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HomeMy WebLinkAboutMiscellaneous - 158 DALE STREET 4/30/2018 (2) _ 158 DALE STREET 1 210/037.6-0007-0000.0 i I i I I I i If 4 Date../V*/*`*y................ TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING s`4�cHUS� // r I 110 . This certifies that .............................................1l..[[..... .......................... has permission to perform ..... Q:..!.!.r.�� �(/J ................................................................ wiring in the building of....................e-�P /�'�''`J .......................................................................................... at ...�� ....:. /� � .................... ... orth Andover,Mass. ............................................... Fee..... -�. .......Lic.No. %7uS t� ELE TRICAL NSPECTOR Check# f.3 o? 5c,2- /t5 dam-- �ePurenceiu uI✓crr,��rvwe:, Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL IN O TION) Date: /O/ /V City or Town of: yn-m &d=L To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 16-9 �/ - ,�' Owner or Tenant e-v.:-.Zf c/�,f q n Telephone No. Owner's Address 6�r,� ' Is this permit in conjunction with a building permit? Yes No� ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number..of Feeders.and_Ampacity Location and Nature of Proposed Electrical Work: e// 6z) r oc'- Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tot al Transformers KVA No.-of-Luminaire Outlets No.-of-Hot Tubs Generators KVA No.of Luminaires Swimming Pool hove [i - ❑ o. Emergency Lighting nd. nd. BatteoUnits w No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond: Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons _..,- _ No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other 4 Connection No.of Dryers Heating Appliances KW SecuriNo. f Systems:* or Equivalent N°.-of Water KW No.-of No-of Data Wiring: Heaters Siens Ballasts I No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a No.of Deices or Equivalent Wirinp OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectrical Work: ��'�� (When required by municipal policy.) Work to Start: C Inspections to be requested in accordance with MEC Rule 10,and upon completion. d 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 pains and penalties of erjuy,flifit e information on this application is true and complete^ /r FIRM NAME: 5. ��c�,c. . �dr� o ��5 GLG LIC.NO.: ��r7OS�✓� Licensee: Iyle ell � � Signature LIC.NO.:_2170j (If applicable,enter "exempt"i the ense number line. /f / Bus.Tel.No.,. Address: 9 w�d'0'/ /�cx�� /�a��'� /`fni/D:h'/ ���t �j�y� Alt.TeL No.: *Per MG.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's-agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ i Commonwealth of Mas usetts Division of Registrati Board of Electn. MICHA +� I 9 WAVE NORTH A^ Master Elec a 0 q f 21705-A 07/31/2016 �' 008772 License No. Expiration Date. Serial No. v Date. G j�Q:.�. .... . HORTIy pf ,tea° ,°1tip 3? �` TOWN OF NORTH ANDOVER j , PERMIT FOR GAS INSTALLATION v ,SSACrMUSEt This certifies that . . . Al .f. . . . . . .y /? .`. has permission for gas installation . k!./7.t-� . . . . . . . . . . . . . . . . in the buildings of . �?G. .�.`<. `^ at . J) . . . . . . . . . . . . . . . . . ... North Andover, Mass. Fee. 3 p Lic. . . . . . AAS INSPECTOR Check# 655 �� i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) l — NORTH ANDOVER Mass. Date 10/07 2008 Permit# toel �) T.9 158 DALE ST KEVIN MCLELLAN Building Location Owner's Name Owner Tel# 978 688 5007-617 510 3497 Type of Occupancy RESIDENTIAL New Renovation ReP lacement Plan Submitted: Yell N FIXTURES W Cn Uw x 94a W a w U z wJa z V) g 0¢ � z ox w Q of m F W a O O O W F" W 1130-50 'j0.j0 w w U) W z ¢ x a a W �a w w E• x cn x a z (DF-q LLiz H F [~� �W a Z 4 z O U) w W > W W Z Q Q Q O O W O W E-F T- 2 O CD 2 w 3 Q C7 .7 U o4 > A Al H O w SUB-BSMT x BASEMENT 1ST FLOOR -4 2ND FLOOR 1 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7"FLOOR 8T"FLOOR +1 1 1+1 1 1+ 1 1 Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street aCorporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter WAYNE FORSYTH INSURANCE COVERAGE: I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes ✓ No ❑ If you have c ecked ygs,please indicate the type coverage by checking the appropriate box. A liability insurance policy F/ Other type of indemnity ❑ 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. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General� rdsS. By Type of License: ••Plumber Signature of Licensed Plumber or Gas Fitter Title as fitter M3874 ••Master License Number City/Town •-Journeyman APPROVED(OFFICE USE ONLY) i Date TM h TOWN OF/ NORTH ANDOVER PERMIT F081P'LUMBING s � s ,SSACMUSEt This certifies that has permission to perform . . . . 1?.v! -. A plumbing in the buildings of at . D tlq f�-r. . . F-ter'. . . . . . . . . . . . . . .. North Andover, Mass. � Fee%�U. . . . .Lic. No. D�y�. . . . . . . . . . . :... . . . .I-^. . . . . . . . . PLUMBING INSPECTOR Check # 7850 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location Owners Name-� , �. rJ Permit# ?X12 Amount 1pa— Type of Occupancy New Renovation Replacement Er Plans Submitted Yes No FIXTURES z x z w w w a O F z o w U Q 3 Q U z z r6 �. a w W Q w c d a F U Q 3 x a z ren F �4 a O z z H w x w � � SL BH4vII WSMI yr � Isr.FLooR M FLOOR FLOOR 4M FLOOR 5M FLOOR 6M FLOOR 7M FLOOR 8Ri FLOOR (Print or type) _ Check one: Certificate Installing Company Name MV QP4 a UP el- L,✓4' Q' Corp. Address l,)�j ke- J,' P,") Partner. to"oGL L ou,, ©iST�U Business Telephone 93"7- 3 y O Firm/Co. Name of Licensed Plumber: QA-o C </3-/!/r{,- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy R Other type of indemnity El Bond a 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 El 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 Massachusem"Stat1e PIlum.being ode and Chapter 142 of the General Laws. By: Signature or Licenseaum er Type of Plumbing License Title City/Towncense Numoer Master Journeyman a APPROVED(OFFICE USE ONLY Date...... .............. .. .......... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING • This certifies that ./. .... ..... . ............................. has permission toperf orm ........................................... wiring in the building of................................................14 .............................. ..... a t 41.—. 1 ........................ ... . North Andover,,Mass. Fe;i--��7 Lic. lu... . ........ ..................... ' ,3............ ELECTRICAL INSPE Check # 8342 Commonwealth of Massachusetts Official Use Only Permit No. C/Q�`5/� Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank 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 W INK OR TYPE ALL INFORMATION) Date: 9-,//-0J7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /J-Y, 041t° .51'/e-e f Owner or Tenant l f#4 Cc i Telephone No. Owner's Address S Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Bog) Purpose of Building ,� 1 Utility Authorization No. Existing Service 106 Amps 0 V Volts Overhead � Undgrd❑ No.of Meters New Service 06d Amps 4c)& 1(9(10 Volts Overhead 2' Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ��4rcolt Shu Completion of thefollowing 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 K-VA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting * rnd. rnd. Baftea Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and b InitiatingDevices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: d -v F Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such 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 pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:_&AW %'Tev1c r?S" LIC.NO.-Ir/ 7- I Licensee: 2y/'sy 7- 7r,"A f.1-'--t) Signature LIC.NO.f/1/S/J R (If applicable, enter "exempt"in the license number line)s /e 7` Bus.Tel.No.�1?t 346 S'�3 3 Address: /)�i t.dkr✓ '� �Gbvr/4,,e1 { O/P 3 C� Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent t� Signature Telephone No. PERMIT FEE: $�s. The Commonwealth of Massachusetts Department of Industrial Accidents ti tl Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_�& /<m rb <eD Address: 15- i � S City/State/Zip: G�ortf c ,Gy o 611,3 C/ Phone#: 9/7 3 j56 5`d 3 3 Are you an employer? Check the appropriate Obx: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. E] New construction employees(full and/or part-time).* have hired the sub-contractors 2. a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in 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.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). "Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a .fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un er thepains andpenalties ofperjury that the information provided above is true and correct Signature 4: Phone#: �/ d 5;7 C5 3 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#• Date. . �.� �!� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING �Ss�cHusE� This certifies that . . . c, i.'. . . . . . . . . . . . . . o has permission to perform . . . . . . . . . . . . plumbing in the buildings of at . . /. . . .h? �-T . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . .: . . . . .Lic. No.. . . . . . . . . . . . . . . . . . . !,,. . . . . . . . . . . . R PLUMBING INSPECT OR. Check # NiAbSACHLISETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING (Print or ype) All Mass. Date �v r(j- 2,0_4Q (� --"1_ P rm i t - Building Lo ation / l � Owner' m 1 KJ Type of Occupancy New❑ Renovation 0 Replacement Plans Submitted: Yes 0 No❑ FIXTURES B.P. # SEWER # SEPTIC # 0 T 71n u, inS1_1 >_ z Z Z > ul LU Ln z � w _ ~ Z (D to w � U Z . c m in w Q to a Z a Z a w 1=— tr Lu O . Lu ¢ Ln ¢ N a z tSJ ¢ = a Z = �' Y N o- ¢ V a o: Ci ¢ > O cn Ln z o_ 0 z z U Y w m t=n o o g _ ¢ Ln o D o ¢ 3 0 m _o ~o SUB-BSMT BASEMENT d 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOG .stalling Company Name Check one: Certificate ddreas ❑ Corporation isiness Telephone 2 ❑ Partnership ime of Licensed Plumber oT Gas Fitter tT Firm/Co. NSURANCE COVERAGE: have a current ll bility insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes 1 No . ❑ f you have checked es please Indicate the type of coverage by checking the appropriate box. liability Insurance policy� Other type of Indemnity 0 Bond ❑ )WNER'S INSURNACE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. ignature of Owner or Owner's Agent Check one: Owner ❑ Agent 0 reby certify that all of the details and information I have submitted (or entered)In above'applicatlon are true and accurate to the best of cnowledge and that all plumbing work and installations performed u r the permit Issued for thi a Ilcatlon will be In compliance with ertinent provisions of the Massachusetts State Plumbing Code and h to 42 of 9G oral Law . By Title Signa re of Licensed Plum or -ity/Town A DDD/1\/L^n ir�r..•......-�__ Tvna of I i---- Y BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS 1<RE�CNIa P116"ESS INSPECTIONS FE>: N0. A►►UCATION FOR Pt11MIT TO 00►LYMrINO NAME a TYPE OF Ill"AlNO LOCATION OF/rILDINO PLrMant MOT ONAWRO DATE -19- ;MING INa NISPECT011 f t I - 1 i \ �� ti I I .. � � ! .� � � � � � � �� �� � � ` j , � � � _� a �.�, � a Location No. �'� Date NORTH TOWN OF NORTH ANDOVER s • - y • ; , Certificate of Occupancy $ ++,�a'^•°''t�+ Building/Frame/Frame Permit Fee $ s4CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4117037 �� Building Inspector TOMLINSON&HATCH,LLC 11 CHESTNUT STREET ANDOVER,MASSACHUSETTS 01810 f Paul L. Twomey, Esq. Estate of Smith 14 Essex Street Andover, MA 01810 i SAO TH Town of No. Ll r . C% -- LAKE a dover, Mass., Znp'46 I� COC NIC KE WICK y1. OOATED FP�,`�5 1 v V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System AP 4 BUILDING INSPECTOR THIS CERTIFIES THAT..... a .. .......I�......... ...... .o.. . ....... �`..£s .. 5 � r Foundation S -1- . has p rmission to e�ect... .4 �r............... buildinon ....�. 8..........7.. R Rough ���►��r I Qr Ails 0 D w s / h Chimney tobe occupied as.. .................................................................................................................................. ............................. 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 action, Alteration and Construction of Buildings in the Town of North Andover. (307 12 l� In ,040 WSUN-, PLUMBING INSPECTOR Viol67 ION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ................ ....... ...................................... ......................................... . Service "goo 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. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging,clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. e. Location 4 A t No. 6 Date NORTH TOWN OF NORTH ANDOVER Oi .•o ,•',•t,0 00 • ; , Certificate of Occupancy $ cMus Building/Frame Permit Fee $ sw Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # SI Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �/� DATE ISSUED: T SIGNATURE: Buil�Commissiomlforof Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed U Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 11.8 S wetage Disposal System: Public W. Private ❑ Zone Outside Flood Zone 11 Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record 4ts cyC-Sin [Tf (44,111r,71 Na Tint) Address for Service: 6 XX V ' 6 f-&77,-1- D!8/ Signature Telephone 2.2 Owner of Record: O �I Name Print Address for Service: 0 j M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ EN24 (_ • 6tckrt2 Licensed Confuction Su'per'visor: 060597 O I LA E S M4%5 License Number mn A rens 3 /`�� O y i Q & 1 Expiration(Date nature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name � ' �� l�C � f1�1�� I I\�G W( V✓�� r " ►'�S S O I�S( Registration Number r Addr ss j 7 S /b y C. q 7 0 ` Z V Expiration Date( �1 Signature Telephone G) f SECTION 4-WORKERS COMPENSATION(NVLG.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......X No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) )d Addition ❑ Accessory Bldg. ❑ Demolition PL Other ❑ Specify Brief Description of Proposed Work: IJ f—M-0 ►S� ��v412 v2 cad`1 S k _R%V4 V4 4, nfw Jl.A7h6w d_?,N412,)e AIL 'L.M'd slE/ L:1'- s / I l .n 144 N. ✓t w d?,12 6�&C J f1 1Ah2w1 K v J SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OICIA1 USE'OTLY, "r Completed by permit applicant 1. Building (a) Building Permit Fee 5701 6Va Multiplier 2 Electrical (b) Estimated Total Cost of 6-5b Construction 3 Plumbing ( Building Permit fee(8)X (b) 4 Mechanical HVAC 8i bo 6Tt__1 5 Fire Protection 5-6Sb 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OW A NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ( I, as OmaeaaZAuthorized Agent of subject property Her orize �. d6M 6 TO to act on behalf,i all mawork authored by this building permit application. ����6 SiZature of Owner Date t SECTION 7b OWNER/AUTHORIZED AGE T DECLARATION h145 ash/Authorized Agent of subject tJ t{. property. Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ll)al , P amen ZZ Signature of Oar/A crit - Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVMERS iST 2 ND 3 RD SPAN DUvIENSIONS OF SILLS DIMENSIONS OF POSTS t DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X >r MATERIAL OF CHIMNEY 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 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. ** *********** ********* ** *4PPLICANT FILA S Q►JT THIS SECTION*********************** APPLICANT . LOCATION: Assessor's Map Number2 g _ PARCEL_ _ SUBDIVISIONLOT(S) STREETG /� _� D "✓(�L_Tt___________ ___ $T. NUMBER__---- *** ********************* *** ***OFFICIAL USE ONLY*** ***** ***** ***** ***** * RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED_ DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED �Y COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED_ DATE REJECTED SEPTIC INS13ECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDINd INSOECTC1k----------------------__ ______DATE________ Revised 9197 jm •(' �.�...-...:.---...w....�..._,..�.�y-.-�✓['GIIOOQ�G[Ca7Gf6 I I ' }.� T004YLIfL(YILII/BCLU/L . BOARD OF BUILDING REGULATIONS' icense`A. NSTRUCTION SUPERVISOR NVmlbe: 000577 Bif jj '03/12 9ra3 �I^>�pisH2%1x404 Tr.no: 19305 4 Re' Gtbd'X00. I 1 ' 3 HENRY C BECK t4s{ t 1 LITTLE'S LN G r NEWBURY, MA 01951 Administrator 2 _ �� -� ✓fie {oJomvina�uvea� a�,/�aaoac`uraelta Board of Building Regulations and Standa6Js HOME IMRLI2f,VEMENT CONTRACTOR RenaA4931 ,gip olnt 71.5/2004 t Type: Aj Vale Corporation HENRY C.BECK R CgvpT A SUI 1 Little's Lane ` moi r►u✓! Newbury,MA 01951 4 01/19/2004 MON 13:41 FAX 978 465 6204 Chase & Lunt Insurance 1a 001/00L i ACED- CERTIFICATE OF LIABILITY INSURANCE CSR Pw DATEYI IMM/DD/YYY F3ECKE-2 �f 01/19/0.1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF 14=QRIVIATION Chase & Lunt Ins. Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 Sox 590 HOLDER.THIS CERTIFICATE DOES NOT AMENt, EXTEND OR 47 State Stroet ALTER THE COVERAGE AFFORDED 3Y THE 1301-10 1ES BELOW. Newburyport MA 01950 Phone; 978-462-4434 Fax:978--465-6204 INSURERS AFFORDING COVERAGE _ NAIC# INSURED INSURER A:- One :Beacon Insurance _ 20621 _ INSURER B' Safety Insurance Co zany_ 39454 Hen C. tker Custom _ Buil- INSURER Atlantic Charter Ins Co _ One Llule rI5 yane INSURER D: - Newbury MA 01951 INSUU RER F' COVERAGES THE POLICIES OF INSUKANCE LISTED BELOW HAVE DEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY HEHIOD INDICATED NOTWITI ISTANOING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVI ITCH THIS CERTIFICATE MAY BE ISSUE D OR MAY PERTAIN,THE INSURANCE AFFORDED BY THt NOLILALS ULUCKIHED HEREIN IS SUDJCCT TO ALL THE TERMS,EXCL JSIONS AND CONDITIONS OF SUCH POLICIES AGGR17GATF I IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSRPOLICY EFFECT --- '- LTR IYPEOFI SURANGE POUCYNUMBER PATE(MMIDDrM DATE iMM/DD UdlTS GENERAL LIABILITY EACH OCC JRRENCE 31000000 _ A X COMMERCIAL GENERAL LIABILITY A$R527179 04/01/03 0401/04 PREMIS6S;Eaxa,re ce) _ >100000 _ CLAIMS MADE I X I OCCUR MED EXP(joy one person) 15000 _ PERSONAL BADV INJURY '91000000 GtNERAL/,GGREGATE u2000000 GEN'L AGGREGAI E LIMIT APPLIES PER. PRODUCT'-COMP/OP A(G :52000000 _ POLICY 17 FRCT LOC AUTOMOBILE LIABILITY T COMBINED SINGLE LIMIT B ANY AUTO 0785261 10/20/02 10/20/03 (Ea&WIden) ALL ONMEU AUTOS -� - BODILYINJJRYi lOOOOO X SCHEDULED AUTOS (Per parspn; X HIRED AUTOS -orINJURY 300000 ()-or 8 X NON-OWNEDAu10S IIercclderq PROPERTY DAMAGE i 50000 (Per acridar r) GARAGE LIABILITY AUTO ONLI'-EA ACCIDEN r 5 ANY AUTO !( OTHERTH/,N SACC ! AUTO ONLY. A(C $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR E CLAIMSMADE AC3UKtUA1E DEDUCTIBLE T RETCNTION S I WORKERS COMPENSATION AND r X TORY L IMTI1 E R EMPLOYERS'LIABILITY -- C ANY I'ROPRIETOR/PARTNER/FkECUTIVE WCEO0114601 10/25/02 10/25/03 E.L.EACH<CCIDENT •:500000 _. OFFICER/MEMBFR EXCLUDED7 E.L DISEA;E-CA EMPLOY-1 3500000 If ye i,describe ullde/ - - -• •- --- SPECIALPROVI$IONSWow FI f)1SFASE-POLICYLIMT 500000 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONS I VEH1u" EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - Carpentry contractor, CERTIFICATE HOLDER CANCELLATION SAPLASCH SHOULD ANY OF THE ABOVE DESCRIBED POLICIE:3 BE CANCELL'[ S:FORE THE EXPIRA 110 y DATE THEREOF,THE ISSUING INSURER WILL ENDIAVOR TO MAIL 1 O_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLIER NAMED TO THE LEFT,BU1 F 41LURE TO DO$0 SHA-L Sara Schwartz IMPOSE NO OBLIGATION OR LIAVILITY OF ANY KIS D UPON THE W$JF ER,ITS AGENTS Of. 234 Brentwood Circle REPRESENTATIVES, No. Andover MA 01845 AUTHORED REPRESENTATIVE James J Howlett III _ ACORD 26(2001/08) COR')CORPORATION'983 AORT#i Town � of � Andover 0 No. L4 g AOL dover, Mass., COCHICHE WICK ORATED pa \-V 5 7 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System PC? 0 Cis4� , *I . BUILDING INSPECTOR THIS CERTIFIES THAT / .......... ...... ...................... ........................................................ ... .............................. ....... � r Foundation has permission to eat... eM. �r .... buildin on a�4�� s ' .... .... ..... ... ................................................. Rough to be occupied as... i�r '..... r 01..............0..1 ...... 17w..+..1./� �. .. .... .. ............. ... 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 theaction, Alteration and Construction of Buildings in the Town of North Andover. V *7 a A� Ins /Ce Woo •�� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough in. .... ........:............................. ....................:..................::::.:" Service 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. Location No. C Date NOR71y TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ ` ` Building/Frame Permit Fee $ < Foundation Permi Fee $ E s�cMus Other Permit Fee $ Z!;b Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 3 Z' Building Inspector - - �'3! 32.50 pA79 ?835 Div. Public Works PER'lfIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION ( Z.`% 57- PURPOSE OF BUILDING 5-fvp .iSIre a� .. OWNER'S NAME � __ i�l =Q�yL� , - NO. OF STORIES �SIZE OWNER'S ADDRESS in�) 1_ // `�v BASEMENT OR SLAB .ARCHITECT'S NAME 1 V�°�.Cl� •+ SIZE OF FLOOR TIMBERS IST 2ND 3RD f (BUILDER'S NAME 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 % IS BUILDING ADDITION MATERIAL OF CHIMNEY --- IS BUILDING ALTERATION N o 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 SIDES EST. BLDG. COST ��t OC7 o OO PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED • �' �� 4aEmummma�INSPECTOR SI TURE OF O NER R AUTHORIZED AGENT F E E3 Z..�� INN OWNER TEL.# PERMIT GRANTED\ CONTR.TEL.# ! n I CONTR.LIC.# J H.I.C.# A4�w 183 ' c ,�3���►. 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION �t 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D __ i PIERS PLASTER DRY WALL _ UNFIN 3 BASEMENT AREA FULL FIN. B M AREA _ 'i. 1/2 l/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"JD ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 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 11 NO HEATING 1 NORT O of E RAndover j No. 002 r- _ -ort dover, Mass., ARRA& 5 19145 �0 l't- LAKE COCNICMEWICK �V AERATED PP BOARD OF HEALTH Food/Kitchen Septic System . PERMIT T DBUILDING INSPECTOR s. 5�� THIS CERTIFIES THAT ........................................................................................................ Foundation � S'� .W� .S"T" Rough .r has permission to erect.... .Dorc--......................... buildings on .............................................................................................. S Chimney ' ` /A S 4JA t7r l-k IJ6 C e Ato be occupied as..4�...I... ooh...............P................................... ►........................................................;.. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final ::4 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 6 M THS ELECTRICAL INSPECTOR UNLESS CONS U T S Rough ..... .................................................... .............................. Service BUILDING INSPECTOR Final Occupancy Pennit Required t0 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ~1.83_z_�7 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE I C 51• 't S� JOB LOCATION l �G�-� r Number Street Address Section of town "HOMEOWNER" Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor . (State Building Code, Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory 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 . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1 ) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . HOMEO�vNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 .0, Construction Control . Date. .��-a?S"03 A tl NOR7M 3r��,� •�;._'tiooL TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING 41 SAC US This certifies that . . 2.�N.S h a.w. . . . . .P. . . . . . _ . . . . . 5 has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .� .(. ^ . . . . . . . . . . . . . . . . . . . . . . at . . . o . . 7 R. .e . . . . .. . . . . . . . . . . Nort Andover, Mass. Fee. s . . .Lic. No.1 %9,5.g PLUMBING INSPECTOR Check # ' 5 8 .i 5 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS � Date Building Location /5'y j2,1t L- 57 Owners Name S i r�f>t Permit# Amount '— Type of Occupancy New Renovation Replacement © Plans Submitted Yes No FIXTURES H o z w � w x w x w Z 4 � a a x x A a r 3 a H � Ste» >� Nr M MOM MIUM Im FLOCR 4MHDM 5M HACM 6M it" 7MHD 9MIU R (Print or type) Check one: Certificate Installing Company Name Q_rJ, �'Ni1 "`� '`"'� t�f ❑ Corp. Address 26 Partner. Business Telephone '✓Firm/Co. r r q Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0._-' Other type of indemnity 1:1 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 in_sur e 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 Massac State PI bink, o nd Chaptey�142ftheGeneral Laws. By SignaLure or Mceiiseuum er Type of Plumbing License Title leUse, City/Town Eicense TNumDer Master ❑ Journeyman APPROVED(OFFICE USE ONLY a MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508)475-3555, 373-5721 June 5 , 1991 Mr. Robert Nicetta Building Inspector Town Hall - Main Street North Andover, MA 01845 RE: Steve Smith - Dale Street North Andover , Massachusetts Dear Mr. Nicetta : Enclosed herewith please find a copy of a site plan prepared by my firm for the client. Mr. Smith has requested that I forward to you a copy of this plan , so that you may review same , and provide any comments to me relative to compliance with Zoning. He ultimately wishes to obtain a building permit for construction of home on this lot. Your earliest review and response to me would be appreciated. I look forward to hearing from you regarding the above and enclosure . Very truA , , tRG MERRIM RVICES Stephen E S Proje,c s enc -4foo . ''�, 6