BROKER
1, 4f In said county of depose and
say that I was engaged directly by the Assured named herein or infonned by the Assurvdness Insurance licensed Agcnt/Broker that after diligent
efforts,he/she is unable to procure in companies admitted to do business in this Commonwealth the amount and/or type.ofinstrance necessaryto
protect the insurable interests described above. This Affidavit is made to comply with the requirements of Section 168 of(,'hapter 175 of the
General Luws,and to authorize me as a licensed special insurance broker undcr.said section to pro a insuranec for said insurable interest beyond
that which companies admitted to do business in the Commonwealth are willing to write theroon. The following atmpanies or groups arc among
those.which have acoepted all or part thereof,
Company NAICN Policy No Premium
Amendments to Atf'idavit: D increase D I)ecreasc:
1 hereby verify the foregoing statements and declare that they were made under the penalties of perjury.
SS/Fed.Tax Id: Signature: bate:
A cepy of this all idavit must be kept in the Special Brokers,File and the original filed with the division of Insuranoe of the Commonwealth of
Massachusetts within twenty days following date ofprocuremcart.
NORT►y
Tovm - o E D / Andover .
No. low ~ `_
ffJill.
CI _ _ _
�� �= �A dover, Mass.,
COCMIC
DRATED P'*110 C:j
H
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT..... 1..^........... . .0.. .......................................................................................... Foundation
has permission to erect.....
Rr1110 .......�.... buildings on ....... ...
1.�..........1%A 0.*.I!�...... �.V..�...... Rough
to be occupied as..:....... l... .Cr I�......1!, Ar 1 1....... 11........ cu Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application n 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. 94 � � 130
� � no PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
Rough
CA
...... ..................................04............................................................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
Date. .��� °� �. ...
NORTH
Of�••`� 1'bO
TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
9
�9SSACtNUSEtt
I
hk .� '
This certifies that .Ill) t . oC .
has permission for gas installation .� .5. �{'��. . 12. 0.0 k .�. . .
z
i� the buildings of . . h I�� . . . �^a v . . . . . . . . . . . . . . . . .
A J.I. . .IW A� 1�.�9-e-. . . . .. . . . . ., North A lover, Mass.
Fee. .??S :�-Lic. No.F,55,1 .t. .
�� GAS INSPECTOR
Check#-
4V72
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date O 7— Z, —02-
NORTH
02NORTH ANDOVER,MASSACHUSETTS
Building Locations I Permit#
A Amount$
`t 0, x) !,d(c) V er + w a, Owner's Name CO!"l/I d L 4 Q 41-¢
New❑ Renovation Replacement ❑ Plans Submitted ❑
U � � •7
d a WWF 0
GP: A U �r Z F 0.i O
C7
A
t CAGW7 d a � O C C a JI
�
SUB-BASEMENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH . FLOOR
STH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH . FLOOR
(Print or typp)
w f j/7 !gyp G I� l� G O ^p� C one: Certificate Install" Company
Name. Corp.
Address ISO X 7 2,8 ❑ Partner.
&.a, Q n do ✓g4, /List a,
Business Telephone cl 7g_ g 7 5— 4Z 9 L? ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter '-o b e r f C� I d n heft e
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Vj No❑
If you have checked�please indicate the type coverage by checking the appropriate box.
Liability insurance policy 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 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 Permit Issued for this application will be in
..pmpliance with all pertinent provisions of the MassachuseAts State f3as Codeand Chapter o General Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber 8577
City/Town ❑ Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) Journeyman
Location
No. 8 6 Date
NORTH TOWN OF NORTH ANDOVER
1 :_ 9
. a
Certificate of Occupancy $
�'�'" •''<�'
s "us E Building/Frame Permit Fee $ a�
S �E
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
16165 �-
fBuilding Inspector
r M
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
,:.n 13:�' ',...� � �fVi�'V#11 �1J+�r� 5:� E.. *' h'` �pyw Y.'w'uF,'✓
BUILDING PERMIT NUMBER. DATE ISSUED: 02 -Q' O 13 X
SIGNATURE: /U to ic
Building Commissioner/In for ot'Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
l I�f MA>zTl a iq4i-
7
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
v
1.7 Water Supp1yM.G.L.C.40. 54), `w a. 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private ❑ t`' Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn
2.1 Ownepr�of LLRecord/►^, 1 1 j�f� ��
'i 1 H 4 UAt 1)A ural l�:�
Name(Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: O
Z
rn
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
Ad ess >
Expiration Date
Si a re Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑ v
C mm any Name M
M
Registration Number r
�r3 C�.esrN� T ST � gr
ess 1r
a
Expiration Date /1
Si re Telephone G)
f r �
1
SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......El No.......❑
SECTION 5 Description of Proposed Work(check aR a licable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑
C' _ 'e. -4 Y: -
Accessory Bldg. ❑ Demolition Othgr Specify
Brief Description of Proposed Work:
(� n
JC6Y,6a , 1 3-)
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to beQI `Ia CIAi, ISE-0NLY
Completed by permit applicant
..........
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction 0
3 Plumbing Building Permit fee(a)x (b) A�
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
fiIt1RS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
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
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 Name
Signature of Owner/Agent Date
WIMIM2.12 TV
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T VIBERS 1 ST 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DUvIE NSIONS OF GIRDERS
MIGHT 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 (-)Cj cf,
G f�-1-auS�a--✓
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT �N($ "Af 61& D(10HONET
LOCATION: Assessor's Map Number HS r PARCEL
SUBDIVISION LOT(S)
STREET �Y�"+ `� h -- ST. NUMBER_
************************************OFFICIAL USE ONLY***********************************
REC PENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINIST TOR DATE APPROVED O
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
�a�/
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 im
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:
f
(Location of Facility)
Signature of Permit Applicant
3 -
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
4S 1= 3o
iZ—tet �i��Q
LOT AREA
±13,387 S.F.
i
IP (F) sp
PROPOSED
6'9"x 13'9 vo
DECK 'ADDITION .
0
BH
N EXISTING
W/F HOUSE
CN N0. 119
O') 40. '
W W
�? o
IR (F)'
131 .47' - �
MARTIN AVENUE
REFERENCES
NOTES
N.E.R.D. PLAN 4758 OF 1962 THIS PLAN WAS PREPARED FOR SUBMITTAL TO THE
BOOK 997 PG 129 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT.
FIRM COMMUNITY PANEL NO. 250098 0003C OFFSETS & DISTANCES SHOWN SHOULD NOT BE
EFFECTIVE JUNE 2, 1993, ZONE X. USED TO ESTABLISH PROPERTY LINES.
ZONING DISTRICT = R4 SEE ARCHITECTURAL PLANS BY OWNER FOR ADDITIONAL INFO.
I CERTIFY THAT THE INFORMATION SHOWN ON THIS PLAN
IS BASED UPON RE INFORMATION AND ON AN ACTUAL
FIELD SURVEY I CT TO THE BEST OF MY KNOWLEDGE PROPOSED PLOT PLAN
FOR BUILDING ADDITION
10Hf1 �z
N MR. JAMES LOGUE
A. ,
d�cEIHiNMEY
1,44 119 MARTIN AVENUE
rw � NORTH ANDOVER, MA.
P SSIONAL D SURVEYOR DATE SCALE: 1 = 30 DATE: 2-5-03
DURAN ASSOCIATES, P.O.BOX 571 WOBURN, MA (781) 932-3236
�, NvK ray
E �
Town . ofdover
No. (oo
3 �
0�A Co� ape
H,C �,� dover, Mass.,
DRATED lk? \_ 5
S
BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...
...�~.��.............�.. .. ................ ................................................�!............................... Foundation
��has permission to erect.... X.0.�.I............. buildings on ... ......... 4 � A�.,,.,,.. Rough
..... ..............................
to be occupied as Chimney
......../�C.1..... 6 MAP........ ..... ... ... �+ �.................................................................................
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. 4Y S � /� O ��
0 4 *WPLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTIONS 7' ELECTRICAL INSPECTOR
CRough
01000 ep,.... .. ...... ............ Service
40110 BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building
GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
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.
dWA
. .- ,
_iao)t4 V7 AJ
, l
r,
Y J rY] 1
14. 8A
aia 44-
,�..,.tt_��;,/-1-1,vc�:ta ..���; " �...� t� .art-✓-ti, ,,� ,' � r ,�..+ -�-t i:i- I �, }1py�10 ,l-�1.1','�4`I�d''�'�
:
e./�e� 7 A-41 AA �"' .. --Lt�M ' hi O.ry i + HIAA 4.I
'� ly;c�t' tl`'•'t tom' -�!� 1�: -��-�''� .�c .,I .-� �, ��� .. 1 ' � _ - � ,�I
IN
ITIF
1 .
I _ b
� `�'�Z �kyr, _ - .'1't dJ ►t' .-►� t,►''��-+ ,,
1 a
1 ,^x r,\: -
'`
1
1 Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
�3�s 1
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: / -O 3
City or Town of: /V' /� `.,� To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) //f � r 2"-, ,� 44—
Owner or Tenant , �, ,,t;� Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
2p -ExPurpose of Building Utility Authorization No. 12p -
Existing
isting ServiceAmps / Volts erhead ❑ Undgrd❑ No.of Meters
New Service _Z!f'U Amps Sad/ Z y vVolts Overhead Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
41 Location and Nature of Proposed Electrical Work: w,r . 2 �/� /
Completion of thefollowing table may be waived by the Inspector of Wires.
No.of Recessed Fixtures 20 No.of Ceil:Susp.(Paddle)Fans r No.of Total
Transformers KVA
No.of Lighting Outlets Z No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting
rnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of SwitchesNo.of Gas Burners No.of Detection and
'� Initiating Devices
No.of Ranges No.of Air Cond. Z Total Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Numbe"r Tons KW No.of Self'-Contained
Totals: .•• ' •''''"''* *"*'******••••.•............•..... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage 's in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE []/BOND ❑ OTHER ❑ (Specify:) /1?— _'
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 3-/y-a 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is trite and complete.
FIRM NAME: - .f�•7 /1 /'/� � LIC.NO.: y3
Licensee: amyls � .,: //�° Signature 41C.NO.: 3 3
(If applicable,esrt r "exempt"in the license number line.) Bus.Tel No.- d'
Address: syr ��' - �r �/ Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee&fes not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement.�I am the(check one) ❑ owner ❑ wner's agent.
Owner/Agent11*
Signature Telephone No. PERMIT FEE.a$
Date. ` j/ D-3..... .
NORTH
TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
{ 1 •
*SSACHUSEt
This certifies that . `'` .�.l I.z. `. . . . l. . .P. . . . . . . . . . . . . . .
11
has permission for gas installation . .V� �.t... . . . . . . . . . . . . . . . .
in the buildings of . . c? ` . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . .�. . .►!�!�R. . . .�... . . . . ., North And ver, Mass.
Fee. .3�? Lic. No. a.1a . . . 27% . J, 1
GAS INSPECTOF�
Check# a CI
43 '16
NORT►{
°:t"`° '•�"° TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�SS�cHusE�
This certifies that .... .... ...../. ......., .............................................................
has'1ission to perform ......L.. �:2..../.71a r.j.....�.<..�
a �
wiring in the building of.......,f..
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date -j--1 4
NORTH ANDOVER,MASSACHUSETTS
Building Locations Permit#
Amount$
Owner's Name
New❑ Renovation ® Replacement ❑ Plans Submitted ❑
� w �
U
W W a a .Ti H
z a C4 H
F-4
O
x U c c °a > H
0
a H o
S
UB-BASEMENT
ASEMENT
T. . FLOOR
D . FLOOR
D. FLOOR
H. FLOOR
H. FLOOR
H. FLOOR
H. FLOOR
H . FLOOR
(Print or type) / one: Certificate Installing Company
Name l�l��G A-(.1:cA20 I hJ
Li Corp.
Address 11 'f=tsll�. �j ❑ Partner.
Mf\ 01S 5 Z.-
Business Telephone 4�3.-1 19 f'f',G S Zt11 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter M IY_� AA46&4.44
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑
Ifyou have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ 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 ce fy that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my owledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State se and gap 142 the General Laws.
1/� 4L
By. Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber 7_`j '2--/
City/Town ❑ Gas Fitter License Nurn6er
Master
APPROVED(OFFICE USE ONLY) Journeyman
2S
Date. • -/I^'O 3
NORTN
•, TOWN OF NORTH ANDOVER
..SMO
3? ��.r •..,• 0
PERMIT FOR PLUMBING
: l
SSACHUS�
Thi certifies that JN\.3 b??(1 . . . . . . . . . ��
. . . . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . �'. . i. . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . .
at. 9 M A.IZ.I.kw . A`.'-`.. . . . . . . . . . . . .. Noh Andover, Mass.
�tµ CL-
7
Fee.�3' .Lic. No..�. .�o�l . �o� �. . . .
G + PLUMBING INSPECTOR
Check # � +
5543
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
- Date _
Building Location 11 U1 W + A) A'11 Owners Name L.U/-,V(< Permit# S .J'Y3
Amount G�3
Type of Occupancy �, ✓�'y
New ® Renovation Replacement ® Plans Submitted Yes ® No
FIXTURES
W) rA0
w a
aW E* U En
rA
Ey
a
a a H W A W x a
P"
F Z A,
ST&BM
B SME NF
lS'1:FLO(1I2
2N]FLOQt 1
M FIOQt
4IH FLOCK
5TH FI M
6TH FIOCR
7IH FLOOR
SIH FI M
(Print,or type) Check one: Certificate
Installing Company Name (� 1-+ � �� ❑ Corp.
Address \'1 FRAl-( 1(� `z� Partner.
-::�;4 L+ " c31rz5�
Business Telephone e-11 -opt9-65 Z(o Firm/Co.
Name of Licensed Plumber: !V1 k�� Lt Nm
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
ig�ature Owner Agent E]
I he4by 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S to Plu b' g e and Chapter 142 of the General Laws.
By: signaure-or-Licensea rJurneer
Type of Plumbing License
Title l Zl':�7 I
City/Town License Number Master Journeyman ®-
APPROVED(OFFICE USE ONLY