Loading...
HomeMy WebLinkAboutMiscellaneous - 19 SECOND STREET 4/30/2018 -19 SECOND STREET 1 J 210/030.0-0036-0000.0 CA, t ��j i f TOWN OF NORTH ANDOVER NORTH 1 y Office of the Building Department 3= b`STfLiC"b'.b�po� Community Development and Services p 1600 Osgood Street *moo * North Andover Massachusetts 01845 4 •� • ' �9SSACHUS t�9 Telephone(978)688-9545 FAX(978)688-9542 November 24, 2014 June Thornton 22 School Street North Andover MA 01845 RE: 19 Second Street On November 24th, 2014 the Building, Electrical, and Plumbing Inspectors walked through 19 Second Street. The following lists of violations were observed: The roofs of all four(4)units need structural repairs and new shingles (NOT 3 TAB) on the front, rear, and rear additions. Numerous holes and deterioration was observed. All four(4) chimneys need rebuilding/repointing from the roof up with new flashing. Heavy tar was observed around chimneys covering existing flashing. Holes were observed in the chimney around flue pipe. Chimney appears to be an unlined brick structure with two (2) gas appliances vented into it. The chimney will not be adequate if updating to new energy efficient appliances. Defective wiring was observed, extension cords were prominent in several areas, water was observed in light fixtures. Wiring needs evaluation and updating. Heating was nonexistent on second floor. No heat source was observed in bedrooms or bathroom. Present heat source is a single floor furnace. No heat source was observed in kitchen area. Brian Leathe �b-V--� Local Building Inspector. p ,fes Z� i 1 7 f: {y wk,. w y. 1 a { Y'' r w r ; I L 4 � Yom, G t 4 EE f 4 1 � " 5 e� ` l s r �Y I" { 4 w F Y � � r� t � } 1 i Y -•74 1 h, :*ir5`LL Wit.,M Zm 1 1 I RA x t r S "1 r` a � x c., 3 F .. It r. 07" ro ° . : v } tq N tN r �_— } "1 n< � y � w �s 3 i Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Insured: Paul & June Thornton Property Address: 19-25 Second Street Policy Number: FP1741258 Date/Cause of Loss: 10/15/2014, Water/Rain Seepage File or Claim Number: 30684-P Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 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. Pat Garrett 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. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Deems, Maura From: Grant, Michele Sent: Thursday,July 09, 2015 1:18 PM To: 'J Jackson' Cc: Deems, Maura Subject: RE: 19 second st Thank you -----Original Message----- From:J Jackson [mailto:mamai 4@yahoo.coml Sent:Thursday,July 09, 2015 1:09 PM To: Grant, Michele Subject: 19 second st FYI, they are here putting in the electric for the baseboards in the room that needs heat.The fixed the light In the hall yesterday. Sent from my Whone Date.. NORT/y 3? ; ` TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING r ss,CMU This certifies that ..... ,l - ,1. .�!./................ . -! 1..G...... has permission to perform .......^ LU! ...............��`1i ...z.G....................... wiring in the building of...............�. �!�'j�,i V........................................................ at ....//.....1.�,�'......5. .�*��.......,5 ,.,./�............. ............North Andover,Mass. 4 Fee/.Z ...Lic.No.G b <-5?....... '. ! ! .� .......... ELECTRICAL INSPECTOIt� Checkit I Z 6 3 Commonwealth of Massachusetts Official Use Only Permit No. o Department of Fire Services -o—y 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 Code(MEC)),,527 CMR 12.00 (PLEASE PRINT INMK OR TYPE ALL INFORMATION) Date: a0t-,�r City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inten'on to perform the electrical work described below. Location(Street&Number) j 7 SePG'd Ad -' T Owner or TenantylA E ` fWItA kiLJ Telephone No. Owner's Address Ig .SG G Ny #Da)tl A4,4 _ Is this permit in conjunction with a building permit? _ Yes � No ❑ (Check Appropriate Box) Purpose of Building /�51 ¢µC C ( liia t61 fy) Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:l iylht S�Co �- /~Kt ,0V e 7� Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Wo.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig ting y rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burgers No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number TonsKW No.of Self-Contained Totals: "'" "" """"' ...""""............ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs FNo.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 Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ©BOND ❑ OTHER ❑ (Specify:) I certify,under the sins and penalties of erjury,that the information on this application is true and complete. FIRM NAME: . itJ �-- t,S �C LIC.NO.:A09p `14 Licensee: r 5 / ,ru&I e Signat a LIC.NO.: (If applicab e,ente ggxempt"in the license amber line.) Bus.Tel.No.:�&� Address: "7 L o�Sk9pG� � No- 4g4 !V(f{ *Per M.G.L c. 147,s.51-61,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 PERMIT FEE. � Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the , Q 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 ' 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[E Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: 14 Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors C m ts: Inspectors Signature: Date: FINAL INSPE ION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: / % S DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 0 The Commonwealth of Massachusetts f Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Wei/-YGN Address: G{rruJ00�4 :. City/State/Zip;,/(1()- /-F"d oue/` '0"'1 Phone#: 7F/-,q9V-7.9W Ar�youa ployer?Check the appropriate box: Type of project(required): 1. ployer with t' employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 [—]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.F�J.Electrlcal repairs Or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Wny,applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. A 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.#: C Expiration Date: Job Site Address: `::n J �e�6 t1 Gf Sl City/State/Zip:/VO- A4 Ow !'K"f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rti y nd to ns d pey& 'es ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: ZV- &Y- ?f Y,4 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#: Q 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'compensation insurance. If an LLC or LLP does have 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 1 be returned to the city or town that fhe application for the permit or license is being requested,not the Department of 1 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 burn leaves etc.)said person is NOT required to complete this affidavit. 4 The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia NORTH ANDOVER BOARD OF HEALTH ORDER LETTER Issued under the provisions of the State Sanitary Code, Chapter 11, Minimum Standards of Fitness for Human Habitation, 105 CMR 410.000. Date: November 1, 2001 To Owner of Record: Property Location: June Thornton 22 School Street 19 Second Street North Andover, MA 01845 No. Andover, MA An authorized inspection was made of your property at the above address by North Andover Health Department personnel on November 1, 2001. This inspection revealed violations of certain regulations of the State Sanitary Code, Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct these violations within the time allotted on the enclosed form. Failure to comply within the allotted time period may result in a criminal complaint against you in the Lawrence District Court and may result in an assessment of a fine. You have the right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven(7) days from the receipt of this order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this order should be modified or withdrawn. All affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. You may be represented by an attorney. You also have the right to inspect and obtain copies of all relevant records concerning the matter to be heard. Sandra Starr, R. S., C.H.O. Public Health Director D E C E NOV 1 5 BUILDING DEQ' VIOLATIONS TO BE CORRECTED NO LATER THAN SEVEN (7) DAYS FROM RECEIPT OF THIS ORDER LETTER: VIOLATION REGULATION REINSPECTION 1. Ceiling panels over sink show water 410.500 stains from leak. j • Water damage is apparent around bathtub on second floor—floor is spongy,which i indicates possible rot. - Eve ryowner shall maintain ...floors ..ceilings free from chronic dampness...in good repair and in every way fit for the use intended. 2. Stair rail going to second floor is loose 410.503 - The owner shall provide a safe handrail for every stairway that is used or intended for i use by the occupants. 3. Walls above bathtub are breaking down, 410.504 cracked and bare surface in spots. - The wall areas above built-in bathtubs... shall be covered by a smooth, noncorrosive, nonabsorbent waterproof material to a height of not less than six feet. 4. Back porch appears to be connected to 410.500 &452 dwelling by a single nail/bolt and is un painted and not otherwise sealed. 5. Occupant complaint about the frequency 410.351 of bulb burnouts and explosions. - The owner shall install in accordance with accepted ....electrical wiring standards, and shall maintain free from..,defects the following: (A) ...all electrical fixtures, outlets and wiring. This report has been forwarded for action to the electrical inspector and the building inspector. Also, included is an informational form on the "Legal Remedies for Tenants of Residential Housing." Cc: Tenant Property owner BOH Electrical Inspector Building Inspector File c 1 Legal Remedies for Tenants of Residential Housing THE FOLLOWING IS A.BRIEF SUMMARY OF SOME OF THE LEGAL REMEDIES TENANTS MAY USE IN ORDER TO GET HOUSING CODE VIOLATIONS CORRECTED. I. Rent Withholding(General Laws Chapter 239 Section 8A) If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: A. You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materi- ally impair your health or safety and that your landlord knew about the violations before you were behind in your rent. B. You did not cause the violations and they can be repaired while you continue to live in the building. C. You are prepared to pay any portion of the rent into court if a judge orders you to pay it. (For this it is best to put the rent money aside in a safe place.) 2. Repair and Deduct(General Laws Chapter 1 I 1 Section 127L). The law sometimes allows you to use your rent money to make the repairs yourself. If your local code enforcement agency certifies that there are code violations which endanger or materially impair your health,safety or well-being and your landlord has received written notice of the violations, you may be able to use this remedy. If the owner fails to begin necessary repairs(or to enter into a written contract to have them made)within five days after notice or to complete repairs within 14 days after notice you can use up to four months'rent in any year to make the repairs. 3. Retaliatory Rent Increases or Evictions Prohibited(General Laws Chapter 186,Section 18 and Chapter 239 Section 2A). The owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owner raises your rent or tries to evict within six months after you have made the complaint he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages if he or she tries this. 4. Rent Receivership(General Laws Chapter 1 I 1 Sections 127C-H). The occupants and/or the board of health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner.The court may then appoint a"receiver"who may spend as much of the rent money as is needed to correct the violation.The re- ceiver is not subject to a spending limitation of four months'rent. 5. Breach of Warranty of Habitability. You may be entitled to sue your landlord to have all or some of your rent returned if your dwelling unit does not meet minimum stand- ards of habitability. 6. Unfair and Deceptive Practices(General Laws Chapter 93A). Renting an apartment with code violations is a violation of the consumer protection act and regulations for which you may sue an owner. THE INFORMATION PRESENTED ABOVE IS ONLY A SUMMARY OF THE LAW, BEFORE YOU DECIDE TO WITHHOLD YOUR RENT OR TAKE ANY OTHER LEGAL ACTION,IT IS ADVISABLE THAT YOU CONSULT AN ATTORNEY. IF YOU CAN- NOT AFFORD TO CONSULT AN ATTORNEY,YOU SHOULD CONTACT THE NEAREST LEGAL SERVICES OFFICE WHICH 1S: (NAME) (TELEPHONE NUMBER) (ADDRESS) FORM 11 HOBBS&WARREN,INC. NOV.1979 Location No. �S Date - 7_a r NORTH TOWN OF NORTH ANDOVER + Certificate of Occupancy $ �M�S Building/Frame Permit Fee $ S `n Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ /75- Check 7SCheck # my � `y r Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING 'y 777 -77 7. BUILDING PERMIT NUMBER. DATE ISSUED: ic SIGNATURE: Building Commissioner/1for of Buildings Date Z SECTION i-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: t % DQ � /C n Number Parcel Number p 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 ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record � ra i�v Z ,e T/10,�x.) ate 1,9 Avg Name(Print) ' .� Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone .QOECTION 3-CONSTRUCTION SERVICES 90 -3.1 Licensed Construction Supervisor: Not Applicable ❑ N CD Licensed Construction Supervisor: .� // J / /a O WA)/C7,,,.) Z? License Numbermn Address / ✓L /��!/G / w700 ic Expiration Date' Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v AAS Company Name rn Registration Number r Address rM �/ as Expiration Date ^� Signature Telephone Y I 4V 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.......El No.......❑ SECTION 5 Description of Proposed Work check all applicable) 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 OFFICIAf USE OINLY Completed by permit applicant 1. Building AO O 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction �l � 3 Plumbing Building Permit fee tel 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 AGfAT OR CONTRACTOk APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authoriz to act on My behalf,in n e work authorized by this building permit application. Signa e 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/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 ND 3 RD SPAN DrWNSIONS OF SILLS DMIENSIONS OF POSTS DRALNSIONS 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 Town of North Andover NORTH O Si%-to 16 �. rt O .a� yc ' ' .1''• ° O Building Department f°- 27 Charles Street North Andover Massachusetts 01845 : .^ (978 688-9545 Fax (978 688-9542 "� 9SSAGHU`��'� DEBRIS DISPOSAL FORM In accordance with theons of MGL c 40 s 54, and a condition of W Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location J ignature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. NORTIy q Town of Andover No.04"I -A dover, Mass. COCHICHEWICK �t AORATE0 P? `� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..7�4....wI � BUILDING INSPECTOR :.. Foundation has permission to ...�.N.L? .��........ buildings on ....... 1.9.....S.r,Cawet $f-- I Rough to be occupied as..T.P1,AC.M4AWA+ .tolodU46so .................................................................. chimney provided that the person accepting this permit 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. O P 47S` PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARELECTRICAL INSPECTOR S Rough t .... Service . ................ ........ .............. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Location / / \. P CUA-)d S t- No. -313 Date A 5,h/r 401tT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ s r Building/Frame Permit Fee $ a� Foundation Permit Fee $ SJwCNUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ d� Building Inspector Div. Public Works PERMIT NO. 313 _APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA NIAPNO.a v LOTNO. � 2. RECORDOFOWNERSUIP 0) 'o ON DATE BOOK PAG ' +. a SW y, %ONE SUB DIV. LOT NO. 1 v $ b LOCATION PURPOSE OF BUILDING c \ � O\\'NF.R'S NA11IE NO.OF STORIES SIZE J n O\\'NER'SADDRESS L.-QD be BASEMENT OR SLAB l.. � 2ND 3RD � ARCHITECT'S NAME SIZE OF FLOOR TIMBERS BUILDER'S NAME SPAN - DISTANCE TO NF.ARESI'BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE 1 HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x s IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND \PILI.BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER D IS BUILDING CONNECTED TO NATURAL GAS LINE 1NS1•IICTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST nn, no P\GF 1 FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM iCLFCTRIC NIA-ERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. A'rr:\CDFD(,RAGES MUST CONFORM(TO STATE FIRE REGl1LATIONS 4. APPROVED BY: G� PLANS NIIIST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TEI.# ` CONTR.TEL4 N-4 �!U CONTRAAC# SIGNATURE OF OWNER OR AUTHORIZED AGENT r i FLE !\9 JUL - 9 PFRMITGRANTED Cy Revised-5/s/99 jN1 - _ FORM U - LOT RELEASE FORM INSTF�UCTIONS: 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 V 1f\� , -D c`�, a 1.� _ PHONE_ �J / LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) " STREET ` S(ZCOr� ��- 11.4ST. NUMBER_ ** * * *********** *************OFFICIAL USE ONLY************ **************** *** RECO !!5TIONS OF TO AGENTS: CONSERVATION ADMINISTRAT R DATE APPROVED DATE REJECTED— COMMENTS- TOWN EJECTEDCOMMENTSTOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS a FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS . DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 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 c3/-3 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: r 4 J v < - lmdca lr i7rt n (Location of Faci ' f Signature of 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 l - - - The Commonwealth of Massachusetts j Department of Industrial Accidents . Office of Investigations -Boston, Mass. 02111 .H ora Workers' Compensation Insurance Affidavit Name Please Print �1 Name' Loc3tlon: c;)e;� is `moo C;tv a U Cz_-� Phone In I am a homeowner performing 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. a Comoanv name: Address City: Phcne T Insurance Co. Policy Comoanv name: Address City: Phone Insurance Co. Policy m Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,5C0.00 andlor one years'imprisonment as weil as civii penalties in the form c`a STOP WORK ORCE=and a rine cr(3100.00) a day against me. I A, understand that a copy cf this statement may be forwarded to the Office of Invesugations of the DIA for coverage vernrication. I do hereby certiry under theains and penalties of perjury that the information provided above is true and correct. 1' Sionature Print name _� y n Sz C) r v _�o n Phone Offical use only do not write in this area to be completed by ciry or town cfnciaf '/ 3 13 City cr Tcwn /V 0• 14N/Uddi/`e//�( \\ P=rmitl' (of q Building Dept ❑Check if immediate response is required ❑ Licensing Board Selectman's Office Contac:person: Rhone ❑ Health Department Other F �ORT1y Town of 0 D ®`Ver No. 313 � - coc �o A , EQ dover, Mass., 7 / ORATED pP� BOARD OF HEALTH Food/Kitchen PERMIT T Septic System 'Own�v ^ +,0 /V BUILDING INSPECTOR THIS CERTIFIES THAT............................................................................... ....................................................... ........ Foundation has permission to erect.../v��...�............. buildings on .........../...�� ....,,.....�.. O ti Rough g to be occupied as.... .r.. ........... N........ a�� ../.. .... .�✓.r..//��y 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 this Permit. Rough !" 3 O PERMIT EXPIRES IN 6 MONTHS Final P 3 6 UNLESS CONSTRUCTI NST TS ELECTRICAL INSPECTOR t Rough D ......................................................vlfr , Service Repro *& BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.