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HomeMy WebLinkAboutMiscellaneous - 140 GRAY STREET 4/30/2018 / 140 GRAY STREET 210/107.D-0119-0000.0 _ L I I Date. .... HOF TFC 3� y` TOWN OF NORTH ANDOVER • . PERMIT FOR GAS INSTALLATION SACHU5Et This certifies that . . 1-`101nwr5 . . . • . . . . . . . . . has permission for gas installa//ti__on/ . .�G?? . Sri. . . . . . . . . . 1.!&k� in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North dover, Mass. Fee A4 4� Lic. No.4/%17P. ��... ' GASINSPECTOR Check# :5-0606 $.j 67 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYU'r �n ,� � �� MA DATE � PERMIT# JOBSITE ADDRESS� C�- u� OWNER'S NAME GOWNER ADDRESS _ TE FAXTYPEf '.NT OCCUPANC PE COMMERCIAL) EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION:El REPLACEMENT:F1 PLANS SUBMITTED: YES Q NO APPLIANCES1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 1 14 BOILER BOOSTER CONVERSION BURNER TM A4 COOK STOVE DIRECT VENT,HEATER _ I � DRYER � �( ._. FIREPLACE 1 .—i FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNITE OVEN h _ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Fl _ E - 11gi INSURANCE COVERAGE have a current liability insurance policy or its substantial a valent which meets the requirements of MGL.Ch.142 YES _ NO a IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COV GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _-I OTHER TYPE INDEMNITY Ej BOND F OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT 0 SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia a wit rtinent provision of the Massachusetts State'Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME --J LICENSE# SIGNATURE MP MGF _I JP J JGF[_� LPGI t CORPORATION Q# J PARTNE 0#=LLC[�,,i_!# COMPANY NAME: _ ADDRESS � L_ J CITY STATEZIP� ITEL a� '�? FAX CELL EMAIL Ill ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES r Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 41 AL The Commonwealth of Massachusetts Department of rndustrial Accidents Office ofInvestigations ..600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant I o ration Please Print Le�bly • � NaMC(Business/Organization/Individual): _ - - Addr - –– — City/State/Zip: Phone M r-E�11 ou!an employer?Check the appropriate boa: ama em to er with 4. Type of project(required):P Y ❑ I am a general contractor and I employees(full and/or part-time).*' have hired the sub-contractors 6. ❑New construction . I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling slip and have no employees These sub--:Contractors have worl4.ng for me in any capacity. workers'comp.insurance. 8' .0 Demolition [No workers'comp. 9• Buildin addition insurance 5. ❑ We are a co ❑ g tion rporation and its required.] officers have exercised their 10-ElElectricalrepairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself,[No workers'comp, c. 152,§I(4),and we have no insurance required. t em to des. 12-❑Roof repairs . P Y� [No workers' comp.insurance required.] UP Other *Ho arF�h'e'�=thatsubm bo . m2ustalsofillOntthesecUAnb lov.shmu;nn+Wewo, s ompms 0_POEcy information. T Homeowners who submc rd it this affidavit indicating they Ore doing all work and then hire outside contractors must submit a mew 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. am an employer that is providing workers'compensa information. tion insurance far my employees Below is the policy and job site 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 s1,500.00 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 hereby certify under the pains and penalties ofperjuq that the information provided above is true and correct: Signature: Data: Phone#. F only. Do not wf:ite in this area, to be completed by city or town offzciaL n: Permit/License# ority,(circIecne):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son; 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 6r 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 apartaaents 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 6r 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 iintil 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 theboxes that apply to your situation and,if necessary,supply sub'contractors)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.rotumvDd to the city or town that the app lioadon•For tLe peraai`s or License is being*req'Jest.A4,not the 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 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 pemrit/lice'nse number which will 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. The Office of Investigations would'like to thank you in advance f6r your cooperation and should you have any questions, please do nbt•hesitate to give us a call. The Department's address,telephone and fax number. The Com—monwealtl of Massachusetts Department of Industrial Accidents Office of Investigations 6600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 ext 406 or 1-8-77M S-SAFE Fax#6.17-727-7749 Revised 5-26-05 _, Location 5�& r ? No. I: Date 9 ZS 5 MOR.o TOWN OF NORTH ANDOVER ? �� �0 O 0 A Certificate of Occupancy $ Building/Frame Permit Fee $ �'�s'• E��'« Foundation Permit Fee ' $ c sACNus f Other Permit Fee $ Sewer Connectiogt Fpe $ Water Connection Fee $ TOTAL $ Buil g Ins ect r 8949 Div. u is Works Location C) 7? No. / Date 0 I., p0RTM 1 TOWN OF NORTH ANDOVER ?O'�"so "'6�QQ M p Certificate of Occupancy $ r �> �; Building/Frame Permit Fee $/o,57y, S-6 t� Foundation Permit Fee $ s�cMust C; -ti• Other Permit Fee $ bgC Sewer Connection Fee $ ` Water Connection Fee $ a i TOTAL $ /---1,zl#i Cr d �ip ilding In hector 3 9 5 14 Div. Public Works PER111T Nbz — - 2� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, Mk55. �►' PAGE 1 MAP K-4O. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. �- LOCATION PURPOSE OF BUILDING OWNER'S NAME &7,jW /GU �n &, agz _/ NO. OF STORIES SIZE J�IZ-- OWNER'S ADDRESS p�Mev s., `'n' A�fJ ��' BASEMENT OR SLAB ARCHITECT'S NAME O' �Z4 ( /_ /f a! SIZE OF FLOOR TIMBERS �IST J2y�ieND 3RD BUILDER'S NAME � _J ( Niro / SPAN s/�I DISTANCE TO NEAREST BUILDING �C� /V DIMENSIONS OF SILLS DISTANCE FROM STREET !f 'L f '• POSTS DISTANCE FROM LOT LINES— SIDES /a , d /REAR O a'( '• GIRDERS AREA OF LOT �,�� T� 'f& [� FRONTAGE q/�' ^� HEIGHT OF FOUNDATION �/ THICKNESS �® t/ a v Ofi IS BUILDING NEW i/f� SIZE OF FOOTING X N IS BUILDING ADDITIO MATERIAL OF CHIMNEY 16 k IS BUILDING ALTERATION w/d a IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 4.,o IS IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER •If " IS BUILDING CONNECTED TO NATURAL GAS LINE 6, INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. IfT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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- saiLDING INSPECTOR SIGNATURE OFF OWNER O UTHORIZED AGENT F E E OWNER TEL.# /rd� ���` Z"/ PERMIT GRANTED CONTR.TEL.# 19 a BLDG. PERMITFLS CONTR.LIC.#. +:22 &AA LESS FDA FEE DUE FRAME PERMIT $ 'JAW I 1 In BUILDING RECORD 1 OCCUPANCY 12 _ SINGLE FAMILY S'-ORIES 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 8 INTERIOR FINISH - CONCRETE / _ a I 413 CONCRETE BL K. PINE - BRICK OR STONE HARDW D _ CI PIERS PLASTER - -"- DRY VJALL UNFIN, J 3 BASEMENT I �+`7 I) AREA FULL ' FIN. M'T' _ � (� ' A ATTIC AREAREA / /r /. FIN. NO B M FIRE PLACES f r HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS /� CLAPBOARDS I 2 3 DROP SIDING CONCRETE ��� WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMtAGN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME I t BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME G� 11 CONC. OR CINDER BLK. lo�}r�' I,�^^ STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR 1I �}E"lt� h 150rADEQUATE NONE r'f 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT I SHED r WATER CLOSET mar ASPHALT SHINGLES r LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING - TAR & GRAVEL STALL SHOWER _ h ROTI ROOFING MODERN FIXTURES '7s ` TILE FLOOR TILE DADO 6 FRAMING I i t HEATING lr� d WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM Q STEEL BMS. & COLS. HOT W'T'R OR VAPOR i WOOD RAFTERS AIR CONDITIONING /h/ 4 RADIANT H'T'G 0//y UNIT HEATERS 7 NO. OF RSrS GGAS F-M- TT 2nd —__ ELECTRIC ist / 13rd I NO HEATING ' I The Commonwealth of 3'fassachuse= Deparmenr of Industr al Accidems a cm 600 Washing on Scree: � Workers' Compensation Ilmursnce AdTidavit i art a orlt owner- rror:^.ing ail wor.:-vse-. I am a Soie',rccre:cr and have no ore .vcrams '_v ==ar.-: I ala an e:npiover providing womers• cctr_e=Satcn :ar=v ^;:cveeS worltiag on=is,ob. compan-name r s- y addres J 'lI.z 1,�,.�•Fi� �� rC/.Y7 - phone�- ! !%CI d� l C1'l / incnrnnce c,). I ��f�1 l Y 'K',\��� ��l l z�\S.�i Z-2a iiv,e L' -'i _i�C5 I :.^ a soie_rc=.eccr. general contne:or, ar noWe�wner , _= ane; 2--c -,ave...__ :_ conz_...o ; rs s:ed be:ow -Vto :.ave t::e :oilowing wor<e:s' colrcer.sanon:occes.• compan-name_ address- c:.v. •,hone 3- - .... .:...... . r�mt)anv nam•- •_ address' ;:.. .... InSII *-}o llev 3. .. - .. ' 3Jnoaiuoe-^ ae^e3sary Failure to secure coverage as required under Set:700 _a oC.ltGL L--=a.eau M =e:=poslpo12 of..^.=11221 peM21nCS of a :ine up to s1:00.110 ana/or one Years'imprisonment as well as civil penalties in :he.'or= of s S70?w 0R..`ORDER sod a a12e oCSIQ0.J0 a dav_ 2g1inst-ne- I understand that 2 copy orthis statement m2v be forwarded to the Ot'ce of laves&,sdons of=e DU :or coverage ver:5c2 ion. I do herebv cerr�s under the pains and penaaLdes?tpcors:,i s jt&:Jtior-ri=on provided z6ove s�le/and/carry= P^nt name t Alfii official use only do mot write in this ars to be ennpkead b7 city W wwa OJMCW city or town: pc-maittiesase I —Building Department g [Licensing Board Lchcckmediate response is required [Sclectmen's OfficeCHealth Departmentn- pito«t, "Other tT.�2/rS►JAI � ra AN I I p r FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary N 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***************** APPLICANT: _ ,�.�/.f'LU ,r l�1,fvrT,✓ Phone(Sa�] LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) Street (e I7.- o'2...- St. Number ************************Official Use Only************************ RECOMMENDATION OF 7OWN"GENTS: Date Approved 76 6 Conservation Adminis rator ` Date Rejected Comments T f�1� i�M� �( Yd SJ�s��r 5L it_ Date Approved 2Z ' Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 7-?f 5' - driveway permit Fire Department - L � Receive by Building Insp ctor Date JAN I I I r oRtrara� ii--_ MsaMs�� •:-1 914 �lwm of ', sl-is•s� s-11 - - a N ANOMER Pa. FINS-6"4_ COMMONWEALTH OF DEPARTMENT MASSACHUSETTg ONE ASHBORTON PF PUCE SAFETY BOSTON.MA 02108 F"'IL1�top����:sacurisat ' L I :XPIRATION DAT E LSC 'raise.,,,•S:f!s$y;;�s�� 01/18/1996 C� ti CONSTR. SUPERVISOR ESTRICTIONS CAUTION NONE EFFECTIVE DATE OC_N0. 06/30/1993 FOR PROTECTION AGAINST 01 24 2$ THEFT, PUT RIGHT THUMB _ - 4 5 DONALD F JOHNSTON PRINT PPROPRIATE S +� 006-30- 04 s J1r1AN 70 N S T BOX ON t LICENSE. moo" 6 DOVER MA 01845 BLASTING OPERATORS 0S Qp MUST INCLUDE PHOTO. HEIGHT: No" DUNTIL SGEEASTPEDORR. INATUBEOFT"EDOFFICAALLrDOB; 00-A SSIONER nn \\_ 1934 n rAZ �\_ ="- �tIHIS DOCUMENT MUST SE CARRIEDONTHE PERSON Of OLDER WHEN EN. IS-RITHE m GrrT THUMB PRINT' GAGED NTH SOCCUPATION ' J UL 16.1993 SIGNATURE LICENSEE i � SIGN NAME W F ULL ABOVE SIGNATURE UNE ' MSSIONFR ��• `• li I N I Location /'�/l� -�1-,4 q No. �U Date NaRTM TOWN OF NORTH ANDOVER 4' 9 a Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ► Other Permit Fee $ TOTAL $ Check # /y3,3 a 13770 Building Inspector e TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: s ' 1073 1 Cao SIGNATURE: $uildin Commissioner for of BuildingsDate SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 140 Map Number Parcel Number �—I-1 ► V 1.3 Zoning Information: r(� 1.4 Property Dimensions Zoning DistrictPr Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water S ly M.G.L IC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Pmivate ❑ Zone Outside Flood Zone Municipal 0 On Site Disposal System Q� J SECTION 2-PROPERTY OWNERSHIP/AUTHO —1 RIZED AGENT 2.1 Owner of Record J1U— p6 i n rnpVr rL?w Name(Print) Address for Service:4 - Signature Telephone i 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Lice sed Construction Su-pervisor: License Number Address ExpiratloA I)ate' ic Signature Telephone �• 3.2Registered Home Improvement Contractor /f Not Applicable ❑ A & 14 Company Name 6 IAQ m Registration Number r Address / / /U O �[_ / Exp oars a Date Si na re Telephone Y/ • SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: /� • # - I / A.11 F^ _f e l f y s �, t SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 '` def • ""' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, / ,as Owner/Authorized Agent of subject property Hereby authorize b D _ li (� S�—t°� to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB ND RD SIZE OF FLOOR TBERS 1 2 IM3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM ,i 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 or requirements. AFFLICANT FILLS OUT THIS APPLICANT Im Q (�dU PHONE � 31a g LOCATION: Assessors Map Number 100 PARCEL SUSDIVISION LOT (S) STREET Co (\ASI ST. NUMEER—LD OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: 1:7kM �7 IC 1^ 6 tC CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED I COMMENTS r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE.APPROVED K DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED v'Z DATE REJECTED COMMENTS PUELIC WORKS -SEWER/WATER CONNECTIONS ` DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING iNSPECTOR DATE Revised 9\97 im ' I I CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. LOT 1 SCALE:1"= 40" DATE: 4/15/96 —I Scott L. Giles R.P.L.S. W 50 Deer Meadow Road 20768, North Andover, Mass. 105.5, o co c /< NC 62.2 m / a, I .oN �S9 0 6 I >s- ss 8s- LOT 2 48,867 S.F. rn OD co o N/F STELLA QFFA I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE W. � THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF ati NORTH ANDOVER, MA. CONFORMITY OR NON-CONFORMITY Lµms WHEN BUILT. WHEN CONSTRUCTED. I V � a i , 1 , ' I I i Gly STT I ; i„ its � I I ` I BUILDING DEPARTNIENT DEBRIS DISPOSAL FORK! I In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a property licensed solid waste disposal facility as definedb3'MGL c 11, S 150A The debris will be disposed of in: ocation of Facility - Signatwi of Permit Applicant i Je �6ro ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector s' "r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: _/Jn/7ia Location: CityPhone 0 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity nar'am an employer providing workers' compensation for my employees working on this job. Company name: / )612Z2 Z6v rS An,S rn Address City: & , Agh 6L?, ,Mfg Phone#: Insurance Co. Policv# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. l� Signature , Ze2n & 124 2z Date 4 Print name 1�14,a4—IdJh l-p Phone# If Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensin Board Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION y BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Nwnber: CS 012428 - I Birthdpb: 01/18/1934 i Expires:01/18/2002 Tr.no: 15249 Restricted T4 00 DONALD F JOHNSTON 114 BOSTON ST �N ANDOVER, MA 01845 Administrator t .:�/re'�rive�no�uica/�o�./l{aaoao/iu ; HOME IMPROVEMENT CONTRACTOR Registration. 101290 . k Type INDIVIDUAL' Expiration . 06/25/00 DONALD F. JOHNSTON 14 Boston St Andover MA 01845 ADMINISTRATOR T I Page 1 of 2 RONALD F JOHNSTON& CO.$INC. Donald F. Johnston& Co., Inc. Builders Lic. #012428 Remodelers Lic. # 101290 114 Boston Street No. Andover,Mass. 01845 Phone#(978)682-1619 Fax # (978) 682-1083 March 22, 2000 Lucas&Robin Merrow: We are pleased to submit the following Proposal specifications and estimates, subject to all items and conditions as set forth as follows: To custom finish one attic space Approx. 25'X 16' consisting of three closets one on either side of the.window and one to the right of the stairs. One window seat, two built in drawers under the eaves. 1) Obtain Building Permit. 2) Frame room with knee walls and boxed in collar ties,and install two skylites. 3) Wire Per. Building Code,wiring to also consist of Phone and Cable wiring. As well as eight ceiling lights, receptacles and switches. And installation of Electric Heat with thermostat. 4) Obtain all rough inspections.. 5) Insulate-Ceiling R30 and Walls R13. Obtain Inspection. 6) Hang 1/2" blue board& Skimcoat Plaster. 7) Install finish trim 2 1/2" Colonial Pine. To match existing,build window seat with lid, build in two draw cabinets in knee wall on the back side of the room. II t I� 8) Paint to match existing interior trim and walls Benjamin Moore or equilvent. Walls one coat primer and one coat finish. Trim one coat of primer and two coats finish. 9) Install Carpet&Pad for office room and stairs. (Allowance $16.00 Per Sq. Yd. Carpet&Pad.) 10) Final clean-up and touch-ups. 11) Final Inspection and ready for occupancy. Stock and Labor charges $19,394.00 Payment schedule as follows: $4,394.00 due upon signing of contract, $6,000.00 when framed, rough electric, and skylites are installed. $4,000.00 when insulated& plastered, $5,000.00 due when ready for occupancy. All Material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications above involving extra costs will be executed only upon written orders, and will become an extra on charge over and above the estimate. All agreements contingent u g g g p strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by''Workmen's Compensation Insurance. NOTE: This proposal may be withdrawn by us if not accepted within 30 days. Donald F. Johnston& Co., Inc. Donald F. Johnston President Authorized Signature: Date: O Signature: Date V y c10 Signature: Dater 4� 7 1 Ud s 41 Yey Or 63vs 1l.aK #0 • AI& ^l Cow t Pr ►�i �► iC. a.E a r. ANT It --� � 30 svL• IOU . 2 4AA 2 • �lr t if Hit. � i c R4 f �«> • LI 11 2-2 I 1•zk� T - Pl its, � f _ ! � P a a R-tt pi► . , 141 \2—1. ' • 1 00 ♦. {Ns u�. ii • 1. 4, LAN� tAORTH own o 4Andover No. / 7.3 =_ C 0 t- L A dover, Mass., COC HICHEWICK 0"?ATED P"' 5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT..... MC044 pdp61*9 INPIM0440 BUILDING INSPECTOR 4 .......................................I............ ........................................................................................ Foundation ipi,%A ,�A ............. buildings on ....i4140.....4 SPOOL. !....................... Rough has permission to w9M........................... to be occupied as..­/A**kmo'4F #4 3)0*4 Chimney provided that the person accepting this permit shall in every respect conform to the terms of theapplication...on n-.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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO S T# Rough .............. ... ... .... ELECTRICAL INSPECTOR Oh ............................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Re.move Rough No Lathing or -Dry Wall To Be-Done- Final Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. i i N° z 3 3 Date.......... 12 .......... ...... t NORTH� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �SS�cHusE` (� �t - 2� This certifies that - � .,�. .............. ......... ....... ..................................: has permission to perform ....ti..r --T -r: ................................................ ' wiring in the building of..... ....:"..::. �. .;!:'......................................... at....�y.h.....:.. ✓........�;._y� ........ ,N rth Andover,Mass. �.� ��lf ., Fee ........I.... Lic.No. ...G...... ... �... ...�................. ELECTRICAL INSPECTOR Check #<?� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer we � //[rQ�a+Gi� Office Use Only Department of Public Safety Permit No. 7 l! BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK# 2 2 6 7 Occupancy&Fee Checked $ 40.00 (leave blank) 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 MAY 9 2000 City or Town of READING To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 140 GRAY STREET Owner or Tenant LUCAS&ROBIN MARROW CONTRACTOR D.F.JOHNSTON Owner's Address 140 GRAY STREET READING,MA 114 BOSTON STREET N ANDOVER MA 01845 Is this permit in conjunction with a building permit Yes ® No BUILDING PERMIT#173 Purpose of Building EXSITING HOME Utility Authorization no. Existing Service 2 0 0 Amps 1201240 Volts SINGLE PHASE Overhead Undgrd ® No.of Meters 0 N E ! New Service Amps Volts PHASE Overhead Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work INSTALL WIRING FOR OFFICE IN ATTIC 6 RECESSED FIXTURE Total No.of Lighting Outlets 4 SURFACE MOUNT No.of Hot Tubs No.of Transformers KVA Above In- No.of Lighting Fixtures Swimming Pool grnd M grnd Generators KVA No.of Emergency Lighting No.of Receptacle Outlets 6 No.of Oil Burners Battery Units I No.of Switch Outlets 3 No.of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and +� No,of Ranges No.of Air Conditioners tons Initiating Devices. _ Heat total No.of Sounding Devices. No.of Disposals No.of Pumps kW No.of Self Contained 110 VOLT 7 Detection/Sounding Devices No.of Dishwashers Space/Area Heating KW Municipal 2- 6'ELECTRIC BASEBOARD Local F'� Connection Other No.of Dryers Heating Devices KW � No.of No.of Low Voltage No.of Water Heaters kW Signs Ballast's Wiring No.Hydro Massage Tubs No.of Motors Total HP OTHER: I INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES x❑ NO M I have submitted valid proof of same to this office. YES xNO if you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE xx BOND M OTHER[] (Please Specify) I (Expiration Date) Estimated Value of Electrical Work $ Work to Start MAY 9 2000 Inspection Date Requested: Rough: WILL CALL Final: Signed under the penalties of perjury: i FIRM NAME Leonard Electric,Inc. LIC.NO. A10638 Licensee Signature CIC.NO. I -- Address 10 Farnham Road Lowell Ma 01854 Bus.Tel.No. (978)937-8620 Alt.Tel.No. OWNER'S INSURANCE.WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantal equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement Owner Agent (please check one) CK#2267 Telephone No. PERMIT FEE$ 4 0 . 0 0 (Signature of Owner or Agent) WO# 1 1 3 8 4 I low � � office Use Only - 01 41 �>1mm�nwettl Permit No. 2 G i '13epartment Ed Pubic 26Afrtg Occupancy& Fee Checked 2 yJ' BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 5 �?—q G (%* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. 11 Location(Street & Number) I LIC) G tAc�t S� �-.O+ OC Owner o `� 'r Tenant DO N 15-0 VNJ%to vo ,�^ Owner's Address I �`'� Zosfio N �� � ' '�`t�n��l� 6 ' v ' 0 `�4� Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building ®W L-\ \ " W C1, Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd El No. of Meters New Service R06 Amps) J Volts Overhead Undgrnd ❑ No. of Meters Number of Feeders and Ampacity ` � AL- Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets 7 I No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures /'1 I Swimming Pool Above In- grnd. ❑ grnd. ❑ I Generators KVA V No. of Emergency Lighting No. of Receptacle Outlets O No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges I No. of Air Cond. l tons Initiating Devices No.of Heat Total Total No. of Disposals Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices I Municipal []Other No. of Dryers Heating Devices KW Local ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: i INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO = I have submitted valid proof of same to the Office. YES = NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE �( BOND - OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Final Work to Start Inspection Date Requested: Rough Signed under the Penalties of perjury: _ ) 0-10� FIRM NAME _ f✓ L t.A� c� UC. NO. Licensee v Signature LIC iNO. d G1 BAilus. Tel. No. ��3 ��ya�0 Address )aV �1}Ay E P, �� �.,.e. �dc.s Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that theot have the insurance coverage or its substantial equivalent as r Z quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agen (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x•5565 k 6 1 � r°' Date,.-.S'IG. . . .. . .... . MGI i NORTH TOWN OF NORTH ANDOVER PERMIT FOR 4&INSTALLATION � s �9SSACHUSEt I 5 This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for SM installation . . .IU ,: --. . . . . . . . M r+ � in the buildings of . . 0,�. . .J o.�k.S °.!- . . . . . . . . . . . . . . . . . at 1.Y.o. . !`'Y. . Y.�. . . . . . . . . . . orth An v r Mai. Fee.AY. ,,-. . Lic. No../.0.�1. . . . GAS INSPE TOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File - L he (�omrzvnivea!'th of t�' use only fassuchusetts DePartmCnt of!Ublie Safety Permit b. 1 BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12= oeeuwncT S .'ve Quek" 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO AI1.1Vo:It to be performss ed In accordance with the Massachusetts Electrical Code. S27 C—MR I2.00 ��� (PLEASE PRINT IN INR OR TYPE ALL INFORMATION D Date_ ZG Cit j or To•(an of AN too C,P Tlteundersigned applies for a permit to perform Io the Inspector of Wires: the electrical work described below, Location (Street & Number) Q ���c •7` Owner or Tenant ,uQ L Owner's Address PO r0,� Is this permit in conjunction with a building permit: Yes'❑ No (4ecic'Appropriate Box) Purpose of Building e7t �,plf _ Utility Authorization No. Existing Service s / Volts Overhead ❑ IInd6•d ❑ NO- of Haters Nem Service Aeps / Volts ❑ Number of Feeders and Ampacity Overhead Uadgrd ❑ No. o_' Meters Location and Nature of Proposed Electrical Work • No. of Lighting Outlets No. of Hot Tubs No�of ransformers Total No. of Lighting Fixtures Above In- INA Swimming Pool grnd, grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting No. of Switch OutletsIBatte Units No. of Gas Bunters FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. local No. of Detection and tons No. of Di'soosalsHeat Total Total Initiating Devices No. of pis Tons No. of Sounding Devices RW No. of Dishwashers Space/Area p ce/Area Heating RW No. of Self Contained No. of Dryers Detection/Sounding Devices Heating Devices ICW Local EJMunicipal ❑Other No. of Water Heaters KW No of Connection ll of ��Vo Inge • Si s Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: Ala—nn Installation MN 6 yj(7 INSURANCE COVERAGE: Pursuant to the re I have a c requirements of Massachusetts Laws current Liability Insurance Policy including Completed e OperationslCovera a or i equivalent. .YESAD NO ❑ I have submitted valid proof of same to this office:Coverage tsNOub❑stantial If you have checked YES, please indicate the type of coverage by checking theappropriate � box. SURANC" ��--}} '��BOND lJ OTHER ❑ (Please Specify) fy Estimated Value of Electrical Work S (Expiration Date ' Work to Start'. - Inspection Date Requested: Rough Signed under*the penalties ofperjury* g —Final FIRM NAMEAmeric-nn ons_,,._In Licensee Richard Sampson LIC. N0. Signature Address LIC. NO. 000090 ntral Street Arlin ton, MA 02174 Bus. Tel. No 617-641b�'� OWNER'S INSURANCE WAIVER: Alt. Tel. No. 617-6.48-7200 I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws­'andat m signature application waives this requirement. Owner Agent ' Y on this permit 8 (Please check one) (SL nature Telephone No. PERMIT FEE S S of O+iter or Agent) ..,�'Aw. �,R:ry � . ... ups j�_ _�r>`1..1%... .. .. 1 ..w• sn A Date. . . d... , a i f s of HOR°T TOWN OF NORTH ANDOVER 3� '4PERMIT FOR INSTALLATION • a9 ,' x j { 'ISS ACHus1 , i ' This certifies that . . p has permission foi n allation in the buildings of C�. . . . . . . . . at . . . . . . . . ., North Andover, Mass Fee.34. 4 Lic. No. INSPECTOR 6 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File