HomeMy WebLinkAboutMiscellaneous - 24 BERKELEY ROAD 4/30/2018 (2)1
Location
No.
f% Date -2
MORT►, TOWN OF NORTH ANDOVER
Certificate of Occupancy $
�ssACMBuilding/Frame Permit Fee $ �f
Foundation Permit Fee $
Other Permit Fee $
TOTAL $' S -
Check #
4 5 S 9
l/ Building InspecidFr
< TOWN OF NORTH ANDOVER
` BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
o-ow�l;,�f k
'I")
BUILDING PERMIT NUMBER: DATE ISSUED:����
1.3 . Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
SIGNATURE:
Rear Yard
Buildin o s] ne /I u] ngs Date
Provided
SECTION 1- SITE INFORMATION
1.1 Property Address:
moi'
1.2 Assessors Map and Parcel Number:
o l y C? O "'
Map Number Parcel Number
1.3 . Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required
Provided
Re red
Provided
1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information:
PQblic ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print)
Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
' Licensed Construction Supervisor:
Address`
{f2�/trr�ac� l� cam..�5
Signature Telephone
Not Applicable ❑
060 l 1 2—
License Number
!a
Expiration Date
3.2 Registered Home Improvement Contractor]
Av t1
Not Applicable ❑
Company Name
5'/
Registration Number
Address
Expiration Date
Si nature Telephone
SECTION 4 - WORXERS 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 Z Repair(s) ❑ Alterations(s) B' . Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Descriptions of Proposed Work:
i
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
—eem ete
�O7FICI�S�f31�ii''° k
1. Building �..
(a) Building Permit Fee
Multiplier
j
2 Electrical
(b) Estimated Total Cost of
C i
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
I as Owner/Authorized Agent of subject property
p:.
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I 0_, as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
j�
i
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TRABERS 1 s 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
o
IS BUILDR-4G ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
7—d yyr l� r3
Loation �( E'�t £
c
City J, Phone
cam a homeowner performing all work myself.
01 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 -
Com a
ob-Compa
_Address % �7� EQ 1. .
city: 'e )� �c c G Phone #
Insurance Co 1 V,QlL" v �2 k,'ze. Policv.# �. — .3 .% S ::3
Company name.
Address
Phone#:
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 $1,500.00
and/or one- years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($10O.00) a day against me_
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify under• the pains and penalties of perjury that the information provided above rs bve and correct
Signature /�° Date 4 — `-f —
Print name / rt �' f 0 t Phone #
official use only do not write in this area to be completed by city or town official' Building Dept
[]Check if immediate response is required Building Dept Licensing Board
Q Selectman's Office
Contact person:_ Phone #: 0 Health Department
F1 Other
FORM WORKMAN'S COMPEVSATION
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978)688-9545 Fax(978)688-9542
DEBRIS DISPOSAL FORM
v Qttgo ,6�a�O
ro ..
y� V
GOGNI[KlWKM 1'
In accordance with the provisions of MGL c 40 s 54, and a condition of.
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, sl 50a.
The debris will be disposed of in /at:
Facility location
Signature of Applicant
Date
— p-( C-)(
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
�rnnn�gr Page of
Free Estimates "
105 Haverhill Street'
'Fully Insured t .Methuen, MA 01844)-
THOMPSON'S ROOFING
(978) 691-1355
t Shingles — Slate — Rubber Roof
Single Ply — Copper Work
PROPOSAL SUBMITTED TO
PHONE
DATE
David Crucioti
10-7-00
STRE ET
JOB NAME
24 Berkeley Road
CITY, STATE AND ZIP CODE
North Andover
JOB LOCATION
MA
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
Install aluminum drip edge around roof line
Apply ice and water shield 3 ft. up all along edges
Reshingle with a 25 year Architect shingle
Install new flanges around soil pipe
Cut in a ridge vent
Remove all work related debris
25 year warranty on material
10 year guarantee on labor
Construction lic. 3060112
Imvr_ovement#128612
M 3propogt hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
Three thousand eight hundred and fifty ----- dollars ($
3.850.00
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alteration or deviation from above specifications involving Authorizetl
extra costs will be executed only upon written orders, and will become an extra charge over and Signatu i
abovE the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully Note: This proposal may be
rn.0-11 by W—k--'c !`n.nnnnceti.... 1----
Zfrceptanct of propool — The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to do the
work as specified. Payment will be made as outlined above.
Date of Acceptance: 6"1 t 08EK 2 31, 2 Db0
—1—awn uy us it not acceptea wtnm days..
Signature4
Signature
' i F 1 CA TE OF L I A B I L I T Y I N S U R A N C E DATE 05-08-00 (MM/C^(YY)I
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R:GHTS ~
UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALT
PELHAM -NSURANCE SVCS INC THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1.?1 BRIDGE STREET
INSURERS AFFORDING COVERAGE
PELHAM NH 03076 -
INSURER A: The Maryland
�'SUR�D INSURER B: Liberty Mutual
Thomas Doyle INSURER C:
DBA Thom sons Construction 8 Roofing
8 West Ste. INSURER D:
Salem NH 03079
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NO, ': THSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
�,RTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL:
THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
POLICY EFFECTIVE
POLICY EXPIRATION
T4
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DD/YY)
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1.000.000
A
[X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (An one fire)
$ 300.000
[ ] CLAIMS MADE [X] OCCUR
SCP 34865353
04.15-00
04.15.01
MED EXP (Any one person)
$ 10.000
PERSONAL 8 ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,00^.0^0
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
$2,000,000
1']
[ ]POLICY [ ]PROJECT [ ]LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Each accident)
$
i
ALL OWNED AUTOS
BODILY INJURY
[ SCHEDULED AUTOS
(Per person)
S
HIRED AUTOS
BODILY INJURY
VON -OWNED AUTOS
$
•
PROPERTY DAMAGE
[
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
[ ANY AUTO
OTHER THAN EA ACC
5
[
AUTO ONLY, AGG
$
EXCESS LIABILITY
EACH OCCURRENCE
$
[ ] OCCUR [ ] CLAIMS MADE
AGGREGATE
$
[ ] DEDUCTIBLE
$
] RETENTION $
$
WORKER'S COMPENSATION AND
( ] WC STATUTORY [ ] OTHER
B
EMPLOYER'S LIABILITY
WC2.31S-314995.019
04.21.00
04.21.01
E.L. EACH ACCIDENT
$ 100.000
E.L. DISEASE -EA EMPLOYEE
$ 100.000
E.L. DISEASE -POLICY LIMIT
$ 50C.nn0
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
-Roofing.
I.
i
CZRTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR
Don Foss TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
9 Gumpus Pond Rd. TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
Pelham NH 03076 REPRESENTATIVES.
AUTHORIZ REPRESENTATIVE %
Page 1 ^f 2
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
rpt
This certifies that
..............................................................
has permission to perform .... ...... .........................
wiring in the building of ................................................
at. ...... ............................ i:, ..... . North Andover, Mass.
Fee.: !rR.. 0 (��' ,
........... Lic. No .............. .........................................
.ELEcTwcAL NspEcToR
Check#
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
4
Commonwea11A of ///assael'tudetld Official Use Or
cc��r�
ec]/
2,part.,d o�.}ira SwvicPernnit No.
Occupancy
�✓
Occupancy and Fee Checkedlug _
BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99]. leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MGC), 527 CMR 12.00
(PLE.9SE PRINT iV INK OR TYPE :ILL hYrOluf;IT10N) Date: -C
City or Town of: �)C�(n�I�� 1� ,� To the Inspector of Wires:
By this application the undersigned gives notice of itis or her intention to perform the electrical work described below.
Location (Street R Nun cr)
Owner or Tenant Y�
Telephone No.
Owner's Address
Is this permit In conjunction with a buildin r omit? Yes ❑ No Er (Check Appropriate Box)
Purpose of Building �_c Utility Authorization No.
Existing Service Amps / Volts' cnccad ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undord 1:1b
Number of Feeders and Ampacity
No. of Meters
No. of Meters
Location and Nature of Proposed Electrical Work:
Completion orthe rollvadne table nrav be n aimil br the hrsecrtor o% 1 Vires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fats
! o. of Total
Transformers KVA
No. of Lighting Outlets
No. of ilot Tubs
Generators KVA
No. of L
Lighting Fixtures
Above
Swimming Pool nid. C3In-
rnd. C3Batte
o Emergency
o.Lighting
• Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAR►NIS
No. of Zones
No. of Switches
No. of Gas Burners
No. oetectnon and
Initiating Devices a
No. of Ranges
No. of Air Cone). ataTons
No. of Alerting Devices
No. of Waste Disposers
cat ump
Totals:
um er
_
_pus _j_
KW__ _
_
o. o e - ontantc
iDetection/Alerting Devices
No. of Dishivashers
Space/Area Heating KW
Local ❑ Municipal❑Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or E uivaletnt
No. of ea KW
Heaters
o. o i alo. of
Sits Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Totai III?
Telecommunications ti'irin
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired• oras required by the Inspector of ;Vires.
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. Tlie
undersigned certifies that such cove a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND El0I H1rR ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work:' " (When required by municipal policy.)
Work to Start:
I certifj-,, larder the
FIR11I NAAIE:
and
Inspections to be requested in accordance with MEC. Rule 10, and upon completion.
7/ties a Perjury, t ratthe inform'nation on this application -is trite and complete.
�-1(: '-lEi /�-/7 LIC. NO.: ' A l
Licensee: �57�—%,1�/U Signature LIC. NO.:
(If applicable. enter • ,verr t - in 0 ficence gryj' ne. a Bus. Tel. No.-
Address: �o �e. IX Tho
�%� �DU� 9�1.�Z_ Alt. Tcl. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licen -does not have the liability insurance coverage normally
required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
F
:Rr1tIT FEL:
Signature Telephone No.
r10HTk""e
a+��qS rnrn'f%SJ
Zoning Bylaw Review Form
Town Of North Andover Building Department
27 Charles St. North Andover, MA. 01845
Phone 978=688-9545 Fax 978-688-9542
street:
Ma /Lot: a3 z : o
Applicant: IDA.vilp
Re uest: I a � a
R ao1d2, �v�
Date: y a 0 3
Please be advised that after review of your Application and Plans that your Application is
DENIED for`the .following ZoningBylaw eeasons:
Zoninci Oe -4
2emedy for the above is checked below
Item # Special Permits Planning Board
Item
Notes
C- Setback Variance
Item
Notes
A
Lot Area
3 ,
F
Frontage
Variance for Sin
1
Lot area Insufficient
Independent Elderly Housing Special Permit
Large Estate Condo Special Permit
1
Frontage Insufficient
Earth Removal Special Permit ZBA
2
Lot Area Preexisting
R-6 Density Special Permit
2
Frontage Complies
Special permit for preexisting
3
Lot Area Complies
3
Preexisting frontage
e s
4
Insufficient Information
4
Insufficient Information
B
use
-
5
No access over Frontage
1
Allowed
S
G
Contiguous Building Area
2
Not Allowed
1
Insufficient Area
3
Use Preexisting.
2
Complies
4
Special Permit Required
3
Preexisting CBA
•t e S
5
Insufficient Information
4
Insufficient Information
C
Setback
H
Building Height
1
All setbacks comply
1
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient
3
Preexisting Height
g
4
Right Side Insufficient
4
Insufficient Information
5
Rear Insufficient
y e
I
Building Coverage
6
Preexisting setback(s)
1
Coverage exceeds maximum
7
Insufficient Information
2
Coverage Complies
D
Watershed
3
Coverage Preexisting
S
1
Not in Watershed
H e S
4
Insufficient Information
2
In Watershed
j
Sign
3
Lot prior to 10/24/94N
1
Sign not allowed
4
Zone to be Determined
2
Sign Complies
5
Insufficient Information
3
Insufficient Information
E
Historic District
K
Parking
N
1
In District review required
1
More Parking Required
2
Not in district
C1 e S
2
Parking Complies
3
Insufficient Information
3
Insufficient Information
4
Pre-existing Parking
2emedy for the above is checked below
Item # Special Permits Planning Board
Item # Variance
Site Plan Review Special Permit
C- Setback Variance
Access other than Frontage Special Permit
Parkin Variance
Frontage Exception Lot Special Permit
.
Lot Area Variance
Common Driveway Special Permit
Height Variance
Congregate Housing Special Permit
Variance for Sin
Continuing Care Retirement Special Permit
S Special Permits Zoning Board
Independent Elderly Housing Special Permit
Large Estate Condo Special Permit
S ecial Permit Non -Conforming Use ZBA
Planned Development District Special Permit
Earth Removal Special Permit ZBA
Planned Residential Special Permit
Special Permit Use not Listed but Similar
R-6 Density Special Permit
Special Permit for Sign
Special permit for preexisting
Watershed Special Permit
nonconforming
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based 'on verbal explanations by the applicant. nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for. this review to be voided at the discretion of the
Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein
by reference. The building department will retain all plans and documentation for the above file. You must file a new permit
application form and begin the permitting process.
-aa o?ao
1ttuiiding Department Official Signatuie Application Received Application Denied
.� ry
Plan Review Nalrrativ
The following narrative is Provided`to further explain the .reasons for,D.ENIAL for the
APPLICATION for the Property indicated on tte reverse side:
Referred To:
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