HomeMy WebLinkAboutMiscellaneous - 14 INGLEWOOD STREET 4/30/2018 14 INGLEWOOD STREET
210/011.0-0017-0000-
i
I
Location
No. N Date 6
NGRTpy TOWN OF NORTH ANDOVER
3? � 1 •SOL -
� 9
+ Certificate of Occupancy $
. o, __ • ,
�'�s' •
CNUEta Building/Frame Permit Fee $
JAS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �Z
15045 Building InspectoU
TOWN OF NORTH ANDOVER
BUIL DMG DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
( .�t�;��„
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/Ii7tor of Buildings Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
r
Doi\N„_%n Map Number Parcel Number
1.3 \Zoning Information: \`1 1.4 Property Dimensions:
NO
Zoni,g District Proposed Use Lot Area Frontage(II)
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided red Provided
1.7 Water S 1.5. Flood Zone Information: 1.8 Sew e 1 S tem
npplyM.GLC.40. 54) �S Dispose ys
Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record `
Name(Print) Address for Service
Signature V Telephone
i 2.2 Owner of Record:
i
Name Print Address for Service:
Sign ire Tele one
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
WTI
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
�ompany Rame 1
(,�,� Registration Number
h" `
address Q row
UA �(),A*�_ Expiration Date
gnature Tedenhone-
G)
SECTION 4-WORKERS COMIPENSATION(NLG.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 Descri tioa of Proposed Work check all a Ucabie /
New Const action 0 'Existing Building ❑ Repair(s) ®" I Alterations(s) 0Addition 0
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:.
.F
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be WO NhCom leted b rmit a lit tl a
1. Building (a) Building Permit Fee
�1
dV
nn11 c Multiplier
Electrical (b) Estimated Total Cost of
Construction
3
2Plumbin Buiiding.Perntit fee(e)X(b)
F4 Mechanical AC �Y
5 Fire.Proi&tion
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WIRN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, — � as Owner/Authorized Agent of subject property
Hereby authorize to act on
My belia i a I ma ers r 1 've to work authorized by this building permit applicatio ,
gttature of Owner 61 5 ag V
o�7
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I> ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true.and accurate,to the best of my knowledge
and belief
i _
Print Name
Si ature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRABERS 1 2ND 3
SPAN
DEV1ENSIONS OF SILLS
DRAENSIONS OF POSTS
R,GHT
S OF GIRDERS
FOUNDATION THICKNESS
OTING X
OF CHDANEY
ON SOLID OR FILLED LAND
CONNECTED TO NATURAL GAS LINE
kORTH
LED �
Town of ove
0
No./97
h
C 0C„,� dover, Mass.,
=N
DRATED PS
S H BOARD OF HEALTH
PERN11T T Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT....... .................................:
........ ...1111 ............. .. ........... ................ Foundation
has permission to erect..................4*.*.*,,,,****,*.... buildings on .1.. ..... ...... .............................. ....� ... Rough
to be occupied aChimney
. . . . .. ......... ..................................................................................................................................
provided that the person accept! this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provlslon 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
PERMIT EXPIRES I 6 MONTHS Final
�
UNLESS CONSTRUCTION STARTSELECTRICAL INSPECTOR
Rough
.......................................................................1100.................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
HOME IMPROVEMENT CONTRACTOR ``�---
Registration: 10450E
1 Expiration: 07/14/2002
Type: OBA
A
BOB LYONS HONE IMPROVEMENT
Robert Lyons
7�- eV/Theresa Ave
ADMINISTRATOR Salen NH 03079 {
i
. I
. f
a
1
1
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
The debris will be disposed of in:
(Location of Facility)
Signat r,6 of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
F
OfficeUUN OtNy
�E Lo11tI11DAlUI:filltl �� Pernik No.
ltparttntat alf public gafitq Occupancy A Fee Checked-
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3W Posits bwnN
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CM t2.
90 i
7
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
%* or Town of __ NORTH ANDOV .R To the Inspector of Wtnei
i The udersigned applies for a permit to perform the electrical work described below.
f Location (Street & Number)
Owner or Tenant fJt�l
Owner's Address
_Sa we
Is this permit in conjunction with building permit: Yes._ No U (Check Appropriate Box)
j Purpose of Building _ iySeSlP�t f a
Utility Authorization No.
Existing Service Amps Volts Overhead _I rnd Und .1�
g ❑- No. of Meters
New Service Amps _� Volts Overnead Unagrna C No. of Meters "
I
! Number of Feeders and Ampacity
{ Location and Nature of Proposed Electrical Work U aW) 7&H SCC'' `SCCUeP
Qc
No. at Lighting Outlets I No. of Hot ',-s I No. of Transformers Total
y KVA i
No. of Lighting Fixtures i Swimming P^o, zocve in- r—
Brno. _ crno. '_ I Generators KVA t• f'
No. of Receotacts Outlets ( No. of Oil corners No. of Emergency Lighting I Sattery Unita
No. of Switch Outlets I No. or Gas S;:rr.ers FIRE ALARMS No. of Zones
No. of Ranges I No. cf Air C:.r.c.
otai No. of Detection and
1
:cns Initiating Devices
NO. of Oiabosats I No_of Heat To:ai -otat
aur..::s :ons KVJ No. of Sounding Devices
No. of Solt Contained
No. of piahwasners I SoacerArea Heaur.0 Kw OetectiontSounoinq Devices
No. of Dryers I Heating Cev ces KW Local - Municioaly
Connection ^Other
No. of No Jt
No. of Water Heaters KW I Signs ?aiiasa tLWirinvottage
I g
• i
No. Hyaro Massage Tuos I No. of lvtoicrs -otai HP
OTHER:
i s•
I INSURANCE CCVERAGE. Pursuant :o the reouirements ar t.t�ssacrLsers ;enerai Laws ;•,
j 1 have a current Liability Insurance Policy inciuoing Cc- Ccerations Coverage or its substantial eduivafent. YES NO = 1
have submined valid proof of same to the Office. YES ( vO = If you nave checxea YES. please inoicate the type of coverage by '
checking the aopgdbriate box.
' INSURANCE SONO = OTHER = (Please Scec:•"d)
(Excitation Oatel
Estimated value of !ectr cal Work 5
Work to Stan Insoec:ion Date r,acues:ec: Rough Final
Signed unser the P sine of perlu r� z :
FIRM NAMEIf UC. NO. z—3-iLl�I. )
Licensee Si6,azure
If LI `y
t�✓ne/Z s�C� Bus. .4 D
Addrfss L? Alt. Tel. No. 011,
OWNER'S INSURANCE WAIVER: 1 am aware that the L:censee toes not nave the insurance Coversge or ifs substantial equivalent as re•
Quirso by Massacnusens General laws. ana that my signature an :r%is -ormit aopucation waives this reowrement. Owner Agent
i (Please check ones•
'
(Signature of Owner or Agena :eieonone No. PERMIT FEE
ad3i6 "•
Date. ..........................
-.,1d 1286
f pORTM'1
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
cMuSEt
O
This certifies that �' '� '"�' -^..............
has permission to perform,? *- - .�........ ^ -� ............
' wiring in the building of4....
(1 ........ ................................. .North Andover,Mass.
Fere:�............. Lic.Ne�41� ............... ........ ..........................
ELECTRI
CAL INSPECTOR M
,4
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer.
The Commonwealth of Mossochusetts '!'"'`
Deportmcnf of hiblicScfcfy
ocr.r+wcr i IecO.eeaat
'BOARD OF FIRE PREVERnbN REGULATICIHS S27 CMR 11.00 3/90
��.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AD worlt to 6e perbrrntd/n•ecord.nce%ith she MLLLaehusen,fJKu1u1 Code.S27 CHR 12:00
(PLEASE PRINT IN I2IF OR ZYPE bLL INF0R1iESI01;)
Date
e
Cit m f/ —
Y o r Town of IV �✓� g+✓� � Io the Inspector of Hires:
The unC•rsigncd applies for a permit to perform the electrical work dcscribcd below. _
Loc-ation (Street 6 Number) ,S,7
06rcr or Tenant_ z�,/._Z-0
Ovner's Address ' //4/
Is this permit in conjunction with a building permit: Yes 111--90
(Check Appropriate Box)
A rpose of Building_ Utility Authorization N0.
Existing Semiee Raps / Volts Overhead
Undgrd C No. of :.et.Ts
Kew Sersiee F!y
Asps / ' Volts Ovcrbead ❑dtrd❑ No. of Pkters
N
umber of Feeders and Ampacity
Location and Nature of Aroposed Electrical pork _ //,,,p
I
No. of Light1mg Outlets
No. of Hot tubs No. of Transformers Total
ao. of Lighting Fixtures Above In- VIVA
8 8 Sv1ng pool rnd.❑
S Bird• ❑ Generators XYA
Ko, of Receptacle Outlets j� No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets 7i No. of Cas Burners FIRE ALARKS No. of Zonts
No. of VangcsNo. of Air Gond. Total - No. of Detection and
tons Initiating Devices
Nc ,of Disposalx / No. of eat Total Total
a Tons IV No. of Sounding Devices t
:to. of Dishwashers / Space/Area Heating 1w No. of Self Contained
Detection/Sounding Devices
No. of Dryers Z e- r Heating Devices 151 _ Local❑?lsnieipa2
Conncction11Other
No. ot'wat:er e;eaters Sig sf Ballasts �" Voltage
KirinNo. Hssage Tubs No. of hotors Iotal HY
OAR:
- IKcURtinC'E C0N'EF.AGE: ---• --- _ —. —_— —'-- ---
Puu to the requirements of 11as.sschusetts Central Law
I have a current Liab Insurance Policy including Cot leted
equivalent. YES NOU I have submitted valid proof of aameOtorthianoffice Coverage
g7ESr is substantial
Ii you have checked YES; please indicate the type of coverage me checking the appropriate box.
INSURltT<CE / phi ❑ OT}�R (Please Specify) �7
Estlirated Value of Electrical Work S lExpirstlon ate
Work to Start/�'.z`f In Date Requested: Rough°" �� � ��Final
Signed under the penalties of perjury:
FIRM HA1� ,.t 'le �i .T
LIC..NO,
Licensee , F'Lis ,� � _ ► ,' , S! �b
gnatur LIC. NO ;�, =
/.ddressa, c .c a`tus. Tel. No. ? '-2 / y
'Z%.'S IHSUR/.NCE WAIVER: I as aware that the Lieeniee doe: rot have theAlt�i eurnce coverage oris sub-
8
v -
stantial equivalent a! zequired by liassachusetts General vs�LAat ay signature on this perp
application waives this requirement. Orner Agent (Please check one) T j
fLRK12 FEES �t �"
Signature of O.mcr or Agent Telephone No.
�/d` # ggl
Date....../..
1246
NORTIj
4,
TOWN TOWN OF NORTH ANDOVER S
PERMIT FOR WIRING
�,SSACMUS� p�pp
M
This certifies that .....�lJ.'... ..� . a. r
r. has permission to perform ... +! ...Ka".9..r........................................`
wiring in the building of 1'�:� Ovt
. .... .. .............. ................................................
at........ .............................. .North Andover,Mass.
• ....... Lic.No ....:...........................:..........................
Fee.
ELECTRICAL INSPECTOR
..
WRITE:Applicant CANARY: Building Dept. PINK:Treasurer
rt10. LOT NO. t J 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE — �
ZO E SUB DIV. LOT NO. eNT I
I .
LOCATION h PIURPOSE OF BUILDING
OWNER'S NAME NO. OF STORIES / SIZE
OWNER'S ADDRESS BASEMENT OR SLAB
ARCHITECT'S NAME J SIZE OF FLOOR TIMBERS IST 2NO , 3RD .►
—16UILDER'S NAME 7?L)�2' IE'r� IV) / yoll 5- SPAN
DISTANCE TO NEAREST BUIILIIDDT'BUILDING ,(. J /) DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS e
IS BUILDING.NEW SIZE OF FOOTING X
IS BUILDING ADDITION - MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LLNT
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 3 EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS / - 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 BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED BUILDING INSPECTOR
GNATURE OF OWNER OR AUTHORIZED AGENT
F E E � S. i OWNER TEL.# cs o s-) 6 F,5 s-1 �Z,S
PERMIT GRANTED
CONTRA. TEL.#_
CONTRA. LIC. #�/c (S
H.I.C_# vE��l fYI YO
J.
WHITE: Building Dept. CREAM: Assessors CANARY: '
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(�\ 7,�'fJ6A�»uastU/ea�l�.. ecfurlP,(fJ
— �\ HOME IMPROVEMENT CONTRACTOR
Registration 104508
a Type - ' INDIVIDUAL
Expiration 07/14/98
ROBERT M. LYONS
12 Theresa Ave
G�co�rco �Salem NH 03079
ADMINISTRATOR
-
P
I
4
The Commonwealth of fassachuserts
Depamnent of Industr al Accidents
AM
a /ffft�dmr�stli�s
-FRO `= =a' 600 Woshingron Street
�A' ;b Boston,.Nass 02111
woricen' Comoensarion Insurance Affidavit
Hair�•
loc^ticn- y
^cne s
I am a:^.omeownerter orming ail wore^vse-.
77 r am a soie orct:re:cr and have no one'xerk�--o y ani ==ac:-.i
I am an empiover providing workers" ca==e^^.sairen :cr my ==xve_s+xomng on =is -oo.
comnanv name: .
a dregs-
CITE: ']atone I'
insarnnct c.3. -A
A I am a so ie =repne:or general contrzc:o . c: -oQeow-ier .r jn ..
r; and nave n __ _e contrc:ors ;is:ed below wao ;.ave
the :oiIowing worka7s �omoensarion ?o�c
comvanvname. z,/11�)
address: �iGGi /��/Jlal� `
Wit., c .�Or ,�► ��� chane� /�`� 'r k�'sJ)i33Js[/4
insun�e co. s' �11,C C� /f" �/ 11r��� ` nolicv3 CJ�00��C
co m p�pv name: _
2ddress:
c.ry. eifane 8.
3.
msorznce co, eofi&
'A,oaauact ar_�arv�
Fatlure:o secure coverage as required under Section —SA ai.NIGL 1..as.ena :a me:woostnoo of cnmtnal penatnes of a tine up to Sl_:o0.tlo and/or
one years'imprisonment as well as civil penalties in the dorm of a STOP WOR_`ORDER and a cine of 5100.00 a day_ against ne_ i understand that a
copy of:his statement may be forwarded to the OtTice of:avesciga3oas of:!ac DLa ror coverage venticaoon-
1 do hereby terrify cinder the pains and penalties of pc,'uj7-4.a:he:ntorns=on provided above?s-rue and corer
_ Signature Bate
Print name Phone.#
o(Ticial use only do not write in this area to be coctptcsd by dry or M-M aMici"
ff
city or town: peraitticease d —Building Department
C:Ucensiag Board
L-CkP.I—
(P-1
mediate response is required [Selectmen's Ogee
[Health Department
n: patoa►e t, ^Other VVS PIAS
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675
02/12/05
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.313
NORTH ANDOVER BUILDING COMMOSSIONE
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: WILLIAM GEREMIA
Property Address: 14 INGLEWOOD ST NORTH ANDOVER MA 0184
p Y 5
Policy Number: 0657272
Type Loss: Ice Dams
Date of Loss: 01/20/05
Claim Number: 214983
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139,
Section 3 B is appropriate, please direct it to the attention of the writer and include a
reference to the captioned insured, location, policy number, date of loss and claim or file
number.
MPIUA Claims Division
CMA00021