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HomeMy WebLinkAboutMiscellaneous - 2060 TURNPIKE STREET 4/30/2018N J Q Q �^ lI 8 N p� O O O O Date ...f'..y ................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that4,.... fl �u/75� has permission for gas installation O% • �1'� ► 11� 2 ............ .... ............................. ................ in the buildings of. ........................................................................................................ at ..-v � 0... u� N e'�� S : , North Andover, Mass. olL Fee' Lic. No...' �?� .Z... ................. ....................IA- ................................................. GAS INSPECTOR Check # 1\JC�j�i'O�13� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY. D n tie f - r1�1 __.__� MA DATE PERMIT # - I G' JOBSITEADDRESS(Z(o0 T�rnA 5f OWNER'S NAME k�nun� Ii GOWNER ADDRESS 00 j r 0 ofS _ TEf k7 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL CLEARLY NEW: d RENOVATION: E] REPLACEMENT: PLANS SUBMITTED: YES Fj NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER E:._ L:] :j -- - - 1::j E_ ---- —. CONVERSION BURNER COOK STOVE.- DIRECT VENT HEATER DRYER �. r �1 - (-- i _.._ ._ ._ _.. FIREPLACE J FRYOLATOR _ ,j FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNITOVEN POOL POOL HEATER ROOM / SPACE HEATER �Y Y. I _- -_ [-- _ I _ ROOF TOP UNIT TZST jUNIT HEATER UN ENTED ROOM HEATER WATER HEATER OTHER F-- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1060 NO Ej IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ({ BOND EJj s 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 [j AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. !)"-- 11�� PLUMBER-GASFITTER NAMES p (tea LICENSE # /b _o SIGNATURE MP M MGF El JP ® JGF 0 LPGI E-R CORPORATION ©# = PARTNERSHIP ©#= LLC []#= COMPANY NAME: _ _A,t�v _ _ _ _ ADDRESS CITY L wvY C _� STATE LED ZIP U_]TEL FAX CELL 7 3MAIL — — .� h H O O H U a Cn w O ❑ z O N❑ W � � ~ W O 0 a U w �* Z W a w cn o. a O > W w w Cl) a z a a a � U J a Q � x w H LL V) H z° 0 H U W r L7 Ch The Commonwealth of Massachusetts - -' Department of lndifstrigl Accidii�ts Office of Investigations 600 Washington. Street .Boston, NIA 02111 -www.massgov/lila Workers' Compensation Ynsurance Affidavit: Builders/Cont°actors/Electr is ians/Pliimbers Applicant Information Please Print Leg .1y /f Name(Businessiorganizaiionftdividuat): 4'asem✓ Address / P74 A4n" ( L, .9L;,j, City/State/Zip: % ,, w re�c.,P MAI— Phone #: M? -6Y3-22-22( Are you an, employer? Check the appropriate box: Type of project (required): LEI I am a employer with 4. ❑ I am a general contractor and I 6. [] New construction employees (fall and/or pari -time)* have hired the sub -contractors 2.0 I am a sola proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and`have no employees These sub -contractors have 8. [] Demolition working forme in any capacity. workers' comp. insurance. g, 0 Building addition (No workers' comp. insurance 5. ❑ We are a corporation and its Officers have exercised.their 10.❑ Electrical repairs or additions required.] of 3. Ell 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 wehave no 12.QRoo repairs insuraucerequired.] ? employees. [No workers' 13. Other comp. insurance required.] ,!Any applicartthat checks box#1 must also fill outthe section below showingtheir workers' compensation policy information. 'Homeowners who sabmitthis affidavit fadicat*T9 they tie doing all, work and then hire outside contractors must submit a new affidavit indicating such. lContractors that cheekthis 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 formy employees Below is the policy andjoh site information. Iusurance Company N Policy ## or Serf ins. Lia #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensationpolley declaration page (showing the policy number and expiration date). Failure to secure coverage as re%'edunder Section 25A ofMGL 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 ofInvestigations of the AIA for insurance coverage verification. Ido Hereby certify, rider file pa' s and pena ties o fpepjury that M0 information provided above is tree and correct. Si�natur e: Date: T7 Q 7Y- 3(06'(P �(v,(- 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 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 k . the service of another under any contract ofhire,- express or implied, oral orwritien." An employei is defined as "an individual, partnership, association, corporation or other legal entity, or anytwo or more of the Foregoing engaged in a j oint 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 notmore than three apartments and who resides therein., or the occupant of the dwelling house of another who employs persons to do maintenance, construction orrepair 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 thep formance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hXbeenpresented to the contracting authority.." Applicants Please fill out the workers' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and Mahone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to cant' workers' compensation insurance. if au LLC orLLP does have employees, apolicy 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 retumed to the city or town that the application for the permit or license is being requested, not the Department of ludusirial 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 thatthe affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of f vestigations 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. fn addition, an applicant thatmust submitmultiple permit/license applications in any given year, need only submit one afCdavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town). " A- copy of the affidavit that has b een. 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. Anew affidavit must be filled out each year. 'Where a homeowner or citizen is obtaining a license ox permit not related to any business or commercial venture a dog license orpermit 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 aid fax number: Tho CQM- oUwealth of Y'amac,.hwe"its - Depaxtment o£ZndmWal Accidents Qf e WIRVIDSfiga:&M 6bQ Wa4 gtion Boston, 42XXl. TQ1- # 617-7.2' -4900 ext 406 ox x-877-1�A.S A 1 Revised 5-26-05 Fax # 617"727'7749 Www.wagov/dia -Is Date ....... ..1. 41 ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION r9�/ A ................... This certifies that . �e ..P.�.............�........1...............(.............................. has permission for gas installation .......................................�ge-e-- .................... inthe buildings of ................ 1 �^ %.................................................................................. at ... o� O.G.Q...../... Vic+. r°:..� ...5�� ,North Andover, Mass. Fee ..:�Q....... Lic. No... Q. g�..... GASINSPECTOR Check # 6 69 0 5 1 r r J . LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER I UNVENTED ROOM HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YESONO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND F r 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 _i AGENTE-11 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true ancWccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nce ith all Pertinent vi f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , ,v/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ��/ _ MA DATE PERMIT # JOBSITE ADDRESS I~C�,0�OWNER'S NAME GOWNER ADDRESS TEL^ _ FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL EDUCATIONALI RESIDENTIAL"` CLEARLY NEW: RENOVATION: E] REPLACEMENT: PLANS SUBMITTED: YES D NOD APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER __ ) F.: - z-_ r__ -j E ::J I—J 1. - 1. . BOOSTER E::j L:] ] ::J E- – CONVERSION BURNER COOK STOVE I .., ! _ . _ .ED DIRECT VENT HEATER .�y DRYER FIREPLACE FRYOLATOR- �I FURNACE--- I L GENERATOR GRILLE INFRARED HEATER [!( H—H LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER I UNVENTED ROOM HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YESONO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND F r 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 _i AGENTE-11 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true ancWccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nce ith all Pertinent vi f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , ,v/ V1 F F U W � a rl W o a z o yF] w >- LLI~ w O IL U W �* z W � w a LU O � w w w Cl) a a w a 0cn U J E, a IL a w iii s w t- LL H O H U w C�7 C7 O a �J The Commonwealth ofMassachusetts Department of IndustriglAccidents Office of Investigations 600 Washington. Street Boston, MA. 02111 U1 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name City/State/Zip:, Are you an employer? Check the appropriate box: 1 I am a employer with 4. ❑ I 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.] Typo of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11KPlumbing repairs or additions 12.❑ Roof repairs 13.❑ Other xAny 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. tContractors 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 information. Insurance Company Name: - Policy 0 or Self -ins. Lie. Job Site compensation insurance for my employees. Below is the policy and job site City/State/Zip:. Atiach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as xequiredunder Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerootp the pains that the information provided a�ovelis tree and correct. 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. CitylTown Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other - - Phone #: rr Information and Instructiolm8 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 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-contractor(s) na' e(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 LL C 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 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 orpermit 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 Coxa moawealtla of M,9 Depaftent off dustdal .A,celdonts Office ofIntyestigati 0m 600 washiwoa Street Boston} MA. 02111 Tel, # 617-727-4900 ext 406 oz 1-877-MASSAFF, Revised 5-26-05 Fay ,# 617-727-7749 '[xFCSFS2F moon rrnrs��:i.. r � 7 2 Date. .�... J- ..... NORTH TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION A s r This certifies that ..:... �:.'�. -. ... !' �.t .�'..�.r' .... •J rl has permission for mechanical installation . f....... . in the buildings of.' . .... ............. . at :? 0..8... , North Andover, Mass. Fee..7.'>..:. Lic. No...?.. '. `.� ........... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date :1 S o�,L/ / Estimated Job Cost: 1,-( l( 3g S Plans Submitted: YES NO Business License # Business Information: Permit # Permit Fee: $ Plans Reviewed: YES NO G9 Applicant License # 3� 3 Name: 0 &A (sIcs Wt Street: City/Town: A Telephone: 9�S� `6SI -y y o 3 Property Owner / Job Location Information: Name: A ah 5 0 %&,r r\ L,Y t Street: )-0 �0 City/Town: Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family '' Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. V'- over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: 0-, Y %-o-u� , M INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes [9"'No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy H Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box , I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Progress Inspections Comments ,Y Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master -Restricted City/Town Journeyperson Signature of Licensee Permit # Fee $ Elio urn eyperson-Restricted License Number: 3_% 3 Check at www.mass.gov/dpl Inspector Signature of Permit Approval I- 1- I a 1- 1- i- I I I- r 0 e per 14- r J W J W V W F OO O u U = n1 Tr 0°' A-���>'00 oA>O=yaw sA p AQ.mpD qm r 3 O T00 O A x N m N N < Z m 2 1 0 n T ; 0 m N 0 N x D 0 EA n m p c N N z C1 D v x Ta t-+3 yZ7C -+w 0D0m min0 0�<m -D+ C3m'' TmroSy m y p N D Z N C Z O A~ x o0 x3 °nJOT A O O m„ O w N 0 3 x 0 ~ A z x f Z Z N A D Z m � A 0 x Z. D A n ~ A T A T m Z 0 X A Z 1�a O v C w a y or ", l zzzni 00005 Z Z A Z • on n Gti D D� v n Ix IZw D v w n nymoO AZZCcAOpDv A D AW N DOm a N x n n 1 0 0 0~ r N A 3 Y T 0 m m OOpO~xpA 0-+ C JOm~ .ZZZ0vZZ0 3 r O 0iwm 0 N 0r e DZ m Z 7c z D 0 0; m, g m Z ^ Z { n ~ z 0 0 U) I N ODD O 3 A m T C 11 A V 3 O A Z O m Z Z T< N A m l W C 3 t x m p v D w z ` m •i ZZ 0 mD 6 Z y A mm �n3 N m 1 w 0 Z D D Irl I I°' 0 z ' � N I IJ N I I IJ I I I 1 0 n OON ro' mCm zm .4 a0 z COX �XN ^D^-1 \I ..I w0*- p3m M -1 z.D' I(_A0 60-1 ;az0 MOE �-qN M 0 0CN F rOO 10r Ty0 r • -� z�z -� 0 =o 0 Xa n 10 to m to -n m G1 00 3 w c a z R m A 0 x. v s•. T _kM 14M o a 0 w C v w o w Q+ co w a a w W A°G uv ro w O � G ►. o A o A T _kM 14M c o : m C C ti O C H O C O : ci V 'nom CL ev ca O C ;,C O O o Y �L v C r N c� O O V r t;c oc — E •N CL V.E ca 6 O "ED `- IE c i �3 Molr N O7 ,w' V� r N O .a Cc C N C O C� cc aw � m ' y O C: O C! C c Oa N a C = O O m N O Cl Z O ev ` co CO CL • C Qcam C O ~ r0-. y CL m Vi to = O oc N E d= 1 C ci z o c3 cm co T _kM 14M Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for P rmit (below) Map and Parcel :Vg_C, Purpose of Application (check below) Ptone Num er o f ant: Single Family _ Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. V� The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per 4 Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Signature of Owner or Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit • FORM U - VERIFICATION 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 local or state law, regulations or requirements. ******************Applicant fills out this section*********�****,i{`'•�j 0� APPLICANT: l `envy i Phone �' f lff g3 LOCATION: Assessor's Map Number �CD W_ C Parcel Subdivision Lot(s) Street �5�e,.�,�y�'� �1�� �!l�� St. Number ************************Official Use Only************************ TIONS OF TOWN AGENTS: . /1 A I _ / ation Comments JAE own Planner Comments i:nistrator Food Inspectt-or-Health Septic Inspector -Health Comments Public Works Date Approved ' Date Rejected I �IA Date Approved Date Rejected Date Approved Date Rejected 02 / / At— Date Approved Z 1 Date Rejected On- - sewer/water connections ��w %%ZZ 7 - driveway permit Fire Department 4-14 Received by Building Inspector l w _ 7lZz/ g7 Date S y r. w Ln V. :s N w- m fh UC I^ - C! 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C -+- Q m L Q U3 ca N v r- �Q x B N X x x X U3 o ^' = a� M o O 03 U3 LU o 3 W E3 (D O O N � � CJJ o (� Lfl IL - L -w n (P Cc Lam► (D O m n [0 O T 3 (P C -+- Q m L Q U3 ca N v r- �Q X 0 B N X X M ?� X U3 O O � N � %U m LU 3 W :3 (D W v r- ip X 0 X v ?� W 0 O O O F N � %U m LU 3 � O � O O N � � CJJ o (� Lfl IL - L -w n (P Cc Lam► (D O m n [0 3 -U os- � X X O ?� 03 0 O O O F N � os- X X � - Q p 0 X UJ w Q3 %U m LU 3 � O � O � n o 3 (� Lfl IL - L -w n (P Di m n [0 i1 Iff x Q O O rn� _ W Q �rnrn md X C'f' Q o' n � n Q p Q X UJ -A_ %U O LU :3 cou � � O � n Q 3 (� md X C'f' Q o' n N n X p X X UJ LU :3 cou La L Q 3 (� n Di n N X X QO X X UJ GENERAL BUILDING NOTES/CHECKLIST 8/45 POST ALL LOT NUMBERS AND PERMITS (copy ok)..or no insps. INSPECTIONS: (Minimum) Excav, Ftg, Fnd, Frame, Insul, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior piers FOUNDATIONS: Rebar as required Anchor bolts or straps Damproofing Foundation drain- pipe/stone/fabric filter cover FRAME: Fireblock - over girts/plates between floor joists Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters- watch bearing at walls. Ridge & Hip-- Provide proper connections. Cathedral roof rafters- Use "Hurricane Clips" tie to plate. Stair stringers- watch cuts and heal support Joist hangers- fully nailed w/ hanger nails. Sill plates 2-2x6 (lpt) w/ sill seal. Girts- solid brick or steel plate bearing at foundations 1/2" air space at sides in foundation pockets. Lateral bracing at ends. Certified calcs. required for Beams/LVL's/Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances- stairways, under beams. Attic Access. (min. 22x30 w/3'headroom above). Crawl space access. (min. 18x2+) Bath exhaust fans to have metal duct. Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. ` 1/2 of required glazing shall be openable. Bedrooms require min. 20x24 egress window or door.. Vent attic spaces- "proper vents", soffit and required ridge vents Firecode under stairs if used for storage. FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. surf. DECKS: Lag to house, provide flashing. Rails min. 36" high, Balluster max space 6". Over 8' abv. grd., use 6x6 posts w/ lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Ready to move -in Ti - /f, 1. September 29, 1997 OCMULGEE ASSOCIATES, INC. CONSULTING STRUCTURAL ENGINEERING 317 High Street. Ipswich, Massachusetts 01938 Voice: (508) 356-7833 FAX: (508) 356-3465 Building Inspector Town Hall 120 Main Street North Andover, Massachusetts 01845 Reference: Lot 613 Residence 2060 Salem Turnpike Street OA Bi1_e 97176 Dear Sir:: The area of foundation wall projecting in front of the yard setback dimension may be removed by sawcutting the wall vertically and Can be replaced by installing a new foundation wall so that is overlaps the existing sections. Because the wall spans vertically from the basement slab to the first floor, there is no structural impact from cutting out a section at a one location and rebuilding it at a shifted over location. .The joints between the original and new wall sections should be damp proofed in the same manner as any other construction joint. If you have any questions or comments, do not hesitate to call me. Sincerely, Ocmulgee Associates, Inc Wa e C. King, WING .. ft V378 Y t OCMULGEE ASSOCIATES, INC. CONSULTING STRUCTURAL ENGINEERING 317 High Street, Ipswich, Massachusetts 01938 Voice: (508) 356-7833 FAX: (508) 356-3465 September 29, 1997 Building Inspector Town Hall 120 Main Street North Andover, Massachusetts 01845 Reference: Lot 6B Residence 2060 Salem Turnpike Street OA File 97176 Dear Sir:: w The area of foundation wall projecting in front of the yard setback dimension may be removed by sawcutting the wall vertically and Can be replaced by installing a new foundation wall so that is overlaps the existing sections. Because the wall spans vertically from the basement slab to the first floor, there is do structural impact from cutting out a section at a one location and rebuilding it at a shifted over location. The joints between the original and new wall sections should be damp proofed in the same manner as any other construction joint. If you have any questions or comments, do not hesitate to call me. Sincerely, C G ? 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E O � 3 7[3 < m x 'i7 O X (A X tP :3 =Lek to La Q Coo n (0 N X x 'i7 p X (A X tP CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 325 Date June 24, 1998 THIS CERTIFIES THAT THE BUILDING LOCATED ON 2060 Ttmnpike St MAY BE OCCUPIED AS SingiP Fam;13t txx,ll;no IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Mark Ruggles o � ADDRESS 8 Victory Rd Bellrica MA 01862 'tip b•. �. •''`.�, � jiAcwust' �Bu for fo (Type or Print) NORTH ANDOVER Ma ss. :�.4; . `.. -Date:''% ! E Building Location(`k Permit Owners Name ML I.J. �,� (� �;�• , yi New Renovation j] ' Replacement Plans Sybmitted ` FIXTURF ' • H :. Z Y < • � • O Z x 4n < aa: a cc z O z a s a A W 'n 'm = W U Q < z a a a<—< 10_ W O 7 Wot tC < Wcc 61 G a J= W x 1- F-• � O � .J Ih- < < :l: Z �. Y d O ' ~ t1 > 1- O x a a 1- Z O O Y _x W F- O N= • • ; i < �- < < x h N < < O < J < a QC 0 < O < M a< J m a O a J = 1- N IL O q < •c lq Q i SUB--tBSMT. BASEMENT I � 1ST FLOOR I ( l 2ND FLOOR a 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOO-mw NowR 7TH FLOOR ' STH FLOOR t 7 Check one: Certificate ' ®—Corp En Partner. N !a Shlu lJ • W, 0364-3, C'j Firm/Co._/ Business Telephone 6,a3 ' S Y (- a c?q / Name of Licensed Plumber: eon --B k G N l31z 2&9 y, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy D11"Other type •of indemnity E] Bond L Insurance Waiver: I, the undersigned, have been made aware - that the licensee of i this application does not have any one of the above three insurance coverages. • Signature of owner/agent of property Owner Agent�� I bmbtr cautifr That all of ilm details and information 1 Isawc submiticd (or cntcacd) in aMavc application ire Ince 40Naw to" bad M alf �• • hmwkdgc nod that all plumbing work and installations licr(mrmcd undo t'auut (ssucd (or this application will be in ooNgtilancp wj& W Vgt6qW PW,4 V164114o(tM Maatachusctlt Statc humbimg Code and Ciaptcr .142 of tlac Gcnaal Laws, • • 4 w (Print or Type) installing Company NameP-RalJ09AC"arl P+ zpc Address By Title• city/Town: ADDtznvrn 70FFirF usE nwLyi Signature of'Licensed Plumber Type of Plumbing License 7IS3 License Number L-tF Ma star Q Journeym" 3533 rs HORTI� F 9 1 Date . /-. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� - J /j^/ This certifies that ....�: �.�-:`-:�.-�.--�.. . �......... � has permission to perform ... -�............ `" .......... plumbing in the buildings of�.N at: .: . `.' ... = .... ......::�..... , North Andover, Mass. /�` . o Fee'. ? ..... Lic. No....' ...... ...................... I ....... o �f�_•w,� `f, {� PLUMBING INSPECTOR N WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location x% , Date d ?0:MORTIy TOWN OF NORTH ANDOVER 4.•0 ,•'�ti.0 t 0 Certificate of Occupancy $ Building/Frame Permit Fee $ " NUs <� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL j 9 0 6&l 8/97 12:19 750.00 pAIouildind Inspector ,. 1" Div. Public Works M 0 X U 0 z 1-6, . �) � 0 ZN "T rU' w w c Ao w C o w COD o � C H O C w w° U a w w '° x bo w w z v CO cn cn g 0 ROMA -kM • c y- m c o � C H O C • + : •dam � d C :t ' N � E C 0 CD m c ,CL N ' m m N O N cm C m � o m �mo aC.3 W, N " m i c o¢ N IS O p C G d H y m C Q = m :m�3 :a o coo LL A P: N dL vm• VD a �0a m g 0 ROMA -kM