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Home My WebLink AboutMiscellaneous - 166 REA STREET 4/30/2018 166 REA STREET 210/098.A-0012-0000.0 ` _ 1 i New England Claims Services, Inc. 131 Dodge Street,Suite 6 Beverly,MA 01915 Phone#(978)927-3000 Fax#(978)927-3002 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec 3B To: Building Commissioner or Inspector of Buildings City Hall North Andover, MA 01845 To: Board of Health or Board of Selectman City Hall North Andover,MA 01845 RE: Insured: Jeffrey& Charlene Hart Property Address: 166 Rea Street,North Andover,MA 01845 Cause of Loss/Date: Weight of Ice or Snow Loss of 10/14/2012 File or Claim No: BOS 050521 Claim has been made involving loss, damage or destruction of the above property, captioned g P P P rty, which may either exceed 1 y $ ,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Robert L.Smith,Jr. Adjuster On this date,I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Si ture // Date 756 "1 Date.. . ......... HORTM 3r '' TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION . 9 n 'Is,SSAc HUSE1t [� This certifies that . . ,��96 ?y�' ./. l!6. . . . . . . . . . . . . . . . . . . has permission for gas installation `.,G G in the buildings of . . . .///�`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .� . . . . . . . . . . . .. North Andover, Mass. FeeJ.G. .:. . Lic. No.'I. ft . . . t!: .F.ti- .. . . . . . . GAS INSPECTOR Check# ? } MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: , MA. Date; Permit# Building Location: ROwners Name- r. �tPO [�x rt Type of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional❑ Residential v New: ❑ Alteration: ❑ Renovation: ❑ Replacement: W Plans Submitted: Yes❑ No❑ FIXTURES N z F Y S U) N U _ m Z (9 J V Z LU U) O W W o z z o W 0 Op a i- W rn W m 0 a I- o W K rn > w zlic 0 '' N O a w = u. W H �' Q W W W Z 9 (� = W ~ rn = z W Q' R > V W z O J [— P O z J O u_ 1— W ~ W W V z W rn J a m W O z O N > z f- _ SUB BSMT. ' BASEMENT 1 FLOOR 2 FLOOR 3KuFLOOR 4 1H FLOOR 6 FLOOR ti 6 FLOOR VH FLOOR TJ -i'FLOOR Check One Only Certificate# Installing Company Name. orporation Address: Citvrrown: State: ❑Partnership Business TeI• Fax: a woo ❑Finn/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes[tYNo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 12'11" 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this box❑;1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plu ing Code and Chapter 142 nUhe General Laws. Type of License: 00, By ❑Plumber I n a% dq Title ❑Gds Fitter a ure of Licensed IumberlGas Fitter Gaster Citylrown ❑Joumeyntan License Number: a APPROVED OFFICE USE ONL ❑LP Installer 0 Date... TOWN OF NORTH ANDOVER 0 I- PERMIT FOR WIRING Thiscertifies that ............. ......................... ...................................................... . .. has permission to perform . ................... ............................. wiring in the building of..... ........................................................................ ........................... .......................................North Andover,Mass. — Fee' `.............. Lic. . ..... .cr. ............... .. .. ........................... ELECTRICAL INSPECTOR Check # 'z WHITE: Applicant CANARY: Building Dept. PINK:Treasurer r a Office Use Only �> E C�QriilltQnlUE�l of FiBSFIt 1tSE1 Permit No._L?ls / n .• 3evartment of 13uhlit 0,ttfetg Occupancy A Fee Checke BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:001 3110 (leave blank) APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date .4:1'? �a l City or Town of �� fl .��/ J✓l�t� To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location.(Street & Number) Owner or Tenant itf Owners.Address �� is this permit in con' action with a building permit: Yes ❑ No L (Check Appropriate Box) Purpose,of Building. ir•� /Cy Utility Authorization No. Existing Service _A(! AmpsZZr.L/ A a Volts Overhead Undgrnd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total A tletlsets ighting Fixtures Above In Pool grnd. ❑ gr ❑ Generators KVA No:-o,' Emergency"Legh ng y eceptacle Outlets No. of Oil Burners Battery Units witch Outlets No. of Gas Burners FIRE ALARMS o. of Zones anges No. of Air Cond. tal No. of Detectio and . tons Initiating Devi es isposals No.of Heat T al Total Pumps ons KW No. of So ding Devices ishwas rs No. of elf ContainedSpace/Area H ating KW Dete ion/Sounding Devices ryer Heating D ices KW Lo I Municipal ❑ Connection ❑Other No. of No. of w Voltage ter Heaters KW Signs Ballasts Wiring N . Hydro Massage Tubs No. of Motors f' Total HP //2 r 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 ❑ I have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the aPerWriate box. INSURANCE ,Q BOND ❑ OTHER ❑ (Please Specify) Estimated.Value of Electrical Work$ G90 (Expiration Date) Work to Start �0 Inspection Date Requested: Rougha./LL G`A L Final Signed under the Pe alties of erjuty: C FIRM NAME Licensee .- LIC. NO. Signature �I—LIC. NO. Address Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware t�the �nseedoes not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ _ .,�cac Location No. �'�`� Date ! NQRTIy TOWN OF NORTH ANDOVER f r c t�.° ,••ti r 3? 16. • COL j k + s + : ; , Certificate of Occupancy $ 1'�s'"'•° '<� Building/Frame/Frame Permit Fee $ sgCHU0, 9 Foundation Permit Fee $ Other Permit Fee $ f'r TOTAL $ l� f Check # 15750 /=%-Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO.FAMILY DWELLING. BUILDING PERMIT NUMBER: 2�' DATE.ISSUED: SIGNATURE: Al c Building Comnlissioner/IEEL=tor of Buildings Date SECTION 1-SITE INFORMATION 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.Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide -Required Provided .Regwred Provided 1.7 Water Supply M.G LC.40. 54) r i 1.3. Flood Zone Information: 1.8 Sewerage Disposal System Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disoosal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name(Print) Address for Service S' a Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: i License Number Ad rens T Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name l y ��: ��/<�;� Registration Number Address Expiration Date S. nature Tele hone 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 buildi permit. -Signed affidavit Attached Yes.......V No........❑ SECTION 5 Descripfiqirof Pro osed Work check all a licable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant 1. Building v D (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Constructioi', 3 Plumbing Building Permit fee(a)X(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 as Owner/Authorized Agent of subject property , Hereby authorize to act on My beh f, 1 0 e, I ve to ork authorized by this building permit application. :2 4(.- Si er Date SE O b OWNER/AUTHORIZED AGENT DECLARATION 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 i Z�MaY Print N e 1c, (L Si r/A t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2NV 3 RD SPAN DRvIENSIONS OF SILLS DBAENSIONS 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 NAT URAL GAS LINE COQ ��; �o1,PCN0J- �-,j o N 5tt7� y I— ' �X (� eKcSf z FORM U - LOT RELEASE FORM 5 (0 f\(00 (,-- 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*********************** APPLICANT (f� �L� //L►Gy� PHONE LOCATION: Assessor's Map Number I S PARCEL l ) SUBDIVISION �,� LOT(S) STREET / b l2e'A )"/i ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** REqpMMENDATIONS OF OWN AGENTS: l CONSERVATION ADMINJIRATOR DATE APPROVED 7115 ?9 ``�p DATE REJECTED /v COMMENTS D �S �%�too TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS • FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED PTIC INSPECTOR-HEALTH DATE APPROVED --yfq aZ DATE REJECTED 1 COMMENTS ADOIDUey �J (�,h A)eW 10- PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm I I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant //(.op 2— Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 4 The Commonwealth of Massachusetts Department of Industrial Accidents s Office o�lnvestigaflons Boston, Mass. 02111 Worcers'Compensation Insurance Affl-davit Please Print Name: ��L�G `�l (�i T� Location: Citv !'l ( —U J Phone am a homeowner performing al myself. work • �! am a.sole proprietor and have no 0116 working in any capacity f am an employer providing workers'compensation for my employees working on this job. C mname Address G' / =�i�W! /� Phone : — Y�(7 ! �. t'��e • . � ! � Z L . . . C• /t>G Z-- 31,5 r�33 9�^mac 2- ---------- Ad—dress Address CttY: Phone#- . n _ r�• - Via►. �aftttse te>r seoerro a as required under section 25A or USL 1,52 can lead tatt�&,fi�fposivvn of Erlhr`nai and/or one years•improomtent as welt as dvN R :aft aFtlne crp to$1.500.00 understand that a-copy penattiies in the al a slop WORK ami atiite of(3IOLG O)a day against me. i opy of offs statement may be forw2rcted to the t5ffite of�c/OW alAl For cmwage�r . i do he►ty certify under the pains and pmwAfes of p rjury Met theme PM*L-d atwve is true&W-Correct Sighature /J Date (i 1 Print name /3/ Phone# ►fficial use only do not write in this area to be completed by city or town diciar il.Check ifimmediate response isI] Building Dept Building Dept 0 Licensing Board intact person- ❑ Splectrnan's Office Phone# 0 Health Depad/nen,t 0 outer j R MAY's COMPS NATION J.. Meyer Decorative Surfaces �y 51 Concord Street YY 11�S�1V1yi�T North Reading, MA 01864 I N T E R N A T 1 0 N A L 800-356-0073 2000 JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F•S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S 1 1 2 3 4 5 1 2 3 4 1 1 2 3 4 5 6 1 2 3 1 1 2 3 4 5 1 2 1 2 3 4 5 6 7 1 2 3 4 1 2 2 3 4 5 6 7 8 6 7 0 9 101112 5 6 7 8 91011 2 3 4 5 6 7 8 7 8 9 4 5 6 7 B 910 2 3 4 5 6 7 8 6 7 8 9 3 4 5 6 7 8 9 B 910 11 121314 5 6 7 8 91011 3 4 5 6 7 8 9 9 10 71 72 13 14 15 13 14/5 16 17 18 19 12 13 14 15 tfi 17 18 9 10 11 12 13 74 15 14 15 16 17 18 19 20 11 12 13 14 15 16 17 9 10 11 12 1314 15 13 14 15 16 17 18 19 10 11 12 13 1415 16 15 Ifi 17 18 19 20 21 12 13 14 15 16 17 18 10 11 12 13 14 15196 i6 17 18 19 20 21 22 19 20 21 22 23 24 25 16 17 IB 19 20 21 22 21 22 23 24 25 26 27 18 19 20 21 22 23 21 Ifi 17 18 19 20 21 22 ZO 21 22 23 24 25 26 17 18 19 20 21 22 23 22 23 24 25 26 27 20 19 20 21 22 23 24 25 17 18 19 20 21 22 23 %%25 26 27 28 29 %"/a%23 24 25 26 26 27 28 29 30 31 '/a 24 25 26 27 28 29 28 29 30 31 25 26 27 28 29 30 25 26 27 28 29 27 28 29 30 31 21 25 26 27 28 29 30 29 30 31 26 27 28 29 30 25 26 27 28 29 30 tAl E 1 i t �. 7-7 I 1 3 1 E [ 1 3 i i ( M (41 I 1i I ( f �� € a �• t i ({ E F (1 I i 7 i I j E �1 LOT�I LoT ?0 LOT I —1 - %' 0 p m nn LOT' I`) �e _T'nrZy ?N ¢s`t lio, 16(, Sa � LP;. LOGATION OF STAUGTM101% SA5Eq ON LINES OF OCC U k`CIC7N ONLY. AMORE ACCURATE LOCATK3Ad WILL REQUIRE AN lNSTRUMENT' � �74 �O S G+�L-E, 1 Co AMERICAN SURVEYING COMPANY OF BOSTON, INC. JOHN S. WRETAN 1264 MAIN STREET WALTHAM. MASS. 02451 A REGISTERED LAND SURVEYOR, PHONE (781) 893-6477 FAX (781) 893-7091 DO HEREBY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION MORTGAGE INSPECTION PLAN PLAN WAS PREPARED FOR FLEET DATE: 9/5/01 CLIENT: HORNUNG RECORDED AT: 'ESSEX COUNTY REGISTRY OF DEEDS N CONNECTION WITH A NEW CLIENT REF* NOi-1582 BOOK: 1227 PAGE:Z L.C. CERT #: MORTGAGE, AND IS NOT INTENDED J 0,#. 2500980006 PLAN REFERENCE: PL 3696 OR REPRESENTED TO BE A LAND DRAWN PER TOWN OF: ASSESSORS OR PROPERTY SURVEY. NO THE LOCATION OF THE ORIGINAL MAP#: PARCEL#: DATED: CORNERS WERE SET, AND IT DWELLING SHOWN HEREON EITHER ADDRESS: 168 REA ST. NORTH ANDOVER MA CANNOT BE USED FOR WAS IN COMPLIANCE WITH LOCAL BORROWER: HART APPLICABLE ZONING BYLAWS IN ESTABLISHING FENCE, HEDGE, EFFECT WHEN CONSTRUCTED OR BUILDING LINES..THE LAND (WITH RESPECT TO HORIZONTAL SHOWN HEREON IS BASED ON DIMENSIONAL REQUIREMENTS ONLY), CLIENT FURNISHED OR IS EXEMPT FROM VIOLATION INFORMATION, AND MAY BE ENFORCEMENT ACTION UNDER MASS THE SUBJECT DWELLING LIES IN FLOOD ZONE X SUBJECT TO FURTHER G.L. TITLE VII, CHAP. 40A, SEC.7 AS SHOWN ON THE NATIONAL FLOOD INSURANCE PROGRAM— OUT-SALES. TAKINGS, EASMENTS, UNLESS OTHERWISE NOTED OR INSURANCE FLOOD RATE MAP DATED: 6/2/93 AND RIGHTS OF WAY. NO SHOWN HEREON.A CONFIRMATORY COMMUNITY / PANEL #: _2500980006C RESPONSIBILTY IS EXTENDED INSTRUMENT SURVEY IS ADVISED HEREIN TO THE LAND OWNER OR WHEN STRUCTURES ARE SHOWN FIELDED DRAFTED I CHECKED OCCUPANT. IT IS NOT INTENDED LESS THAN 1' FROM PROPERTY OR BY: I MF TO BE RECORDED... REQUIRED ZONING SETBACK LINES. DATE: 9 3 01 9-S-o F.B. 1099 PGE:54 1 • / ail 5 N13*42,10"W--�- 300.00 s, r� 1500 GALLON BENCHMARK: SPIK v l SEPTIC TANK ELEV 1 E w 1000 GALLON cr D rn PUMP CHAMBER 0 30=---•.�. W 00 000 00 0 w o yyN��Gi a_J WmV? PRESSURE 2 1 WATER LINE I BENCHMARK #1: TOP RIGHT CORNER OF BOTTOM STEP. ELEV 100.00 (assumed) c> , NORTH F Town O I,.,... Over T O - LA ori dover, Mass., COCMICMEWICK ADRATED P?F`�,�5 S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System q �� BUILDING INSPECTOR THIS CERTIFIES THAT......... �.�... � V� R' ........... .......... ......................................................... ......................... Y Foundation • has permission to erect.4- . I.Q.,.... buildings on ...I. d.......�r0........is.............................. Rough to be occupied as alt 4, 's Q a,Y Q 4 O �� s 1q..VSvN r�0VbV4 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-Lawes relating to the Insp ion, Alteration and Construction of Buildings in the Town of North Andover. / / a *86�00010WPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MON ELECTRICAL INSPECTOR UNLESS CONSTRUCTI B Rough ....... Service .... . .. . . . ... .... ..... .. ........ 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. NORTH Town of over woo _�... N * - 3 T C% O - LA Ori dover, Mass., 91004;� COC MICKEWICK %A0RATEO S H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System r0V BUILDING INSPECTOR THIS CERTIFIES THAT......... �... .......... ........... .......R............................................... ......................... . , Foundation has permission to erecf..� .y..�.I..lQ....... buildings on .../,,�d.......740M.A........6.............................. Rough to be occupied as So at* 4 '` Q Q,Y 0 O �� C K S � SRN ro 0 N 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-Law relating to the Ins? ion, Alteration and Construction of Buildings in the Town of North Andover. ? O P 7/ a �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONIN-'� ELECTRICAL INSPECTOR UNLESS CONSTRUCTI B Rough MEOW:.............. ............................... Service 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. ��<) Date NaRTh TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee $ a KMusE Foundation Permit Fee $ Other Permit Fee $ �__-- TOTAL $ Check # �/ S Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLINGMa .. BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: 2�v (() all— Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: A Map Number Parcel Numb& 1.3 Zoning Information: 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 ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record /Name(Print) Address for Service I Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: GS O 9 LicenseNumber mn Address e �GL/��// Oe✓1 CC - O 2 Expiration Date ic Signature Telephone < 3.2 egistered Home Impr ent Contractor Not Applicable ❑ v Company Name �f' ` /3 rn y, aC�`/'/�t S 1 Registration Number r Address r (/ Expiration Date ^Z Si nature Telephone Q 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 A_ Repair(s) ❑ Alterations(s) �9 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ems v e o Gey-d'C_ — SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be .OFFICIALVStONLY . Completed by permit applicant 1. Building l.� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of ) _ Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 'a SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> c as Owner Authorized Agen f subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1> as Owner/Authorized Agent of subject propertv 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 Si aturu e of Owner/Agent Date i NO. OF STORIES SIZE BASEMENT OR SLAB s SIZE OF FLOOR TIMBERS I ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE u The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 0w` Boston, Mass. 02119 5�lb Workers'Compensation Insurance Affidavit Name - Please Print Name: ?!)C;C r ��sD.J " Location: P2 y c.Jf (A S City I�✓Q:7� &_*__ I /0 a Z(f 7 Z— Phone # (e / I am a homeowner perfomiing 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#7 Insurance.Co. Policy# Company name.- Address ame:Address City: Phone#• Insurance Co. Policv# Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a fine up to$1,500.00 and/or one years'imprisonment_as well_as_civil.penaltiesjnlhelmn-d-a-STOP WORK ORDER and..a.fine_d_($1D.0.DD).ajday.againstme. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ti do hereby certify under the pains and penalties of perjury at the information provided above Ass true and correct. Signature / Date �1—/' --03 Print name a-u I�c� �- o l �o�J P_hone.# L Y Official use only do not write in this area to be completed by city or town official' City or Town Perm t/Licensing Building Dept ❑Check it immediate response is required .0 Licensing Board C] Selectman's Office Contact person: Phone#.• E] Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S.150A.. The debris will be disposed of in: / (Location of Facility) i�y� Signatur Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i I 92- �anamanureall�t o�i1��nsoae�uo�la BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR Number: CS 011494 Birthdate: 03/29/1955 Expires:03/29/2004 Tr.no: 20004 i Restricted: 00 DAVID A JOHANSON 74 RUTLAND ST WATERTOWN, MA 02172 Administrator � � � 9 Z C� g �� Craftsman Contractors David A.Johanson 74 Rutland St. Watertown, MA 02472 bZ (617) 924-6850 t PROPOSAL Charlene &Jeff Hart 166 Rea St. N. Andover, Ma. (978) 258-1189 Remodel of rear three season porch. Remove existing aluminum sliders(6 units). Remove existing drop ceilings (2 ceilings)and strapping. Remove existing exterior wall finish to studs on main house. Stack all debris from work safely and remove from site in a timely manner. Frame new walls of 2x4 @ 16"on center, '/2 " cdx plywood sheathing, with 2x6 headers at window openings and new door opening. Build down existing roof framing to accomidate roof ventilation and insulation. Collar tie's may be needed to secure framing properly for cathedral ceiling. Install new Anderson d windows on sides of room sizes 34x49 double hung,two units on each side, and 2 windows on back sizes 30x49 on either side of slider. Install 2 new skylites sizes 22x49 on either side of roof. Remove and re-install existing Anderson slider door into new opening on back of room, plastic sheet off existingopening to new work area. Exterior finish to match existing finish with vinyl sidingand aluminum trim. Insulation Walls R 13, Ceiling R 30, Floor R 30. After floor insulation bottom side of framing to be covered by '/2"cdx plywood. Install 1/2"sheetrock on all walls and ceiling, with tape and joint, sand and prime new work. Interior finish to match existing house for window casings, door casings and baseboard. Rug allowance of$ 500 with pad, rug by owners choice. o inc ude outlets, fan box in ceiling wit swi c es , outlets and phone jack s on exterior wall. registers installed. All material, labor, dumping, and sub-contractors supplied by builder. Total estimated cost $ ' [ Z� S�-o Remove wrought it railings at stairs. Install new Oak knewel p _ew oak top rails, new painted balasters. Paint new b ers, polyurethan 11 new oak. Total estimated co — — aDavid March 15, 2003 Crafstman Contractors NORTiq TO" , OfAndover OY . H., ti. ;• ,.t.. No. oI CC W�Q� dower, Mass., ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR Tel ,� �rl��c. a �- THISCERTIFIES THAT..................................... ......................................... ........................................................................... Foundation has permission to erect....ftV. ..... buildings on ....l. ..&.......�..� ........., V.. �.................. . Rough S d.c ,� w w 0 1S.( r to be occupied as �� 4 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 thi Permit. Rough PER EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST T ELECTRICAL INSPECTOR Rough .............................................. Service 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE 1 Smoke Det.