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HomeMy WebLinkAboutMiscellaneous - 241 MIDDLESEX STREET 4/30/20181 N J O . g� v 0 m j CO . 1 m O U O � o m c m 4. Location No. /2r Date ,d TOWN OF NORTH ANDOVER Check # /0 1` 0 14453 .1-, Building Inspector/ C/ Certificate of Occupancy $ o •� '�s''•°' Eta' s►cwus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /0 1` 0 14453 .1-, Building Inspector/ C/ TOWN OF NORTH ANDOVER . - BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 5".,a.,. f'"�a � n BUILDING PERMIT NUMBER: /CZDATE ISSUED: J SIGNATURE: Qj2x,�� Building Commissioneffln§&tor of Buildings Date SECTION 1 -SITE INFORMATION 1.1 Property Address: F41 1.2 Assessors Map and Parcel Map Nu ber Number: Parcel u ber qI Ft-�JTJo ✓E2 1.3 Zoning Information: Zoning District Pr. -Posed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUMIDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G L.C.40. 54) Public 0 Private 0/ Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System D SECTION 2 - PROPERTY OWNERSHIP/AUTHORMD AGENT 2.1 Owner of Record b Al rA f4 M A- L L o .Z'i ( r'1 1 DD c,6=5!5k S> Name nn IAddress for Service:Ila lo 5- 0 — C) 's -8 ature Telephone .2.Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Kp,rn r"1 M e, r-4 4 o� Licensed Construction Supervisor: C 5 10 C 0 6LL License Number 11 r1 Address (03 324 - f; (Al l Expiration Date SigreAfure Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 aR applicable) New Construction ❑ Existing Building R' Repair(s) . ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ?oq-C 1� i;-? /L. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by penmit applicant OFFICL.IISE �DNLY z 1. Building j Ob (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 7Soo 3 Plumbing Building Permit fee (e) 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, J dfi GLS as Owner/Authorized Agent of subject property Herebm authorize to act on My &al in all ers �ti to work authorized by this building permit application. Si &attire of O et Date X'-2 /Mo CTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TAKERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE U) m m Cl) 0 m w v, y C `C CO) Cl) 10 0 CD n Z CA 06 F � C O y O o v CD CD o CD CD 0 CD ca C O Vi CD CL O CA o I CC CD 3 v CA O CD Z o CD CD0 0 `•G CA C w—*= p = _ O C• H p Q N dO S. CD y =ami m 'ca cl n c) m _ �o O H O S� H• � O� „'► .O•► to N T c o CD� m o Fn - CD H N � 2 0 3E o m m: o a S. O� o n O ..► -� p H CD .m c 5'a H CO CL to O p•: O � m OCD ti o tC7D C d CD H CD ty CA H CL 0 — � c W y ` < its to .. m y ^! � CA 40 N;Zo: CD o 1 :�' : C, 3 '0 o CC, �► cl A Q CD CD M d d .do CL CA c o . o� h 3 a o o UQ o 0 p o a- o o CL y 0 0 c uepanmenr of fnaustrial Hccldents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: city Phone Qam a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Ea Company name- 9'AIy If, Q J M � Tam Rc51�2r}T/dam 5 Address 7 C -f- W rJ IJ 03.Y4l Phone # UO Insurance Co Z.y 14,-7eZ i C.&; Policy.# W L 3& 7 70.59 Comon a name: Address Phone#: ylnsurance Go Policy # 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 ($100.00) a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do herby certify under the pains and penalties of perjury that the infonnation provided above is true and correct Signature v" ` nate i r zao l Print name K/ -•i --1r'7 ll�Phone # 6o3-3d9-g/0ff Official use only do not write in this area to be completed by city or town official' E Building Dept ❑Check if immediate response is required " Building Dept El Licensing Board p Selectman's Office Contact person._ Phone #. E] Health Department Other FORM WORKMAN'S COMPENSATION ACORD� CERTIFICATE OF LIABILITY' INSURANC�P'ID CD ` DATE (MM/DD/YO ENVIR-2 11/27/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeSanctis In$urance Agcy, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ten Walnut Hill Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Woburn MA 01801 COMPANIES AFFORDING COVERAGE Phone No. 781-935-8480 Fax No.781-933-5645 COMPANY A Steadfast Ins. Co./Zurich INSURED COMPANY B CNA Insurance Companies COMPANY Environmental Restorations Inc C Zurich American 16 Hazel Drive Hampstead NH 03841 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR AA0374515100 06/10/00 06/10/01 PRODUCTS- COMP/OPAGG $ 1,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNER'S & CONTRACTOR'S PROT X Inc.Asbestos/Lead FIRE DAMAGE (Any one fire) $ 50.1000 Abatement Liab . MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY B ANY AUTO B002513348 04/12/00 04/12/01 COMBINED SINGLE LIMIT $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY. ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY xWC STATU- OTH-TORY LIMITS ER : EL EACH ACCIDENT $ 1,000,000 C THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE (MA,NH„CT,NJ) 11/24/00 11/24/01 EL DISEASE - POLICY LIMIT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1,000,000 OFFICERS ARE: EXCL WC3677059-01 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Illustration of coverage CERTIFICATE HOLDER::. CANCELLATION ILLUS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ILLUSTRATION OF COVERAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY h OF ANY KIND UP9,N THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZE p"REPR SENTATiVE , :2 ,, 4n7 ACORD 25;5 (1/95)::: ACQRD CORPORATION 1988. Kamm Meehan V.P. Lead Division Environmental restorations, Inc. A professional approach to quality service Deleading • Sandblasting • Asbestos Removal 16 Hazel Drive, Hampstead, NH 03841 Tel (603) 329-6101 • Fax (603) 329-6234 / �Ilfl� - TOWN OF NORTH ANDOVER 04 PERMIT FOR PLUMBING SSACHUS�� I This certifies that ......... has permission to perform.. ....- .��.yc!.......... . plumbing in the buil Ings of ....� .....�...L ....... at/ ........... North Andover, Mass. Lic. No..' .............................. PLUMBING INSPECTOR Check # �6212 MASSACHUSETTS UNIFORM APP n-\ (Print or Type) , l Y O� j:4 nrl o I C, Mass. Building New ❑ '.sWJ.iNM= Renovation ❑ TION FOR PERMIT TO DO PLUMBING 16A9 Permit #� e /g x �7 Owner's NameUdi`���r L� Type of Occupancy Residential Replacement N Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg. &Plg. Co. Inc. Address _ 35 Pleasant Street Stoneham, Ma 02180 Business Telephone '781.-438-7776 Name of Licensed Plumber Gordon Switzer Check one: Certificate IX Corporation 714 ❑ Partnership F.1 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements'of MGL Ch. 142: Yes ® No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Cinn�}urn nr A.......... rte...."'- •--- I hereby certify that all of the details and information I have submitted (or entered) in above 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 with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature o cense P4umber Title r City/Town Type of License: Master Journeyman I] APPROVE6WFICE USE ONLY) License Number 8322 %2" Watts 9D bfp on water line to steam boiler N N J N Z O Z Z 4 I O b O ? W t- W 'n F z U Q N Z a W LL J — m x¢ `� '¢ w m F x o a a— 3 rd td W Z 2 o �" F• a W � W O Q a¢ W= J N Q ti J— x a p s X a N N Q F > 1- O N N > v1 f Z O O to = z W I- 0 C W b r(j Ri SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name Heritage Htg. &Plg. Co. Inc. Address _ 35 Pleasant Street Stoneham, Ma 02180 Business Telephone '781.-438-7776 Name of Licensed Plumber Gordon Switzer Check one: Certificate IX Corporation 714 ❑ Partnership F.1 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements'of MGL Ch. 142: Yes ® No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Cinn�}urn nr A.......... rte...."'- •--- I hereby certify that all of the details and information I have submitted (or entered) in above 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 with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature o cense P4umber Title r City/Town Type of License: Master Journeyman I] APPROVE6WFICE USE ONLY) License Number 8322 %2" Watts 9D bfp on water line to steam boiler N ' 2 ' N ' N ' W t a c� o + + +j •r ' z Z � O I N o V m N ' 2 ' N ' N ' W t a c� o + + +j •r ' z I o m z o a = N n O p °w C7 z v ►- z a m U. 0 a O a J = a C7 w J O a A. 3 O LL LL O O m W a' p a a O In < V f pC J w CLW w CL LL N , Y '1 r N 1 N Z J Q 2 Z y LL I This certifies that --"...,;r: has permission to peri wiring in the building at Fee SA /P.. Lic. i Check # /-V 0 ..5 549 Date... TOWN OF NORTH ANDOVER mr-r-%LAt-v- r-r%r-% %AfIr-tVILI&� ......... . .... .......... . ......... f. ........................... North tin i -r, Mace ... ........ ELECTRICAL INSPECTOR i �� u! r./,�! u�/; 1(.)8L L.1 VIiKIJI USC U)tjly �., ..�..w, r1 , Permit No e�arinLPnl ? _;)ervrces - Occupancy ant Fee Che:4Cd ` E3C�AFZn Of FIRE FRCVENTION PEG ILATIc.�NS (Rev. 11/99) tcavc Ian —� \ APPLIC'ATiON FOR PE'R� TQ P�RFURM ELECTRICAL 1lVQF�K All murk to he perlomwd in acc:ordal c c wr,h 1c ,\"fa�;;tehu;clts Glcr.tricat Codc {1�1[t ), 527 CMR 12 00 (PLE JS[' P1?h'YT IN INK 0h' Y'YNL;',4LL 1rV1 liitl. 110iV) DaIv.:T City or "fowl' of: 7"�i _ Y1G'e°v _4= TO the Ir�t`sperlor of Fy'irc�s; Dy this application the undetsigncd c vcs noise cif IiS nr het I'w" t i �n to perform the elct:nlcj! \votk described . �}f _below. Locatiuts (Streel & I1fu11tbcr) Owner or l enaitt Tdrphone No, Owner's Address Is this }?cnuit 111 C01111111Ct11)ti LYltll a L1ui}dinp 1lcrnrI . 1'cs .1 1`10 (C11CCl: 1111Lirn}?nate Uox) 'urpose of Building Ut;t;i) 1luthorizaliun 1Vu Exisfill" Set vice 11111115 W" W!\'tilts 01cn1xad Usltlhrtl No. (if Meters 1110s Ser -Ove Antrls I __Volk cnccad Utldhrd No, of )(eters. Number of Feeders and Antpacity Location atld Nature of Proposeil Electrical Work: No. of ftecessed Fixtures `^------ 1'o. of Cc•if.-SU51). (t' 1tJ�iIC) l'a115 � pr Lrrc fns rrrorol w4res. I O. of �Olar ~� tVo. of llut "fuhs - ^ KVr 1• No. of Lighting OlttlCIS ~�- Gestcrafors KVA, �`p. of L,ighlili� Fixtures A. AA01'C-��I-- `( -t Stsimntiup ! t. 1 d. G. 0 .11;@r�f?tlel l0 ltltt� .. _ rnd, _ rafter Units No. of Receptacle Outlets �— -- - n. o it Burners FITLE ALAR IS rho. of Zotles IINO. of SwilclleS 0 Cin$ 11urners —_- . 1 O. O� -f wiectiou and - __�.____.._InitiatinngDevices No. of flanges tVo. of Air Cot1d. olaf Tons o. 9f Alt rtill0 17t''1ft S 'Nn. of Waste Disposers _�_! __ _ _,—_ - ffcat Yun1p ',Nun11>er -Totals; _--^ 'Pons 1C 1V --� 0. Of elf (C0nla-jtled IDetecfiott./Alertina Devices '�u. of Dishwasher's --...-----•-- SpacpJArea bte-lting l<1V local l�tultitip�! Cou lccti n n 0 1 h No. of Dryers Appiinnces K\V Security vslents: No. ofbes'ices or Euivalent IliU. Q1 lYafcr ffcatcls \o„of__._.__ No. offlat^ Si��us )dartasts 11'irilaS: 'Of — No. Devices or Equivolent No. f i,droninssage L3allitubs No. of Motors Total HP c econlnntuications ! "irilig. OTHER: ----- ,illnch nlhlilionnl detnrl if'riesir•ed• or as required b• Inspector Insector of Wires.INSUPL-0C L-. CON-EH,\GE: Unless waived by the o�Noer, no permit for the performance of electrical work way issue unless the ticensec praviLies proof of liability insurance includinv"completed operation" coverage of its substantial equiv,alem. The undersigned certifies that such coverlgc is in fotcc, and ltas exhibited proofof same to the p rrilit issuing office. CFar_QK ONE I`s RANCt, oNr) �7 0HIFR f_=) (Spet:iry ��� � %. &41:4Rr-V aS 5: �rn�r4l6j lc. SSAfe q /X k” � _ —__ TY (E\ptrlltGn Fs6iii-iled Vilite of Acritical \Volk: -3 CIO e` (When required by municipal polio ) Work to Srw Q r/ inspct lions to be rquesled in acrc:'rdance Ni lilt tNIEC Rule 10, and ul.lorl cur,lpletion. 1 i Lv7ir1,rrfrif< r tlrr 1>ni111 nnJire'trnllic'S vjl,rrjrLn, ritrtf rL. 1n jnt lnliou Rrr !111.5 nl,pli(-0fiut, is true and comple,,er. 1C. NO (ll alrnhcnCle, e,rtcr i t rhe h en.ce nu"rt,-r lure) Address: Ius. TCI. i\i1_C /r� �/w - c _v ��-_..-�--'—'-- © �. Tel, 011'tN6''R' S IiNS((I 1. YAWE I2: 1 am aware ta('t he }.ice, S,re Acus mol have the h3bifity insurance cc+.era�c sally requ;rc'd by 11•.1' 0v lily signatu c bean, I hcicby wa;ve ,lis frrl,;,r; >Ir,tl I au? ilia (rlleck cite) ❑ C)"'ne'r D oxttcr"s a^_Ct14. 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