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Home My WebLink AboutMiscellaneous - 1881 GREAT POND ROAD 4/30/2018 (2)North Andover MIMAP May 23, 2017 035.0-0072 035.0-0073 035.0-0074 148' 035.0-0076 035.0-0077 035.0-0078 /035.0-0094 #45158' 156' 153' 1S6' 159' 132 035.0-0087 035.0-0093 #99 #111 #123 #53 #63 #75 #87 035.0-0092 035.0-0091 035.0-0090 035.0-0089 035.0-0086 035.0-0088 MVPC Ba 0 Municipal Boundary Rail Line Interstates Interstate — Major Road — Roads i r Easements ❑ Parcels 0 Hydrographic Features — Streams Wetlands a Exempt Lands 1" = 179 ft #1895 035.0-0004 035.0-0038 035.0-0051 #1881 141857 035.0-0057 #1849 —156' ,1 152. 25 ' Lake Cochichewick #1815 #1831 100' --`_: 119' . Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack 035'.0=0027•.. Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data • ::._ .flu :::•_::•.� ..>sJc<.:::__ map for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING ♦ THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY w # OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT c ♦ 035.0-0058, THIS INFORMATION ju ??lu 035.0-0005 35.0-0005 :=�•:•� • #1915 .r:.: -006:1<035.0 ....... 0 35.0-0108 AC: -- 144' .......... .._��r;'=- ...__ :: •y..,:::� •,i, 300' 'U35 0 0021}"=_�••.=•-• MVPC Ba 0 Municipal Boundary Rail Line Interstates Interstate — Major Road — Roads i r Easements ❑ Parcels 0 Hydrographic Features — Streams Wetlands a Exempt Lands 1" = 179 ft #1895 035.0-0004 035.0-0038 035.0-0051 #1881 141857 035.0-0057 #1849 —156' ,1 152. 25 ' Lake Cochichewick #1815 #1831 100' --`_: 119' . Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack f V&ORTM qValley O Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data ,'1110 �r ' ��a 00 provided by the Executive Office of Environmental Affaim/MassGIS. The information depicted on this is C A map for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING ♦ THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY w # OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT c ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION North Andover . . May 23, 2017 tied`°... ._,— , ...;-:'-s��: t.r€_»�il�isu3ill'e�`^ �t.,�ti�h:rv��•M,a r,.��;.+E'i�-��-`�' tF. .','.. �, ti l4 fl '.,. v v. e. VJJ: V -VV iJ}�YJ�+.�V/LYy�'� ^�'�"_•"`�,^�� .�.Y. ,• 035.0-0094 � � ur.-- �.. e-'-- _ � - _ ----�____' _..-. —_'=—'--_----�, o I� a -d n a ( x `Al Ty 035.0-0093 gar '_'�` #99 #111' #123 #53 k r 703 035 0-0091 VZ dil �.. $ .. Y `' !, a r.+�` �•k .'�,�`• � ,,,, ry A .t # 1915 035.0- o05Y1' "`7 I• .., Y;;`' •, § Tf ,� , 035°0-0057 I �` t R #1849 1 �"• ' v ��"""'� t �;;: s� � � a$ +rrc•.. a t a -t i � 'd`' „�•. #4831 *i � , L. ..` 4 133'_ - -0021 - .�... ,,. . 0-0022 �� 0 MVPC Bo Interstates = Interstate _ - Horizontal Datum: MA Staleplane Coordinate System, Datum NAD83, — Major Road Meters Data Sources: The data for this map was produced by Merimack — Roads pORTH 4 Valley Planning Commission (MVPC) using data provided by the Town of O t� to 1 North Andover. Additional data provided by the Executive Office of i Easements ? t -r��s 00 Environmental Affaim/MassGIS. The information depicted on this map is 0 Parcels 10-3. A for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING M • THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY f t ^ # OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT c m� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 1" = 179 ft »{�. It W C b 0 O M c w 0 zW O V) Q F O CD O Q N N x U `n Q W a O N O O O O 7 6f1 M N fA N O O O O 7 69 M N 69 FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements.. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE LOCATION: Assessor's Map Number 0,35 PARCELGS/ SUBDIVISION LOT (S) STREET /,01r ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS Ana1;c-a„+ r"000sQs werK above. J VA 44 E P--C.W G -b SEPTIC INSPECTOR -HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97Im • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING y BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/12ifor of 13 uildings Date SECTION 1- SITE INFORMATION 1.1 Property Addr 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUII.DING SETBACKS ft Front Yard Side Yard Rear Yard Regaired Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 ,Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record SIi'/o� /'y�;�/jN� E Rd Name (Print) Address for Service ` a tgna re Telephone 01 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: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ou M z O O pz 1�1_ oo O on ic M r r z ^ Q SECTION 4 - WORKERS COMPENSATION (AG.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 licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: '6004.- ---w Z & 40k 0*44 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Z}FCIL.Y Completed by permit applicant 1. Building (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 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ' as Owner/Authorized Agent of subject property Hereby authorize 4 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/A ient Date welymms 11100105 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1-JEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE December 11, 2002 Mr. Robert Nicetta Building Inspector 27 Charles Street North Andover, MA 4'1845 Re: Addition to existing. structure Dear Bob: Please find enclosed a rough draft of an addition my husband and I would like to proceed with in the very near future. My understanding is you are the first step in this process. I would appreciate you contacting me at your earliest possible convenience to discuss the possibility of this endeavor. Yours truly, Si one & Bob Marchand 1881 Great Pond Road North Andover, MA 01845 978-683-9322 H O N K ro w CT �u o (D o m ro • • 10 10 't] O C H m Za rn mrom n H O ro mro0 �� ro Gd > H w o�q�ro CO[7H0 rorort�ro o n co N O Z O U) H H co 00 ro .. .. w i C• rt N H r G O ro 0 rn �n x 10 0 0 Fl rt H t7 '• a 51 n m m o N m N w N O N N O N F' PLOT PLAN 1881 Gmat Pond Road No. Andover, Mass.. Buyer: Marchand Scale: 1"-b0' N.B.- Do not use offsets for establishing lot lines for the erection of fences, 1•ralls, hedges, . etc. NIF 5TEFAN0WICZ �4VEP, k"A ri /V,, F P. D. 800k 11.1m, F'AGE 5-,58) I hereIV cert]-f'y that the building on this property is located as shoran on plan and complies -rith the 9ui.lding and. Zoning Laws of the Town of ado. Andover. CYR EXIIIEERIX SERVICES, I ;C. 300 CANAL STREET LAWREI CE, MASSACHUSETTS Date: June 1, 1979 NOTE: Tltt o 10 not a ti rvey and is to be uoeccl for mortgage pu-rpoves only. 0 34.5 37.8' to lot line 26.5' auii Jol of cL•Z£ CCt O O a Oo P � P cl c N ,a N L� en ON O O 00 P � �P O P JP II II II c�c � rr1�� vl !Yi l 1� 0. ra l I� Simone_T,:..Marchcihd (mviae), M'v V'l lk.%o 1. marchand., Bln: NONE ... ...... .. m c a r� han e Si,umone T n"'. rchand(unvia- ck e HONT,p i ti • �9SSACHUS ��g I Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978T688-9545 F6478 68°8=942" Keg uest: Date: Please be advised thatfter review of y DENIED for the following Zoning BylaH v -....__.-ie our Application and Plans that your Application is The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be'based on verbal explanations by the applicant nor shall such verbal explanations by.the applicant serve to provide definitive answers to the'above reasons forDENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached, document titled "Plan Review Narrative" shall be attached hereto and incorporated. herein by reference. The building department;will retain all,.plans artd.documentation for the above file. Yo must file a new building permit application form'and begin the permitting, process. . � f� .� ./Building Department -Official Signature Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: t t u. Plan Review Narrative The following narrative is provided to further explaan,thereasons for deii for the application% permit for the property indicated on the reverse side: , ` Referred, To: Conservation Planning Other Board nent of Public DEPT Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover MA. 01845 CH i ssA „S� ; .Phone 7i3 0-W&F 978-68 =9942 .__Street 8 AlIcant 5 rn� �u`� A P ) h ti i ,h Requet." 1UN Date: (A,, tulS�. I—._c Please be advised that after review of your Application and Plans,that.your Application is DENIED for thejollowinq;Zoning.Bylawrlreasoit"s: The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations.by the,applicant-serve to - provide defimtive.answers to the above reasons for DENIAL.Any iriacciiraaes,: misleading information, or other subsequent chanes to the information g submitted by the applicant shall be grounds for this review to be voided at the discretion of the ttached document titled "Plan Review Narrative" shall be attached hereto and Inco" "orated; he Building Department The al be by reference. The building department will;retain,all4plans and documentation for the apove file. You' must fie a new building permit application form and begin the permitting Process.-,`_ t ./(3uilding Department Official Signature 9 Application Received Application Denied Denial Sent : If Faxed Phone Number/Date: N Plan Review Narrative5 J4, The following narrative is provided to further 6xplatnAh reasonslor denial ,'6_Elie-application%"~ permit for the property indicated on the reverse side: Date ... '....�?�.-.: /4/....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........�r' .�!.....j[................ �../�...<-:.�......................................... has permission to perform ..e ...,.:... z.1�4...�/...........:.rc-. v� wiring in the building of,,,.,,.,,, /:gip r, v .............................................. Z.— North Andover, Mas . Fee.................................. -- Fee ..:....:............. Lic. No..FL.I Z................. ........ ........................ .........•,`�..:!!1 f � ELECTRICALINSPECTOR�� Check# X3%3 �--- 1257.7 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. _ / Z S—% % Occupancy and Fee Checked [Rev. 1/071 (leave blank 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 NK OR TYPE ALL INFORMATION) Date: �`— sz — / 6f City or Town of. NORTH ANDOVER To the Inspector of Wi-r By this application the undersigned gives notice of his or her intention to perfo the ctrical work scribed below. Location (Street & Number) Owner or Tenant S�� ,y, /M 4,tC k AJ Telephone No. Owner's Address I Is this permit in conjunction with a buil ng permit;. Yes ❑ No � (Check Appropriate Box) Purpose of Building_ i V E �� ixr Utility Authorization No. - Existing Service ZUe Amps - �" Volts Overhead 9— 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: Cnvn»lotin-i n{Ilio {n1lnv,iv r I 1 I.- , A. .47-.4L- r.. ., „f'7d1.1. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans <,-p—, w ..., No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. arrid. Ao. o mergency Lighting Battery 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 Initiating Devices No. of Ranges No. of Air Cond.. Total Tons No. of Alerting Devices g No, of Waste Disposers Heat Pump Totals: Number .Tons KW No. of Self -Contained Detection/AlertinLy Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No, of Water KW Heaters Heating Appliances KW No. of No. of Signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 97res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: $7,'L% / 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 cov,e_ra�ge is '>ce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE ❑ OTHER ❑ (Specify:) I certify, tinder the pains and penalties o erjury, Z 11e in ntation on this application is true and complete. FIRM NAME: � LIC. NO.: Licensee: Signatur LTC. NO.:%�� (If applicable, e er "exempt" in the license number line) 7- Bus. Tel. No.: Address: 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 Signature Telephone No. PERMIT FEE. $ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an JV14 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the ' notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Co ts: VE_ Inspectors Signature: Date: U DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com y The Commonwealth of Massachusetts Department of IndustriqlAccidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): 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. F1 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. 7• ❑ Remodeling ship and'have no employees These sub -contractors have 8. [❑ Demolition working for me in any capacity. workers' comp. insurance. 9. [J Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. ❑Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] i employees. [No workers' 13.❑ Other comp, insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConttactors 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. Lie. Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). i 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 cert under the pains and penalties ofperjury that the information provided above is true and correct. Simature: Date: Phone #: Offccial 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. PIumbing Inspector 6. Other - - Contact Person: Phone M, Informati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a 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 producedacceptable 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials f --N 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 burn 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 600 Washington Stxeet Boston, MA 02111 Tel # 617-727-4900 ext 406 or 1-877-NI.ASSAFE Revised 5-26-05 Fax # 617-727-7749 ww.wass,govfdia Date ......` TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....!...�.`/ . G.... ...... has permission to per ........ �.U�L �cus........... �... wiring in the building of ........... M ..�KC.:qe� i.) ............................... at ....... ��?:!? . f.(...:... ,North Andover, Mass. Fee . q.:5 ............. Lic. No. ............. ....... ELECTRICAL INSPE R ` Check N 8532 l,omanonurealth o f ///a .CL6el6 Official lUUse +Only aUe artme►u; o B �dre �ervicee Permit No. P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC), 27 CMR 12.00 ((PLEASE PRINT IN INK OR TY E ALL INFORMATION) bate: �?�, �g City or Town of: Iyy A "& _ 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) 1!B?-)%Oaeftr ?bND 7-0Alb- Owner or Tenant 61 P4,04a P'1dVU of APj*0 Telephone No. Owner's Address Is this permit in conjun'Aoonn with a building permit? Yes ❑ No ®-- (Check Appropriate Bog) Purpose of Building is Utility Authorization No. '94. ,Q:M 2, Existing Service ZOO Amps JLO NO Volts Overhead R Undgrd ❑ No. of Meters I_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity No. of Recessed Luminaires addle No. of Ceil: Sus . F P (Paddle o ota Trransformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ arnd. d. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners N-o.-ol Detection an Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers P eat um Totals um.., er Tons . ..................... o. o e - ontame Detection/Alerting Devices No. of Dishwashers S ace/Area Beating KW P g local ❑ municipal❑ Omer Cyonnection No. of Dryers Heating Appliances KW Security Devices or Equivalent No. of Water KW No. o o. of Data Wiring: Heaters Signs - Ballasts No. of Devices or Equivans lent No. Hydromassage Bathtubs No. of Motors Total HP a No. of Devices oor Equivalent OTHER: Attach additional detail ij desired. or as required by the Inspector of wires. w Estimated Value f Electrical Work: (When required by municipal policy.) Work to Start: �+ 0 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 cove�asq is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the FIRM NAME: I Licensee: (Ifapplicabl& enter ` Address: ROU and penalties of perjury, that the information on this application is true and complete. iLd L IrZ L 111C. NO.: AOWS__ i''rJtyy Signature LIC. NO.: A040!9 "' in the licen h number line.) Bus. Tel. No.: -�Sa W -L %J%bX1 A&g *hi- 03t -) 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)[ -1 owner 0 owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ,� +, A ,. ..� . �.. _.... .� !�~ � r ... .. ... .. �.. _. r.. .. .. .. .... .. ... _ I ... .t � '�A V � . �r .... }} ( . .. ... _�. .. .... �r . 3. �., .__..... � � � � n r . � � � L _ � .� � . " � ! ! � t'. ' .. � ` r F :J . .. .... .. ,. .. ... ... .. _. ., .. t.. � ... _ .. _ .,. � _ .. .. , ;P.,r M The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 _q� www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:1��,��,f�/ % -Phone #: Are you an employer? Check the appropriate box: 1. E� 1 am a employer with vPr.o 4. ❑ 1 am a general contractor and i employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] ' employees. [No workers' comp. insurance required.] Type of project (required): b. ❑ New construction 7. eRemodeling S. ❑ Demolition 9. ❑ Building addition 10.EJ"Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.7 Roof repairs 13.❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new atTidavit indicating such. 'Contractors that check this box must attached in 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: r Policy or Self -ins. Lic. i#: /.'� .. y ��%/ %i`% Expiration Date: GJ'/� : Z% T / Job Site Address: i� % %'..C�� o �� City/State/Zip:: C ;,`:� ..r,� ,IX:2 � T_ 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 1vlGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisomnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date: 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. Hoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Location No: Date' �oRTh TOWN OF NORTH ANDOVER 4ge ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 1617 a i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: E DATE ISSUED: L SIGNATURE: Building Commissioner ctor of Buildin2 Date r SECTION 1- CiTF TIVIMDMATTl1N � i J�%>•� � �L r j L0nmg lltslnd Proposed Use 1.6 BUILDING SETBACKS (ft) Front Yard Required I Provide 1.2 Assessors Map and Parcel Number: Map Number Parcel Num er 1.4 Property Lot Area (sfl Side Yard Provided Rear Yard Provided 1.7 Water Supply M.G.L.C.40. 8 54) 1.5. Flood Zone information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal , ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT 2.1 Owner off/ Record Name 6b tP 7 / I kaA �/ VJ/ 6 9 / � l' OI D / l.� o Address for Service f 93 — 9.3_,2 NO, 49L)o VLEl, Signature 2.2 Owner of Record: Name Print y SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Address for Service: Signature Telephone 3.2 Registered Home Improvement Contractor AVL ,V/;C, Company Name I -11-93- Not Applicable ❑ License Number Expiration Date Not Applicable ❑ 4 tl S-6 2 Registration Number Expiration Date t 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 a licable New Construction ❑ 1 Existing Building V I Repair(s) ❑ I Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: '�""" ' `•' S' �2�� 4- .REZOOF- I SECTION 6 - ESTIMATED CONSTRUCTION COCTc I Item Estimated Cost (Dollar) to be75 OFFICIAL USE ONLY * , C2KIeted by permit applicant A tz n' f =1xI 1. Building (a) Building Permit Fee �y D Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) s 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Q Q Check Nurnber gym%. i lviv /H V W i1 1(AU 1 nkJK1LA 11U.N 1U BE CUMYLE'J'ED W HEIN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 Oozier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 11 12A I T CA S r L C.v /y E 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 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD 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 el� 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 at: 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 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: + .5 --'CWC Fire Department Sign off: Dumpster Permit 11, /9?/ & (Location of Facility) cait Signature of Permit Applicant T �� /0'-� Date :��ite ?anvrnanu�ra�tir• a`,.: �(,i7,i;1izC'iu�,SeCfa �. Board of Building Regulations and Standards �j. = G HOME IMPROVEMENT CONTRACTOR == t s Registration: 104569 ,�,; � Expiration: 71142006 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & David Castricone 7 Hillside Road Bmdord, MA 01921 Administrator CA m m m m x CA CO) S ♦� e F v■ y C � � d CA CM) 'O O CD C7 Z y CL �• O CL CO) O 0 o CD v CD O V CD CD O CD ccl C13 C CD y. FL, C2 y �• O CCD � v CA O 10 CD z O CD C CD 0 C ? O 0 cr 7 :2 CO m A CL col O 01 d� P= nw m m d. =r Ot .-I p m 1N O "= O m co O H� C09 = O -0 CL O =r O m y w M y CLW La gym: H 1 m: co, O O ; oC: mo CA CD Wim: ?m H CD o. =co o, m ate: b b a El 2 o c D ro o b n w o Crl r N o rX C) ro z EL n 7z aGc o z CL 0cpxto z r C) CA � ^ o n. n o x z v7 2) rA 1 1 z O No CM 0=3 0 9 0 c PL0_T P.LAI; r 1381 Great Pond Road I3o. Ar4overlMan. Scale: 111-60, Buyer: Marchand Do not use offsets N �� for establishing lot lines for the erection of fences, t-ralls, hedges, etc. 'VIF STEFAN0WlCZ 11 Z 2� 14 Date: June 1, 197 D f M s�o 0 may. a 0. / j t_ w r r -4 VERA',, 800K. //,1M, PA 5-39 ) I hex-ebY c6 tj_.fi'y that the building on this . property is locate(' as aho"M on plan and complies ,Tith the BBI-Iding and Zoning Lac;Ts of the Toi,;n of +o. Andover. CYR EIZIMERLIG SERVICES, I C. X00 CABAL STREET LAWR.EI;CE, MASSACHUSETTS 0 110TE: Thi: i o not a survey and is to be uoc (I fox• mortgage purposes only. Zoning Bylaw Denial s Town Of North Andover Building Department �N�s 27 Charles St. North Andover, MA. 01845 �7 Phone`$=688-9545,ax978 688=��42 Street, vg g (D,../c A Ficant �mow,�,k Arc �!/ k-� 4 Date l..a 1 '� '� }. ,O Please;be`advised that after review of your Application and Plans that,your Application is DENIED for the following, Zo ing Bylaw reasons:. Zoning - Item-. Notes Item Notes q Lot`Area , 1 ,Lot area Insufficient 1, Frontage.,Insufficient . 2` LottAreaPreeistmg... X _. 2 Frontage Complies 3 Lot Area Complies Preexistin irehta e g g. e.S . Insufficient, Information- 4." Insafficient Information _ _...... B Use "Allowed 5 „ ,No,access,over.Frontage _ 1 G Contiguous Building Area .`2., ,,.. .Not..Allowed,------------ • - i--` _ "InsufficientArea 3 Use Preexisting, . 2 Complies :..- 4 Special-Permit'Required 1 S .. 3 _ .. Preexisting CBA y g 5. Insufficient Information 4_., ..H Insufficientanformation C Setback - Building Height Allaetbacks comply HeigftUat6eds Maximum 2 Front insufficient 2 Complies 3 Left Side- Insufficient .. 3 Preexisting Height 4 Right Side Insufficient "Re " 4 Insufficient.lnformation, 5' ar Insufficient ' l Building Coverage 6 Preexistin _setback s 9 (1 - - _.1 _: 'Coverage"'exceeds maximum 7 Insufficient Information 2 Coverage Complies k e D Watershed - 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information _; 2 In Watershed Sj Sign 3 Lot.prior. to,1;0/24/94 1 Sign not allowed N- 4. Zone to be Determined 2 Sign Complies_ 5 Insufficient Information 3 Insufficient Information '- E Historic District _. K, Parking 1 In District review requined 1 More Parking Required 2 Not in district 2 Parking Complies 4 h Plan Review Narrative The, following narrative is provided to further explain the .,reashns for denial for the application/- ''f permit for the property indicated on the reverse side: