HomeMy WebLinkAboutMiscellaneous - 234 MAIN STREET 4/30/2018 234 MAIN STREET
' 210/042.0-0011-0000.0 \.
i
4233
Date. . .. ..
�aORTN
°::�`";•1"° TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�,SSAC14US�
This certifies that .....
has permission to perform ......................5-11.0,/1 �R �'....CAFE �7e............
wiring in the building of l/`4 /
........ ..!��.....�<.........f.h......G,& &. ./...................
....... .....•�Cl`.l .... ..................................,4North Andover M
Fee...�.?..4�....... Lic.No✓ ,�..< ........ .... �........ ...
t LECTRICAL INSPE R
Check #
THECOAMOATHEALTHOFMASSACHUSErrS Office Use only
DEPARTMENNT OFPUX 1CS4FETY
B0AR00FFIREPREVEVH0NREGUTA770NS527CNIRI2.M Permit No.
Occupancy&Fees Checked
APPLICAHONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dates 27 2o6Z ,
Town of North Andover Iv
To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant
Owner's Address Seyyy P 6—'�'�`�-..�._•—,..
Is this permit in conjunction with a building permit: Yes® No (Check Appropnox)
Purpose of Building I"Utility Authorization No.
Existing Service DO Amps volts Overhead Underground No. of eter
New Service �..s. Amps / Volts Overhead di Under round
g� No. of Meters ,
Number of Feeders and Ampacity --T��
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers
Total
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
round KVA
round
ID
No.. f Receptacle OutletsNo.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
b No.of Gas Burners
No.of Ranges No.of Air Cond. Total
FIRE ALARMS No.of Zones
_ __ _Tons ...-�.--,.,.....,-
Ne.of Disposa:� No.of Heat _ Total Total No.of Detection and
Pum s Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained -�
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local
Municipal Other
No.of Water Heaters KW Connections
No.of No.of
Si ns Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER
n% an0CGovVag-- Rumarttothetagm n1MlScfMa%a*M(tsLaws
haveaamerltLiab&yhmua=Fbbynrh>dagCc)np)Es,- Co'ageoritsstllfntialequabt YES NO
havt;Aftitlodvalid sametotheOffm YES � 1f}ouhave YES, - iatcatethe ofco
hedcingthe x Mby
VSURANCE F1 BOND
Expnafimr)ak
Volk to StattEst m*d VakrQfE1aarical W0jk$
ignedtmda-�ieR�lalbesofpetjtny: v � finall
RMNAME
_
IimmNo.
Lioa>SeNo
BusiriessTel No.
l/ Ah Tel No.
JVNQZ'SINSURANCEWANFR lam a dlattheLxmsedoesnothavethenouanceoDveiageoritssiftmhalegtuvalagasmquiiedbyMassadlusettsGff)eralLam
3that mysignatuteonthispamitappl waiNes reqkumat
lease check one) Owner Agent
Signature o
T
Owner or Agent elephone No. PERMIT FEE$
Location sq
No. S Date �.� /X An.
�aRTM TOWN OF NORTH ANDOVER
i Certificate of Occupancy $
Building/Frame Permit Fee $ 9 3 - C,
3ACHUs
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ' G
Check # :�i l /
Building Inspector
PERMIT NO. `7 APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA
AIAP NO. LOTNO. 2. RECORD OF OWNERSIIIP DATE BOOK PAC E
ZONE SUB DIV. LOT NO.
LOCATION PURPOSE OF BUILDING
OWNER'S NAME NO.OF STORIES U SIZE
O%VNER'S ADDRESS BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBER$'` 1 2ND 3tt
BUILDER'S NAME SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET DIMENSIONS OF POSTS
DISTANCE FROM LOT LINES-SIDES REAR DIAIENSIONS-OFGIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING x
IS BUILDING ADDITION `! MATERIAL OF CHIMNEY
i
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTEp TO TOWN NATER
BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER
i IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTUCTIONS 3. PROPERTY INFORMATION LAND COST
EST.BLDG.COST
PAGE 1 FILLOUTSECTIONS 1-3 EST.BLDG.COST PER SQ. FT.
EST.BLDG.COST PER ROOM
ELECTRIC 61ETEIIS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERNIIT NO.
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPILOVED HY:
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
BUILDING INSPECTOR
DATE FILED 01VNERS TEL#
�-I\ \ \
CONTR.TELH \ ry 1
SIGNATURE OF-OIVNER OR AUTHORIZED AGENT<22&1i' `(��QZ�j CONTR.LIC#
FEE $ �SJ�
PERAITTGRANTED
a v19
Revised 5/5/99 JAI
Castric®ne ROOring & Siding
REPAIRS FREE ESTIMATES
Telephone (978) 682-4266
MARIO CASTRICONE
31 Court Street,North Andover, Mass. 01845
I/we,the owner(s)of the premises mentioned below, hereby contract with and authorize you as contractor,to furnish all necessary
materials, labor and workmanship,to install,construct and place the improvements according to the following specifications, terms and
conditions, on premises below escribed:
Owner's Name................................ ... ....
r�1 .. .......................................................................
...... ..Job AddressP .....................��4IS1. . .... ...'.................................CityXrV'.
............................S..t.a..t.d.........—......Q...,...a.........
.........................................
SPECIFICATIONS
.................. .. ...... �,. .y........... ........ ..� .. ..............................................................
............ ............................................................ .. .. ........... ... ............................................................
... -�................................................ ............................................................................................................................. ................................
...................... ..................`............ `.......................
. .. ... .....
.....
..........�..................... .1-3-1......... .... ..�j.... x...1.,,1 ..........
i\.....
...... .....
r ., . . )......�.�...1.�..�.... . ... ............. ..... .. . . .......... ' .......... .. s? , .... ..... ......:-
................r... .
.... .............. ............
........ .. ................ .......1 ... ,. ,�......_,........... ... . . ...................................
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.....
. ..
........................................................................................................................................................................................................... .......... ...
.................................
Materials and labor to cost$'. —X—�.............................. Payable 8 ..Cull-SL ............................and balance in............
monthly installments of$.........................................each, payable on ........................................day of each and every month thereafter until paid
in full (..............%charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and a
completion as requested by the contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid
immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs, attorney fees and expenses, in
addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor;and also that the obligations hereof shall bind and apply to their heirs,successors or estates
of the parties.
The undersigned warrant(s)that he is(they are)the owner(s)of the above mentioned premises and that legal title thereto stands of record in his(their)name(s).
PROVISO:This contract shall be void and of no effort if credit approved of owner(s)is refused.
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this
contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and
the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in opera i6*t
IN WITNESS WHEREOF, the parties have hereunto signed theirnames this ............ �19..�qAccepted: Signed.. ..... ...........................
Owner
(OWNER HAS 3 GAYS IN WHICH TO CANCEL CONTRACT) �
Signed......................................................................................
Owner
Pr... .. .. ...G ��J. . . :: ?�. Q................... Signed......................................................................................
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The Commonwealth of Massachusetts
Department of Industrial Accidents ,
Office offntresffyatfons
600 Washi/igton Street
y
Boston,
Mass. 02111
Workers' Compensation Insurance Affidavit
a
cati
hn
AX -�
n I am a homeowner performing all work m self.
[] 1 am a sole proprietor and have no one working in any capacity
0 1 am an employer providing workers' compensation for mNO 1AINK"awal"
y employees working on this job.
adire•
w Lys
a
0 I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices.,
company dame
t Y N 4 M.
i ' }
v.... ... .. ... 0.1
.
ARMS
to
tn3Urance etli •' -: ',....i ' ....:� ,'::.: �- ,_. � < � °>tk 3 { � '. tt }' e ''�„ .
q.4l1liY# �
,.. .
s
address.'.
-
ansnranc�. . J 1
17.41i�Y#
ection 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to 51,500.00 and/or
Failure to secure coverage as required under S
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of sioo.00 is day against me. I understand that a
COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
!do hereby certify under the pains and pen ties of perjury that the information provided above Is truend a
rrect.
Signature U
ate `
Y .
Print name De —Phone
Phone
oMcial use only do not write in this area to be completed by city or town oMelat +
city or town: permitAicense#_ -Building Department
MMUMRNEM
[]check if immediate response is required []Licensing Board
[]Selectmen's Office
pllealth Department
contact person: ,phone#;, -Other
(revised 3/95 PJA)
Information and Instructions s -
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees.. As quoted from the.`.`law", an enrp[oyee:is,defined as every person in the service of another underany
contract of hire,.express.or implied, oral or-written
An employer is defined as an individual;,partgcT,S iR,laSSociaxiQlt, r�orpor��tipn,Qr,Qther legal entity, or any two or more of
the foregoing engaged in a joint enterprise,�and 1t�yl,4diugl�lta.l�egal;repfesenitatives 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 section 25 also states that everystate 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, 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.
pin
'Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
MAN NN
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Ma. 02111
fax l!: (617) 727-7749
phone 4: (6117) 727-4900 ext. 406, 409 or 375
BUILDING DEPARTMENT
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL-c 40 S 54,a condition of Building Permit Number
Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as
defined by MGL c 11, S 150A
The tris will be disposed of in:
Loc rion of Facility -
Si a 6of Permit Applicant
.Y (f
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of
the Building Inspector
tAORTH
Town of Andover
No.
x4f
dover, Mass., 49
0 0
C HEWICK
lei O)t?A T E D
Ire, BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
a
THIS CERTIFIES THAT........ BUILDING INSPECTOR
.D. wo %
....................%..N.'41 I
.................I....................I............................................. .......... Foundation
has permission to erect..*�O%%..P.......... buildings on .....A.A.4........ ................... Rough
to be occupied as.....*...P Ob
........... ...... ............*"***..... 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
M %( It PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTI N S-&RT ELECTRICAL INSPECTOR
A Rough
...................... ............. .....................................................jw* Service
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.