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HomeMy WebLinkAboutMiscellaneous - 142 MAIN STREET 4/30/2018 (2) ���\ �l r� `y ` I \. I �' Location No.-SID �C�— ZON3 Date 6 $ 113 • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ x Other Permit Fee �:>rj $ 3C)� TOTAL $ Check# 7� 26369 Building Inspector NORTH �,wt f SS LED 16• "YO 6 OL } 0 to TOWN OF NORTH ANDOVER i y . ran e.DS SIGN PERMIT CFe1l��� DATE: May 8, 2013 PERMIT: S030-2013 THIS CERTIFIES THAT Jane On A Budget has permission to erect a sign on-142 Main Street, 24"x72" 6 mm PVC, Red Background , White Lettteririg "Voted #1 Consignment in North Andover"_ provide that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Amount Paid:$30.00 Check 233 Receipt 26369 ' i i { APPUCATIION 1600®' good Sttreet Builldlimg 20,Smite TZWK OF NORTE[AND(DV B. Date: r � Name of applican4 who is purchasing the signO1�_ e. N n k j n-�q vu cm�5�, . Site Owner _ i Lt�� �. !� i n i I Phone#of applicant who Is purchasing the sign —� — Q SiteAddressL ILS La (�, �� Name of stgn company � �1 Phone# 97 R:,2Q MainSize of Proposed Sign o?U " Ilan cel k " � illumination: QNot illumainated How attached! a)Against the wall l bLxe� b)Internally illuminated b)Root c)Externally illuminated c)Ground d)Otherr� � ' Materials- o f�m k/C 10 C -� q Proposed Calors: Background a e (n Lettering - Border Cost of Sign v 0 3a ltimananin®d A>�eBnmm®mts: Ma No permanent/temporary sign shall be erected,or enlarged until an MaterialopVhsfb✓li ✓ application on the•appropriate form furnished by the Sign Office has been filed samplewith the Sign Officer containing such information including photographs,pians Color sample ✓ Site and scale drawings,as he may require,and a permit far such erection,alteration, Drawings Plot Plan(Required far.all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the of proposed sign Sign Officer determines that the sign complies or will comply with all Other,specify applicable provisions of the By-Law. Will sign Overhang any public road or walkway Yes( ) No(vj . If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPT ]SATE FILED- Receipt# Check# Revised 10.3.1.2006Form sign Permit Application SIGNATURE OF APPLICANT APPROVED By { i r c JYL VE " y r r 71f 496a"010 r7! � 4 i i i r" r yi 1 New sign to replace existing sign Size: 24" x 72" Color: Red & white Material: 6mm pvc Mounted with screws into siding _ y _F f f ..;;i nrK n;�h.:UiK n3„tn a '.'"i�•iC{i 'A`T`! l L a m o 0 N ..... , 0 AN& WM;, PSCdA*6' . onsi 1 � rw. f M r f � 1 f i N TM 4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Permit# 661 X6/2/20091 Date: June 29 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 142 Main Street - Richard Lentini owner MAY BE OCCUPIED AS Retail Shop —Jane on a Budeet ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY: Certificate Issued to: Jane Nabokin 2 Park St No.Reading MA 01864 Buildi =nsppe=ctor Location yz /l/Grid •f�4 No. Date / I MpRTq TOWN OF NORTH ANDOVER t f D i Certificate of Occupancy $ s i cMus Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ ?� TOTAL $ Check # �x Building Inspector I ►ORT!{ 0 40 .S k o TOWN OF NORTH ANDOVER * ' � • " �` SIGN PERMIT Iraq �r,9$sAC�s� I I I DATE : Aunust 7. 2009 PERMIT: S01-2010 THIS CERTIFIES THAT Richard Lentini — Uaspale Consignment Shop has permission to erect. 2' X 6' Wall Sign on 142 Main Streetprovide that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings SIGN PERMIT APPLICATION 1600 Osgood Street Building 20, Suite 2-36 �rTOWN OF NORTH ANDOVER Site Owner Applicant G1"� I �► O�o(� 1� Tel Site Address Z i Size of Proposed Sign vtO Map Parcel Illumination: a)Not illuminated b) Internally illuminated How attached: a) Against the wall c) Externally illuminated b) Roof c) Ground Materials: vG d) Other }} Proposed Colors: Background Lettering Cost of Sim 1 ( q0' 00 Border Note: No permanent/temporary sign shall be erected, or enlarged until an Required Attachments: application on the appropriate form furnished by the Sign Office has been Photographs of building filed with the Sign Officer containing such information including Material sample photographs,plans and scale drawings, as he may require, and a permit Color sample for such erection,alteration, or enlargement has been issued by him. Site or Plot Plan (Required for ail free-standing signs) Such permit shall be issued only of the Sign Officer determines that the Drawings of proposed sign sign complies or will comply with all applicable provisions of the By- Other, specify, Law. Will sign overhang any public road or walkway Yes ( ) No< If Yes, Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: Receipt # Check # Revised 10.31.2006 Form Sign Permit Application SIGNATURE OF APPLICANT F .IPF f S; r � y ! f y�' - ... ..__.._.ern,...._..-__.�—._..........._..,._..._�«.,...�..�....,.--..„yP CA 1 - �..F � II III � on�9�9..r.vwi+M"X14 .....�-.•.._-�.. Pte, `3 1 r li 2' x 6' I 6mm pvc f arctic blue & black vinyl ! , Caps height: 8.5" I Upscale Consignment Shop Location G''-L1 `� No. Date 4� MORT� TOWN OF NORTH ANDOVER Oi1,�au :a,�0 � O R h p Certificate of Occupancy $ HuEta Building/Frame Permit Fee $ 3d �cs Foundation Permit Fee $ Other Permit Fee $ TOTAL r $ v Check # /U 22 ) �- S 44 Building Inspector 9 3C J NoRTh OE�t�s° i��NOL/ TOWN OF NORTH ANDOVER s°+. KY •� * SIGN PERMIT �1asIcHug DATE: June 16, 2009 PERMIT: S43-09 THIS CERTIFIES THAT Dr Richard Lentini — Jane on a Budget K has permission to erect. 8'x2' Wall Sign on 142 Main Street provide that the person c — accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings 1 0 l SIGN P11MUT APPLICATION 1600 Osgood Street Building 20,Suite 2-36 TOWN OF NORTH ANDOVERtv C° �� Nebo Tel Applicant V�2 Site OwnerCD ,�,} ' Z Site Address__ ��`�.- ' �- � tib_ Size of Sign } Illumination.: a)Not illuminated t, „ Mall Parcel b)Internally illuminated " go C)Externally illuminated f� How attached: a) Against the wall o h}Ron; e) Ground d)Other ,, n Proposed Colors: Background r Lettering � Cost•of Si r Border Nate: No permanent/temporary sign shall be erected,or enlarged unfit an application on the appropriate form furnished by the Sign Office has been ReguEred Attachments: filed with the Sign Officer containing such information including Photographs of building photographs,plans and scale drawings, as he may require,and a permit Q Material.sample for such erection,alteration,or enlargement has been issued by him. r Color sarnple Such permit shall be issued only of the Sign Officer determines that the Site or Plot Plan(Required for all free-standing Signs) sign omplies or will comply with all applicable provisions of the By- Drawings Ofpraposed sign Law. Other,specify �. i Will sign 01,erlrang any public.road or walkway Yes{ ) No{ �� If Yes,Name of Agency who will provide liability insurance: - AN INCOM-pLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: Reecipt# Check ## tvsed 1V31.2'86[ SIGNATURE OF ApPLrcAI 'r Farm sign Permit Appli=ien ia v I 5• a#i ' s ^— �Ji , --�—.+.....,rte...,.. NNW IT I ." n 1 x (�► $( 1 4 Overall size: 24" x 96" Cap height top line: 12,5 '�� Cap height bottom line: 4.75" #} Lowercase height top line: 5,5" . " 1 Lowercase height bottom line: 2,5'" u � � � '° � � Material: dibond ` NORTfj Town of 0 Y d3s o yy dover, Mass., J9O T 0 - LAKE A. TqW COCMICMEMCK %SDRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • • BUILDING INSPECTOR THISCERTIFIES THAT....... ......... ...�..h..........1.N... ........................................................................ Foundation f i has permission to erect ............................ buildings .../h .i.�r..�...........�M..l..lwl�.w.,�"� ........... Chimney .� provided that the person accepting this permit shall in every respect conform to the terms of the application on file inr this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 6?nal AW-- Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 6 PERMIT EXPIRES IN 6 MO THS ELECTRICAL INSPECTOR UNLESS CONSTRU Rough ..... ................................................................................................. Service BUILDING INSPECTOR . Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final = No Lathingor D Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. µORT a TOWN OF NORTH ANDOVER °0 OFFICE OF ° p BUILDING DEPARTMENT * — * 1600 Osgood Street �cHusE��� Building 20 Suite 2-36 North Andover, Massachusetts 01845 Telephone(978)688-9545 Gerald A. Brown Fax (978)688-9542 Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2, the total estimated cost of the construction including all related construction costs* of the building located at / Y2 M 4/h/ 97'146 0T NPANY 44001104 amounts to � d ? Sll . © a ' ^� T 1 I, /C ft Cl NGN L- P//�/�1 / ,being the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating, electrical, air conditioning, painting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment are not part of the total construction costs. Signature of Owner COMMONWEALTH OF MASSACHUSETTS Gi��nex Cantu s.s. 20- . Then personally appeared the able named R 1 ( rl 0 ali n i and Made an oath that the above statement is true. Before, Me, otary Public OFFICIAL USE: Final Cost: Original Estimate cost of general work: -- --- --- - --. Cost Difference: �.� Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: - - - Inspectional services Department 2005 F:\tinalcostatfidavitfonn Strict code enforcement makes the town safer Before buying, renting, leasing check zoning BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 0ORTH TOWN OF NORTH ANDOVER OFFICE OF ° BUILDING DEPARTMENT 1600 Osgood Street 9 y^e Building 20 Suite 2-36 SSacNuS� North Andover, Massachusetts 01845 Telephone(978)688-9545 Gerald A.Brown Fax (978)688-9542 .Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2, the total estimated cost of the construction including all related construction costs* of the building located at / M,+/h/ 44AU 114amounts to $ 09 S /T4 D o r ^ f 1 C f10 r L- ezy`//J / ,being the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating, electrical, air conditioning, painting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment are not part of the total construction costs. Signature of Owner COMMONWEALTH OF MASSACHUSETTS e?zneX C anj:14 S.S. "Cul $ 20�. Then personally appeared the able named Rrehrlrr`l I0 gni and Made an oath that the above statement is true. Tom Before, Me, ` otary Public OFFICIAL USE: Final Cost: Original Estimate cost of general work: Cost Difference: �� Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: � Inspectional services Department 2005 F:\linalcostatiidavitfonn Strict code enforcement makes the town safer l Before buying, renting, leasing check zoning BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date NORTh I ' 0�0 ��°��°� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACNUSE' This certifies that----`/ , . .�`'. � . . . . . . . . . . . . . . . . . . . has permission for gas installation•. �. -�-f::;. ..�a:, / in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . ., North Andover, Mass. Fee!%k. . . . . Lic. No.. . . . . . . . . . .. . . . . . . . ... S INSPECTOR Check# /V2 670 i MAS.SACHUSE M UNIFORM APPLICA'TON FOR PERMIT TO DO GAS FI'TT'ING r (Type or print) NORTH ANDOVER, MASSACHUSETTS Daft 2& U 9 �J Building Locations _ 7 �?�;,J -5 j Permit Owner's Name Amount New D RenovationEl Replacement0117 Plans Submitted ❑ zwz t� w ca m U C C C w a O O = O � F W Z U W x m z ddF O a > rdzl eZ d W F F W W C7 C W F W F d y C a Z Q > rn z p Z w0 cri F W kH . SEM ENT Zd ENT LOOR LOOR LOOR LOOROOROOROOR. ---------- .........El 1... OOR (Print or type) Name Z von n„ �� �A Check one: Certificate Installing Company 7 Corp. — Address C; carz �7 �;' v/ �3 5 13usmess I elephone g 7 J Z/ C-. 7 -7 zirm/pco. Name of.Licensed Plumber or Gas Fitter FINSURANCF COVERAGE � a current liability lnsurance pp cy or it's substantial equivalent. Check one:have checked es please i icate the type coverage by checking the appropriate box.Yes No�ty insurance policy L Other type of indemnity D 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. Signature of Owner or Owner's Agent Check one: Owner ® Agent13 t hereby certify that all of the details and information I have submitted(or entered) inabove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G ode and Chapter 142 f the General Laws. By: igni re of Licensed Plun1 ber O as Fitter Title Plumber , v City/Town, S— G Fitter License I NUMUMr ED Master APPROVED(OFFICE USE ONLY) Journeyman 4 i r pMM ALT ASS A - Ij 'A - 'G ST RI, ISSUES THIS;'IIG�NSE TO MtBER K;E I TH.. . L�ypN 15: L ` WG1 MAV, -RHILL r. 'AV-18&,S-, 7 3 �z<I � 1126 0�5/01./lrp f , 4358 4.. C.P •.,.CONTROL# E 5 2 4 7 41 - ..' IMPORTANT f If this license is lost or destroyed, notifypp� Division of Professional Li ensure, 239 Causeway St; 5th"Floor,Boston,MA 02114. { If your name or address shown is changed, notify your board 7 Of correct name or address to insure proper mailing of next b Renewal,Application. Always refer to your license number. �:X- This licese is subject to the provisions of the General Laws as amended. It is a personal privilege,and mu'st`not be loaned t or assigned to any other person. Keep this license on your person or posted as required by law. g 5 1 i LAWRENCE H. OGDEN,PE. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978—352-2858 cell 978-502-5921 February 11, 2009 M inghlin oad 03826 reet, orth Andover,Ma. 01845 ar Mr. Cunningha requested I visited the above site 2/10/09 to review the 7.5" * 8.5"girders at the second floor level supporting the chimney above. I met with you and Dr. Rick Lentini the building owner.The purpose of this visit was to inspect the condition of the girders. The front girder has cracked to the left of the chimney and in my opinion is insufficient to insure continual support of the chimney. The rear girder is probably also overstressed. As we discussed there are two solutions, one is to place steel beams under the girders with supports to the foundation or to remove the chimney. Since the chimney is no longer used the chimney will be removed. This will significantly reduce the load on the girders. When the chimney demolition is complete I will revisit the site to determine the remaining load on the girders and prepare a sketch for the repair. This will most likely consist of sistering wood or LVL joist to the girders. Should you require any additional information please do not hesitate to call. Yours truly, /�d Of awrence H. Ogden,P.E. MAssa�, AF Cc. Dr. Rick Lentini oco y 132 Main Street A 27765 a North Andover, Ma. 01 845 FFss IST Mr. Gerald Brown North Andover Building Commissioner Date '�..: ..n./......... ,AOR r" °!, :•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING r SS CH h This certifies that ! " . - .. -................................................. has permission to perform wiringin the building of.•.................................................................................. at f . North Andover,Mass. a-v Fee .......... Lic.No. .`c �' . �•'i_. 4 EmcrmiCAL INS TO Check # 8 5 ./ Commonwealth of Massachusetts Official Use Only �• Pi ermt No. Department of Fire Services — BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (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 LV INK OR TYPE ALL INFORMATION) Date: U City or Town of: NORTH ANDOVER To the Ins ector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1419, Hyl �?- Owner or Tenant Telephone No. 7/n,---3,7 �- Owner's Address IMF" .Si Is this permit in conjunction with a building permit? Yes Z?- No ❑ (Check Appropriate Boz) Purpose of Building � � � t=�FI Utility Authorization No. Ezisting Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: �L .5'7Z►l�' err Completion 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 Swimming Pool Above ❑ In- o. o Emergenc- y ,ig ng d. rnd. Batte Units No.of Receptacle Outlets �No.of Oil Burners FIRE ALARMS No of Zones q No.of Switches No.of Gas BurnersNo.of Detection and Initiating Devices CQ No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: No.of WaterNoof No.of Devices or Equivalent . Heaters KW No.of Data Wiring: Si s Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:_ Inspections to be requested in accordance with MEC Rule 10,and upon completion. 7 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 BOND ❑ OTHER ❑ (Specify:) I certify,under the,�°ains and penalties of perjury, that the information on this application is true and complete. . _ FIRM NAME: Aj, j ✓�J i LIC.NO.: Licensee: ,1p,i us�i .t+_P/� Signa ture` s oo (If applicable, en er"exempt"in the license number line.) LIC.NO.: r Bs.Tel.No. 4-e ,Address: 3 *Per M.G. c. 147,s. 5 61,security work requires Department of Public Safety"S"License: Alt.L cl.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 F1 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $�c:� 2 Y 1 ` r v The Commonwealth of Massachusetts i Department of Industrial Accidents Office of Investigations ii KU 600 Washington Street U°i Boston, MA 02111 {�1 www-mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Aanlicant Information Please Print LeQtbly Name(Business/Organization/individual):_a,-,, � c� ,(•U2� Address: e� City/State/Zip: _Lh5ch, Phone#-_2_12115 - Y-2-3"- 3/ Are you an employer?Check the appropriate box: I.El 1:am a employer with 4. ❑ I am a general contractor and I Type of project(required): mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a.sole proprietor or partner_ listed on the attached sheet.$ 7• ❑Remodeling ship and have no employees These sins-contractors have 8. ❑Demolition working for mein any capacity. workers' comp. insurance. g, ❑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 11-ED Plumbing repairs or additions myself. [No•workers'comp. c. 1.52, §1(4),and we have no 12. Roof insurance required.]t ❑ repairs q ] .employees. [No workers' 13,j]Other comp. insurance required.] *Any applicant that checks bo)eif 1 must also fill out the section below showing their worker¢'compensation poiicy information, t Homeowners who submit this affidavit indicating they are daring all work and then hire outside contractors must submit a new affidavit indicating such. 4Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'con p,pu „a)_,;n aon. lam an employer that is providing workers'compensation insurancefor try.employees: Below information 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$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 hereby certify under the pains and penai es ofperjury that the information provided above is true and correct Sicrmaiure , z/L�-� Date �V_�`p� Phone#:---------------------------- i Eal use on1y. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one):Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspectorson• Phone#: Information and Instructions Y 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-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 returned to the city or town that the application for the permit or license is being requested,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 numberfisted 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 applicam 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 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 bum 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. f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 Tel. # 617-7?7-4900 ext 406 or 1-8.77-MASSAFE Fax#617-727-774 Revised 5-26-05 www.mass.gov/dia d SENDER: 0 1 also wish to receive the y • Complete items 1 and/or 2 for additional services. d • Complete items 3,and 4a&b. following Services (for an extra d in • Print your name and address on the reverse of this form so that we can fee : m return this card to you. ) CD • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address y m rn does not permit. a. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery a • The Return Receipt will show to whom the article was delivered and the date V c delivered. Consult postmaster for fee. f0 Article 3. A dressed to: / 4a. Ar a Number S a / c 4b. Service Type E Sp�/�TC'� I j l`( C ❑ Registered ❑ Insured /LJ �lir w '�] Certified ❑ COD 5 �L�� M �/V �1¢ ❑ Express Mail ❑ Return Receipt for „ vl Merchandise o D 7. Date of Delivery '►- Qc 5. Ad see) 8. Addressee's Address (Only if requested Y and fee is paid) t LU'6 ture (Agent) ~ PS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENTU S IVIM� OF POSTAGE,$300 Print your name, address and ZIP Code here • P 354 489 729 Aoiceipt for - Certified Mail No Insurance Coverage Provided WITTED STATES Do not use for International Mail -STALSERvICE (See Reverse) Se Street and No. [kL P. State a ZIP Code m a /� 1 Postage 4 Certified Fee )/ / J Special Delivery Fee a Restricted Delivery F IL Return Receipt S (� to Whom&Dat reS Return Receiptto c Date,and Addre ddr I 3 TOTAL Postage c &Fees 0 Postmark or Date M E 0 LL a STICK POSTAGE STAMPS TO ARTICLE TO COYER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier Ino extra charge). IC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. oa 3. If you want a return receipt,write the certified mail number and your name and address on a (Cu return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endoise front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery rewicted to the addressee, or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. § 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If LL return receipt is requested, check the applicable blocks in item 1 of Form 3811. rn� a r 6. Save this receipt and present it if 1yoa make inquiry. o U.S.GPO:1991-302-915 109 Pv I 2.521 TOTAL: s 2.5,2 =k:K:ft U.S. POSTAL SEPV I C:E :4c:tc:fc NORTH ANDOVEP EPANC H 40. ANDOVER,MA 01845-9998 ____________________________ C:LEPK #0 nATE: 09,,'01,3/95 04: 33-,53, PM ---------------------------- ---------------------------- 1Ca9 PY I 2.52 TOTAL: $ 2.52 --------------------------- :i4:k:F: THANK YOU :4:4:44 J R 4 Town of North AndoverNORTH .1OFFICE OF ,r?o f•" f •. +ooc COMMUNITY DEVELOPMENT AND SERVICES - p 146 Main Street KENNETH R.MAHONY North Andover,Massachusetts 01845 'SsAc►+us�� Director (508) 688-9533 Szotember 8 , 1995 Mr. Ed Nantoski Sportsfan Attic, Inc. 142 Main Street North Andover, MA 01845 Dear Mr. Nantoski : Your acplicat�cn sign permit at 142 Main Street is denied. Seczicr 0 . 3 . 12 c= the North Andover Zoning By- Law states, "Projec"ng signs are prohibited" . Section 6 . 6 , paragraph 1D.4 states, "No sign s:_all project more than one (1) foot over any public right-cf-way and shall be covered by appropriate liability insurance as de_ermined by the Building Inspector and verified by a Certi-ficate r-Z Insurance filed with the Town Clerk" . According to Seczicn =CA of the By-Law, you may grieve this dec�s�on within thi_`v , days the Zoning Board of Appeals . Yours truly, D. Robert Nicetta, Buildi_na Commissioner Zcnino Enforcement Officer D RN:crb c/Board of Selectmen. Kenneth R. Mahony, Dir. Certified Mail, Return Receipt Requested 1 • BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parriao D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell a�7 s ���z� �,iy1«-► � cb4�Ssr�G s?f�.1, �'����--�p h�-a�vt� r�o� 3-1-1..4 } cn Q .�M�ns�+ 33'� ! ►-1 1'`� �/ `-r�c�-crzm$�►� �.'7./p',�' �r ?�d�'zt��CD-�t ��� c�---����"J .`�� (i�macro �v�'N--L sZo-,�►� �-�C�v�i �7-�i-�}8 c�'S o�•t 'moi +ls �•d ����►� '�•� ��,y-z�S �o������, ?� s n��s . ��'���„ '�1s �''�'Y'��.1 -��/�,•cr� -z,L�^oQ"t! t�Zac�l �Ll, �►o� Z/�•� cv�+��1-z�cv Qq�c�a v,, 5� _1�7�V.,� �`I�-tea z-v�. Z.-�1 1.�! �s'`^�` jiS -�N/NMS J -Iprf/cyr� ��5�yn�n a� • �a n, s Location Z, rn A 16 ST No. Date -- A 3:p: "ORT" TOWN OF NORTH ANDOVEF# 4 �ao 0G a Certificate of Occupancy $ x _ • * > = • Building/Frame Permit Fee $ ~ ZACHUS t� Foundation Permit We $ Other Permit FeeVA:�ka$ a- Sewer Connection Fee $ _ Water Connection Fee $ TOTAL $ j J �� agS-z— Building Inspector T� 8326 Div. Public Works PER111T NO. Elsa APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. I LOCATION /gg �'J• ! / A/ c 7- PURPOSE OF BUILDING OWNER'S NAME � I(H /I�/ /� �z- /---A/ // NO. OF STORIES SIZE O�NER'S ADDRESS /`� Jy)iCl �/Q 4 /-�--�� BASEMENT OR SLAB ARCHITECT'S NAME l7 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME _\ L1-5 y�/s 1 n1/ SPAN DISTANCE TO NEAREST BUILDING) / DIMENSIONS OF SILLS DISTANCE FROM STREET '" POSTS DISTANCE FROM LOT LINES-SIDES REAR "" "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION - THICKNESS 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 LINE INSTRUCTIONS 3 PROPERTY INFORMATION / LAND COST SEE BOTH BIDES C �C OR EST. BLDG. COST j co- PAGE t FILL OUT SECTIONS 1 - 3 /8 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 BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED P BUILDING INBP[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT sG lye F E E OWNER TEL.M S-0 2- PERMIT PERMIT GRANTED CONTR.TEL.# / 2 19 gs- CONTR.LIC.N C2 H.I.C.k 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 rrryyy��— y 2 FOUNDATION _I 8 INTERIOR FINISH CONCRETE I d t 2 13 CONCRETE BL'K. ���III PINE BRICK OR STONE HARDW'D ——__ PIERS PLASTER U V DRY WALL UNFIN. / /J 3 BASEMENT AREA FULL FIN. B M AREA _ /^L�J � AIV / {� '/. 1/2 �/� FIN. ATTIC AREA / l NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ �l BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR_'Z_EQUATE POOR EQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK \, \ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR, HlTILE DADO 1 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 OI l B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING NORTH Town of ..r, Andover 238 a r .t dover, Mss 19 LAKE COCHICHEWICK 00:?ATED BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT79%4! .Q-U..... ................................................................................................ Foundation has permission to t,....A111EA ............... builds ot4 ....M&Q.........Z........................................... Rough to be occupied a, . ..... ......S�m.... Chimney provided that the person accepting 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS U Rough ........... ..Q. ............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR R Display in a Conspicuous Place on the Premises — Do Not Remove Finalough 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