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HomeMy WebLinkAboutMiscellaneous - 133 GREENE STREET 4/30/2018 133 GREENE STREET 210/033.0000.0 t F Date. 31�19T. . 34"12 �'<eo°TM�tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMus� i A This certifies that . p.,(n.y./ . . . . ... . . . . . . . . . . . . . . . . . . . . has permission to perform .PC Av.L"W4 a m,�, .k . . . . . . . . . . . . . . . . . � plumbing in the buildings of . . . ?.?�. . . �.q44«?!. . . . . . . . . . . at. .%•3J . e.13P!.'k!. . .5'11.... . . , North Andover, Mass. Fee4>. A Lic. No.. .` 's"�?. . . . . . . . . . . . . . . . . PLUMBING IN PECTOR o C � WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 0 NORTH ANDOVER, Matt, Oaie . .tp� Buniilno l 3 �i (� Permk �Z Z : ' Location , d.af i Owners Name Rdb 1419V New O Renovation Replacement O Plans Submitted: Yes p . No.p 1:1XTUSE9 11 « M ! WX F « � M o s M 2 J N I. u !- N N O s O = « 4 i at 31 � O w • Y r r M O S « » • s r ILL �. 0 AA 44 axe 16 .4 44 w 0 i i r °s a Aj eAeEaleNT IAT FL00 I , IN* FLOOR 31 1 IL 11110 FLOOR 4TKFLOOR - tTN FLOOR eTNFLOOR tTN FLOOR LITH FLOOR Check one: CadVicale iInstalling Company No Address GP, O Parinarshlp O Firm/Co. Business Telephone Named Licensed Plumber - . INSURANCE COVERAGE: a Mack one 1 have a current (lability Insurance policy or No substantial equivalent. Yet g--- No O � _ ' h you have checked jM, pleaoe Indicate the type coverage by checking the appropriate box . :' A liability Insurance-policy Other - type d IndemnMy O gond a OWNER'S INSURANCE WAIVER: Ism aware that the 11censee sites not have the Insurance coverage required by Chapter 142 of the Maas. General Laws, and that my signature on This permit app(IcaUom.wabes.wa Check one: _.. _...... .. . .... .. . . Owner .__ .. .. .. a care o ata er.a m., - .. _ , . hereby corily that al of the del fis and Information I have submitted fol entered)to above _.. . ,. Inawled a and that al binp work and Initalattone aPpAcalfon acahue ladaonuatalo tbeAea4ot;p►y. P per^ pMorm.d under the p.nM lewd for w. tbn Will be.b oomplance with an perllnen provlslons of lire M&Mchuiette Slate Pkrmbkp Code wW Chapter 112 of go General This 99FIM1116 City/Town License Number, Type ofrrnna Ucense:PkbiMailer IIPPtKKD(OFFICE USE ONLY) Journeym `❑ i ' PER-MIT NO.Cl�- 0 _ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER MASS. PAGE 1 I MAP NO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES 6,,_A_ 7,"�_ 1 SIZE Sj f /' / OWNER'S ADDRESS BASEMENT OR SLAB 5116il— ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST _ _ _2JJD. 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDI G DIMENSIONS OF SILLS DISTANCE FROM STREET W/ "�' " POSTS DISTANCE FROM LOT LINES—SIDES ((JJ f� / REAR GIRDERS �� AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION / d� THICKNESS O- ft IS BUILDING NEW SIZE OF FOOTING A X /w/!�O "'Ia'w�— IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE fj IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES all�EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. " EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST ILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGN RE OF OWNER OR AUTHORIZED AGENT FEE PLANNING BOARD PERMIT GRANTED r 19 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/, 1/2 1/1 FIN. ATTIC AREA _ NO B'M'T FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE �— STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING (I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS -GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING z j PLOT PLAN NORTHERN ASSOCIATES, INC. 68 PARK ST. 2ND FLOOR ANDOVER, MA 01810 TEL:(978) 837-3335 FAX:(978) 837-3336 MASSACHUSETTS OWNER: TERRY HOLLAND DEED REF. . LOCATION. 133 GREENE STREET PLAN REF. #1780 CITY,STATE. NORTH ANDOVER, MA SCALE: 1"=20' DATE. 7/06/16 JOB #: 63.00' 1 I I {-H LOT 2 j 11,900± s f { I 1 PSROPOSs D'y - GARAGE t f STY ADD. TO BE p REMOVED o EXISTING D➢1'ELLIIVG #/13/3' L�1'0.00, ST BEET G REEKE OF JOHN 97 S Date... AORTH 4,. 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING .oN— S CHUS This certifies that .......... .........../--� ..................................... has permission to perform ... wiring in the building of................ 7'.,7-lar................................... at....... .....15,-- ................................. .North Andover,Mass. Fee..��. Lic.No.. W944......... . '. --ACTrA6ECTOR'"�� Check # �-� Commonwealth of Massachusetts70ccupancyy Official Use Only J Department of Fire Services 99 Z�— BOARD OF FIRE PREVENTION REGULATIONS d Fee Checked [Rev. 1/07) Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 CMR 12.00 (PLEA SEPRINTININK OR TYPE ALL INFORAMTION) Date: a d q 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 r tit+e 5�►-. Owner or Tenant Telephone No. Owner's Address an Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Bog) Purpose of Building Ow-e t��1 h e� Utility Authorization No. 7 Existing Service 60 Amps /ao1CWolts Overhead Undgrd❑ No.of Meters New Service 200 Amps 1 a /,-9a OVolts Overhead Undgrd b ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: -4,0 40 aQO 'Z°i'"Vi('C'- Com letion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp. (Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' No.of Luminaires SwimmingAbove In- o.o Emergency ig g Pool d ❑ d. Batte Units rNo.of Receptacle Outlets No.of Oil Burners FIRE ALAIttv[c too of Zones Switches No.of Gas Burners No.of Detection and Initis ' Devices Ranges No.of Air Cond. Toil No.of Alerting De ' Tons vices Ilea g Heat N Waste Disposers P amber To _ o.of Self-Contained Totals: "'µ"�"' `"` -' Detection/Alertiin Devices Dishwashers Space/Area Heating KW Local❑ Municipal Dryers Heating A Connection ❑ Other No.of D ry g ppliances KW Security Systems: No.of Water No.of No.of Devices or E uivalent Heaters KW of Data Wiring: 5i s Baa llasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: No,OTHER: of Devices or Equivalent r Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of EI tncal Work: (When required b music' q Y municipal policy.) P P Y) Work to S` to o1 a ec �G5 Insp tions to be requested in accordant e with MEC Rule 10,and upon completion. INSURANCE O RAGE: 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 issuingoffice. CHECK ONE. INSURANCE BO I certify,under the ainsd pen ties of perjury, that the information on this application is true and complete. FIRM NAME: ,.LIr IC.NO.: Licensee: v Signature (If applicable, enter " ewt"in th license number li ) LIC.NO.: Q Address: � Bus.Tel Na: *Per M.G.L c. 147,s. 57-61,security w k requires Department of Public Safety"S"License: Alt Licl.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 Signature Telephone No. PERMIT FEE: $ 14a • ' The Common weafth of Massachusetts kj Department of Industrial Accidents i ` Office of Investigations 600 RZashington Street i Boston, MA 02111 j wwi -nwss g'ov1dia Workers' Compensation Inskmce Affidavit: Builders/Contractors/Electricians/Plumbers APPlicant Information Please Print Leaibl Name (Bnsiness/Orgenization/Individual)• QyL(Q S Address: CA r q44 L Cityshde/Zip: y� v PGt (/�/� et Phone #: . e-* ^ ©" Are you an employer?Check.the appropriate box: 1.❑ 1: am a employer with 4 F[]Remmnodeling project(required): ❑ I am a general contractor end I employees{full and/or part-time).* have Dred the sub-contractors construction 2yEZ I am a.sole proprietor or partner- listed on the attached sheet, t deling ship and have no employees These sub-contractors haveworkin for me in an iitiom g y capacity, workers, comp.insurance.[No workers'comp. insurance 5. ❑ We are a corporation and its ing addition required] officers have exercised their calrepairs or additions I am a homeowner doing all work right of exemption per MGL ing repairs or additions myseI£[No-workers'comp, a 152, §I(4),'and we have no insurance required.].t -employees, [No workers' 12•❑Roofipairs t COMP. insurance required.] 13•❑.Othtr 'Arty applicant fiat checks bot #I must also fit(out the section below showing their workers'compensation policy information Homeowners who submit this affidavit indicating they are doing all work and then his outside contractors must submit a new affidavit indi ' such. ;Contractors that check this box mustattached an additional sheershowi fire name of the sub-co cuing ' ttttactors and their vmrkers'comp•policy infD m hon. 1 am an employer that is providing:workerscompensation irssurawe for my employees; Below is the policy and'ob site . information, Insurance Company Name: ' Policy#or Self-ins.Lie,#: Expiration Date: Job Site Address: City/statelzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and e • tra Failure to secure coverage as expiration date fine up to $1,500.00 and/or one-year imprisonment;aswell$s civil penalties in thof MOL c. 152 can e forme of a STOP Wion ofORK ORpenaltiesnof a 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 d a fine Investigations of the DIA for insurance coverage verification. 1 do hereby c y under the paints and p es of perjury that the information provided above is true and correct Si ture: Date: � bel Phone Official use Only. Do not write in this area,to be completed bycity or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health Z Building Department 3.City/Town Cierk 4. Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: Phone#• 0 Information a ind Instructions Massachusetts General Laws.chapter 152 requires all emp Ioyers 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 includirikg the legal representatives of a deceased employer,br the receiver or trustee of an individual,partnership,associatioiu or other legal entity,employing employees. Howeverthe 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 wdrk 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, lAGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the pm fonnarice 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 compL=tely,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 cavy workers'compensation insurance. lfan 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'#he Department of 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 nurnber.listed below. Self-insured companies should enter th=. self-insurance'liceme 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 A-ill be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. r 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: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-9.77-MASSAFE Fax#617-727-77451 Revised 5-26-115 www.mass.gov/dia