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Home My WebLink AboutMiscellaneous - 1327 SALEM STREET 4/30/2018 / 1327 SALEM STREET J 210/106__A_0125_0000.0 Location No. Date /0 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ CU Buildin d/Frame Permit Fee $ 1 J�roo �� Foundation Permit Fee $ k Other Permit Fee $ Sewer Connection Fee $ M Water Connection Fee $ TOTAL $ Building Inspector' r 6-70q t971 2 Div. Public Works �Lpcation .lVo. Date NORTh . TOWN OF NORTH ANDOVER pf�i� o yeti V Q Certificate of Occupancy $ a Building/Frame Permit Fee $ CMuSEs Foundation Permit Fee $ .� Other Permit Fee $ Sewer Connection Fee $ ` Water Connection Fee $ TOTAL $ Building Inspector ` 9 71.3 Div. Public Works Locations No. Date X4-27 NORTH TOWN OF NORTH ANDOVER ,`,.'rO oc Certificate of Occupancy $ ` Building/Frame Permit Fee $ 1 �i�s°°',•°'''t�' Foundation Permit Fee $ SACH Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee X077 5a a" TOTAL $ wldi Ins ., . 44/22/95 09:12 1,077--5U-7-R'g- j 1 i_ 8976 . Div. ubf Works PEEtJtI'[ Na., �\ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 20 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE — ZONE I SUB DIV. LOT NO. LOCATION 1327 Salem Street PURPOSE OF BUILDING Single family residence OWNER'S NAME Saraceno Const . -, Co . , Inc . NO. OF STORIES 2 SIZE 15 $—s f OWNER'S ADDRESS 10 Stevens Street , Methuen , AASEMENTORSLAB Basement ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2X10 2ND2X10 3RD BUILDER'S NAME Alfred Saraceno SPAN 12-14 DISTANCE TO NEAREST BUILDING 60 ' -I- DIMENSIONS OF SILLS 2X6 DISTANCE FROM STREET 120 ' + POSTS 32' concrete filled DISTANCE FROM LOT LINES-SIDES 31 ' & 57AEAR150' + GIRDERS 4 2X10 AREA OF LOT 46 , 800 FRONTAGE 15 0 1 HEIGHT OF FOUNDATION 7 911 THICKNESS IS BUILDING NEW yes SIZE OF FOOTING 22tt x 1011 IS BUILDING ADDITION no MATERIAL OF CHIMNEY Meta - direct vent IS BUILDING ALTERATION no IS BUILDING ON SOLID OR FILLED LAND Solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION. IF ANY yes Approved 3-20-9 IS BUILDING CONNECTED TO TOWN SEWER no Petition# :060-95 IS BUILDING CONNECTED TO NATURAL GAS LINE no INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST $105 ,000.00 SEE BOTH SIDES a S()a EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT$ 53 . 80 ' PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER R001$15 , 500 . 00 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY • ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUS BEFILE AND APPROVED BY BUILDING INSPECTOR DATE F LE -1 7- BUILDING INlPtCTOR SI R O OW OR AOtITORIZIED AGENT F E E ��l 3 OWNER TEL.# 508-687-3277 PERMIT GRANTED s CONTR.TEL.# 508-687-3277 19 ! CONTR.LIC.# 027144 Pam l 3/ 3 _ /�.0 , `''..x H.I.C.# E.PERMT$ « BUILDING RECORD y 1 OCCUPANCY 12 SINGLE FAMILY SrouitS THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY - OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH.PORCHES, GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION SALEM ST _ 2 FOUNDATION 8 INTERIOR FINISH ----- i 17 i r -------"r ----------- __ oil $18'4' S2O•�f Z3'� " CONCRETE a i 2 13 - % 6E CONCRETE BL'K. PINE __ _ 18.36 3 I BRICK OR STONE HARDW D PIERS PLASTER _ lo?4" m2 DRY WALL UNFIN. 3 BASEMENT I ``�• I y N AREA FULL FIN. B M'T' AREA _ - ,.`r,0.45 ( A ` . .�� FIN. ATTIC AREA 'y .�3 \�., NO BMT FIRE PLACES .�� I 'i S R��{,RE .. a fid` HEAD ROOM MODERN KITCHEN _ y �Oq I, f ,� ' f�T`gCP ` , 4 WALLS I 9 FLOORS RV CLAPBOARDS B 1 2 3 `� / m I - I�1 r�-� ^ ! co DROP SIDING CONCRETE �4 - WOOD SHINGLES EARTH �_ ASPHALT SIDING HARDW'p ASBESTOS SIDING _ COMMON v I ti �-_ �__ 92 � f I VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY 0 Z� ry STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ CO N BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING _ STONE ON FRAME SUPERIOR I� POOR ppCAa ADEQUATE NONE dry. ^� ' _ ` Lv 5 ROOF 10 PLUMBING p-Z-\' ��\ orb ci GABLE HIP BATH (3 FIX.) !' QTS GAMBREL MANSARD TOILET RM. (2 FIX.) FIAT SHED WATER CLOSET _ ^ 0to , iV ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES tV O m TILE FLOOR TILE DADO O OO i 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE \ �' FORCED HOT AIR FURN. \ TIMBER BMS. 6 COLS. STEAM \ STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING \ RADIANT H'T'G UNIT HEATERSN2O•S6'17w 7 NO. OF ROOMS OIL 150.16' o ELECTRIC 1st -I 3rd I NO HEATING `.+ .'I.' '`f. * 77 �` RE^BRADS JOYCE 8R'AQ;. Town of North Andover t NORT1y � • � iiA:l� ?°°<"`° '°• "�o TOV�µ GLERK OFFICE of N0 ,. . . ITY DEVELOPMENT AND SERVICES MAR 20 4 15 146 Main Street Orth Andover, Massachusetts 01845 9'TS ACHUSEt This is to certify that twentj(20)days have elapsed from date of decision filed without filing d0 Date 4,01:' iL /7, Joyce A.Bradshaw Town Clerk BOARD OF APPEALS NOTICE OF DECISION ra Property: Lot 20,Salem Street a vii Q& p � 5�•C • c. Ruth B. Pickard Date: 3-20-96 1J.27 Salem Street Petition# :060-95 O a,&.AANorth Andover, MA 01845 Date of Hearing:1-9-96, 2-13-96,3-12-96 6 The Board of Appeals held a regular meeting on Tuesday evening, January 9, 1996 and continued through to March 12, 1996 upon the petition of Ruth B. Pickard requesting Variances pursuant to Section 7,paragraph 7.1,7.2 and Table 2 of Zoning Bylaw for property located at Lot 20,Salem Street, Zoning District R-1. The following members were present and voting:Raymond Vivenzio, Ellen McIntyre, John Pallone and Joseph Faris. The hearing was advertised in the North Andover Citizen on 12.20.95and 12.27.95and all abutters were notified by regular mail. Upon a motion by John Pallone and seconded by Ellen McIntyre the Board voted unanimously to Grant relief of 40,320 square feet of lot dimensional area from the requirement of 87,120 square feet and relief of 24.90 feet of street frontage from the required 175 feet. Voting in favor; Raymond Vivenzio,John Pallone, Joseph Faris and Ellen McIntyre. The Board finds that the petitioner has satisfied the provisions of Section 10,Paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. BOARD OF APPEALS, ATTEST; •A7�rue Cony William Sullivan,Chairman �O. ,3v�c 8lP BOARD OF APPEALS 688-9841 BUILDING 688-9845 CONSERVATION 688-9830 HEALTH 688-9540 PLANNING 688-9535 Y SAW ®PTH RSG RZNCe �GrRY A rpUr AT � I Own nof - rt o _DNn dover O �� L .. No. 131 • o ' '1 7 _` North dover, Mass., y / 7 19 6 \ ,/ ,ORS TT E d��C) ` 1 BUILD F BOARD OF HEALTH PERMIT T 0 Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ,, C�•o•........ ,•• a.�t S� Foundation has permission to erect.............. ............ buildingk on ............132--e..?...........SG. .4k.5.. ' ........5.`Z,....... Rough tobe occupied as ...............................................................moi. ..........1 �?t.�,. ...................................... Chimney provided that th( Jerson accepting epting 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 Final ELECTRICAL INSPECTOR Rough .............................. Service ... . . . .. ....................................... BUILDING INSPECTOR Final cp: t( 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. 4 Street No. �� Smoke Det. - ° � /z o�✓ttcwdac:zuaella Fadlurot°; " • :,:;t t`� ✓tie �anvrnarcu� flt�ss'c`„ ,.,roc c,loa Restricted To' 00 DEPARTMENT OF PUBLIC SAFETY 00 - None CONSTRUCTION SUPERVISOR LICENSE Birthdate 1A - Masonry only Nu�ber Expires /- CS 027144 03/23/1991 08123/1943 1G - 1 8 2 fa�ily Mies Restricted To: 00 AIFREDO SARACENO 10 STEMS ST NETNUEN, NA 01844 i 1 L Town of North Andoverof p°RTiy OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES - 146 Main Street KENNETH R MAHONY North Andover,Massachusetts 01845 -SA MUS y Director (508)688-9533 i e November 28 , 1995 i "cam. S s Builders t .. 23 Pine' Street Methuen, MA 01844 ��' Attention: Alfred Saraceno Re : ' cation ilding Permit - 10/31/95 1327 Salem Street VZA c6f Dear Fred: Please be advised that the above-referenced permit is being HELD pending receipt of information affirming that the Lot complies with zoning in an R-1 District . The required area and lot frontage in an R-1 zone is 2 acre minimum with 175 ft . frontage . Kindly provide this th the required information as soon as possible . Thank U. Y rst ly, ich o tuoni, � Lo nsp:tor � V RAC: o c/R. Nicett mission r BOARD OF APPEALS 688.9541 8-9545 CONSERVATION 688-9530 HEALTH 688-9340 PLANNING 688-9535 Julie Patrino D.Robert Nicetta Michael Howard Sandra Starr Kathlem Bradley Colwell DEC. 05 '95 11: CRE HORTH H11L)OVER , ^ We, GEORGE 11. FARR AN I) WAIVDA 11. FARR, husband and'.Wife both of North Andover, EasexCounty, Massachusetts, x.bxto.,4Xxtaxctk4, for consideration paid, grant to KENNETH E. PICKARD AND .RUTH B. PICKARD, husband and wife, as tenants by the entirety, both of 1-31.7: Salem Street North !`ndover, Essex County, Massachusetts V) or '' -with poltlaIIEI Zthr aMilto Cd the land in North P ndover, Essex County, Massachusetts and being`-two (2) lots of land situated on Salem Street, on the Southwesterly side, and being shown as Lots y 18 and 20 on a plan entitled ".Part of Salem Forest North Andover, Mass. , George b Farr, Developer, Scale 1"=40 , May 12, 1970, Raymond Pressey,Inc. , Registered Land Surveyors, .1.,ynn, Mass. " recorded with Essex North District Re istr of Deeds ° as Plan #6196. Said lots being particularly bounded as follow Z LOT 18: NORTHEASTERLY! by Salem Street in two courses, 117. 73 feet and•32. 23 w feet; SOUTHEASTERLY: by Lot 19 on said plan, 320 feet; Y 4 SOUTHWESTERLY: by other land. of Farr, 130.90 feet; co NORTHWESTERLY: by Lot 17 on said plan, 328. 68 feet. Containing 44, 790 square feet more or less according to said Plan. c� Ir LOT 20': NORTHEASTERLY: by Salem Street in two courses, "144, 26 feet and 5. 84� feet; co SOUT11111,ASTER.LY: by Lot 21 on said plan, 320 feet; SOUTHWESTERLY: by other land of Farr, 150, 16 feet; U) NORTIRVESTERLY: by Lot 19 on said plan, 320. 77 feet. bContaining 46, 800 square feet more or less, according to said plan. N Being a portion of the premises conveyed to us by deed of Elsie M.Heinze, etals, dated July 17, 1967 and recorded with Essex North District Registry.of Deeds in ro Book 1087, Page 31.. s4 O The consideration for this doer] is Fifteen Thousand no/100 ($15, 000. 00)Dollars. V y r December 5, 1995 D. Robert Nicetta ` Building Commissioner Town of North Andover North Andover,MA. 01845 RE: 1327 [Lot 20] Salem St. Dear Bob, As per your request enclosed please find deed for above referenced property. As discussed,Inspector Colantuoni has determined this parcel does not comply with current zoning requirements. I appreciate your review of this deed to determine any "grandfather" status of this parcel. If there is additional information you require please let me know. Very truly yours, Kevin M. Wood cc: S & S Builder's, Inc. Kevin M. Wood Managing Partner IV/MK V/MK _ Properties DEC Z 2 Bourbon Street Peabody, MA 01960 Office: (800) 535-9721 Fax: (508) 535-0579 Car: (617) 586-4142 Each Office is Independentiy Owned and Operated nes. (617)639-0038 a 12/01i'19915 11: 57 508-689-282_". B_IIILI:ER, IHC. PAGE E 02 Town of North Andover No Th OFFICE OF � '` ".4 0 0 COMMUNITY DEVELOPMENT AND SERVICES - i 146 Main Stivxrt •�`•�: int RL MA IONv North Andover, Massachusetts 01845 �ssAcmU (508)688-9533 November 28 , 1995 S & S Builders 23 Pine Street Methuen, MA 01844 Attention: Alfred Saraceno Re : Application for Building Permit - .10/31/95 1327 Salem Street Dear Fred; Please be advised that the above-referenced permit is being HZ4Q pending receipt of information affirming that the Lot complies with zoning in an R-1 District ; The required area and lot frontage in an R-1 zone r i s 2 acre minimum with 175 ft. . frontage . Kindly provide this office with the required information as soon as possible . Thank you . y rs tr ly, rchard C'olantuoni , Local Inspector RAC : gb c/R . Nicetta, Bldg . Commissioner BOARD OF APMAL8 698-9541 TIM)WO 699 9545 CONSERVATION 699-9330 HFALTH 6869540 PLANNWO 699-9535 ]ulk Pzrrvco D.Rbbdn Mown mc3iul H wotd 5609WS Off K&Wem Bndky C*fftU . L PERJiiT NO. J f VI�P111AUpfi:,FOR` PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 • MAP 4,40. LOT NO. 20 2 RECORD OF OWNERSHIP DATE (BOOK I-BOOK - ZONE I SUB DIV. LOT NO. F - I LOCATION 1327 Salem Street PURPOSE OF BUILDING Single family residence ' OWNER'S NAME S & S Builders, Inc. NO. OF STORIES 2 SIZE 2,6jg4rs/f SF a' OWNER'S ADDRESS 23 Pine Street , Methuen, MA BASEMENT OR SLAB Basement (b 244I¢- "0- ` ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST •2X10 2ND 2X10 3RD BUILDER'S NAME Alfred Saraceno SPAN 12-141 DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS 2X6 DISTANCE FROM STREET .-POSTS--W' concrete filled DISTANCE FROM LOT LINES —SIDES REAR " GIRDERS (4) 2X10 AREA OF LOT 46,800 FRONTAGE HEIGHT OF FOUNDATION 719" THICKNESS loll IS BUILDING NEW yes SIZE OF FOOTING 2211 x 1011 IS BUILDING ADDITION MATERIAL OF CHIMNEY Metal - direct vent IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER YeS BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER No IS BUILDING CONNECTED TO NATURAL GAS LINE No 3 PROPERTY INFORMATION INSTRUCTIONS ,f,�yti Sl PiA � Q LAND COST $105,000.00 2,l• n EST. BLDG. COST i•{10 W M • + n4,1 Illi PERMIT FOR FOU"b�h FTI ()M EST. BLDG. COST PER SQ. FT. $53.80 PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED BY PAR:. i.; - " PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM $15,500.00 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDINGFEE PAID AA EE 4 APPROVED BY 1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULA19 • PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECT - O 1 DATE FILED - _ BUILD NO INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGE:;n Ra F E E i w OWNER TEL.# PERMIT GRANTED G O PERMIT FOR FRAME/BUILDING CONTR.TEL.# DATE: FEE PAID CONTR.LIC.# 02-7 1 z:St • H.I.C.# OCT 3 1 W5 oo j ��1213 t • ��3 "y Z, h t• • ' � r • •�'�I ywA J BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILY STORIESTHIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY , _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION SALEM ST ., 2 FOUNDATION 8 INTERIOR FINISH ----!_ 7-------- 0•-5 - '------------- �i� 518'4' / CONCRETE 3 1 2 13 �/ I / CONCRETE BLK. PINE ti -- - - - - -- -- O BRICK OR STONE HARDW DI" �off?Q. PIERS PLASTER j� I % Q. DRY WALL 3 BASEMENT 11 '%R\\l " h — -_ _ cb AREA FULL A FIN. B'M'T' AREA ��, [I R�5€ Y ''t .�c ' 14 '/I '/. FIN. ATTIC AREAJ 13 RE \ b NR O B M T FIRE PLACES a oi' ./ 1� / SV HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS O Qtl., CLAPBOARDS B 1 23 �f 1 /= DROP SIDING CONCRETE I_ i ✓ �4� _ / ^� WOOD SHINGLES EARTH ASPHALT SIDING HARDt'✓'D ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE o to STUCCO ON MASONRY F.9 o STUCCO ON FRAME / 91.5 BRICK N MASONRY ATTIC STRS. a FLOOR I_ 00 BRICK ON FRAME t ' CONC. OR CINDER BLK. W _ STONE ON MASONRY WIRING STONE ON FRAME t SUPERIOR POOR « I_� �O ADEQUATE NONE o�� 5 ROOF 10 PLUMBING 00 .� N �p_ - j�4= I ` O GABLE BATH (3 FIX.) Z HIP r. GAMBREL MANSARD TOILET RM. (2 FIX.) ^q� - - 4 C FLAT `SHED - WATER CLOSET 1� ASPHALT SHINGLES LAVATORY ^t0 o" \ l 0�2`•' Z 1 WOOD SHINGES_. KITCHEN SINK. SLATE - NO PLUMBING- TAR 6 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES ' TILE FLOOR ^ _ ry �1��• - ti TILE DADO � O i 6 FRAMING 11 HEATING v vp�co0, _ f/ WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS J�, AIR CONDITIONING ''"•' RADIANT H'T'G UNIT HEATERS N20.56'12YW _ GAS 150.16' oll All, 7 NO. OF ROOMS OIL 4 J B'M'T 2nd 4 _ ELECTRIC `q-N I 1st 5 13rd I NO HEATING n 4++n•!•'R ['+�.j fes. ..+ s PER-MIT W0.�,�� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP Iwo. " LOT NO. 20 12 RECORD OF OWNERSHIP jDATE (BOOK PAGE ZONE I SUB DIV. LOT NO. F i LOCATION 1327 Salem Street PURPOSE OF BUILDING Single fam-il ' residence OWNER'S NAME S & S Builders, Inc. NO. OF STORIES 2 SIZE ��''i ,�,i.1GY,;/f 2&C-)^ �(� OWNER'S ADDRESS 23 Pine street BASEMENT OR SLAB BasmmtLt IN \ 2—440— ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2k10 IND 2X10 3RD C� BUILDER'S NAME Alfred Saraceno SPAN 12-11. 1 DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS 2X6 DISTANCE FROM STREET POSTS 32" concrete filled DISTANCE FROM LOT LINES -SIDES REAR " GIRDERS ((I'- 2X11! AREA OF LOT 46,800 FRONTAGE HEIGHT OF FOUNDATION 719" THICKNESS loll IS BUILDING NEW yes SIZE OF FOOTING 22171 X 10;# IS BUILDING ADDITION MATERIAL OF CHIMNEY Metal — direct Vent IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER Yes BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER No IS BUILDING CONNECTED TO NATURAL GAS LINE No INSTRUCTIONS 3 PROPERTY INFORMATION ! LAND COST $105,000.00 SEE BOTH SIDES ..�.."�-�..,.... Y y�TM�_ EST. BLDG. COST @ F/„� r•; T— PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. $5 3.S 0 PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM $153,500.00 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS �� PLANS MUST BE FILED AND APPROVED BY BUILDING SPECT 11( /y ' � e/ —r DATE FILED SUILDINO INiKCTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E OWNER TEL.# PERMIT GRANTED CONTR.TEL.N I I Is CONTR.LIC.a4! 697-71 7 H.I.C.# BUILDING RECOR15 1 OCCUPANCY 12 SINGLE FAMILY 11 A STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION SALEM ST 2 FOUNDATION 8 INTERIOR FINISH .. �� $18 4' ------------- CONCRETE x a 1 2 I3 }' 1 I r $20'�5'�3 Z �o 6F -- __ _ ' CONCRETE Bl'K. PINE 18.36 �� _ BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL UNFIN. 3 y J o 3 BASEMENT I i'' .P n ApE(•• — -. .�cb AREA FULL FIN. B'M'TAREA FIN. ATTIC AREA R NO B M T FIRE PLACES i T RL\Si�Y HEAD ROOM MODERN KITCHEN '-+ • \ \ ^/ 4 WALLSI 9 FLOORS Q'.` RE ERVE CLAPBOARDS B 1 2 3 W) lI o` I - /P \ i'"• � DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"J'D pry V �• 97 ASBESTOS SIDING COMMCN __ f VERT. SIDING ASPH. TILE —{I •i „�_ - o ,0: STUCCO ON MASONRY STUCCO ON FRAME --Hl BRICK ON MAS NRY ATTIC STRS. & FLOOR I_ �� _ ' ' �O ;' BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME ' _SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING �'- p Cao \oa GABLE HIP BATH 13 FIX.) m��; __ 11 GAMBREL MANSARD TOILET RM. 12 FIX.) � �� _ -�� / f/ ^ L I I �r FLAT SHED WATER CLOSET ^�Q) ASPHALT SHINGLES A LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO O 6 FRAMING I 11 HEATING l WOOD JOIST PIP ELESS FURNACE \ _ FORCED HOT AIR FURN. \ ��\ \ TIMBER BMS. b COLS. STEAM STEEL BMS. S COLS. HOT W'T'R OR VAPOR WOOD RAFTERSA_ AIR CONDITIONING \ / RADIANT H'T'G - — / UNIT HEATERS N20'56'1';W MS GASNO. OF ROO 150.16' OIL L;3 B'M'T 2nd _ ELECTRIC W3 1s} 5 13rd I NO HEATING i 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 local' or state law, regulations or requirements. ****************Applicant fills out this section***************** SR RAe44U/-- a. Z�_c (.87-327'7 APPLICANT: C. Phone (508) 2 LOCATION: Assessor's Map Number 106B _ Parcel Subdivision Lot(s) 20 Street SALEM STREET St. Number 1327 ************************Official Use Only************************ RECOMMEND#T ONS F WN AGENTS: Date Approved 1® f4 11 1P Conservation Administrator Date Rejected a Comments �IVI�.I Mh � �k Se I,L L�SiGr1 �- Q S+ i Date Approved own Planner Date Rejected r Comments Date Approved Food Inspector-Health Date Rejected - 41IS" Z "4 Date Approved i Septic Inspector-Health Date Rejected Comments a� Public .Works - sewer/water connections `(� j e)_27-9 5' drivewaypermit t l D 2.2-`�� -17- Fire Department e � �� w 1?ej ,,j '4 6 Received `by� Building Inspector Date OCT 3 1 1995 NORTH - � F 40 Of ower 0 0 No 55 , r: h O �t - dvver ass., ��r�me�e Z 19`Z "OAT WICK AORA7ED S BOARD OF HEALTH PERMIT T Food/Kitchen 1 )Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..2.k1s,...7BQk .7-:W .:.................................................. . ................: .,.................. o undat on has permission to erect .... .MP... buildings o ,.... �.�n...... .. .. / Rough to be occupied as ?. ,... !�� Q...... .. ......4!..4!�(�....r.!!oG4ro .� ............ Chimney Ch' provided that the person accepting this pe it shall in V)iery res ect conforrY oto the terms of the application o ile in Final this office, and to the provisions of the Codes and By-Liiws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY-PARA. 114.8-S. B.C. VIOLATION of the Zoning or Building Reg,ations Voids this Permit. Rough -� � Final PE RMI EXP 6 MO FEE PAID UNLESS N •I. ELECTRICAL INSPECT Rough ' - _ - ............... Service �y�-�---_--BUILDING` SPECTOR Final rR Occup Perm Required ' Occupy Building G 9 - 1,,- OR R Display in a Conspicuous Place or the Premises — Do Not Remove Fi a No Lathing �orry Wall To Be Done � � Until Inspected and Approved by the Building Inspector,. o1 FIRE DEPARTMENT 0d Burg 0 Street No. Smoke Det. RTH i...:. oTwn . o JL 0 dover No. 131 f- OL dover, Mass., y / 19 96 2 COC MICMEWICK A°RATEo PC-1 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System ' O? a �, BUILDING INSPECTOR THIS CERTIFIES THAT................................�4.? CA v. ................. 5 ...... .�.............................. Foundation has permission to erect..............CWE.......... buildingk,on ............1.. ..?........... .( .�..1'`'L.........5.'�'. ....... oug to be occupied as................................................................. .........i&--AiNf.,. �Y................................... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in in01 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. PERMI1 FOR FOUNDATION ONLYPLUMBING INSPECTOR " REGULATED BY FEAR",. 114.8-5. B.C. � 2 VIOLATION of the Zoning or Building Regulations Voids this Permit. oug �� y-9 4ti4 PERMIT EXPIRES IN 6 MO - FEE PAIL) o 6 i/L_::�- -- ✓ UNLESS CONSTRUCTION START/8? ELECTRICAL INSPECT ................................. . :... .... ....... ...B... ervi UILDING INSPECTOR Occupancy Permit Required to Occupy Building X °q 7 G S INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Fi ugh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner O Z Street No./,3,?7r- ' Smoke Det. r; CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 131 (1996) Date FEBRUARY 27, 1997 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1327 SALEM STREET MAY BE OCCUPIED AS SINGLE FAMILY DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Saraceno Con r1jrtion 10 Stevqns Sp. ADDRESS wt iipz- mA/ 4/00, scMus ui! ing Ynspector --`v "N %Ar@mr%JnW1 f%rr Lg%.;AIIUM FUR PF-RM1T TO DO GASFITTINQ a. (Print or Type) NORTH ANDOVER, , Mass, Date 19 9;7— Building Permit Location J � Lai✓� Owner's •� '� Name New ❑ Renovation p Replacement p Planes Submitted: Yea p No (p a X , C 9 o N d am+ w e° z x a 4 N �d�@ Q o a ' o x H td h �1 a C Us f g7r: Q to w0 3PQ� K w q o �i 'z O O 26 9 $, O J V IC Y b '' BtJq—®'klTe OAORMENT IST FLOOR 2NOFLOOR IL SAO FLOOR 4TH (FLOOR STH FLOOR ! eTH FLOOR ' 7THrLOOR k + OTH FLOOR HIM] Check one: Certificate Installing Company Name —�"� (!(/ Corp, .-Address d Partnership ❑ Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter /97 q/ J040✓*1 ,INSURANCE COVERAGE: Check one I.have a current liability Insurance policy or its substantial equivalent. Yee K No ❑ If you have checked yea, please Indicate the type coverage by checking the appropriate box. A llablilty Insurance policy Other type of Indemnity ❑ Bond O OWNER'S INsunANCE 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: Signalute of Owner or Owner's Agent Owner ❑ Agent ❑ .I hereby certify that all of the details and Information I have submitted(or enters above application are true and accurate to the best of my krwMedge and that all plumbing work and Installations performed under the perm Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter I of a1 Laws. TkPolulmubcer ense: na e o nee um er or as er TRW. aplterasterLicense Nuumber !�o'�^ umeyman ArVEO(OFFICE USE ONLY) .w�.�.V� F4°�'."'r"�'^''-... ti;«—.-r..ar`^w_.-,..,�lncc�..: ax•:w. �... _. �_ _._. . ;d 2 Date�. �.:�1. .�.?... .. s / MOHTh -TOWN OF NORTH ANDOVER pF t��eo ,e,1'O �? pp PERMIT FOR GAS INSTALLATION . ice : . �9SSACHUSEt This certifies that . . �'`� .V C>z f .�.�°�. �?�. . . . . . . . . . . . . . . . . . . . has permission for gas installation . R'q h k. b !A.Yl c iz. . . . . . . in the buildings of !�Ac a!:!."' . . . . . . . . . . . . . . . . �' 7 S lrr at . ,�pp . . . .S�. . . . . . . . ., North Andover, Mass. Fee�O,/-,,7 Nijf No./7-) .4�.�. . . . . . . . . . . . 30.00 PAIASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File �•nv.anw.r�u�ef 14 UNIFORM APPLICATION FOR PERMIT TO DO PLUMBINU tv IPr(ni ot Type) NORTH ANDOVER, Maas. Oale 2 3 Ip 7 Sanding Permit *• Location Owner's Name ltr (-z New Renovallon O Replacement 0 Plans Submitted: Yes O No.❑ FIXTURE$ Is W at « s J « 0 at h A tr !1 J « 1W0 <44 M Is tr M = « _ 0 P U at ~1t < M %. _ I ar s H - X 44 06 s+ I- o >< • p s • e e e s It . s ...... _ ......_ •�: _ •Nal-ieMT. - - _ - __. _ _... .. ..__ eA10MfiNT IST FLOOR &NO FLOOR $110 FLOOR -4TN FLOOR TM PL0011 _ OTN FLOOR. ITM FLOOR sTNFLOOR - Check one: Certificate Installing Company Name -1 � E3 Corp. Address oya. l 0 Partnership -24 C3+rm/Co. .. Business Telephone -(0-Vo .0:. z D_ •Name of Ucensed Plumber INSURANCE COVERAGE: cilec I have a current Ilablity Insurance policy or Its substantial equWanL Yes No p It you have checked y", please Indicste the type coverage by checking the appropriate box . Other Y A ilablil 1nsursnce-P�cY Bond ❑: OWNER'S INSURANCE WAIVER. I im aware that the ilcensee does not have the Insur ince coverage required by Chapter 142 of the Masa. General laws, and that my signature on this peit applicaticsgukon.waives.Ihla enwnj ._._, ._ .;:.._ rmCheck one: -._._...._. ... . .... . ... Owner Q _.. Siona ure O ar.or Oovner1 en r - _ 6. _ I he��certify that all of the details and Intormetlon I have wbmttted for enleredl h tion gra.ttw.and. s • and that a1 bhV work and Instigations of aocurata b-Itva:b�dof;any�- Dorf tned under the stets lot pp Pe Inenl aP w{I be . pert provisions of the Mauachuutls Slala Pknnbinq Code end chapter 11 of� It wish tall This na are sed Fknbu C ty/Town Ucense Numbet I Mf'f'IOVED(OFf10E USE ONLY) Type of P1un binQ License: Maslar [-)� l Journs . yman ❑ I > mss. Date. fyS �� N 3387 s' HORTM TOWN OF NORTH ANDOVER btu 3? °•tom ...� • OL PERMIT FOR PLUMBING S4C14US��b << ` This certifies that. . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform 1 �a C k Flo w is /j. . . . . . . . . . . . . . . . . . . . plumbing in the buildin sof . fY1 t! !✓✓1 e w . . . . . . . . . . . at. /? -?.`7 . . .S! ?'!,. . :1/4� . . . .. N h Andover, Mass. Fee. �. �. .Lic. No.. . . . . . . . . . . . . . LUMBING INSPE TOR 06/30/97 12:10 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer )f'J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GA (Print or Type) SFITTING , Mass. Date 19 permit # - Building Location. ,i�tl Owner's Name Type of Occupancy /('mss' - New M3 - Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ ' No ❑ N N W N Y Q vi v1Q N R O N F- W W o: O o N ra Cl u F. ( + L .O F- W Q us 4 D. C o }- N tl = F N a > WC W W W O ? _ m O � S OUJ > V W ti 3 D c7 J U C b a a M- O sub—aSMT. BASEMENT I 1ST FLOOR 2ND FLOOR I + I I I I I 3190 FLOOR I 4TH FLOOR I I ( + I STH FLOOR I I I I I 6TH FLOOR I 7TH FLOOR I I I I STH FLOOR Installing Company Name /t Check one: CertKicate � Address' @9--7Corporatlon ��,y•',' �� ❑ Partnership Buslness Telephone a Firm/Co. Name of Ucensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current 1l#Illty insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142 Yes (J-' No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A ilabillty 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'sAgent Owner❑ Agent [:1 1 hereby certify that ail of the details and information I have submitted(or entered)in above application are he and accurate to the best of my knowledge and that alf plumbing work and Installations performed under thepermit ued for this application will be In compliance with all Pertinent provisions of the Maasachuse(ts State Gas Cede and Chapter 142 of the eral laws. "y TWolfUcensa: encTINS bertur o cense u e or Gas ,tiertterCily/Town orUcense Numberf'ik7VF neyman .,j.,.,... ,,.�•_„4,.�--<-w "�wis�i�.:'r-..r��?vrC.�r. .r+s*.ri,[+rig-wltvwed�,=.�.-a w a 2547 Date ��"/w oFSN°pT"�ti TOWN OF NORTH ANDOVER 0 � `p PERMIT FOR GAS INSTALLATION., �9SSAC HUSEt CL `� This certifies that . . . . . ... . . . . . has permission for gas installation . . 5. . . . . . . . . . . . . . in the buildings of . . . - . �. at -f fe.. . . . . . . . . . . .. ., North Andover, Mks. Fee. Lic. No.. 3 Y.Y.G. . . . ASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD: File r i I (� f{� Office use Only u4e cfamm11umm�th d _qnS#13r}}�� Permit No. BepartIDEItt t7f Vublic *afetij Occupancy&Fee Checked 3/go Qeave blank) 99 BOARD OF FIRE PREVENTION REGULATIONS 527 27 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Lo' AkA`� i 4GW or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Aky-k/" � Owner or Tenant NCO \ 1 A Z) �� L° -M ^ Owner's Address i � 5 1):g C,:� T k Is this permit in conjunction with a building permit: Yes I'' No C (Check Appropriate Box) Puroose of Building Sus Utility Authorization No. Existing Service Amos Volts Overhead L! Undgrnd 1 1 No. of Meters New Service Amps`aQ J 0 4 0Voits Overhead r —Unagma No. of Meters Number of Feeders ana Ampacity LA kf'4 Location and Nature of Prcgosed Electricak Work -("IrA A..f'Jl a`CT`E� �k'oct"rv7 kt- e-1 A_J�r_ d c - T Total No. of Lgnting Outlets i No. of Hct - cs No. of ransformers KVA in- No. of Lighting Fixtures i Swimming Pcoi ro e— Erne. _ , Generators KVA No. of =mergency Lighting No. of Receetacle Cutlets I No. of Oil curners I Savery Units No. of Switch Outlets I No. of Gas Burners I FIRE ALARMS No. of Zones No. of Air Conc. Totat No. of Cetection and No. of Ranges I tons Initiating Devices `feat Total Totat No. of Disposals No.of Purrs Tons KW No. of Sounding Devices i No. of Seit Contained No. of Dishwashers ScaceiArea Heatir.c KW Oetec::onisounetng Devices Municieat Other No. of Dryers Heating Devices KW Locai Connection No. of No. of Low Vcitage No. of Water Heaters KW I Signs Sa iasts Wirinc No. Hydro Massage Tubs I No. of Motors Total'HP OTHER: INSURANCE COVERAGE: Pursuant to the reduirements of Massac-Lsers g _eneral Laws — I have a current Liaetiity Insurance Policy inciucing Come•.etga Ccerations &verace or its suostantial ecuivaient. YES — NO — ! have suomirted valid proof of same to the Office. YES — NO — if you have cnecxea YES, please indicate the type of coverage cy checking the aoprooriate box. _ INSURANCE — BONG — OTHER = (Please Scec:fy) � (Expiration Date) Estimated Value of E!ec:rical Work g W �dd GD v work to Start Inscec::on Date Racues:ec: ugn Fnai Signed under the Penalties of perjury: ^ n LIC. NO. _�— FIRM NAME JL`� Si azurZ,2 LIC. NO. Licensee g� aus. i. No. Alt .el. No. Address OWNER'S INSURANCE WAIVER: I am aware that the Licenseeave the insurance co rage or ns suostantial eaurvatent as re- quired by Massachusetts General Laws, and that my signaturemrt application waives this reouirement. Owner Agent (Please check one) Teiecnone No. PERMIT FE= S iSignature of Owner or Agent) T-9565 r *�TO � Date.. . . . .. ... . ... ... . . .. . t . 2656 r NORTH TOWN OWRT ANDOVER G"t, Cm_ _ p PERMIT FOR INSTALLATION C.. { y i 9SSgcmusEt This certifies that. n . . e . . .`.� .��:. . . has permission for9Rhinstallation . . . . . . . in the building f C�/.f. . . . . . . . c��t �, at �Akl. . . .�1.. . . . . . , North Andover; Mass. ?'yk .' Fee. .��.." L_iLc. No. qO . . . . . . . . . . . . . . . . . . . . . . . . . . ►„'^' ' INSPECTOR ti WHITE:Applicant CANXR Building Dept. PINK:Treasurer GOLD:Fe E Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . .D . . . .IPL v. . . . -.L... . . . . . . has permission to perform . . .� !�,��ti. � . . . . . . . . . . . wiring in the building of . . . . . ".►. . . . . . . . . . . . . . . . .at . . -� L�'`9 Sr- ,North Andover, Map. Fee . ic. No. ELECTRICALINSPECTOR Check# l b3 11130 'u. permit iiecricaigoneAmenamentss27uAiKg.ou�Hules: inaccordance-withthe provisions ofM.G.L.c.143,§,3L,the y C\ aplication form to provide notice of installation of wirin shall be uruforin throughout the Commonwealth,and applications shall be filed' on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corpozation stated on the permit application.Such entity shalt be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. r Permits shall_be limited as to the time of ongoing construction.activity,and maybe deemed bythednspector.of_Wires abandoned.aad.invalid ifbe.-- . or she has determined that the authorized worm has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.perrrtia opplicatign. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-tern economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits'and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending through August 15,2012. Mule 8—Permit/Date Closed: Note:Reapply for new per ' ❑Permit Extension Act—PermitMate Closed: Official jJsepnly Commonwealth of Massachusetts L ! II Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3 a e 7- 2 t /L City or Town of: NORTH ANDOVER 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) 4 3 2 `7 e�'a lc m S Telephone No.q-7 1,- -72—r- rPd y Owner or Tenant rr Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate Box) . Utility Authorization No. Purpose of Building - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters a Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followtn table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- mergency Jig tmg No.of Luminaires Swimming Pool rnd. Elrnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Detection and No.of Switches No.of Gas Burners initiating Devices No.of Ranges No.of Air Co d. Total No.of AlertingDevices � Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipal Other Connection Heating Appliances KW Security Systems:" No.of Dryers No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW Ballasts No.of Devices or E uivalent Heaters Signs Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Z 7S. 0- (When required by municipal policy.) Work to Start: $ .oc7- 2a ix 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 licensee 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 q9—BOND ❑ OTHER ❑ (Specify:) I certify,tinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . / /r 74r,"C L L G LIC.NO.: 13 7 �a Licensee:/�. /R s S (1r A/t Signature LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.• R'7 t•9 7 3. - a�/ Address: 2 W ' t ,7 r&1/1h or `_ �'� Alt.Tel.No.: *Per M.G.L c. 147,s.57-6l,security work requires Department f Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does 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 ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. r r . rectorecommexts: Re-xnspeetZouxe�WLW'(W.00)j I e iftnatuxe••.,o f- tials) Slate passet •-� aiTetT--� ate xus eetioxzxeg*ea($50.00)- [ . XubpedoJra'co m eAfg: r (iisiectoxs' `ignature•- o ixtttZaTs) Slate MAP,GPODM 'assetT--�' � �+'aS�etT-•j � �te�zus�►eetzo��e�uixe�($ 0.00)�[ � • aspectoxs'comxae�.ts: ' M (uaspectoxsI,Rigmt ze•-m intnl is ) 'Date MOPEMON-y-SERVI E: . Mu Di sser�--[ ) �'ailerT--� � �e-xnsPection.xequixe�($50A0)�( � , .�ectbxs'coJomeph: . (Cxtspec#oxs'�zgutuxe��onztiaxs) pate ' • r q,8PEcOr'XON- om.E.: e- f ) +'aile�f• [ )- 'ate Inspection xegufxed($50.00)•-( ectars'colitme]�fs: . Ohspectoxs'Minatae..ao xnitiaTs) date ' `A V� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): v� Address: G12 L �./�•i�I��t �of City/State/Zip: oo,1,4 Phone#: 9-7 - -7 3- 3 Are you an employer?Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. El Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' comp.insurance required.] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 14omeowners 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 alk an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ��fi y`,�C Policy#or Self-ins.Lic.#:c Expiration Date: fi 3 Job Site Address:_ 13 2 -7 City/State/Zip: , 1/� 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/lerebycert i-indenihe pains and penalties of perjury that the information provided above is trite and correct. Signature: Date: -'Ll a 4C 7 6 L Phone#: `l-7 — -7 3 - 3 3 Q �/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other I, 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 three 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, §25C(7)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 sign 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 M Industrial Accidents. Should you have any questions regarding the law 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Kevised 5-26-05 Fax#617-727-7749