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HomeMy WebLinkAboutMiscellaneous - 234 MIDDLESEX STREET 4/30/2018 -234 MIDDLESEX STREET 210/014.0-0065-0000.0 ` L Location No. G� Date �� o NaRT� TOWN OF NORTH ANDOVER ?0'4 .60 ,�,h.O � • 1 Lp Certificate of Occupancy $ �'�s''• E�� HU s Building/Frame Permit Fee $ tC 1 " Foundation Permit Fee $ 4iOther Permit Fee $ TOTAL $ Check # r 17185 Building Inspecto V , TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. - X 3' 0 SIGNATURE: Building Commissioner/Insixaor of Buildings Date - z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dia;ic—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqlIired. Provided ReqIjired Provided 1.7 Water Supply M.G.LC.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHEWAUTHORIZED AGENT 2.1 Owner of Record Name(P ' Address for Service: ;nature Telephone i ;.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ .I�cetised Construction Supervisor: �Zi`/�iat �✓ License Number Address �1 ® _ a4LW-41V-1 EXP iration Date —� Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address 137h/O Expiration baW ^ Si nature Telephone Y+ 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 applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) .❑ J_A_d_(dE_ion ❑ I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ,X .. "til h 1� '►,,'s'o, Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (}FFICIAI(;USEaQ1Y, Completed by permit applicant y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of 9 Construction / 3 Plumbing Building Permit fee(a)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 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My be f in a tma ve w uthorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 ent Date IBM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DEMENSIONS OF SILLS DIIv1ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTiy ONM Of _ Andover , No. �r- dower, 1V�ass., `13 DS/ T O - LAK COCMICMEWICK ADRATED PP��.(� `S V BOARD OF HEALTH PERMIT T. D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .. ... ............................ .... ................................................. Foundation has permission to erect........................ ............... b dings on . ............. ......................................... ...... Rough to be occupied ..................................................... Chimney . . . .. .................................................................................... provided that the person accept! this permit shall in every respect conform to the terms of the application on file in Final, this office, and to the provision 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T Rough s � 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 i Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts M , d Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers'Compensation./nsuranceAffidavit Name Please Print Name: Location: 623 ji/ /11 loaz:'- Ss Phone # I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity, 1 am an employer providing workers'compensation for my employees working on this jots. Company name: 0 'Sa:�" 3 Address ,S� &3f4-'iW T Insurance Co. Ldiay- � �°1�/E r� �� Policy# ���y�elk /2- (j6-3 Company name. ` Pio° . ----------------- Insurance.Co. Poficv.# Failwe to secure co verage as required under Section 25A or MGL 152 cans lead to the and/or one pears'irnprisorrnent.as VM6Lass:ar�l peoafties-b-tba orm—OtA STOP �� 0n of alto oat P df aXfihe iipe`to.s understand that a copy of this statement may be forwarded to the Mks of t -(3100M)�= - rnestigations of#w DIA for co�age veffiewion. I ob hereby c&WMwer the pis and penaNess of perjwy#W Me k*m)8d rrprovA*dabovie is true aW conft-t Signature [ate 5=/3 G Print name-4RT 14-Uk 71T, ALS 14 Pine-# Oficial use only do not write in this area to be comps by city or town ofridw City or Town Per g. (]Check if immediate response is requved Bullff�k°iit.Sl1 do lH� ❑ contact person: Phone# S6/echnarHealth Del 0 Other 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 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: (Location of Facility) Signature/ofPermit Appl ant 41 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Page# of pages CS # 022680 'NN 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: Job Name Job# Address 'f-� ( —I i f % Job Location 4'lf ! Date Date of Plans Phone# /r Fax Architect / We hereby submit specifications and estimates for: :......_ /' 'U 3.. `} �! .Y. .... . .._ d...........yl.o. - .......... ................ .� J._ Adle . � ........._ . ...... ffWe i 7propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ Dollars with payments to be made as t I ows: 'Old Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays ��� beyond our control. Note—this proposal may be withdrawn by'/O/S if not accepted with days. rr� 01cceptance of 13lropogai The above prices,specifications and conditions are satisfactory and are ignature ��1-A'Iyu Ia1 hereby accepted.You are authorized to do the work as specified. "R Payments will be made as outlined above. / Date of Acceptance 5110 o q Signature s NC3819 MADE IN USA - _ _��•�,-�ze toanzmw izureci�/ a�../�,aoacitfu�oe�d t BOARD OFBUILDING REGULATIONS .` License: CONSTRUCTION SUPERVISOR. m Number: CS 022680 •'Birthdate 06/09/1.939 t �Lf. Expires 06!09/2004 Tr no: 26824 1 "a Restricted ARTHUR J WALSH JR< ' w j r 55,PLEASANT ST N ANDOVER,WA 01845- Administrator .�..•� y �.I IZC �O�/yl//YI.O�I7.C(/P.Q�G�� �a.�i(,IC�Iw./LLI.OYAj[O e� Board of Building Regulations and.Standar4 HOME IMPROVEMENT CQNTRACTOR , 1 Registration X03358 ' R f Expiration 77/2004 L Type Private Co atio rporri A J 'WALSH&SONS IiC 1y j Arihur,,Walsh'Jr 55 Pleasant-St N Andover;MA 01845,4;,5,, ,*; w �'.,"Administrator i i WATER AND SEWER ADDENDUM S1ASS4CllVWrN ASSUc"IN1103N or 0ACIORS' This Addendum is a part of the residential tenancy agreement(lease or tenancy-at-will)between FAI"al ci � 4-77P..-) N Jrk ("Landlord")and o ("Tenant") dated rega�r�diiinng. trental of a dwelling the"Dwelling")in the Premises described as f e /V L U 11 (the"Premises"). In the event this Addendum conflicts with M residential tenancy agreement, then this Addendum shall control. 1. Tenant agrees to pay Landlord for water and sewage charges for the Dwelling on the terms and conditions set forth. Landlord has certified eligibility of the Dwelling and compliance with General Laws Chapter 186, Section 22 and regulations in 105 CMR 410.354. Attachedis-acoov._of the Certificate filed-12yAhe Landlord with the local Board o Health or other department having authority to enforce the State Sanitary Code. 2. Landlord As Consumer Water separately charged to the Tenant pursuant to this Addendum shall be delivered by the water company to the Landlord and the Landlord shall: (1) be the consumer; (2)for billing purposes, be the customer of record; (3) be responsible for payment of the water company bills; and (4) be subject to any actions of the water company for nonpayment. 3. Direct Metering If the Dwelling is connected to a meter installed by a water company; the Landlord is lawthorized to charge Tenant for water and sewer usage and Tenant agrees to pay for same. Such charges are 016. to the condition that the meter measures only water that is supplied for the exclusive use of the Dwelling unit`gihdt ily to an area within the exclusive possession and control of the Tenant of such Dwelling and does not measure water usage for any portion of any common area or by any other person or dwelling. Upon request by the Tenant, the Landlord shall apply for a test of the meter to determine its accuracy. The Tenant shall reimburse the Landlord for any cost incurred in connection with such test. If the Tenant does not reimburse the Landlord for such cost, the Landlord may add such cost to the next bill sent to the Tenant and such cost shall be considered to be part of the bill. 4. Submetering Billing Provided that a submeter and other devices required by Chapter 186, Section 22, have been installed by a licensed plumber, the Landlord is authorized to charge Tenant for water and sewer usage and the Tenant agrees to pay for same, provided that submetering equipment has been installed in each dwelling in the building and in the common areas, so that all water used is measured by both a primary meter and a submeter. Each bill for submetered water usage shall clearly set forth all charges and all other relevant information, including, but not limited to, the current and immediately preceding submeter readings and the date of each such reading, the amount of water consumed since the last reading, the charge per unit of water, the total charge and the payment due date. Such charges shall be billed to the Tenant in at least as many periods as the Landlord is billed by the water company providing such water to the building or such payments may be made on a monthly payment schedule as agreed to in the written rental agreement; provided, however, that if the Landlord bills the Tenant on a monthly basis, payment of the bill by the Tenant shall be due 15 days after the date the bill is mailed to the Tenant, but if the Landlord bills the Tenant at intervals greater than 1 month, payment of the bill by the Tenant shall be due 30 days after the date the bill is mailed to the Tenant. If the Tenant fails to make such payment, such nonpayment shall be a material breach of the rental agreement. 5. Cost Calculation The Landlord shall determine a calculated cost per unit of water consumption by dividing the total amount of any bill or invoice provided to the Landlord from the water company for water usage, the customer service charge and taxes, but not including any interest for the late payment, penalty fees or other discretionary assessments or charges,for all water provided to the premises through the water company meter in that billing period, by the total amount of water consumption for the entire premises. The total amount charged separately to each submetered dwelling for water usage for any billing period shall not exceed such calculated cost per unit of water multiplied by the number of units of water delivered exclusively to the particular dwelling for the same billing period, provided that the Landlord has verified that the total amounts of water usage measured by all submeters in the building, including all submeters for common areas, does not exceed the total amount of water usage in the building for the same billing period. 6. Maintenance The Landlord has an affirmative obligation to maintain in good working order the water supply system to each dwelling unit and any component thereof, including any water conservation device and submeter and to respond in a timely manner to any request by the Tenant for the repair of any defect or malfunctioning in such water supply system, including any leak. ©2009 MASSACHUSETTS ASSOCIATION OF REALTORS® MASSFORMSry ee....„�..� SLtewlde Standard Red Fblme Fermo owoaru"rtv 47207.0107.20.09!463672 David Man c—i Real Estate 508 Main St North Andover,MA 01845 Phone:978-688-440" Fax 978-682-7998 David Minicucci Produced with ZipForm®by zipLogix 18070 Fifteen Mile Road,Fraser,Michigan 48026 www.zipLogixcom Untitled 1, 7. Commencement: Meter Reading When a tenancy commences after the day on which a billing period of the water company begins,the Landlord shall mail to the Tenant on the first day of the tenancy,the reading on the submeter for the Dwelling on the day the tenancy commences and may bill the Tenant only for water and sewer usage based on water measured subsequent to that reading. 8. Termination: Meter Reading If the tenancy terminates before the end of a billing period for which the Landlord has not been billed by the water company, the Landlord shall give to the Tenant on the last day of such tenancy the reading on the submeter for the dwelling unit as of that day together with a final bill for water and sewer usage in the dwelling unit since the last prior reading of the submeter for.such dwelling unit.The Landlord shall charge the same rate for the water and sewer used by the Tenant as the water company charged in the last bill issued to the Landlord. Notwithstanding the requirements of Section 22 (f) of Chapter 186, the bill shall be immediately due and payable by the Tenant. If the Tenant does not pay the bill, the Landlord may deduct the amount of the bill from any security deposit paid by the Tenant in accordance with Section 15B of Chapter 186, prior to returning the balance of the security deposit, if any, to the Tenant. If the Landlord is not able to give the final reading on the submeter for the dwelling unit together with a final bill for water usage to the Tenant on the last day of the tenancy, the Landlord shall mail such reading and such final bill to the Tenant no later than the day after the termination of the tenancy, provided that the Tenant has provided the Landlord with a mailing address. If the water company subsequently charges the Landlord a lesser rate than the Landlord charged the Tenant in the final bill, the Landlord shall recalculate the bill forthwith based on the lesser rate and mail to the Tenant the revised bill together with a rebate for any overpayment made by the Tenant. 9. Testing Upon receipt of a bill for water usage from Landlord and within the time allowed for paying the bill, Tenant may request that a person or entity with expertise in the installation and operation of water submeters and with no financial or other relationship with Landlord,test the submeter for the Dwelling of the Tenant to determine whether it is measuring water accurately. If the submeter is found to be measuring more water than is being used in the dwelling unit, the Landlord shall install a new submeter at his own expense and shall also pay for the cost of the test. The person conducting the test shall determine the amount of water that was improperly measured during both the prior and current billing periods. The Landlord shall calculate the amount the Tenant was overcharged for the prior billing period and reduce the bill by that amount, or, if the Tenant has already paid the bill, give the Tenant a rebate in that amount. If the submeter is found to be measuring no more water than is being used,the Tenant shall pay for the cost of the test; provided, however, that if the Tenant does not pay for the cost of the test,the Landlord may add such cost to the next bill to the Tenant. 10. Leaks In the event of a leak in the water supply to a dwelling, the Landlord shall determine the amount of water and sewer usage that was measured on the submeter for the Dwelling as a result of such leak, after a review of the billing records and consultation with the repairing plumber. The Landlord shall then determine the amount of the bill for the billing period in which the leak occurred that was attributable to such leak and reduce the bill to the Tenant by that amount or, if such bill has already been paid, grant the Tenant a rebate in that amount; provided, however, that with regard to any leak about which the Tenant knew or should have known,the Landlord shall only be required to reduce the bill to the Tenant, or to grant a rebate in an amount attributable to the water and sewer usage measured on the submeter as a result of the leak between the date the Tenant gave notice to the Landlord and the date the leak was repaired. 11. No Additional Fee Except as authorized by law, the Landlord agrees not to charge, to seek to recover, or to allow to be charged or recovered, any additional servicing, administrative, establishment, meter-reading, meter-testing, billing, or submetering fee or other fee. 12. Nonpayment In the event of nonpayment of a bill to a water company by the Landlord, such water company shall have all the remedies against the customer of the water company available pursuant to any law, rule or regulation. The Landlord may not shut off or refuse water service to a Tenant on the basis that the Tenant has not paid a separately assessed submetered water usage charge. Date: lzz w - Y� ," Te Landlord P Tenant 2 MASSFORMS- ©2009 MASSACHUSETTS ASSOCIATION OF REALTORS® � awwme Manderd RW Eswe fame ow.ortruhv'. 47207.0107.20.091463672 Produced with ZlpFonnS by ApLegbr 18070 Mean We Road,Fraser,Midhigan 48026 UnGded MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II), the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. 03' r r PROPERTY INFORMATION 6-MA, `� ��s e �I Unit# .J° — F/ab #Of units in bldg. Ci /Town: r A�-J 0O%J6t2. MA Zi Code: d EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation'devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2' gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra low flush water closets(toilets)not to exceed 1610 gallons per flush(1.6 gpfl The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. t '9 Submetering equipment information: .,T_T/l CVJ _ ��Q j ,?®e/U09/1 Manufacturer Model# Licensed Plumber Certification r3,'lC /307) /�//r? Print Nime of Plumber License# ate I 7dify that(check all that apply): 5 I have installed the submetering equipment listed above in accord2ilce wi accepted plumbing standards. ❑/I have installed one or more water closets not exceeding 1.6 gallonsver sh. Luf Determined that existing water closets do not exceed 1.6 al ns per us . g ❑ The plumbing permit issued by the city/town,if required,is ached. Dwelling unit is connected directly to a meter installed by&w i o V, accordance with 186 22 does not require the installation of a submeter. ' § (p)' Signed under the pains and penalties of perjury, igna r of Li en d Plumber Property Owner Certificatio I certify that: (1) This dwelling unit is eligible for the imposition on the tenis of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All Showerheads, faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter j measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186 § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)I will provide to the tenants of this dwelling unit, prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form; (6) That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, AIL Print Name df Own r Signature f er ate Board of Health/Health Department Received By Date MDPH/CSP Submetering Certification Form,Revised 10/06 Produced with ZrpFOMM by zipLogix 18070 Fifteen Mile Road,Fraser,Michigan 48028 uauuea