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HomeMy WebLinkAboutMiscellaneous - 136 SALEM STREET 4/30/2018 136 SALEM STREET 210/037.C-0019-0000.0 Locations a ; No. Date 3 iZ4 qy. 4 :. iORT1y TOWN OF NORTH ANDOVEFE 3: �� aO�L x # Certificate of Occupancy $ q 45c> . ; . Building/Frame Permit Fee $ 7� A Foundation Permit Fee $ Uj ._ S� cMuse Other Permit Fee $ Sewer Connection Fee $ '? aM Water Connection Fee $ o TOTAL $ F W l Building Inspector 79 96Div.'Public Works PERMIT NO. l APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. ;LUCATiONi I-MFM sw PURPOSE OF BUILDING V41t r- OWNER'S NAME G�R.M�f..1�ca .� /; NO. OF STORIES SIZE OWNER'S ADDRESS I S /_ 'SA �-,s C•�C!n a�t BASEMENT OR SLAB gL¢'> ARCHITECT'S NAME I`P�(_��✓��1.-GN1 _cJsTwF—O SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING l��1 {„- DIMENSIONS OF SILLS 'z, ��10 DISTANCE FROM STREET Ted 1 4 " POSTS DISTANCE FROM LOT LINES-SIDES 16e,1 + REAR GIRDERS AREA OF LOT 2'g, FRONTAGEy HEIGHT OF FOUNDATIONrJ1. O« *THICKNESS (p`I IS BUILDING NEW SIZE OF FOOTING 1041 X (4 IS BUILDING ADDITION +� �$ MATERIAL OF CHIMNEY K! IS BUILDING ALTERATION ``ir= IS BUILDING ON SOLID OR FILLED LAND :50I.I) WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1 � IS BUILDING CONNECTED TO TOWN WATER ve-s BOARD OF APPEALS ACTION. IF ANY - IS BUILDING CONNECTED TO TOWN SEWER 640 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONSO 3 PROIPERTY INFORMATION . LAND COST SEE BOTH SIDES EST. BLDG. COST lit, boo PAGE t FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST B FILED AND APPROVED BY BUILDING INSPECTOR ,.AT FILED C' V a� BUILDING INSPECTOR ,SIGNAT RE OF O NER OR AUTHORIZED AGENT F E E ctOWNER TEL.N PERMIT GRANTED CONTR.TEL.# t9 c CONTR.LIC.k. p H.I.C.# Q Aft= ®1t 11 1995 fo BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES I 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 2 FOUNDATION -I 8 INTERIOR FINISH CONCRETE B 1 2 I_ CONCRETE BIL K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ _ VJAII UDRY NFIN. i 3 BASEMENT AREA FULL FIN. B MTAREA _ 1/1 1/1 '/ FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 23 f DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D+ _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ t STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC, OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I--I POOR _ - ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.I - FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK - SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES TILE FLOOR TILE DADO I 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 I NO HEATING r1C � sa 70��— Town of ORT owe r P0 Al Jry No. 6-1 over, mass.. "Ua" 2.('L 1911S wrt 0 lt� LAKE 1 44 \ COCHICHEWICK C of�A'rED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..� ZMM... A.PA.................6 .A...Y"N ........................... Foundation. A has permission to eWt....Aa1911.A?!t4........ buildings on...1-4(a SALMyn J�'t ...................................................................................... Rough to be occupied as I..�401"%m....I.wxx....EA.m.m.pown......k..A'4'Q.....k-UAL-Ixegu�E....em....... Chimney provided that the person accepting this permit shall In eve N 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 PERMIT E'XPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS COR C Rough .. ...... .. .. ... ........Z... _.. - Service BUILDING iINSPE OR 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT . .. .. ..... .,r. t �K .N..r---.. ....'4: v^4A�.��".�.i, ..- ._• a W"es - :k: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***************** ,tj APPPLICANT: &ALVAaA-A- Phone 686 ' 5717 r LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) treet 15(0 S.46,Le7m 1� R. EEizm St. Number 136 ************************Official Use Only************************ RECOMMENDATION OF TO AGENTS: Date Approved 3 2-j lQQ L Conservation Administrator Date Rejected Comments /w � 5 lb r444A) AN 1&aW S p6ll� Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected IDate Approved Se �Insp�ecto�r-He�alth�� S� Date Rejected Comments Public Works - sewer/water connections - driveway pe t & Fire Department - Received by Building Inspector Date i 1 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE P-644 JOB LOCATION I 6ALG7&i 6TP-JO-= T Number Street Address Section of town "HOMEOWNER" CQ Pwit�- i tAA, &m-1 4atjA 6 86 5.717 470 - 1760 A2-A-, Name Home Phone Work Phone PRESENT MAILING ADDRESS 3(o SA[_� Sz Nop-tH- A,Nvd r=r-_ mAs--. 618q-� City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six 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 109 . 1 . 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 to six family dwell- in attached or detached structures accessory to such use and/or farm g � Y / structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance 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 . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 .0, Construction Control . M t . {fy ,� +������•t� J "� �� d}�, � i �++b'�' ��' +, t� � k" K'a�3?. (-a „„ T•r•Y'°c ,. ems .,; r>,,r a�, r �` ,-« � 1 *w f-t.f' +k't'.�5� ;�• K",'Sw:t � _ 3�Y n"1 r�3#.r r"'r+e, „c raj,�'" Ym i' ^� r -�.� '$ �t. r"z 7•"y Aad••9 r� � a. .A. �,.wA Y�.�.sx:>ak.k•�F�'r'�w�� t�,�,,,.:, ... ' _ ,3 � �'t��F,�-� ART- 0" ' 9= T �'• �r h." # 4 V r-4 �, �" � � �-�� : 1.�4. �S• yr, t ��4t� ��Y 4 �, a �`#" �. 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I ' I 1 I I ( I o P''.� - 1 - .mwHsuww�M., ..n 4rw �f1 W � nw..raW�+'u r._"""q"°' i'•..� �eawl� .wrMp,p 11" , .nxa..,,y., w •.��. .r..r .'"+'-'"""A"_,aJ��F , wy,/rr� - wJw.wnr...a . p.acalY..:a.w�'N}.au'!�+'o' / { , W + .� ,.........r..........+r .0 . ..,. -._` ,.rlv a .j '9CJ , -�+ � /'. ', l l ,T,V 1! ,J"a M' q 1T �✓ ��/)� M° f + i y 1 v I I I I I I .9F:. fig• , lop `.."��` --- .......,.,,,,._....._._._.�....�....a.,......-•...=.a.'.s.-",...,�.-..,..w'.:.,��.,,�,,, � .•'���l _ I -- I - I ._ ... --- 7 ` Date.. .��.' .' .... ` i NORTPI °�"o TOWN OF NORTH ANDOVER ' ` p PERMIT FOR WIRING ,SSACMUSEt - .1 This certifies that i. ' 1. !` L1` (........ ................ has permission to perform ......... r't............:. wiring in the building of ! 3� 5� � S .. ,North Andover,Mass. Fee..................... Lic. i.. .. . .ELECTRICAL INSPER Check # 7z)7 839© / Official Use Only Commonwealth of Massachusetts Department of Fire Permit No. �3 ` p re Services = Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 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) (6, SC-1-`Y A, 'A Owner or Tenant C06mpsm ]" OL Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building _t-,,1,e r 1 Utility Authorization No. Existing Service Amps / 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: ;(fie y Zdiy P1 p --ttt 9+0,1t 'reS � ' a Com letion.o the following table mav 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 Swimming Pool Above ❑ In- —E1 o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Drevices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat ump Number .Tons _ KW No.of Self-Contained Totals: Detection/Alertin2 Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW SecN o systems: or Equivalent No.of Water � KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 4 (When required by municipal policy.) A Work to Start: 1117 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 cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties o erjury, that the information on this application is true and complete. FIRM NAME: �G�►at l c,.t list LIC.NO.: a0 Licensee: �iC ,a e( ,� rw t i%*t Signature �— LIC.NO.: 0 a � A (If applicable enter" empt"in th license number line.) Bus.Tel.No.: 1 Address: l,y oo L&A k M L+k,j e^ q 45 o 12 s Alt.Tel.No.. 9 940 *Per M.G.L c. 147,s. 57-61,security work requires Department of 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 Signature Telephone No. PERMIT FEE: $ hl 007 e ;4, The Commonwealth of Massachusetts kvDepartment of Industrial Accidents n Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): Q( Address:_.1 A Rijn `t-te City/State/Zip: Ak4.(m)f11 /VGS5 , 01fig4phone #:- 7g•��3` a Are you an employer? Check the appropriate JYox: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 New construction 2.dTmployees(full and/or part-time).* have hired the sub-contractors am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' c6mp. insurance: , 9. ❑ Building addition [No workers' comp. insurance 5. F. 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 11.E:] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.[:] Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Beadvised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u der th ains and penalties of perjury that the information provided above is true and correct Signature: • Date: Q 0 Phone#: 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 Contact Person: Phone#: r it B' p f' Date. .............................. 6 ,AORTH, ?°•�:�``°:•_�"°o TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUSE� r ^fes Thiscertifies that ...........r....................................................................... /D 0* u has permission to perform .. ..`...`........ r ...�: res ... � n � .. ..... .... wiring in the building of...................................................... ....... ....., /r/r4C�h� at......................................... ................................... ,North Andover,Mass. Fee..... ....... Lic.No./�....-6�3.3 �..� ..� ELECTRICALINSPECMR Check # ! 5416 Official Use Only l Permit No. �I ZTE COWWONWEALZtf0 911ASSACVQSE77S department of rPu6fu afety Occupancy&Fee Checked/ BOARD OF FIRE PREVENTION EGULATIONS 527 CMR 12:00 APPLICATION FOR PEW TO PERFORM ELECTRICAL WORK All.work to be performed in accordance 'h the Massachusetts Electrical Code 527 C R 12iOO (Please Print In ink or type all information) Date �� 0 To the Insp ctor f Wires: Town of North Andover V The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number ! J�'- N A Owner or Tenant cn /d Owner's Address 0-77f f Is this permit in conjunction with a,building permit Yes 0 No (Check Appropriate Box) Purpose of Building 1144 ,'k Utility Authorization No. Existing Service Amps Voits Overhead 0 Urxigmd 0 No.of Meters New Service Amps Volts Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 0 1 Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 in 0 ..No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency'Lighting No.of Receptacles Outlets 2 No.of Oil Burners Units No.of Switch Outlets 2— No of Gas Burners FIRE ALARMS No.of.Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers SpacefArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers HeatingDevices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW ISi ns Bailases I Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES o NO o have submitted valid proof of same to the Office YES 0 NO 0 YES ease indicate the type co by checking the appropriate box INSURANCE BOND o OTHER r (Please Specify) (Expi n Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties ofpeoury: FIRM NAME----7 C) UAA LIC.NO. Licensee IJ Signature LIC.NO. / Nt/�ifC ll/j �X Bus.Tel No. Address5U�[ (/ GGGttt Ah Tel.No. OWNER'S INSURANCE WAIVER: I am awar not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on t is permit application waives this requirement. Owner Agent (Please Check one) ��r�/ Telephone No. PERMIT FEE $ —`� of owner or Agent)(Signature a9 ) I� z The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations a` Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Ci Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an 0 employer providing workers' compensation for my employees working on this job. Com an name: Address Ci : Phone#: Insurance Co Policv# Compgny name: Address City: Phone#: Insurance Co Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.0 and/or one years'imprisonment-as mellas_cml.,penattiesin-thefamofa.-STOP WORK ORDFR_and a fine of_(.$10O.D0)a�iay.against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date Signature Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check'if immediate response is required - p Licensing Boar O Selectman's Oi Contact person. Phone#. ❑ Health Departr, Other