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HomeMy WebLinkAboutMiscellaneous - 122 CHESTNUT STREET 4/30/2018/ 122 CHESTNUT STREET 2101060._ A-0020-0000.0 i 1 Commonwealth of Massachusetts 0111ciaF1::;e011ly Department of Fire Services j Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 9;05] (leavebl' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK •111 fork to he performed in accordance lith the N-Iassachusetts Hcctrical Code(%IF.C'). 52'CNIR 12.00 (11LE,1SE PMT 1;V LVK OR TYPE ALL l.VFORJL 1TION) Date: 2 - ?_ v6 City or Town of: 1\10TM i�Nr'J _ To 1/7e In.vpeaor of lvire,y: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) Owner or Tenant N 16 01- 15 .-L C44Ai i f1l�J/�r'�i�. Telephone No. Owner's Address I 22N�S�`,Ur 5 t"• Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building-P.., ,r Ad Utility Authorization No. Existing Service )9-0 Amps //Q / 220 Volts Overhead ❑-'' Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4,122 1-7/c)4 4W it-W- JL,,Wi-z 0CdSX1,L_th;j9hwe, Completion letion u/llhe idloiiiriig fable niav he waived by the his pector t:/Wire.: No.of Recessed Luminaires 17 No.of Ceil:Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above F In- ❑ o.o Emergency rg utg 7 rn d. rnd. Battery [:nits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.ofD "t De tion and No.of Switches N o.of Gas Burners 1 Initiating Devices No.of Ranges No.of Air Cond. 2 Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW I No.of Self-Contained ... ........... _.................. .. . Totals: Detection/AlertingDevices t No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection _ No.of Dryers Heating Appliances KW Security Systems: j No.of Devices or Equivalent I o.of Water No.of No. of Heaters KW ...: Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total NP telecommunications Wiring: No.of Devices or Equivalent 6 OTHER: - .Illcrch acldiiiorurl derail i/'rl(,Sj1-ed, or as required by rhe lusperlor u/ I/,[/(:,. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 2 - ?- T6 Inspections to be requested in accordance with EIEC Rule 10, and upon completion. INSURANCE COVERAGE: finless waived by the owner, no permit for the perrormance of electrical work may issue unless the licensee provides proof of liability insurance including"complc,ted operation"coverage or its substantial equivalent. `I"he undersigned certifies that such coverage is in rorce,;uu1 has exhibited proof of,ame to the permit is.uim;ortice. CIIECK ONE: INSURANCE [" BOND ❑ 0FIIFiR ❑ (Specify:) /rerlifj,, under die pains uud perrallies g1'per urp, dnrl the inJormalion on r/ric upp/icvrliun is true and complete. ---\: d).( C F•11INI NAME: k � LIC. I'10.: Licensee: °�'p�.1i�1 G _ RYi`}� ;signature CC,. LIC. NO.: o�53 Ig2 —--- .. (IJ';;pp/icnble, .nrer "e.:•cnyi7"in Il...•l��cnsr nrimh,-r iine.i BUS.Tel. NO.: 1 address: Alt. Tel. No.: S irity System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE \NAIVER: I all( aware that the Licensee does nol hove the liability insurance c:ovcra,. e ncrnially required by law. By my signature below, I hereby waive this requirement. I fun the(check one)❑ owner ❑ owner's agent. Owner/Agent :signature Tcicphoate No. PF_R.,WT.FF-E.- S s Date. ��/. .... . ... ,r MORTM ,I jpy` ��.o ,s1tiO 3 TOWN OF NORTH ANDOVER p � PERMIT FOR GAS INSTALLATION h �9SSACMUSE�,( This certifies that . . . . . .�. . .. . . .`.. . . . . . . . . . . . . . . . . , - . . , has permission for gas installation . . . . . . . . . . . . s' in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ! . . . . . . . . . ., North Andover, Mass. Fee. Lic. No. � G�. . �" �i� .- .. . . . . GS INSPECTOR Check# C 5 4 "1 6 o. N ASSACHUSEI'I'S UNIFORM APPUCATON FOR PERNIIT TO DO GAS FTFrING (Type or print) Date NORTH ANDOVER,'MASSACHUSETTS Building Locations L Z+ Ce Cr Permit# l Amount$ �V /91JrXU60 W4SS- Owner's Name r ,„�` New n/ Renovation �,. "`"replacement 4 Plans Submitted ❑ z F W a 3 a o- a w � o SUB -BASE M ENT a B A S E M ENT 1ST. FLOOR 2ND . FLOOR �r 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) tJi i /t� � C e one: Certificate Installing Company Name 2i" Corp. Address �� - ST ��1 Partner. S - Business'Te ep one9'7 G k7 !! 3� �Firm/Co. u i J Name of Licensed Plumber or Gas Fitter V J /=1 Cif fir/ �s J7 9 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® NoO If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy � 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 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 compliance with all pertinent provisions of the'Massachusetts S s Code ar�i Cha ter 142 of the General Laws. comp P P Signature of Licensed Plumber Or Gas Fitter By Plumberftp ' Title City/Town Gas Fitter License Sumner er Master Journeyman APPROVED iOFFICE USE ONLY) r r Date. C. . M o' HORT,. •� . tie TOWN OF NORTH-ANDOVER r t Pl� tNFl1'iFOR PLUMBING 11'� ♦r,o nl���(�7 S'SAOMUS� �C / ' This certifies that �^. .!�`! N.1 `'` ,F has permission to perform . . .1A_.f . .. . . .-:�.... . . . . . . . . . r plumbing in the buildings of . . .Al .h. . . . . . . . . . . . . . . . . . . at .1. .C ,r�/.-!�. . . . . . . . . . . . . .. North Andover, Mass. I . Fee�`� Lic. No.t� G y �� -�.... . . PLUMBING INSPECTOR Check # 6791 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location /ZZ- C1lee Tk1i '7 Date Owners Name 1�U G�N�yL Permit# Amount Type of Occupancy /9 W eL-C-�/e&— New Renovation Replacement 1-3 Plans Submitted Yes No FIXTURES H z H � W v� U z o W w x ° z z a .i � 3 U ri asQ Z a a a ° F 3 a as A 3 H1 SUB-BM l��vrrlr � Ise MOOR zn H-cm - 3M H—CM �. 4M FLOM M 1FLaxt 6M Ff-" 7M it" sM IHWJOM (Print or type) Check one: Certificate Installing Company Name /Q19V I 0 � L�pt�/��1�✓ ❑ Corp. Address 3 fiyt°&- S7`nL r 1 Partner. ✓�? C-I"N✓LvJ Business Telephone -7— / 7 �/ ® Firm/Co. Name of Licensed Plumber: /¢ �/1/564�1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuset Plumbin e and Chapter 142 of the General Laws. By: b atur- v.i-1censuu rium-uer Title Type of Plumbing License �eig City/Town icense um er Master ❑ Journeyman APPROVED(OFFICE USE ONLY Date... ......... TOWN OF NORTH ANDOVER 4L PERMIT FOR WIRING This certifies that .. . . . .......... ............... . ......................... has permission to perform .... I .)...................................................................... wiringin the building of................................. ................................................ atJC2,4........................................... 1........................ .North Andover,Mass. Fee ........... L i c.N 6 V139 ELECTRICAL INSPECTOR CMCk # 6440 ! Commonwealth of Massachusetts Official 1 :,c 011IN —7 00 o. Department of Fire Services I Pcrniit N � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9,05] (leave Kink) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %%ork to he performed in accordance lith the%,lassachusetts Electrical Code(%IEC). 527 C%IR 12.00 (PLE,ISE PMT IN INK OR TYPE,ILL INFORHI TION) Date: 2 - ?_ V City or Town of: 14o ApaTo the hupecior ol'T-Vires: By this application the undersignedgivesnotice of his or her intention to Perforill the electrical work described below. Location (Street& Number) —t Sj— OwnerorTenant N(cot- Ec-, C+-LAI 00t1_J1401C__ Telephone No. Owner's Address I22 C-Y497WtA1__ :5 T_ Is this permit in conjunction with a building permit? Yes R__ No ❑ (Check Appropriate Box) Purpose of Building fL4W,1 Ad&-- Utility Authorization No. Existing Service-)0-'57 Amps //0 220 Volts Overhead Lam' UndgrdF_1 No.of INIeters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 49,9 t-710A( complelion(?/Ihe fidlol a)le mul;be ivaivcl by the hes 1rCL't0)',)1'117ii e. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans 1 0.of Total 17 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above 7; 1 n_- , No. of Emergency Lighting No.of Luminaires Swimming pool i F-1 - 7 grnd. grud. F� Battery Units No.of Receptacle Outlets 2,0 No.of Oil Burners FIRE ALARMS INo. of Zones No.of Switches No.of Gas Burners No.of Detection and Totil Initiating Devices No.of Ranges No.of Air Cond. _2_ Tons No. of Alerting Devices "eat[lump Number Tons KW ,No.of Self-Contained Us' Number 'I P � No.of Waste Disposers T ... ....... ......... .................. Totals: I— I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local F� Municipal El Other Heating — Connection _ting App lia W Securit Systems:* No.of Dryers Heating Appliances KW y e.ms: No.of;Sevices or Equiv lent o f No.of Water No.o No.of "caters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total NP r—elecommunications Wiring: No.of Devices or Equivalent 6 OTHER: A 114% A Hach ot Ittiliollal'Ielail II'dusireti, or as I vqu ii-Led hl rhe hI.yjIULII)V o; If Estimated Value of Electrical Work: (When required by municipal policy.) i VVork to Start: 2 106 - Inspections to be requested in accordance with NIEC Rule 10, and Upon completion. INSURANCECOVERAGE: Unless waived by the o,,vner. no permit for the performance of electrical work may issue Unless ill(,,licensee provides proof of liability insurance. including"completed operation"coverIwe Or its substantial equivalent. File undcl-si-ned certifies that SLICII coverage is in 1,01,ce- , and has exhibited proof of same to the permitofrc e. Cl IECK ONE: INS(_'RANCE. [2" BOND F] o ri il',R L-] (Spccily:) I cerly.j,, under the pains and penalties ql'perjury, that the ill .111111ion on 111is application is True and coniplete. FIRM NAME: �A /2-t ld 70,1 LIC. N 0.: PC Licensee: Vd Al3 S i g na t u re, . C__ LIC. NO.: -r �192- MC/ILL 17�,Vnalll&r(iiie.1 ML� - Bus. Tel. No.: Address: Alt. Tel. No.: `Security System Contractor License i-CqUirccl for this work; if applicable,enter the license number here: OWNER'S INSURANCE VNAIVER: lani aware that the Licensee d(V,y170//7(IlIe the liability insurance covcrw_,e llorlllllly required bylaw. By my Sil'llatt.irc below, I herchy waive this requirement. 1,-:iinthe(check one)oov,viler ❑ owner's ,agent. Owner/Agent -1 'signature Tcicphoac i`o. PF-k111T FF-E.- S s+' The Commonwealth bf Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, ,IM 02111 www.niass.gov/dia t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Il3usincss Organiraliuniln�liviJual): Address: City,State,Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction ,��employees(full and/or part-time).* have hired the sub-contractors 2.I" t am a sole proprietor or partner- listed on the attached sheet. ` 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for ine.in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 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 repairs insurance required.] + employees. [No workers' 13.❑ Other comp. insurance required.] --- - 'Any applicant Thal checks bus,11 must also fill out the section below Showing their workers compensation policy intiinnation. +f lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aftidavil 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 nn employer drat is providing workers'compensation insrrranc•e for my employees. Below is the policy and job site information. Insurance Company Name: Policy :1,1 or Self-ins. Lie. 4: _ 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 NIGL c. 152 can lead to the imposition of criminal penalties of a Fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 cerli/' under the pains and pens ties o/'periury that the iglimmation provided above is true and correct. JL mtttre: C. _ nate: 6 D 6 Phtmr '+ d)%/icial use only. Do not write in this arca,to be completed by c•ilt or town uJ/ic ial. City or Town: Permit/License# Issuing Authoritv(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 1. Electrical Inspector 5. Plumbing Inspector 6.Other _ Contact Person: Phone M: ti Location No. Date MORTh TOWN OF NORTH ANDOVER Of�„au a,h0 Certificate of Occupancy $ Building/Frame Permit Fee $ 2cn "v Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F u.6 Check # 18518 Building InspeEdr TOWN OF NORTH ANDOVER BUILDING DEPARTMENT A1rfLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING --rra:....�..�,�'�G.:,.a`'�. kG a rSL .a' . This Section for Official Use Onl q 'b'' / se?f. '«`•W. BUILDING PERMIT NUMBER: ✓./ DATE ISSUED: Z SIGNATURE: Building,Commissioner/InTLxLor6t Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: a O Q� ► A d1 0,9ZL( Map Number Parcel Number 1.3 Zoning Information:C/( 1.4 Property Dimensions: v R-13 aPsikdo,i�A� ad 4 00 s i'S1. 0 l Zoning District — Proposed Use Lot Area Fronts ft > 1.6 BUILDING SETBACKS(ft) m Front Yard Side Yard Rear Yard Required Provide Required Provided Re fired Provided k�jOY( ( aft 1.7 Water S ly M.G1..C.40. 54) 1.5. Flood Zone Information: Sewerage Disposal System Public Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System ❑ 4i, t h�3y tiF.� V) 2.1 Owner of Record Ci�F is o L� Glncs S'r�ee,l' NA o Name(Print)- Address for Service: rte' 01-) q �S �Cl m Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Z O Signature Telephone Z * tx 90 3.1 Licensed Construction Supervisor Not Applicable ❑ SRO Address License Number O Licensed Construction Supervisor: 3 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number M r Address r Expiration Date Z Signature Telephone G) rt I, C�ln� ®Ui,J�✓t/ as Owner/Authorized Agent Here declare that the statements and information on the foregoing application are true and accurate,to the best of my Hereby g g Pp knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date I.tem Estimated Cost(Dollars)to be 0' r F � Completed by permit applicant ,r,:� ,>,m � a ,, ` �_ t�. ,.,•�,� 1. Building (a) Building Permit Fee E�3 Multiplier 2 Electrical (b) Estimated Total Cost of UtJ Construction from(6 3 Plumbing Building Permit fee (a) X(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number 'k-W_ `u t r a} iy K A d i 5 r �a �� z.. x4 cur m`A ly:. P. �iS;!�}l,al,t,,•c:u 4 1U'wl...i i u;2. 7 9 f �+ �_ ,�'ra .f.r,�`i�'"�t� d� _-;,�, x,Y�"- r i :;.�, "{' ,.5,ti ...�.+r .�' !�.7 �� ,';-HtaU4fi ,.isr:,: '`'Y 5'?..: �i�ii'�+r'Yr-�,�'`)i�}iik3 c{fit•..,;,-�c- _.,V .�A+. f�{1� P r,,ri:s�� r r .�:. d S ry �f 3;x 4 s}'�+•,�+._ li S , �F 3S d,i,�a��' �` � t d,as ir;�'} ...� *t 3"r& .+7 i.�f, z' '"SSF'� i fy�� Jt wh`�.���' '�;?�y�)�i� �v' 1, 'j�<N..,:. s 1, --.-i'� ..':;,,.��:^- NO.OF STORIES a SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 - I SPAN v DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL.GAS LINE - 'Ti 7 SECTION 4-WCWjCM GClIYIPB,E SAT�1pN( C 13 Workers Compensation Insurance affidavit must be completed and su issuance of the buildinrmit. b-itted with this application. Failure to provide this affidavit will result in the denial of the Signed affidavit Attached Yea.......❑ No.......❑ op sECTIOAl s.-I'ROF.ESSIUNe1L bUsAr CONSTRtJGfiION SRYICES F©1Duakn$t aln sTltuEs.svt CONS 1F817CTIDN Ct)I�Tl1tULUA 'I'To : C14ER 116(CClt1TG Mtn AND 35 ApDF.NC11l�D Sll'At'11t} 5.1 Registered Architect: Name: — Address Signature Telephone ,'S..Z Regis�n�rwfeszi � '��� Y i 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 Fyy� P,te7p Company Name: Not Applicable ❑ Responsible in Charge of construction ' "C7`I¢1��raE3`�R�'IQ1N tcjiF.p`Rt'I�Eb'. (ck all,appl�cabl;r� '' New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of proposed Work: -An aCW1'-b(Jy)--6 6 e Iram.1Y( room ad s h 4w Q a, akd !J. t USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-I ❑ A-2 ❑ A-3 ❑ A-4 ❑ A-5 ❑ IB I A ❑ B Business ❑ ❑ C Educational ❑ 2A ❑ F Factory ❑ F_1 ❑ F-2 ❑ 213 ❑ H High Hazard ❑ 2C ❑ I Institutional3A ❑ ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B M Mercantile ❑ ❑ R residential ❑ R-1 ❑ 4 ❑ S Storage ❑ 3-1 ❑ S Z R-3 ❑ SA ❑ U Utility ❑ Specify: 5B ❑ 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: 1. BUILDING AREA EXISTING if applicable) Number of Floors or Stories Include PROPOSED Basement levels Floor Area per Floor s Total Area s Total Hei t ft Ind ndent Structural Itn9tricenng Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I' as Owner of the subject J property Hereby authorize My behalf,in all matters relative two work authorized this budding to act on by g permit application Signature of Owner Date FORM U - LOT RELEASE FORM • 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***** =3 �APPLICANT ()-**,PHONE LOCATION: Assessor's Map Number s 1't- PARCEL 60 SUBDIVISION LOT (S) STREET ST. NUMBER **********OFFICIAL USE ONLY O A OF TO ENTS: Cd SERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS j V1 Wv— U aK- TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197Im North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) T Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a f HORTN TOWN OF NORTH ANDOVER O �,,rlo r 1N Fi °oA OFFICE OF BUILDING DEPARTMENT 400 Osgood Street + o g �'��,r.o:*•'` North Andover Massachusetts184 ss St 0 5 ACHU D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION:_ __ Number Street Address Map/Lot HOMEOWNER L�/1.� Qa-,rt, g1l-do 1`7%1 Namd Home Phone Work Phone PRESENT MAILING ADDRESS C�PCf/�L� Sf City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to 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 HOMEOWNER 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE �."-- APPROVAL OF BUILDING OFFICIAL 130ARD OF AITEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH Town of No. 1417000 CR os dover, Mass., T Q LA E 2 COCMICMEWICK �ttG, ' �ADRATED �S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Z)9P&WAJr4 P BUILDING INSPECTOR THIS CERTIFIES THAT � ��.. �r �.��.,� v� /^ ..... ................. ...... ... ..... ..... .. ......................................................................... ........ Foundation non has permission to orect......... .a. buildings on �OZ a.... �. V'................. Rough ..... .. .. ...... ...... to be Occupied as... 4 4bboaO A Fr4 r /...01�44 r y 4 t- A R� Chimney . . .. . . .. . . . . .. . . . . .. .. . ................................................. 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 he Inspection, Alteration and Construction of Buildings in the Town of North Andover. G O A 1Z 40 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS 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 /C� Q C y s T N S t- No. & Date "Z Gd 40 oT:,�ooL TOWN OF NORTH ANDOVER # Certificate of Occupancy $ sAcHus��' Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # y� /Y 13627 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING K c, O' I �' sb cwt 3 BUILDING PERMIT NUMBER: DATE ISSUED. 11,51.2O SIGNATURE: /���jt c� (S 0 a �dflding CommissioneEI or of Buildings Date SECTION 1-SfTE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: 4 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 1.7 Water Supply M.G.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 2.1 Owner of Record Name(Print) Address for Service Signature Telephone (Q 2.2 Owner of Record: n� Name Print Address for Service: 0 ; M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 1 Not Applicable El J CkC, f Q- Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ <e ti-e- Company Name p� Registration Number �, Address rM r ,�z;-> K�nature Telephone of Expiration Date40 2s(gG) . r, SECTION 4-WORKERS COMPENSATION 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 all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: U SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAI CJSVONIS Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier /0,5 � F 2 Electrical (b) Estimated Total Cost of // o7 b Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 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 I, 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 I, 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 C) Print Print Na e '§Iglnature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB PD SIZE OF FLOOR TITVMERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CI vINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE tit! ic. trc;-J .'�,: #- 6 t,J 1, ,k B HIM -F ;! {r% �rrod JC4 r �#€'3-6# 1':,s8 }tt .t1{ e .'i,?� I..,c:�'f» a ! t i� xb. ? { r "7, tj#.:0 — Ili1aa {,: t :t.. a•Id{ w?: i .. !i 1 •a S41'- t - } r'. t4' t. .icl..�q - i� - t r .l r:' s' t`'y { ,�.,'."K`, af...�.'.•ti£ ts.. } `ta#5_ 1 ..� e ,(.r $,r as( Mond r•.„ '� rl S.3�,,.ix,{ t"y J.. 7;Yrt(�'1f ''lt�; 3 .4 t r -i.t # i. lt,. .i _ i�F Y + 't t WAIT= - t i I ' �rh -3 4 - RS r cam, - , - t5 9 $' ;ti741 GJF`i�t n 3^qs i r.e r i t e 1. Y1 }y T _ 'r !. t§ 4 1 3 @xc r #..Y 3 ac a8_. xr3 1i k '1 3 ! St l - r 1 y ! +t R C 2 4 i f! ' fir't t. - tf ; . E [t r : >< # S t _P t GARC MAIM" L 77 5 r t f JCntp(i 7 Sa f! "t,l 't • i'TMQ-Q4 K,.l t Y F b ,At # �. zo,, i t' i i 3 Vi.�x Jrl '.rk - '#�t, t t +yk� "K, a 't f!! t ,wnARI y.r+'P G .. % - ij lump Ant"S ;. _ r s �j;, id t 4�a r"n' Y& '�' '}�.r for •t4a�ktts{� #}a F. mop oiago A MINNOW"W LLJ rw 4 :`v_ S fI :.rte 4ad 1 o�,lr,asFj.> #t .. 't t ✓p�,. ,ti „t.. ..-i � k`'c.�t►�- Vint ivr t1'' h _ Con+ - ._ two !.-:. t.-: `:: ' gi Nh�r ,i. t ti :3 of ' � .y- s �{`Ft 4^#4�� '#Ga,2..-•r'Elit r `t� 't 1, ,v.r Y 3t;�.a d•�Q. :6 RR/ wt' J - 3 % 5 . •:.� .„ _ - t s n kf�s"+,Il`#�aj� I'I:.�lr:s t# �•A�'t a,iA,� `'µxy'f�j pr to t' t r .3..;,` Y a r'. �i: 4 # +4�-q�n z,., rlt�,Yi t� f a .ak;. � 4 ?tfi•� R � �- t:�i e a k tr - t • r F t % ro � .ti Eft ;,3• +�° i'P'` p}�{6}, `z��tl ,a t �( u + no.r . # s Gt,�t �_ ,+i} :' rt, #w die �., .s •x a .:.'.0 t..� t t.•. / _ `^ t. ;8d:.`rt •,3 i r! t� .rl', yy :`- - .,1 _•,Y 15.{-; r kJ. t• f .r.y:^� .�r�;.�p ,li 1 '4•J ��y.f�ri--t. 't _ # "� } 2. �. ..:`•'. .;l �R_. .., i ,l:J 1 .�':1. not t au• 3(i .. ,t Y�r� f .1•t '�1 i h� R� 5 .) 4 � 7' r L ?t t c t ti4 7.' ,.I+x j{� 73'Yzh � con, h �. }t Sia#9.7t,�^rtux rrC .. d A AS mn F J c i t+R 3 1 •��J t t 33�� r yt � t,., r i '' � - "NAY A 1 - #5 t t 3 t SF i ! q�'•' ti 't # Tom 'a e r .. 1,t! t 3 r F 1 t , J t } , 3 111 i t i f {b t r Y i t F r 7 c t BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of.MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Loc tion of Facility Signature of Permit Applicant Da(e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector t i. 1 ` i 11 txORTfy ovm Of . : Andover No. LA E.:. o dover, Mass., 42 s� COCHICHEWICK %A0"SATED S BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...............�.SA............ ....s....... .. ................................................................................. Foundation has permission to emolp.StOll...p....... buildings on ...... ....... .1�..... Rough GAP 0 0h400 r Chimney to be occupied as.......................... ............... .............................................................................................................. 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough M 1 d PERMIT EXPIRES IN 6 MONTHS Final a UNLESS CONSTRUC ONJA ELECTRICAL INSPECTOR Rough .. .................. Service ING 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 R E V E RS E SIDE Smoke Det. Mario Castricone, Prop. Tel. 682-4266 CASTRICONE ROOFING & SIDING CO. 31 Court St, No. Andover, Mass. 01845 l0 M 00 � � 6�k 1 �A �a � rN 19ivo o v .EJ? ss. Fo,R l/ T N ,FJR D o w wx R S C p x,e J ': 3 6' S 7-O -,,,/,E' R S f�SS o C/l9 T,E S INC R ,60. ,L AND S(.,FtYayoRs Apq )4 2bO.s J`'I,HTNu�N� I�'1ASS_ 4~// GEORGE r o � RICHARDSON � L No.24052 : 9 .o f S f3 RA �,F.Z,�NCAMP c' `GIS.TE"" Q' A URVt' . 014 A? Ali �20 d i i Q Cl 0 06 SHe O M _J Q Q a � D• irlniG Ex s �i Ow E 11 I/✓G * GARlaGF O �PRoPostc � � -t 2/.8 IL NAnn�r/env cry � J2� 4 f I2,S G y r C N X S r H v 7- �oCUS SNoI✓/✓ B /NG ,4OT 2 SNowv oN NoRTN rd E 55J?X RSG /$Ti2y of ,O,�xpS P)-!7N r 31085 % , �a� 5/ 8" CJX PLYWOOP FOOD SN�A11-ILNG I?IpGZ VENT 2X8AT16" O,C, 1/ 2" CA" ON A5PHALT 5NIN6LF5 I X 3 5TPAPPING 12 x-38 IN CLIPPED CF-ILING —TI;f? TO TOP PLATS 5f FP?AMING CONNrCTOP, 2 X 8 AT " ............ . TYPICAL F_AVF5 I2rTAL; z MA5V, I ---- I FA5CIA & 501'rIT TO MATCH r�XI5TINGUUT_INF I• CONTINUOU5 5OFFIT VF_NT @j v I3rnp00M OF 3 POUP3 Fl TOP PLATS ' - WINPOW METAL nI?IP �bG� \ PA laI'-6'� - 60TTOM OF ICF/ WATT 5HII;-b } } PAFT�1' A5 OU11-IN�' . �...... ......iQUlfb I Q11 P-30 INSULATION Cp OP 6'-6" t 1 11 - �N AT 13ANP JOIST � NT, 1�OCi!? 'tI I► `� II II PINI5H 2NI� PL0012 cpt?�ros�n� + F1mI!5 OI!"Z mSf"1w TYPICAL �XTET1012 WALL; + — — 51PIN6 TO MATCH I;XI5TIN6 PULPING wriw13/ 4' X 9 1/ 2" MICI20LAM LVL M015TUI�r l3AP.121F_R rAT 1/2'' 09X PLYWOOV 5HHING PLOOP. JOISTS At 12" O.C. 2X4AT16" O.G. i 12-13 FIMF?GLA5 IN5LILA'WN oo TMAfE_V 2 X 4 POLY VAPOIz r3ARRIE1 12 EN61NEF_�J PL-OOP, JOIST + AT 16" O.C. 1/ 2" GWa < VE;Nt2O1: CONFIRM FLOOD P12AMIN6> - \9 3/ 4" T&G PLYWO01? PI20VIPE; TNF_P?MAL co NAIL & CAL-UF- TO FRAMING [312r--AK AT SLAB/ PIAN, PIN15H IST PLOOR (EX151W + — — 1=IN15H 15T FLOOK cppero n� .., . + TYPICAL 5I1.1-17Ef L: .^ �•:t'� r ANCHOR DOL 5 Af 4'0.C, 10 mss: 5LL 5EAL FOAM IN51ATION _ VaM 2 X 4 T TAtP 511 L —2" THICK 06112 I%XTP,UPr51:2 FOAM POUI?rn CONCC;rTr� POUNPATION yl. 0 IN5ULATION \,1211 CPU5Nr;b 5TONF- :•t 2 - 4*5 I2rPAP, TOP & POTTONl t OWNI:I:/ f3UL1:2r�p CONNI;W — — — — — A FQUATF_ SOIL 6FAP.IN0 CAPACITY — — — ------------------------------------------------------------ PFMF�FVA110N __________-_______ _ -_-___--_---- --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ---------------------------------------- ---------------------------------------------- ------------------------------1r --- -------------------------------------------- ------------------------------------- ------------------------------------------- ------------------------------------ ------------------------------------------ ------------------------------ ----------------------------------------- --------------------------------- --------------------------------------- -------------------------------- --------------------------------------- ------------------------------- ------------------------------------- 5FCON12 FLOOP PLAN 2(D'-O'' 0 AWNING WJN120W5 13M\00M DATH Qu C.//' -OII 1A/ �VV fl O WALK-IN - I Z poor, I sH�L� CL, �fWooM p120V112r- MIN' 6'-8" UP I ►?Isrf? NSA POOM AT 5TWY, sNOW�p ALIGN I pF-MOVr- r_XI5TING WALL WALLS PFOVII:2r NEW FAILING NALL PAI s�b 1%LOOI;, MATCH MCMI? r z o MA5V\ Q v 1Xnp00M - Cly O f(::) W �xisTING WA5NF-1?/ f�Y>%i? IN - pr5MOVF- F_XI5TING ATTIC sTAIk5 CHIMNEY N I7'-21CL, [3NNOOM f?Als� �Loof? LrV�L is t'LM15 AGR 01' CL051✓T r0 MATCH NOTE; MPUCEP CE IUNG HT, AT CLO5F-T WWI �O Y V N I` t\�51��N�� < 6'4 1/ 2'1 + '/ -� CONTINUOU5 C��AW ADOV� CHS 5"1"Wf 5TREE 4 x 4 Woon posrs N0P11d ANPOM, , MA SCALL ;l/all I,.0,1 PATE:8/I/05 2ncdflrevl FIP5f FL00P, PLAN F-XI5rING WINDOW 20'-0'' [3ATH L=1 IV' 'Z i� CL ti 511-nY 5or-r-lr Ar3ovF <NrwW) KITCHEN MFCNANiCAL pOCKr�:r 2 '� z' l CHASE 1001:, c NF,W> PAN11:Y c Nr-W) CL, FACr012Y FIf;E:pLACi: 61�OL1� O KALI. noon 2 I 5 I? < N�W> 6��Af DOOM Z l up�l J CL, L_I_I LA1ING I - z I HVAC �QT. "uprUOW" TWEP UNIT WIN. 5QAT WIN, 5F-A CL, FAMILY BOOM GAS PLAN5 FGA r POWN�p P�5MNC� ��LOCA1� <%XI5rIN6GAS 5F-!?VICF- VA.r. c N�W> LOCA11oN N OPTH ANPOM\, MA 1'-0" PAt:B/I/05 15-tflrev2