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Home My WebLink AboutMiscellaneous - 1641 SALEM STREET 4/30/2018 1641 SALEM STREET 210/106.B-0082-0000.0 ` TOWN OF NORTH ANDOVER i BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � z� i _'��5 �S � .� �'�e •ae.#.3�-ez' �x v M+y� Y !. z sof` � c� yo. v BUILDING PERMIT NUMBER: DATE ISSUED: �,y SIGNATURE: 16 A BuildinE Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 4 1.1 Property Ad-dress: I rMap and Parcel Number: 0 ,5 . 04 Map Number Parcel Number 1.3 Zoning(Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqtired Provided R red Provided Brag d FlDispose 1.5. Flood Zone Information: 1.8 Sewerage 1 1.7 Water Supply M.G.LC.40. 54) System: Public p Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record r �� ame(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construe n Sup ry or: Not Applicable ❑ Licensed Construction Supe isor: j j f y License Number Address Expiration Date ic S, nature �J 7 Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(NL 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.......0 No.......0 f SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: COIL- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be zC}I?kTCiYUSEl`FLY� -. xi d Completed b ermit a licant ; 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC �, ai► 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 BUII.DING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The C=MonweaCth ofMassachusetts oepartn=t of hufustriaC�ccidercts t� � f o Investations 600 Washington Street Boston Y 02111 Workers'Compensation Insurance Afndavit APPLICANT LNFORMATI ' Please PRINT Legibly Name: Location: City: Telephone#: /��V 47, ❑I am a homeowner performing all work myself. ❑ I am sole proprietor and have no one working in my capacity ❑ I am an employer providing workers' compensation,€ my ern;Aoyees working on this job Company Name: / y r I 7-17 Address: l �� 7 /L/ y� Telephone City: Insurance Company: Policy#: ❑I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following. workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy#: Company Name: Address: City: Telephone#: Insurance Company' Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B 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. 1 do hereb certify under the pains and penalties of perjury that the information above is true and rrect. f Signature: A,t_) cl=�ro/2n A Date: L Print Name: �"(� CL,-:9 Phone# y a l� Official Use ONLY-Do not write in this area o Building Department Permit/License#: o Licensing Board City or Town: o Selectmen's Office o Health Department ED Check if Immediate response is required 0 Other INFORMATION&INSTRUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law" an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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,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 in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' .compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Fax# (617) 727-7749 Telephone# (617) 727-4900 ext. 406, 409, or 375 CaStricone hoofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 C MARIO CASTRICONE 31 Court Street,North Andover Mass. 01845 I/we,the owner(s)of the premises mentioned below, hereby contract with and authorize you as contractor,to furnish all necessary materials, labor and workmanship,to install,construct and place the improvements according to the following specifications, terms and conditions, on pre Vises below describe r / Owner's Name :. ....(,{ ' ... : :. .. L. .. . .... ..... Job Address..... yjc �1 ...z� ......................Ci ..State.........:'.(... ..................... SPECIFICATIONS .... .... ................. .......(................... .,................... ,�} ...... .. ............... ........W ... Y�l.. 1'(.C ........... ........................................... ................. •.............. ............. C��GI ............................................. ............................ y ,. ...............................Zti.. /...! ................'°�.. .............. .. .. ......... .... ........................... ............ ............•.................................. ... ..•.... .Y. ............................................... ... w L •f� .. .....•..........................• • •.• . •..................•.....•.•.... . .••�e... ... ..........•............•........... ..... ...................... ........� ...................... .i. ............... ,.. .... l.�. ............ ...........................\ } .... .................... . ....... ` La .......................... �.....�... ... ................ .......... ............... ..� ....................................................... ?....... ... .. . ................ . :�............ .�.... ..............:� c .................................................... .. ....... ................................................ ............................ Materials and labor to cost$ .,1 ............................ Payable.........................................on ................................and balance in............ monthly installments of$.........................................each,payable on ........................................day of each and every month thereafter until paid in full(..............%charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and completion as requested by the contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaic immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs,attorney fees and expenses, it addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor;and also that the obligations hereof shall bind and apply to their heirs,successors or estateE of the parties. The undersigned warrant(s)that he is(they are)the owner(s)of the above mentioned premises and that legal title thereto stands of record in his(their)name(s) PROVISO:This contract shall be void and of no effort if credit approved of owner(s)is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is thi; contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signec by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read anc the contents thereof understood and that no representation ora agreement not herein contained shall be binding upon the parties and that all of the agreements anc 9 9 P P understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in 6pe�n. /"IN WITNESS WHEREOF, the parties have hereunto signed their names this......... .: .day of. .. . 1'iJl4 .....,M �1.`...... l Accepted: t% oct�i - /2 6 i tj Signed........ ... ......................................................... .............��......... .......... Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed...................................................................................... Owner Per �. �G '�J... ...: :..: :�: 4 �1�...................... Signed...................................................................................... Representative NORTH TO" . Of1' E Andover No. al 9 CoC � ,, dower, Mass- HI ?.o►� �d ADRATED PPa\ 5 BOARD OF HEALTH Food/Kitchen rER I T D . Septic System 41160 BUILDING INSPECTOR THIS CERTIFIES THAT.... �........... .... ..... ............. Foundation has permission to erecid". .. .... .....A. w buildings on ..�. /.. .................... Rough to be occupied as.,�/� .. • Chimney . . .. . .......................................................................................................................... provided that the person accepting this p rrtd shall in everyrespect 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 STAIUS ELECTRICAL INSPECTOR Rough ......... .......... .................... ......... Service BUILDING INSPECTOR Final Occupancy Permit 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 Street No. Smoke Det. IF SEE REVERSE SIDE NORTH Town ofAndoverE No. C' (� dover, Mas O — ^ X COCMIC w C V 7 AORATED p'P10 �C`) BOARD OF HEALTH F�([ ood/Kitchen rER Septic System D BUILDING INSPECTOR THISCERTIFIES THAT.... .. �........... .... ........................ .............. ............................................................. Foundation has permission to erec ..� ...... .... ...... buildings on ..�. .... �.. ....... .................... Rough t0 be occupied aS. Chimney P .il��..... ....... ...... .......................................................................................................................... provided that the person accepting this p ai shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS - ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAUS Rough ......... .......... ......... Service too 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. J } ` ,:ti:o Use U,ty plob 77]e Commonwealth of Afassachusetts P.-mit NO.Department of Public ScfctyOccupync�� S (ee CheckedBOARD OF FIRE PREVENTION REGULATIONS S27 CIdR 1200 3/90 tlaave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Mactachusetu Electrical Code, S27 CMR 12:00 (PLEASE PRIVY IN INK OR TYPE ALL INFORMATION) Date /i—28`77 City or Town of i(/DQTH A/VDOyeA? To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ��h�/ �'f,)(rE/Yj .5,7`,ecer 0--ner or Tenant_ /'�D6E,�T / /L qdywe- owner's Address SAME 717-1-1731. Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization 170. Existing Service Amps / Volts Overhead El UndgcdID No. of Meters _ flew Service Amps / Volts Overhead ❑ Undgrd❑ Ito. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total No. of,Lighting FixturesSwimming Pool Above 1:1In- grnd. grnd. ❑ Generators KVA No. of.Receptacle Outlets No. of Oil Burners No. of Emergency Lighting I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and 8 No. of Air Cond, tons Initiating Devices No. of Disposals No. of Heat Total Total PumpsTons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters KW No. of SignsBallastsBallasts trio ag CA �GgiQM No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO O I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work S /75— o O Expiration Date Work to Start 11—,?,9-97 Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY SYSTEMS NORTHEAST INC. LIC. No. 1231C Licensee.DONALD A BROOKS Signat a NO, 12 31 C Address .60 William Street," Wellesley,V70-2 r8l F 1is. el. No. 413-732-1400 Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts Generalwsas,, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 00 Telephone No. PERMIT FEES 3.S Signature of Owner or Agent N2 ,1311 Date..../// M HOR71{ °ft"`° '•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SS�ICMUSE� This certifies that ... ....t .....�.:.... ��..... ..t��l... �5...................... has permission to perform .... tet. ................................................... wiring in the building of.......ki !...�.� ��r Y!L�—............................................... at......` .f..... ..�1 .J. �>7...5.t.............................. .North Andover,Mass. Fee... .. Lic.No../. X ............... �t � �� ELECTRICAL S INPECTOR G 12/05/97 11:17 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer