HomeMy WebLinkAboutMiscellaneous - 130 REA STREET 4/30/2018 / 130 REA STREET
J 21O/O98.A-00094000.0
'I
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Location
No. 3 �' Date
�oRT� TOWN OF NORTH ANDOVER
a
Certificate of Occupancy $
VSs Nus Building/Frame Permit Fee $ J
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
!' Check # a 9 STJ
17851
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Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r
BUILDING PERMIT NUMBER. f DATE ISSUED:
ic
SIGNATURE: C �""
Building Commissioner/Ingector of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
,?C AW
AMap 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 Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomntion: 1.8 Sewerage Disposal System: D
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT historicDistrict: Yes NO M
2.1 Owner of Record
/30 iZe-N
Name(Print) Address for Service: Q
SOS2 G
Signature Telephone
2.2 Owner of Record:
Narut Print Address for Service: z�q
M
Signature Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
Address
Expiration Date ic
Sig...li�tre Telephone r
3.2 Rgiste—red�Hom�e Improvement Contractor Not Applicable ❑
j VIJ v
Company Name
Registration Number r
Address n r'1 d f' p �i�S' ' 3AX
�6>� Sze'3 6-?^I SC<S Expiration Date / /1
nature 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.......0
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:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL U—SKONLY
Completed by permit applicant
1. Building / (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee tel X tbl
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 BUII.DING 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 I
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
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlvIBERS iST 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIIv1ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
rS BUU DING ON SOLID OR FILLED LAND
IS BUIL DING CONNECTED TO NATURAL GAS LINE
�•.. omvmaoxurP,a o i
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
C Registration: 130561
Expiration: 3/24/2006
Type: Private Corporation
NORTHERN GUTTERS
SHAWN MASSE
122 MAPLE ST. CI"-v-1 .u✓
WEST NEWBURY,MA 01985 Administrator
w i
it
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:
OQMp5'tP-IL _ Me- t (0 ,5
(Location of Facility)
Signature of Permit Applicant
2—
Date
{
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
The Commonwealth of Massachusetts
d Department of Industrial Accidents
Office of Investigations
,.K Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
City Phone #
F-1
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
EZTI 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,At
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00
and/or one years'imprisonment_ass wedl_as_cMi.penofttwjnlhefm d-a STOP WORK ORDER.and_a.flne of.(.a1II0.00)-ajday.against..me, I
understand that a copy Zthlssent may be forwarded to the Office of Investigations of the DIA for coverage verification.
do hereby certify undes of perjury that the information provided above is true and correct.
Signature Date 2-
Print
Print name Phone# `7x-363- s
Official use only do not write in this area to be completed by city or town official'
City or Town iUUcensinci
[]Check if immediate response is required ❑ Building Dept
❑ Licensing Board
❑ Selectman's Office
Contact person: Phone#.• ❑ Health Department
❑ Other
NORTHERN GUTTERS INC. /.<Y- o v, PROPOSAL N0.
' T NO.
c
122 Maple Street • West Newbury, MA 01985 SHEE;j�- �_ c��r SH T
Phone (978) 363-5565 Fax (978) 363-8868 DATE
ESTIMATE/CONTRACT SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME M r� t ADDRESS
ADDRESS
iZj _
v C,r4
START DATEg
PHONE NO. S- DESIGNER OF JOB
We hereby propose to furnish the materials and perform the labor necessary for the completion of i��f�11 , , , • ,.,r. ,
Seamless Gutter t rc,c. c.. Z t. V,-s t-. t a,'1 S
Downspouts 'c . ,;e / 4- l'v a C v 7-
Elbows Elbows v t v� f�t'r rY f; s=r 5 X ( s�• !"- :fL. �x •r
Inside Miters
Outside Miters / -� �r� c f .. L ��.�. ;:.v L `.v✓`d,J
Off-Angle Miters L ,; r . /- r. �'� .�- 41 ; G,- ,t i ✓ (,.rC. K
0.32 Gauge
r � r ,
0.27 Gauge
c. ,
Color % 'f✓ /. - f"�t, � 4, _r 1,e-
Canadian Bar Hanger VcJc . e. ,�1 �. ,� ;; ,., , ,,,J
F;fQq Stfapsb,- �: 2" r. 2 . z �3 fin,,
Gutter Screens .s , ,.
r
Fascia
Soffit
Rake
Siding , i j tA
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and speci-
fications submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars $ /V, R� r
with payments to be made as follows-5'0til .�/�{`�s .� L-v c-. '� t•� %>4,%c �t}-� ,, c n. o v
Salesman ,'v,�ti . ;".} ,�- t
t L .rY 1
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order,and will become an extra charge Per
over and above the estimate.All agreements contingent upon strikes,
accidents or delays beyond our control.
j .Note —This proposal may be withdrawn
f �; t (t� ✓L. / ,�:' J 1 ✓��� /car, /' r. ,, , ��t�
0A by us if not accepted within days.
ACCEPTANCE OF ESTIMATE/CONTRACT
The above prices, specifications and_.conditions are satisfactory and are hereby accepted. You are authorized to
do the work as specified. Payments will be made as outlined above. ' (,.r
Signaturef -�
�_ f �, r`
Date - Signature
C\ PROPOSAL
�_•i r! 5 - t.� L `� C 1
S
0 Ck-) ^ I «" �. L " r �✓ ! ! { f1 . [ J r7`'rr ' 1 f`, �.- , ax
t%ORTH
Town of 19Andover
No. 8 1(a
_ _ _ p
. A LE over, Mass., 3o
LA
COCHICHE WICK
o?ArE D APE �y
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
..t. .$....... ......... .... .... ...... .... .... ... .......
THIS CERTIFIES THAT....... d
�Wl ............. ..................................................... Foundation
has permission to erect..... ............ buildings on ..... R 00.4.........C.4L.................................. Rough
.......... .... .... .....
to be occupied as............ .......A11.......i .................................................. 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 the Inspection, Alteration and Construction of
Buildings In the Town of North Andover. P S
A / 9' PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
CONSTRUCTION STARTS Rough
......A.. ...C0.46���
..... .... ......................................................... 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.
SEE REVERSE SIDE Smoke Det.
� Date. .. ...... ..
j
TM
of
TOWN OF NORTH ANDOVER
ti p
• PERMIT FOR GAS INSTALLATION
. 9
SACHUS
This certifies that � � . .� . . . ✓
has permission for gas installation .��-�. / . . . . . . �.J �
in the buildings of
. . , North Andy/over, Mass.
at I 0. 04-. .
Fee_;`.�Lic: No_3;7
GAS INSPECTOW� lJ U
(.heck#
76
MASSACHUSE7IS UNIFO M APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Ujp F1)Jf�0�6-� Mass. Date � • � Permit #
Building Location_ /Ah RCA S► Owner'sName WILLIA11 LJQ,0 ,rnr �1,41N AIJ'VOvc
Type of Occupancy kX51 pGQTI A L
New ❑ Re ovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
ti
CC
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W N
N N V Z ¢ N 7
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W W r0" a
Otl ~ Q D: Z Z O W
Q m Q M O O H cl
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N a W Z Ou W W W Q a Occ W I- Q W
a }- Z J F- Z �. W W;C CCtl 0 > 4. }- U J y W
Z Q W Q C �' >- N M 2 O Y �W_. O X
Q W > W 2. Q CrQ p
¢ .x O tl3: U. : c > Q a F O
SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Addr6ss 55 MARSTON STREET �O Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone -68,7-'1105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
II have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No 11.4If you have checked res, please Indicate the type coverage by checking the appropriate box.
Aliability insurance policy ,
� Y � Other type of indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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
I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and aaxr�gte to the best of my
knowledge and that all plumbing work and installations performed under the permit iss i r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene
Tof Ucense:
Plumber Signature of cen Plumber or Gas
Title GasGtter -145
Master Ucense Number
Cit /Town Journeyman
O IC S_ONL
1
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO PO GASFITTING
c NAME A TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIG NO.
PERMIT GRANTED
DATE
GAS INSPECTOR
Commonwealth of Massachusetts RECEIVED
City/Town of North Andover Fcq '14 2017
o System Pumping Record
TOWN OF NORTH
Form 4 HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer, 1� S�
use only the tab � y
key to move your Address
cursor-do not North Andover
use the return
key. City/Town State Zip Code
2. System Owner:
tab
Name
�D
Address(if different from location)
Cityrrown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 3�I 2. Quantity Pumped-
Date pilo s�-J
3. Component: ❑ Cesspool(s) 2' Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of co iponent pumped:
6. umped By:
N Vehicle License Number
ewarts Septic 58 So Kimball St Bradford Ma
Company
7. Location where contents were disposed:
so mill t bradford ma
Si ature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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