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HomeMy WebLinkAboutMiscellaneous - 145 BEVERLY STREET 4/30/2018 145 BEVERLY STREET 210/005.0-0057-0000.0 9389 Date. . r NOR7M �r��,� •�;.;;�ooL TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING q us This certifies that . . . . . .. . . . . . . . . . has permission to perform . �4'ean 7??r' a#� . plumbingin the build' s of . . . . � CO. . . . . . . • . at . . Sr J No h Andov i, Mass. Fee.Z 7 . .Lic. No./6/�37. . 2:71-0 �1'� PLUMBING IN: ECTOR Check # `�-' ' MASSACHUSETTS UNIFORM APPLICATION;FOR A PERMIT'TO PERFORM PLUMBING WORK 'CITY� ��' ��I do r Mal DATE��/6'.�� I PERMIT# JOBSITEADDRESS /ys Beve,r� 1 OWNER'SNAME1,JL- DGS a I OWNERA-DDRESS TEt I IFAXI I TYPE-Ok OCCUPANCY TYPE COMMERCIALEDUCATIOINAL I RESIDENTIAL I.,I PRINT CLEARLY NEW:I A RENOVATION:I ( REPLACEMENT:�Q PLANS SUSMIT7ED: YES 1 I NO] I FIXTURES 7 FLOOR $SM t 2 3 4 5 B 7 8 9 i0It 12 73 14 BATHTUB -- CAOSS OONNECTION.DEVIGE - DEDICAIEbSPFdIALWASTE-SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATEO WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN l . ' " -" • - FOOD DISPOSER FLOOR!AREA DRAIN !: INTERCEPTOR(INTERIOR) KITCHEN SINK :. —1.... 1 LAVATORY i - i ROOF DRAIN _.. - - -- SHOWER STALL SERVICEIMOPSINI< TOILET f' URINAL WASHING MACl-IINE CONNECTION - WATER.HEATER ALL TYPES. WATER PIPING .OTHER ��A�� a (�e - INSURANCE COVERAGE: - I have a clirrent. iisitratice polig.or its substantial equivalent which meets the regtiirenients of MGL Ch.942. YES I I NO I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COl(ERAGE BY CHECIgG THE APPROPRIATE$OX BELOW LIABILITY iMSURANCE POLICY I)"I OTHER TYPE OF INDEMNITY I I BOND I• i OWNER'S INSURANCE WAIVER:f ani aware that the Iicensee.tloes not have the"insurance coverage required by Cfiaptei-•942 of the Massachusetts Ceneral Laws,and thattq signature on this perleit application Awyes this requirelitent. -CHECKONEONLY:. OWNER I I AGENT SIGNATURE OF OWNER Ott AGENT I hereby certify that all of[tie details and Infonnation I have subiOlted of entered recdarding;lhis application aPe true and accurate to the best of my knowlddge, and that all plumbing work and Installations perforated under the permit issued for this application W11 be in co ptiance rrith[=ion rgvision oflhe INIassachuselts Stale"Plumbing Code and Chapter 14,2 ofthe General Laws. PLUMBER'S NAME ttI_ S%F6EN LICENSE o G it�/0'`3y I I SIGNATURE l MPIN JPK-1- /D/�� CORPORATIONIJI#aI jPARTNERSHIPI �#I LLC I' I#' � I COMPANY NAME+ b76� I ADDRESS X CITYf 3( STATE &,q ZIP TEL �7fJ" 2.75 6S-7 FAXI CELL I EMAIL 7- i I IRO �;klf P]LVJi@�3D1V�i[CoTS7�']E'��')[�I+�NATE, ;RIELOV rc)P•0 � cm Y15L:am � FINAL I[NS]PEg��3N NOT>rS • 5 lV0 ThIIS APPLICA"noM'SERBS AS TFiE PEiznarr `o 6?1.?- 02!�/ I I i I� • I �Y I The Commonwealth of Massachusetts - Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: l S City/State/Zip:,, �4,-rte. 17,w lo�/cd- Phone#: 5?2 22f-- Are 2f Are you an employer?Check the appropriate box: Type of project(required): 1.M-I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.z 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I Q]Plumbing repairs or additions myself.'[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. X do hereby cern under the pains andpenalties ofperjury that the information provided above is true and correct. Signafore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 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 ofhire,. 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 j oint 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 maybe 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 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 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. Anew 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: Tho Comm.onweal&ofmassachusetts Depaztnaent ofZndustdat A.ccxdeals Office of IntyestigatioAs 600 Wasbingtola Stzoot Boston,MA,0211.1 TQL#61.7-727-4900 ext 406 or 1.-877:MASS.AFF, Revised 5-26-05 Fax#617-727-7749 www.xnass,goVAUa TOWN OF NORTH ANDOVER REJECTED Vi APPLICATION FOR PLAN EXAMINATION of,,,•o s Permit NO: Date Received e ! Date Issued: 1�sAGMust� IMPORTANT:Applicant must complete all items on this page LOCATION ly S "J`e lle"I Y fy"—, PROPERTY OWNER J .ems f J' -� tL Print ) MAP NO.: r PARCEL: -5 7 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building A One family WAddition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving relocation ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: b C� fi �� Le C� Phon .�� 'V S' r-e v e,- .�'Vf r Address: 1 � ly CONTRACTOR Name: R ryCt v 44�r' (�,�f � 1110, Phone:61 Z � 7'1f 442 n J Address:— Supervisor's Construction License: t1) 7 �7 Exp. Date: 7//?/4 r Home Improvement License: Exp. Date: 7 cP i ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMI •$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ ,6,(70,e; 0 FEE:$ Check No.: Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools El Well Art Elg Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales El Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting wide unregistered contractors do not have access to the guarantyfund - rSignature of Agent/OwnerSignature of contracto / Plans Submitted Plans Wailed ❑ Certified Plot Plan Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no I Fire Department signature/date F COMMENTS i Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit n r ll,.7 lId Ili a • . �SIC`, �` � � r� ... i�v til �... •..A. ..... HO+•.r ,a.+.wM'w'VxMfo'-uMt�.fVY!!^okk�*=✓n .�.v4+"y"'+w✓Iw�. ..i...+.rwainr.uarw:�..�,Y.^��..•.T'+`'Rr�p.-.�._�?v y.....�...+...�•n.^+^.�w...enr.+.wr+�..�... I ` v . I. t, i �j 1, ........... _ . - :, Sac C U�5 00/ I` 1t # v . pORTp Zoning Bylaw Review Form °'<���°_•.'"° Town Of North Andover Building Department 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 Street: 145 Beverly Street Ma /Lot: 5/57 Applicant: Albert DeLeo Request: Addition to single family dwelling Date: 1-11-07 ' Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning District: R-4 Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting X 2 Frontage Complies 3 1 Lot Area Complies 3 Preexisting frontage X 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed X G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting X 2 Complies 4 Special Permit Required X 3 Preexisting CBA X S Insufficient Information 4 Insufficient Information C Setback H Building Height 1 I All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient X 2 Complies X 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) X 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting X 1 Not in Watershed X 4 Insufficient Information 2 In Watershed d Sign 3 1 Lot prior to 10/24/94 1 Sign not allowed - 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District I( Parking 1 In District review required 1 More Parking Required 2 Not in district X 2 Parking Complies X 3 Insufficient Information Remedyfor the above is checked below. Item# Special Permits Planning Board Item# Variance Site Plan Review Special Permit C-2 Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit - Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non-Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for 2 Unit R-6 Density Special Permit B-4 Special Permit Pre-existing, Non- . Conforming Watershed Special Permit Supply Additional Information The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new building permit application form and begin the permitting process. Building Department Official Signature Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: C Plan Review Narrative , The following narrative is provided to further explain the reasons for denial-for the building permit for the property indicated on the reverse side: Review Reasons for Denial & Bylaw Reference Form Item Reference C2 A dimensional Variance is required from Section 7.3 and Table 2 of the Zoning Bylaw,"7.3 Yards(Setbacks)-Minimum front, side and rear setbacks shall be as set forth in Table 2, except for eaves and uncovered steps....". since the proposed addition,which includes a covered poich,would encroach upon the required 30' front setback. B-4 A Special Permit from 9.2 and 9.3.5 of the Zoning Bylaw in order to extend a pre- existing,non-conforming structure on a pre-existing,non-conforming lot. "9.2 Alteration or Extension-A use or structure housing a use, which does not conform to the regulations of this Bylaw but which did conform to all applicable regulations when initially established shall not be changed, extended or enlarged except in accordance with the following provisions: 1. Such change shall be approved by a Special Permit or otherwise by the Board of Appeals. " and "9.3 Pre-Edsting Non-conforming Single Family Residential Structures and Uses in the Residential 1, Residential 2, Residential 3, Residential 4 and Residential 6 Districts: S. In the event that the Zoning Enforcement Officer(Building Commissioner) determines that the nonconforming nature of such structure would be increased by the proposed extension, alteration, or change, the Zoning Board of Appeals may, by special permit, allow such extension, alteration, or change where it determines that the proposed modification will not be substantially more detrimental than the existing nonconforming structure to the neighborhood " Referred To:- - Fire Health Police X Zoning Board of Appeals . Conservation Department of Public Works Planning Historical Commission Other BUILDING DEPT, ZoningBylawDenia12000 Building Setback ( Front Yard Side Yard Rear Yard Re uired Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use I i Page 3 of 4 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report i In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 ' I Page 4 of 4 I Date— , atet ."d Olo r.. of V4 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 This certifies that,- I t `-' ''. . .. . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . l plumbing in the buildings of'�: . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. �.`? �. . .--*! . . . . _.tom: . . . . . . . ,_ . , North Andover, Mass. Fee /? . Lic. No. ty . ' �. . . .��/.. . . . . . . . . . . . . . . . . . . . VIUU.INBING INSPECTOR Check # 7206 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) b,c C-�' NORTH ANDOVER,MASSACHUSETTS w_va eyr S l S�' �t�C� ��tn l.t j Date �7 " .6 -0,( Building Location d S y Owners Name Permit#�(, .. � �� � Type of Occupancy Amount New-0 Renovation ❑ Replacement ❑ Plans Submitted Yes No ❑ FIXTURES ssBM R4S V)FM' - 21`il FUM tel- OCR 4M FlffR 5M 11aR 6M MaR 7MFUM sMMaR (Print or type) ) �, Check one: Certificate p l , Installing Company Name l d �C f " � � �� � u'�'v V `n Corp. Address ❑ Partner. _ N tX '<. L wL.. �, l Business Telephone 'T 7 9 66 S-G 1 0 9 t 1 '1 ❑ Firm/Co. Name of Licensed Plumber Insurance Coverage: Indicate the type of insurance coveragelby checking the appropriate box: Liability insurance policy r Other type of indemnity E] Bond ❑ insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above 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 Mas husetts StaPlumbing Code and Chapter 142 of the General Laws. c 4 ��' _ BY igna o icens um r Type of Plumbing License Title G City/Town License INUmDer Master "r-M Journeyman ❑ APPROVED(OFFICE USE ONLY L TOWN OF NORTH ANDOVER NoRTH APPLICATION FOR PLAN EXAMINATIONQ�S1LED ,616 6 .. � 0O A 2 DateRece Received Permit NO: Date Issued: �9SSAC Hus���y IMPORTANT: Applicant must complete all items on this page LOCATION 6 7 Snnt PROPERTY OWNER0 �y MAP NO.: ;5- Print PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ( One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Repair,replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTI N QF W RK TE PREFORMED / 'rero^x Jaor /Identification Please Type or Print Clearly) OWNER: Name: �//�o� t� �� © Phone: - Address: S` �y I/J` CONTRACTOR Name: DJrye G l �y��/' Conf><r-i/'C'/1'0._ Phone: 1 Address: h- h rk /C 61 1ytr1&i n2 , i Supervisor's Construction License: 7 2 Exp. Date: zZ/- Home Improvement License: Exp. Date: 7 � ARCHITECT/ENGINEER 0A^JW �-fllti',,tf Name: Phone: (q? � S-` ' OKI, p f n 1 Address: SV/� &J IJ KI, �1 ���Pb�vy,E�Ro Reg. No. !I Lz I FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ eb —FEES C2/, L/ — Check No.: '-���7 Receipt No.: Page 144 J TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting witlp nregistered retractors do not have access to the guara ty fund Signature of Agent/Owner /� �- Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 16� Stamped Plans Aj THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on si —ye &--------no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/SiQnature&Date Drivewav Permit NORTH Town of s 4And over 0 No. . s. dower— LA , Mass., � I� COCHICHEwICK ADRA TE D P'Pp,� -`� `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.. 44sr......D44...................................... .............................................................. BUILDING INSPECTOR �' Foundation has permission to erect........................................ buildings on ,..y�.... ........................ Rough to be occupied as.... O%.d.......ItOtt......... AS..fi.A^..*....................................................................... 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .... ............ ................... Service BUILDING INSPEC 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 Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. N/F N/F GINA TALFORD JAMES HECKMAN 72.50' 1 1 LOT 57' AREA=10,513 S.F. =0.24 AC. i (ABOVE GROUND POOL V) z I-- � W w w W z m 0 o z i ~ U 0ui (/) 03ui w X 14.6'- DECK R W V) J W � J 13.4' m Q ISI � 1 STORY WOOD FRAME 14.8' 13.3' Lo cV to 00 N N N N 165.5' TO MIDDLESEX STREET - - �� 72.50' I I ho B to EVERLY STREET I� (PUBLIC-40' WIDE) I 0 I2.00' I TBB6, .H. S.B.D.H' a W FND. 0W Q F- :c U? NOTES 1. SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS MAP #5 LOT #57. SEE E.N.D.R.D. BOOK #4764 PAGE #245 PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR o ALBERT L. DELEO, JR. I HEREBY CERTIFY THAT THE BUILDING IS LOCATED ON THE LOT AS SHOWN 145 BEVERLY STREET NORTH ANDOVER, MASSACHUSETTS 01845 v y SOF SCALE: 1"=20' DATE: OCTOBER 4, 2006 f 0 10' 20' 40' 60' 5 MERRIMACK ENGINEERING SERVICES 101410 66 PARK STREET � r STEPHEN E. I, R.L.S. DATE ANDOVER, MASSACHUSETTS 01810 Location � - No. l/tea Date Z f MORT� TOWN OF NORTH ANDOVER 0 D + ; ; Certificate of Occupancy $ AcNusEBuilding/Frame Permit Fee $ y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3q I L� 19827 Building Inspector __ Bruce Hughes Lic. #062737 (978) 663-9793 Reg. #122064 B.H. Construction, Inc. Bruce Hughes 12 Kirk Road Billerica,Ma. 01821 Proposal for Mr. and Mrs. Al De Leo 145 Beverly Rd. N. Andover, Ma. (978)686-5803 Second level addition along with first floor renovations: Demolition; The existing roof structure will be removed and placed in an on-site dumpster. The existing siding on the house will also be removed and disposed of. The demolition also includes removing any areas on the first floor to accommodate the addition as shown. Framing; The framing will be as shown in the plan. This includes all the first floor renovations as shown. The walls along with the roof will receive %2"plywood while the floor will receive 3/4" "Advantech" subfloor underlayment. The entire floor of the attic will have a 3/a" subfloor installed. The front portico will be detailed as shown using pre-primed pine and either square or round columns(homeowners choice). There will be a cedar railing installed on top as shown. *The front portico is not included at this time. The front setback would have to be determined by an engineer and approved by the building department. If the portico is approved, it will be constructed as described above. There is a savings of$2,600.00 reflected in the final price due to this change. Roofing and Masonry; The new roof will receive Certainteed"Woodscape"30 year architect style roof shingles All edges will receive aluminum drip edge. The first 3' of each roof section along with the valleys will receive ice and water barrier. All other areas of the roof will receive 151b felt paper before the shingles are applied. The peak will have a shingle over ridge vent to work in conjunction with a continuous sofit vent to help ventilate the attic. The existing chimney will be extended to meet code requirements. The bricks will match existing as closely as possible. There will be a masonry set of stairs installed as shown on the front of the house. The materials will be brick to match the chimney along with either bluestone or limestone steps. Other materials could be used and may affect the price. A walkway constructed of brick pavers could be installed at the base of the stairs to the sidewalk for approx. $20.00 per sq. ft. This is not included in the quote at this time. i I Windows,Doors and Siding; The windows will be Harvey"Vicon"units in the sizes and the locations shown. This includes the replacement of all the first floor units, excluding the breakfast area, as shown.. There is$1650.00 allowed in the quote for the purchase of a new"Thermatrue"front door. There will be an Anderson 6' "Frenchwood" sliding door unit leading to the existing back deck. The house will be sided using Certainteed"Monogram"vinyl siding.All exterior trim will be covered with custom bent aluminum. The front facing windows will receive vinyl shutters. Shutters can be added to any other window for$55.00 a pair. All exterior walls will receive"Tyvek"housewrap before the siding is applied. Electrical; The existing service will be upgraded to 200 amps. The electrical includes outlets to meet code requirements in all new areas. There will be a cable and telephone jack installed in all the bedrooms. The entire house will be hardwired for smoke detectors. This includes all bedrooms along with the common areas. The second floor bathrooms along with the renovated first floor bath will have a fan/light combination which will vent to the outside along with a feed for a vanity light. There will also be a GFI outlet installed in each bathroom. There are 8 recessed lights included in the price at this time. Recessed lights can be added or deleted to any area for $110.00 each. There will also be an outside outlet on the front bumpout along with an exterior light on either side of the front door. The electrical also includes the wiring of the new furnace, air handler, condenser and any other items necessary for the project. Any specific electrical requests within reason are typically done at no extra charge. All light fixtures, excluding the recessed lights and the fan/light combination will be supplied by the homeowners. Plumbing; The plumbing will include the installation of the two bathrooms along with reconfiguring the first floor bath. The second floor laundry and the reconfigured kitchen are also included. This includes the toilets and the vanities in the areas shown. The main second floor bath will have a fiberglass tub unit installed as shown. The master bath will have a 6' Jacuzzi tub installed. There is a$1,250.00 allowance for the purchase of the tub and the faucet. The vanities, vanity tops, sinks and faucets will be part of the cabinet allowance to be described later. The toilets will be supplied or a$100.00 credit each will be given if supplied by the homeowners. Heating and AC; There will be a new forced hot water by oil heating system installed in the location of the existing furnace. The existing baseboard heat on the first floor will be reconfigured as necessary. The second floor will be on a separate zone. There will be central AC installed in the attic to pick up both floors. The two floors will be on separate zones if possible. This should be possible but if the AC installer determines that the cost outweighs the benefit,the homeowners will be consulted before proceeding. The location of the condenser will be coordinated with the homeowners. Insulation and Plaster; The insulation will be installed in the locations and the R-values shown. All insulated areas will receive a vapor barrier. Any perforations between floors will be fireproofed before any blueboard is installed. All interior walls along with the ceilings will receive 1/2"blueboard before ' I being skim coat plastered. The walls along with all the new ceilings will be smooth. The plaster price also includes also includes any necessary patching on the first floor. Interior Trim and Painting; The interior trim will be pre-primed 2 '/i"colonial casing along with 5 '/z" speed base. The doors will be 6 panel Masonite. There will be oak treads with primed pine risers leading to the new second floor. There will be an open railing as shown with oak rails and primed balusters. The painting will include the entire interior(excluding the basement). All walls and trim, where necessary,will be primed before receiving(2)coats of either Benjamin Moore or Sherwin Williams latex paint. The new front door along with the detail around the new entryway will be painted using similar materials as described above. Kitchen Cabinets and Vaniti s; There i aA�$26,500.00 � lowance for the purchase of the cabinets and the countertops. This includes tities along with the tops. The installation of these items is included. The fauces(except for the Jacuzzi)for the kitchen and the bathrooms will be provided by the homeowners from the cabinet allowance. Flooring; The flooring will consist of oak hardwood floors in the second floor common area at the top of the stairs. The first floor hardwoods will be patched wherever required. All hardwood floors—new and patched—along with the stairs will be sanded and will receive 3 coats of oil based polyurethane. The second floor bedrooms will be carpet. There is a$27.00 per yd. allowance for the purchase and installation of the carpet from Mazmanian flooring in Billerica. The foyer,kitchen along with the second floor baths will receive tile. The walls around the Jacuzzi will also be tiled. The installation of the the is included in the quote. The installation quote is based on a fairly basic style, square or on a diamond pattern. Detail tiles or elaborate designs could affect price. Due to the wide price range the tile along with the grout will be supplied by the homeowners. The tile will also be installed by Mazmanian flooring. The price includes all material and labor to do the job as described. The price also includes all permits. BHC Inc. assumes responsibility for all subcontractors. The price does not include any items not specifically mentioned above.A project of this scale would take approx. 16 weeks to substantial completion. This project could begin the fall of 2006. Total Price: $210,950.00 Bruce Hughes 12/j0�6 Payment Schedule; 1) $21,095.00 When the permit is received and work is scheduled to begin. 2) $21,095.00 When the framing and roofing are complete. 3) $21,095.00 When the windows are installed and the siding has started. 4) $21,095.00 When the rough mechanicals are installed. 5) $21,095.00 When the insulation is installed. 6) $21,095.00 When the plastering is complete. 7) $21,095.00 When the interior trim is installed. 8) $21,095.00 When the flooring and cabinetry have been installed. 9) $21,095.00 When the finish electrical and plumbing have been installed. 10) $15,000.00 When occupancy permit is received. Final Payment$6,095.00 When all punch-list items are complete. i Permit Number REScheck Compliance Certificate Checked By/Date 2000 IECC RES checkSoftware Version 3.6 Release 1 Data filename:C:\Program Files\Check\REScheck\DeLeo,Al North Andover.rck PROJECT TITLE: 145 Beverly rd. CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE:Single Family WINDOW/WALL RATIO:0.09 DATE: 11/06/06 DATE OF PLANS: 11/02/06 PROJECT DESCRIPTION: Second floor addition and updating first floor windows DESIGNER/CONTRACTOR: Bruce Hughes Construction Inc. 12 Kirk rd. Billlerica,Ma. COMPLIANCE:Passes Maximum UA= 179 Your Home UA= 174 2.8%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor Ceiling 1:Flat Ceiling or Scissor Truss 1256 30.0 0.0 44 Wall 1:Wood Frame, 16"o.c. 1221 13.0 0.0 91 Window 1:Vinyl Frame:Double Pane with Low-E 110 0.350 39 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requ' ents in RES checkVersion 3.6 Release 1 (formerly MECchecl and to comply with the mandatory requiremie lied in the RES chec pection Checklist. Builder/DesignerDate The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal kip" P.O.Box 1025 State Road Stow IIIA 01775 PERMIT Date: North Andover Permit No Dig Safe Num er (City of Town) (LfAPplicable) In accordance with the provisions of M.G.L.14 8 Chapter_l 0 as provided in section 997 (M R 34 Sw Da� This Permit is granted to: �jyyeF 1yQLGE Full name of person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work day at e- (Give location by stree nd no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ 50.00 Fire Chief This Permit will expire c� (Signature of offical granting permit) Offical granting permit (Title) N° FD 4903 Date ..:/....7...-.v... NORT,4 TOWN OF NORTH ANDOVER A. 9 RECEIPT SSA HU C This certifies that ••• haspaid...�. .. .............................. ........................................ for..... 77F ... ;1.............................. Received by... .... ... ... ... ... ....�/sed ..... Department.......... i......................................I..................... ........ WHITE: Applicant CANARY:Department PINK:Treasurer �� 1 The Commonwealth of Massachitselts Department of Industrial.lccidents Office of Investigations :I 600 Washington Street \ III.;" Boston AU 02111 www.mass.gov/dia Workers' Compensation Insurance ,affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name Illusincss,Urganitatian;lndivirluall: /' �U Cd .1 n6rd Gyf Address: / -- Xi r k �City,;Stater Zip: 047/Phone #: S-- �la -z, e you an employer?Check t appropriate box: Type of project(required): [2. I am a employer with 4• ElI am a general contractor and 1 6. E] New construction iremployees(full and/or part-time).* have hired the sub-contractors❑ I am a sole proprietor or partner- listed on the attached sheet. ' ❑ Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y.KBuilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.[1 Other comp. insurance required.] — 'Any applicant that checks box rt 1 must also till out the section below showing their workers'compensation policy information. ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating:arch. Contractors that check this box must attached an addilional sheet slowing the name of the ,uh-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy andjob b site information. /J Insurance Company Mame:_ ---- Policy 't or Self-ins. Lic. '!: i,7z Vp L�t%`Stb '� _ Expiration Date:_ lob Site Address: / 7 Syc.- G7 t�L City;State,Zip:_ Cif GT (/'P'^ ,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 35A of%1GL c. 153 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 Nk ORK ORDER and a tine 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 r er the pains d pe ies of perjury that the information provided above is true and correct. tit nahlre: nate: Phi,tle-.- --- l = �o -- --- ----------- --------- f?�Jicial rase only. 90 r,et write in chis nr gym,to be •omhpleterl by c-i(v nr town,�Iyieial. City or Town: lirmit/License 4 !suing,Authority(circle one): I. Board of Health 2. Building Department 3.C;ty/T,)wrn Clerk 4. Eltetric.il 1.nspector 5. f luanbing inspector 6.Other f ol�tnct P�:rrrt>I: -- Phone#: HOME IMPROVEMENT CONTRACTOR Registration: 122064 Expiration '7116/2008 T � private Corporation BRACE HUGHES GANSTRUCTION-l i BRUCE HUGHES t =�, �' 12 KIRK RD �.,�` y� DeQu h,Administrator BILLERICA,MA 01821 t i ✓fie Toarnmzaryuuea� �,/�rvaacliu�b (- BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:CS, 062737 j Birthdate: 07/12/1963 Expires:f07/12/2008 Tr.no: 27461 Rests... ';ted;. ,;09 ....,,. BRUCE HUGHES, 12 KIRK ROAD Y �/ BILLERICA, MA 018211-r'''' Commissioner I ' Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) �j d I ` 1 Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits i ❑ Building Permit Application ❑ Wo rk r Com Affidavit e s Comp, ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract \ ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) I ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 4058 . ► ay Date..... �.......................... f HORTI�, 3?°.<;�``_.:•:"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��SS�cHUS This certifies that ...........f....* : : ................................................ �:�-..................................... has permission to perform ...... ........ ��?---.�•� �— wiring in the building of....... , J................................................... at... .`f4. . '..... :�``` ,North Andover,Mass. .�Fee.�?.Q............ L .............. -, ELEGTRICALINSPECTOR Check # /` rl Official Use Only Permit No. � P5 ean�nu�tw� e ss us��s Dr eKt 4 POP&Satiety Occupancy&Fee Check BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 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 P- 39 -D 9 To the Inspector ofWires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number /ys �a•ve r�l/ S Owner or Tenant 4 L J9 7)e lGO T Owner's Address f tl� �{✓�►' v Sr - Is this permit in conjunction with a building permit Yes ❑ Nohedc Appropriate Box) Purpose of Building Utility Authorization No. /OD EAsting Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters New Service �?oy Amps o Vats Overhead q/ Undgmd ❑ No.of Meters!� Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work - CGTG/� ge v i e e a 4e oo r Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fbdures Swimming Pool gmd ❑ gmd ❑ Generators, KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Bumers FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of D rs Heatinn Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = u mi 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 Workb Work to Start Inspection Date Resquested G'4 Rough Final Signed under the Penalties of perjury: FIRM NAMES LIC.NO. Lkensee /Re'L r/0 IS au 40(P 1 Signature 7�?l���D, �� LIC.NO.A 7rS Y Bus.Tel No. 130:z Address L! o ell Alt Tel.NO. OWNER'S INSURANCE WAIVER 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) --tri Telephone No. PERMITIFEE (Signature of Owner or Agent) Location No. -.�4<1 Date ,.oRTh TOWN OF NORTH ANDOVER 3? ' • 0 41 F p . "s Certificate of Occupancy $ CH t<' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S Check # az z 4 13 2 1 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. t2 4/ y I0 - 00 SIGNATURE: M `♦ Building Commissioner/InspfflItor of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l qf' e.Verl Sf-� S " i/t.Jov e-� Number Parcel Number 1.3 Zoning fInformation: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record 1}l b e''t -be L,2~C b e ame(Print) Address for Service OVA,41:t N/ Signature Telephone X2.2 Owner of Record: d `Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ �censed Construction Supervisor: O License Number Address Expiration Date ic Signature Telephone 3.2'Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address _r Expiration Date ^z^ Signature Telephone Y♦ a 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.......❑ SECTION 5 Description 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: 1,2 r 6. Ot?4? y SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 3000 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) Y (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, A/ e-rt > as Owner/Authorized Agent of subject property Hereby authorize to act on My be al 'u a niat1prs relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A en t Date NO. OF STORIES SIZE BASEMENT OR SLAB Y SIZE OF FLOOR TIIvMERS iST2ND 3KU SPAN DM ENSIONS OF SILLS DP ENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH RANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT Me-4, -De Lea / PHONE 66- 6%3 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET.. .I .........s a a............ / a STREET NUMBER ..: �� ... .. OFFICIAL USE ONLY � .......................................................I■............■ ... RECOMNIENDATIONS OF TOWN AGENTS �... .......1..'...............................■.............................■ �1w1y 3 DATE APPROVED 7i 00 CONSERVATION ADMINISTRATOR /DATE REJECTED COMMENTS i IN C�1 C C-A DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSP TOR- TH DATE REJECTED DATE APPROVED SE- PEC R--HEALTH DATE REJECTED COMMENTS '6,1, PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE i 1 1 10 I N r e- a r bc)"Q dot v dkA DEo� LVF.O N /5 EG�E/4G �RE'E7- - 7�•'GRE1or w�SrE.e,✓ i3.a.vK ,csQ S A'E.rEBY CECT/fY TO TyE T/TGE/,f/SU.PO.P q�t/O 1,=zAL Q T R4/�f 727 TNE'dAN,t'TNgT TyE OwELG/.crs' /S LOCATED O-c/ TI/E GpT.�S S/,Gi1✓y ANO T,VAT/T ORES CO,�/FgPM /N IY/Tf/ T,</ETpw.�Ofi�%p,✓�O�/� ZON/N6 .CE6!/GATil7,l/S � /Q. � ` / ,fW&4.t'O1A- SET,IC,,rV EOM STPECT,S f LOT uvES. Y /V QO "r 7WW7-T.y/,S OA-T-ZL/.YB If it/OT_ LOCATED M/ rye F4cQEC�% F{ O ,.r1,4ZAep S-r.�. 771i.S PLroN,moo �1 `yy �4y�lGE P!/,«bSES- LVOT FO.P Bovvoe�y G�ErE.P�f�,✓,4riov Bo�-�o+-eY ivfo.P�- ,41E.P.P/rN.4G(' E.1/B.�dEE.P/.(/6 SE.Pi�/CES ,�T/O�/ TA.t�E.S/ F,�.H Er/STi�/�',P�Cq�ps• (�(� 004ee X72',EE7 Town of North AndoverNORTH O�tt�eo 6q�0 ? »•, e 3 9• '1 O Building Department o 27 Charles Street North Andover Massachusetts 01845 P (978) 688-9545 Fax (978) 688-9542 SSACHU`�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: J -x( Axa/ A54a s all/ Facility location 11 t&� i-t` Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Y b • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location City &rM, Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance Co. Policy# Comoany 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 c Signature Date f - �Print name Phone# 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 ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department Other FORM WORKMAN'S COMPENSATION .• NORTFf Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 -- - -'(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE LlfLoo JOB LOCATION / T >- t Number Str4et Address Map/lot .HOMEOWNER l/7`�@ 14- jrLoo C%_5503 / -Y99'�- Name Home Phoneq Work Phone PRESENT MAILING ADDRESS 1,,1,4, City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned"homeowner.certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER's SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTH Town of _ : Andover No. a►5Y * o LAo dower, Mass., 3 d COCHICHEWICK DS'ATED PPS\ �Cl '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ) BUILDING INSPECTOR THIS CERTIFIES THAT... I.l. �r. ......... .e........C.r . Foundation has permission to erect...AP.x.I..l ..�....... buildings on ....�..7...5 V fir!1 y:::::::::s ::::::,:::, Rough ........ . ................... to be occupied as �� , �o pop / /............................................... Chimney ..Mil........... r. .........?�......�........................................ 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 In ection, Alteration nd Construction of Buildings in the Town of North Andover. 0),4 fi 40*to j,v 10 0 ry rn 4011' L /tit : . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. m �� SO?So, " Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough ........................................................................... Service ;1 * 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. Location No. f.� �� Date MaRT� TOWN OF NORTH ANDOVER � 9 ' Certificate of Occupancy $ };t b'"'O'';<�'• NUS Building/Frame Permit Fee $ 3 s AG Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # 60 -3 3 6 3 9 Building Inspector PERMIT NO. _APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA r � NI.All NO. � LOT NO. S� 2. RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. I"OTNO. LOCATION �L�/tj' l7�VE�� S��ee\ PURPOSE OF BUILDING ! Y30 � b-0 V� �j/PNCC P-VC OWNER'S NAME JQIr� �Q�Qp NO.OF STORIES SIZE S � OWNER'S ADDRESS i CL BASEMENT OR SLAB i't J f 1RCIICIEC7''S NAME SIZE OF FLOOR TIMBERS I 1 ZN� 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET a/ DIMENSIONS OF POSTS 1)ISTANCF"FROM I."O'f LINES-SIDES 13. 1 REAR t/ I DIMENSIONS OF GIRDERS AREA OF LOT/o ��3 S F FRONTAGE IIEIGIIT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION NIATERLAL 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 i BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COS I'A(E I FILL OUT SECTIONS I-3 EST.BLDG.COST PER SQ.FT. EST.BLDG.COST PER ROOM ELECTRIC METERS MAST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. AT"FACHEA)GARAGES NIUSTCONFORNI TO STATE FIRE REGULATIONS 4. APPROVED BY: PIANS NItJST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE PILED OWNERS TEL# lJ (O �a/ 3 y4— CONTR.TEL# CONTR.LIC# SIGNATURE OF-O%VNE OR AUTHORIZED AGENT ILLC.# FEE S3 i PERMITGR.ANTED Revise115/5/99 J1VI ts`Riy� FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** �_vr(c APPLICANT �� �� Lev PHONE 6WG-t63 978- LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ao vert� StC4 ST. NUMBER Sys * *******k************ *OFFICIAL USE ONLY '" 't* " R OI14MEND TIO OF TOWN AGENTS: /ff' X30 gym" C9^^° �P� "`� 2' 12 C SERVATION ADMINISTRATOR DATE APPROVED Z L 00 DATE REJECTED COMMENTS �/� -- 5 �AlfI -00 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT t RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm '7 I � , I 30 to t1 r-v-, Cllr LP---� � / ,5 7-y Y, 1 � � 1 i Tn•"G�E�r ciESrE.az.✓ i3,.dvAC �'.SC� "r AWACBY' cE,cr/fy ro 7We rire-E 1AIS&WOW"50 Rz or RL,4-ev Jb Tt,/E' 0.4A e —1147 7//EO*-dZ41M /S LOCATED O.</ fNE LOT.f,5 -vl vA►'N ANO 7,,w7'/r ORES GONFGt2iY! �N IY/ry T,vETou-:s/OF�✓,a.✓oost�2 ZON/.v6 ,4�6I.eO/.✓rs ISET/AC.t'S EOM STPEG'"T�S LOT U.✓ES. "r f(/,CfyE,C CE.�T/FY T•f4IT 711S OWeZlAla /S�✓OT � LO44rE0 /N r*e FOLIE,r.Ila Ae O &.4ZA.C4 "-4 APE,a. 0�'''q�✓/V FDiP �Syawn!O/t/ i'E ; p. i Y I UAlGL z Soo 9B s {: U • Ne... 77-6; ° 9T P.L.S. GATE .i Tib//,S PLAN FO,���d'1�pGE P!/.�i�SES-SOT FD.P Bovvo,Py GErE.P�I/.✓.4riov_ Bo�.vo-+.ey/.(/Fo.P�s/- ilIE.P,P/ilf.4lX E'.vB.u/EE.Pi�6 SE.P/�/CES AT/O�/ TA.rE.S/ F,�.14 EX/ST��/G��.PECo.POS. G(o PA•P� .f'T.rEET �,, .,aYc3 ANDOi'E.�, �1.4S,SA'C.f�//SETTS v/8/O NORT►y 4Town O o _ 4Andover �.. 0% No. � -,W. Y .: � y91 o LA o lover, Mass., 6fwff of COCMICMEWICK ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........�.. .. �4..e.40.74 BUILDING INSPECTOR ..........D......................................................................................... Foundation has permission to erect....�i, .... .... bui dins on.....IYS....... ,�..�vIe7L'/.... �................ Rough to be I f�+ J%JV •0 1 Al N� r �R occupied as... .. ... ..................... ...................� Chimney p ..................... .........................................Y................................... 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. AA4'N 1r+ N 10 O• NA %J6141 * 044 r PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. P 0 • P+ "41 LIM* S Rough ir PERMIT EXPIRES IN 6 MONTHS Final p S UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS ' Rough ..............M.................................................. ....................... Service 3 Ill Uri BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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.