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HomeMy WebLinkAboutMiscellaneous - 17 MAIN STREET 4/30/2018 f Date1:...`.�............................ Ik O�pORTIt,� 1 TOWN OF NORTH ANDOVER H � 9 PERMIT FOR GAS INSTALLATION 88AC�gg f This certifies that`z:lr—... ......... � ` ` ......................................... Teas permission for gas instal!lation . .................... .......................... Im the buildin-s of.... .....l P o It ` eAA S�- at.... .1............ .+A'` ! ......................................................slrk� orth Andover, Mass. Fee ............... Lic. No.13`5&z. tt p GASINSPECTOR Check# 1 Q `Z of -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I M6 . Art 960,'o MA DATE JOBSITE ADDRESS �OWNER'S NAME �•'r', ��a/% _ v GOWNERADDRESS S15Sel? TEL .33 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO A APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE I �� DIRECT VENT HEATER _ . - DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE --- - ------- ----- --- INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UW HEATER UNVENTED ROOM HEATER I I WATER HEATER r j OTHER F INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW O LIABILITY INSURANCE POLICY [, OTHER TYPE INDEMNITY ®l 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and a curate to th best of y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl' a ith al�Perf t ro ' on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �_lenQ LICENSE#[ 9GNATURE MP*MGF Ejl JP [I JGF[ LPGI© CORPORATION©# PARTNERSHIP©#=LLC #= COMPANY NAME:Z . 1U ytL J � G,a`r ADDRESS _�_� A2 17 CITY ( STATEZIP O'3! 38 TEL FAX CELL-'6 MAIL _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTO R USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PE MIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NO ES The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information � /�J O Please Print LeLribly ,f Name(Business/Organization/Individual): / ° eCJ-1v-1% Aullffg,n6 9- Address:/ City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 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. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. El 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. o 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. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 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. I do hereby cert50th ain dpenal 'es ofperjury that the information provided ah9ve is rue and correct. Si ature: me`— Date: �S `� Phone#: low�— � S'z5 S'� 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#: r 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 of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint.enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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'coal e= .nsafinn incnranre Jf an T T G gr LLP doos ha-N a employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations tions 604 Washington Street Boston,MA 02111 Tel,#617-727_4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 wwwanass,govldia COMMONWEALTH OF MASSACHUSE. S BOARD, PLUMBERS iq'ND GASFITTI RS ISSUES THE FOLLOWING `LICENSE f ' Lf.CENSED AS A MAslER.P:LUMBE GLENN M MCCABE 1 POORPARM ROAD : uwq iZ 1� DERRY SIH 03038-4209.... I I r FOR D,ATE TIME . ,PMONE OF RETURNED YOUR CALL PHONE AREA CODE NUMBER EXTENSION EASE GALL MES AGE WILL CALL 40 AGAIN �� �► s CAME TO U�� SEE YOtJ WANTS.TO SEE YOu SIGNED �niverSa1-48003 North Andover Board of Assessors Public Access Page 1 of 1 NORTH North Andover er Boar ofAssessors CRON SSq�M�S I 41property Record Card Click Seal To Return Parcel ID :210/028.0-0010-0000.0 FY:2014 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels + Search for Sales ,3 Summary1 f Residence Detached Structure Condo 1317 MAIN STREET ...1 Commercial Location: 1317 MAIN STREET Owner Name: FINEGOLD,BARRY R.TRUSTEE DF DALTON,WILLIAM J.TRUSTEE DF R Owner Address: 38 ESSEX STREET City: ANDOVER State: MA Zip: 01810 Neighborhood:35-5 Land Area: 0.08 acres Use Code: 013-MULTIUSE-RES Total Finished Area: 6697 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 536,000 536,000 Building Value: 425,000 425,000 Land Value: 111,000 111,000 Market Land Value: 111,000 Chapter Land Value: LATEST SALE Sale Price: 655,000 Sale Date: 01/13/2003 Arms Length Sale Code: Y-YES-VALID Grantor: CARROLL INDUSTRIES Cert Doc: DOC 75260 Book: 00107 Page: 0161 ' olrYl � (n L http.//csc-ma.us/PROPAPP/display.do?linkld=2433204&town=NandoverPubAcc 4/15/2014 Date.. . . AORTN TOWN OF NORTH ANDOVER FO -awdaiA P • - PERMIT FOR GAS INSTALLATION • � - . h �,SSA�HUSESS This certifies that .A. U.�. . . . . P `'.t* �.�". . . . . . . . . . . . has permission for gas installation . . . . . . . . . . .Z . . . in the buildings of . .� �'. .��'P'�.� �.�j. . . . . . . . . . . . . . . . . . . . . at . . . . � . -' ... . . . . . . . . . . . .. North Andover, Mass. Fee. . Lic. No. 2 2Ca�---- GASINSPECTOR r Check# x; 467 MASSACHUSETTS UNIMRM APPUCATON FOR PERMIT T, DO GAS FIT IMG (Type or print) Date o C:/7 NORTH ANDOVER,MASSACHUSETTS Building Locations / /� `� .S� , lT��O VM fY� Permit# ! / - PW/ Owner's Name Amount$ New Renovation 0 Replacement ❑ Plans Submitted ❑ a rA a 0 a o H o o o° H v� L"r U W V v1 °a F O SUB-BASEM ENT B A S E M ENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or ) Check one: Certificate Installing Company Name l ❑ Corp. Address ❑ Partner. Business Telephone — ® Finn/Co. Name of Licensed Plumber or Gas Fitter /°1iJ /[✓hyo9L401/0 6 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked M,please indicate the type coverage by checking the appropriate box Liability insurance policy 0 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: Signature of Owner or Owner's Agent 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 Massachusetts S to nd Chapter 142 the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ Gas Fitter Icense Number A ❑ Master _t APPROVED(OFFICE USE ONLY) Journeyman r Location No. 1&3 Date 7 �— NORTM TOWN OF NORTH ANDOVER 3:C+t �•e :•.,SCD '. Certificate of Occupancy $ ' Building/FramePermit Fee $ • i r ermit Fee $ s�cMusE G �E Other Permit Fee $ *er aonnection Fee $ Water Coro e16}rFee $ Building Inspector n r� �+ J Div. Public Works PERMIT NO. l APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. I/PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE /•7 OWNER'S ADDRESS �y� � � BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �y SPAN _ /wiLcl(a?.5�1!., ! acs!iRrti A 4. AV -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW - SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY I IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 00DD. Co PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. 1 PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILE t/ F Z- "� a BOARD OF HEALTH GNATURE OF OWNER ORA THORIZED AGENT OWNER TEL k UUN IN. ILL.t6Ax=—zLv— FEE �S CONTR. LIC. PLANNING BOARD PERMIT GRANTED clld� 2- IMOA-R—DOF SELECTMEN sutLD G iNSPBCTOR 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 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE _ B t 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ 1/1 V2 3/ FIN. ATTIC AREA _ NO BM T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDI'J'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME 1 BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME , CONC. OR CINDER BLK. p STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3BATH (3 FIX) GAMBRELMANSARD TOILET RM. (2 FIX.( _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 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 OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING I Location No. Date �L *Tot TOWN TOWN OF NORTH ANDOVER u+ p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s�cMU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL lam= uilding Inspector 5089 Div. Public Works t ' �� f Wu L_ '1d9 VUA6� U ��i� �'C�tl�� � ��o���:ii`J���J�3�t^�r�"" ,�:- a uubd own of � oAndover 11% �.d� , . URIVEWAY ENTRY PERMITer Mass.Aw BOARD OF HEALTH PERMIT . T L.0 f* � � ••••••THIS CERTIFIES THA ` 4...•••......••••••••••. BUILDING INSPECTOR , ,�l/. .S T' haspermission to erect ..... '.......•.••• buildings on . . .... ... . .. . . ... . ... ................ Rough Chimney tobe occupied as. .....................................:.................................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this P PERMIT EXPIRES 1 6 M N T H S ELECTRICAL INSPECTOR Rough UNLESS CONS UCTI S RTS Service Final .. ....................... .. .................... BUILDING R GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector • I NORTH / 3 of "� OF;LEES OF: . o? Town of 120 Main Street APPEALS :.• `;:' NORTH ANDOVER North Andover, i 13lllla�WCi ;� =^�e Mi1s5F1chu5( tts U 1845 CONST IWATION ss "" DIVISION OF ((i 17) HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, UIRECI.OR I In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number f is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Pert it Applicant 7 `! J ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.