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Miscellaneous - 257 CHESTNUT STREET 4/30/2018 (2)
5d 6 d, uk�f C, M 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: t ' Tel #: FROM. -�—i �c�, i o�DZ�S� ADDRESS:SLz-ow* Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: PROPERTY OWNER: OTHER:v-s '�-- Z 5'1 Ckks- Signed: MW Safety Insurance WOOF Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: JOSE LOPEZ and JOSEPHINE LOPEZ Property Address: 257 CHESTNUT ST, NORTH ANDOVER, MA Policy Number: HMA 0357420 Claim Number: BOS00045184 Date of Loss: 9/6/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Lisa Monette Claim Examiner Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (857) 233-8618 Fax: (617) 535-5833 Email: lisamonette@safetyinsurance.com 9/9/2014 - 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with theprovisions of MG.L. c. 143, §. 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be fled On the prescribed form. After a permit application has been accepted by an Inspector of Wiresappointed pursuant to M. 01 c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shalt be responsible for the notification of completion of the work as required in M.G.L. c.143, § 3L. Permits sha Lbe limited as to the time of-ongoing construction. activity, and maybe.deemed-by-thesnspector_of_W.ires abandoned-and-inxalid-nc --. or she has determined that the authorized world has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the. permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of2010 and extended by Sections-74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote-job,growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaispermits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was 'in effect or existence' during the qualifying period beginning on August 15, 2008.and extending'through August 15, 2012. I(Rule 8—Permit/Date Closed: - Z — *** Note• Rea y for new permit ermit Extension Act — Permit/Date Closed: Date....,17 ...........-.....,7 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......... I . ....... t .......................................... - .............................. 0 - , I I -� - , - , 1, 0 , has permission to perform ...... ........................................................... .............. wiring in the building of ... ............................. t, ............................. at ... :� ....... "or M .......................................... ............. .. .. ,North Andover, ass. ............. Lic. No. ............. . . .... . ............... .... . ..... ELECMICAL INSPECTO Check At 13 �onvnonwaa aMad�aeltu�ai For Office Use Only (Rev. 11/99) QQ Permit Number, e, O l% J Occupancy & Fee_7. BOARD OF FIRE PREVENTION REGULATIONS ' APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL, WORK (ALL WORK TO BE PERFORMED WrrH THE MASSACHUSETTS ELECTRICAL. CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: .rte ,,curl City or Town of: 1V'. ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location: (Street & N C /fr S1 /V v —� Owner or Tenant: -( �•?�/�a Z=Z Owner's Address: S �J Is this permit in conjunction with a Building Permit? Yes NO ❑ (Check Appropriate Box) �Jn� Purpose of Building:_ Utility Authorization #: —41 .Existing Service: Amps —/—Volts Overhead ❑ Underground. ❑ # of Meters New Service: 0 Amps f lb / _Volts Overhead Underground.❑ # of Meters:_�� Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: %di�k� >0 6 A/1i9 5111�'X,// Cr u No. of Recessed Fixtures No, of Cell.-Susp. (Paddle) Fans No, of Transformers Total KVA No. Of Lighting Outlets No. of flat T,b- udila1 ui015 I hJA No. of Lighting Fixtures Swimming Pool: Above ground ❑ In Ground ❑ # of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Bumers Fire Alarms of Zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained Detection/Sounding Devices Local ❑ Municioal Connection ❑ Other ❑ Security Systems: No, of Devices or Equivalent No. of Switches 1(0 No. of Gas Burners r t No, of Ranges No. of Waste Disposals No. of Air Conditioners TOTAL TONS:. Heat Pump Totals: Number. TONS: KW: No. of Dishwashers Space /Area Heating: KW Data Wiring, No. of Devices or Equivalent No. of Dryers .._. Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: No. of Water Heaters KW I No. of Signs: # of Ballasts: OTHER; # of Hydra Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner, no permft for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or Its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ . OTHER ❑ Please specify: Estimated Value of Electrical Work $ (When.required by municipal policy) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. DAV( certify, under the pains and penalties cf perjury, that the information an this application is true and complete. �p Firm Name: V ( I✓ I rf C_ XJ k 0 " LIC. # /4�l A 2 Licensee: Q 1@) ib -13 a 14t>,✓k6 Signature: LIC. # (If applicable, enter "exempt" in the license number line) Address: �% u �L' K 0 Z A �[E U i ('�` � 129AL tit i�t� Bus. Tel. # () �1 J'% [7 -JAI Tel. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am th (check g e) Owner a OR Agent ❑ n Signature of Owner/Agent Telephone # 7P S G ;Z — q 22 1 PEWYET FEE: 5 The Commornwea&k of Massachusetts Department of Industrial Accidents• Office of.[ mesti gabMs 600 Mrashington Street Boston, MA 02111 c J www mars.gau/dia . Workers' Compensation Insurance Afradavit: Builders/Contractors/Electricians/piambers ipf Catnt Informatinn NanIIe (Business/Drpmird6onllndividual): // 'f> i Ind �t1� Address: j' -3 yi� 2- City/,State/Zip: (�"D,rA c 1 %6 Phone #:. Are you as employer? Cheek.the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and'F, roject (required): ernPioyees (full and/or part-time).* 2 I am..a.sole proprietor or have hired the sub-contractosw listed coristrvction partner- / hip and have no employees on the attached sheet These soli -contractors have odeling oiition working for me in arty capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and itslding addition 3.❑Ired ] I anti s homeowner doing officers have exercised their right trical repairs or additions ail work myself [No workers' comp. of exemption per MGLbing .c, 152, § 1(4),'and we have no repairs or additions required.].t employees. [No workers' 12.❑Roof reainsurance airs comp. insurance required..] ` FiD applicant limo specks ba#1 mast an i Citi out the section blow showing their workers' 'compensation t room c who this affidavit indicating they ars doing an wmt �Canoactors 13.0.0ther policy information. otors check this that check this box must ached sn additional and Ihon hue outside conuactors must submit a new affidavit indicating ahect shawitr� thename ofthesub-contractors and their worksts' ' �6 such. it i cc , !art€ an employer that is proviaung workers' comperrsatrori insurance or `nF• Fe ; trtnrtaation. infornratfon, f mY enrpioYem, Below is the policy mrd job site . Insurance Company Name: Policy # or Self -ins. Lie. # ' Expiration Date: Job Site Address: CitylStateJZip: Attach a copy of the wortce Failure to re cooepeusafion policy deefaration page (showing the policy number and expiration daiej. I coverage as required under Section 25A of MGL 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 ORD£R 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 of the DIA for insurance coverage verification. I do hereby certify under the pains and pen ofriw7' fell the information provided above is true and rotted Information a nd Instructions N Massachusetts General Laws chapter 152 requires all emp 3 oyers 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 ernptoyer is defined as "an individuaI, partnership, association, corporation or other legal entity, or any two or more of thc'foregoing engaged in a joint enterprise, and includir-ig the legal representatives of a deceased employer, or the r=iver or trustee of an individual, partnership, association or other legal entity, employing employces. '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 gmunds or building appurtenant thereto shall not b..== of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shal l withhold the issuance or renewain l of license or permit to operate a business or *o construct buildings in the commonwealth for any applicant who has not produced acceptable evidenceaV compliance with the insurance coveragge required." Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter irrta any contract for the performance of public work until acceptable evidence of compliance with the insurance requirerncnts 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 -contractors) name(s), address(es): nerd phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members orpartners, are not requiredito cant' workers' compensation insurance. ]fan LLC or --LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also Ere 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, nafthe 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 salt-insurance'Iiconsc number on tire'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 pwrnit/license number which w M be used as a reference number. In addition, an applicant that must submit multiple permit/lice= 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 officiaily 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 now affidavit must be filled out each year. When a home owner or citizen is obtaining a license or permit not related to any business w commercial venture (i.e. a flog license or permit to burn leaves etc.) said pers6rz is NOT.required to compiete this affidavit The Office of lnvestigptions 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 Depariinent's address, telephone and fax number The Commonwealth of Massachusetts Dcparlment of Industrial Accidents Office Qf Investigations 600 Washington Sheet Roston, MA 02111 TeL # 617-727-4900 i= 406 or 1-8.77-W- SSAFE Fax # 617-727-7741 Revised 5-26-45 www.mass.gov/dia Date ... /..... � .. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION o .t5 A This certifies that ............ . . has permission for gas instolation ..�.. .,.................. . in the buildings of ........................... at�%� `..-` = ° . 7.....�..- .. , North Andover, Mass, Fee`.: �. ... Lic. No.�����.. ..... ,............ . Check # ae& �U.1�J V GAS Itr TOR MASSACHUSE.M UNIFORM APPUC,A'IiON FOR PERMIT TO DO GA.S ffrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Oate�y�eT Building Loqations 2 � C�L54 ?07f_ Owner's Name Amount S ✓ New Renovation Replacement Plans Submitted U B -BASEM ENT ASEM ENT ST. FLOOR ND, FLOOR RD. FLOOR TH.. FLOOR T . FLOOR TH. FLOna 7TH, FLOOR. STH. FLOOR. (Print or type l� %� �3 N Name �/ Address 1t G,l, 1wx ]� usmess a ep one 7C- r Name ofLicensed Plumber'or Gas Fitter Check one: Certificate Installing Company Corp. 0 Partner. Firm/Co. INSURANCE COVERAGE ! have a current liability Insurance, policy or it's substantial equivale t Check one: I f youhecked es please indYes icate th a coverage by checking the appropriate box. No � Liabilityrance policy Other type of indemnity n Bond rance Waiver I am aware that the licensee does not n---- °eve the In coverage wired b 13 l Laws, and that my signature on this. ermit g 4 y Chapter 142 of the p application waives this re4uiremerrt. wner or Owner's Ager t Check one: a Owner Aent I hereby certify that all of the details and information I have submitted (or entered) in compliance with all pertinent provisions of the Massachus tts Sabove app gl n are true and accurate to the ratio . best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application tate G will'b Gas Code and Ch 142 of the General Laws, a In By: Signature of Licensed Plumber Or Gas Fitter Title Plumber �(�O City/Town, Gas Fitter (cense umber �Nfaster APPROV, ED (OFFICE USE ONLY Journeyman c w ; w w p Z a W m d < x a C w F C w q w L' C e o z O 7TH, FLOOR. STH. FLOOR. (Print or type l� %� �3 N Name �/ Address 1t G,l, 1wx ]� usmess a ep one 7C- r Name ofLicensed Plumber'or Gas Fitter Check one: Certificate Installing Company Corp. 0 Partner. Firm/Co. INSURANCE COVERAGE ! have a current liability Insurance, policy or it's substantial equivale t Check one: I f youhecked es please indYes icate th a coverage by checking the appropriate box. No � Liabilityrance policy Other type of indemnity n Bond rance Waiver I am aware that the licensee does not n---- °eve the In coverage wired b 13 l Laws, and that my signature on this. ermit g 4 y Chapter 142 of the p application waives this re4uiremerrt. wner or Owner's Ager t Check one: a Owner Aent I hereby certify that all of the details and information I have submitted (or entered) in compliance with all pertinent provisions of the Massachus tts Sabove app gl n are true and accurate to the ratio . best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application tate G will'b Gas Code and Ch 142 of the General Laws, a In By: Signature of Licensed Plumber Or Gas Fitter Title Plumber �(�O City/Town, Gas Fitter (cense umber �Nfaster APPROV, ED (OFFICE USE ONLY Journeyman t �� ildi Uko -----•�n-�acrn of Massachusett Department of IndustrieAccident Df lice of Investigations 600 Washington Street 'oston, M4 02111 W1V11Ltl2Q.SS.eoipld a Workers' Compensation Insurance Affidavit. g>�ders/Coniractors/Elect • •• )Iicaaf Information ricians/Piumbers 1'4aM"- (Business/DTmi=bon/Individual): Address:_ 1 CCA�V � 1p j� S ?� q Qty/%L-/Zip: Areyon an employer? Check the appropriate 1. ❑ I an a employer box; with --- eeT }ogees (full and/or part -tune).* 4• ❑ I aro a 'eneral contractor and I have hired the sub-contractors —Lo}e r — P oprietor or partner- ship ship and have no employees listed o6 the att=hed sheet Z working for me in any capacity These s tab -contractors have workers, comp. [No workers' comp. insurance; insurance. 5. ❑ We are a required.] 3. ❑ I an a homeowner doing all work corporation and its officers have exercised.their myself. [No. workers' comp. insurance ri ght of exemption per MGL c. IS2, § 1(41 and we have required.] t no �emPloyees. [No. workers' • tom 76 Type of Project (required): •6• ❑ New construction 7• ❑ Rem odeIing . 8• E]Demolition 9• ❑ Building addition .Electrical repairs or additions 1' l.❑ Plumbing repairs or additions 12�[] Roof repairs H, insurance required.] 13•❑ Other *AnY appiicam.thm cheeks box # 1 .mast also fi11 out the section blow showing th-ir work t Tiomcowners whu sulmtii.flus rsiL�dautt indicatiit� th are duir,p ?` �m IContractors Ilial thee}: this box must �" iticsriC pensation policy intormahoa. attached an additional sheet showi 'u Ener nitre etttsioe coniraeiurs must sumnii n nen t!E tC name of the Sub -Car, SI71t1aVR lttCi�aF S::ch. I Mn all. entploper thx is Providing , tsactom and their workers comp policy, information r P e worriers• coraens : iw`nrmation. m`ioez iruurance for ng' employees Insurance Company Name: Policy # or Self .ins. Lite. #: Below, is the poficJ, and job site Expiration Date: Job Sift Address: Attach a Copy of the workers' COmneasa6mm ....rc,.,, .I _I_ City/State/Zip:_ ----k ninon page (Showing the policy number and expiration date). Failure to arcate coverage as required under Section 25A of MGL fine up to 51,500.00 and/or one-year imprisonment. as well as 1c• 152 °� lead to the imposition of criminal penalties of a of up to .5250.00 a day against the violator. Be advised that a penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification, copy of this statement may be forwarded to the Office of •" "" ��� ceru1J1 carter the paint and penalties of perjurf, tAx the inform provided above is true and correct Signature: g Uncial use onl p. DO not write in this area, to be completed hJ, , or to wn q ff ciaL City or Town: Issuing Ant6o PermitlLlcense city (circle one): I. Board of Health 2. Suiidine, DepartmentC' 3. 6. Other �/Towx Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: Phone #}: .L1ikvi LuaLiVU t=„jj(J, ;Lj1NL tj(',TjOIlS Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thea employees. Pursuant to this statute, an employee is defined. as ".. the r -y person in the seryice of another under any contract of h ire, express or implied; oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal antity, or any two or more of the foregoing engaged in a joint enterprise, and incluci- is rte the legal representatives of a deceased employer, or the receiver or trustee of an individual, par7nership, associati on or other legal entity, employing employees. However the owner of a dwelling house having not more than .three ap: ar and who resides therein, or the occupant of the dwelling house of another who employs persons to do ma iml nance, construction or repair work on such dwelling house ar on the grounds or building appurtenant th=eto shall not because of such employment be deemed to be an employer." MGL chapter 152 §25C(6) also states that "every state or local iiceming 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 o ff' compliance witb the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither -tine commonwealth nor any of its political subdivisions shall enter into any contract for the perfomumm of public worl< until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Picric fill oaf the workers' compensation affidavit compl-etaly, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their ceriificate(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 cazry,workws' compensation insurance. if an LLCor Up does have -. employees, a policy is required. Be advised that this affielavit may submitted to the Department of Industrial Accidents for confmation of insurance coverage. Also be sure to sign and date the. affidavit. The affidavitshouid be returned to the city or town that the application fur the permit or license is being requested, not the Department of industrial Accidents. Should you.have any questions to re d ng the .haxv or if you ar r -_d to obtain a workers' compensation p'oiicy, Please call the Cfarnnent at the nnznber.Iis".ed below. Self-insured companies should enter their self-insurance license number on the ataprop irate Line. City or Town Oficiais Please be sure that the -affidavit .is compiete and printedle biy. Tne Department has provided a space at the bottom of thc.af5davit foryou to fill out in the event the Office of Investigations has to contact you regarding the appiicant. Please be sure to fill in the permitliicense. number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in arty given year, need. only submit one affidavit indicating currerr, 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 Perim ar licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a licens✓ or permit not related to any business or commercial venture (i.e. a. dog license or permit to burn'leaves etc.) said persorn 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 Commonwealth of Massachusetts DtPartment of Lndustrisl Accidents Office of f avestigat-iions 600 Wash gtQn Street Briton; MLA (12111 Tel. 4 617-727-4900 *zt 406 c r 1-9 7 Mp,SSAFE Revised 5-2645 Fay * 617-72 7-7749 wwW-Maaz&.gov«fl d i `r This certifies that .:'" ...::.............................. �' has permission to perform .:..:.'. {� :: -� - - ' '' r•' �. plumbing in the,bu.ildings of at �4 / `' ` .. t ............. . North Andover, Mass. Fee .� ..... Lic. No—e. !.! j ....... ' . '.. !./ ............. PLUMBING INSPECTOR Check H Date../ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location (fI j/�U) y(Owners Name S� ' Type of Occupancy Date —7"/7'G Permit # s D Amount U% i NewEy RenovationReplacement1:3 Plans Submitted Yes E]No ❑ 0.11 W4 Oki i i , i --7kj W-------.----------------- ' ,0 0 -------.-.--.®-.-. M--.--- ----------®®.-----.---MM -�.------.W---.--------- -..--.--��---------------E 11' --..---.--------.---M----E (Print or type) IP� Check one: Certificate Installing Company Name ❑ Corp. Address ' Cci�cn �7 ��►rl4��c fC� L"1� &1§77 r � Partner. V usmess Telephone 7 �_��� �u Firm/Co. Name of Licensed Plumber: 6 y HCj Insurance Coverage: Indicate the type o surance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity El Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature IOwner ❑ Agent n 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus s State Plumbing Code and Chapter 142 of the General Laws. By: igna ure o1 1-icensea fliumDer Type of dumbing License Title City/Town icense 1Num5er Master Journeyman ❑ �� APPROVED (OFFICE USE ONLY uuu The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 FMashin ion Street Boston, MA 02111 ' Workers' Cwww-num gov/dia . ompensation 1witra.nce Affidavit: Builders/Contractors/Eiectrirsans/plumbers MDICant Informatinn Name Address: 11G City/State/Zip: yel 51 o pl A &6" Phone #:�?���i -ILIAC, Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I 2. er=20oyees (fun and/or part-time).* r am .a sole proprietor or have hired the sub -contractors listed partner- ship and have no employees on the attached sheet t These suii-coniractots have working for me in any capacity, [No worker;' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation and its required_] 3. ❑ I am a homeowner doing officers have dxercised their all work right of exemption per MOL myself [No -workers' comp, c. I52, § 1(4), and we have no insurance required.) t .employees. [No workers' COM insurance uired Type of Project (required): 6. ❑ Now construction 1. Q Remodeling S. Q Demolition 9. Q Building addition 10.0 Electrical repairs or additions I I - F7 Plumbing repairs or additions 12.E] Roof repairs 13.M.other goy applicsnt that homeownchecks bob # t must also fill out the section below showing their workers' oompensation policy information. t ers who submit this affidavit indicating they are doing all work and than hue outside contractors must submit a new affidavit indiaetiag such =Contractors that check this box must attached an additional sheer showir� the name ofthesub-contractors and their mit a n' comp, Avii • irtnrn�ssuc 1 am an employer that is prog:workers' compensation insurance a to Mformadon. for m3' mp yee� Below it the policy and job site . Insurance Company Name- - CX ame-ocy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Failure to s Attach a copy of the workers' compensafion policy declaration page (showing the policy number and expiration date). ecure coverae a coverage required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $I,500.00 and/or one-year imprisonment, as well as civil penalties in the forrn 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 of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and eorred ficial use only. Do not write in this area, to be completed by city or town orxaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp I oyers 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, assodiation, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and includirig the legal representatives of a deceased employer, or the receiver or trustee -of an individual, partnership, associatiorn or other legal entity, employing employees. 'However the ownorof 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 maimtenance, construction or repair work m such dwelling house or on the grounds or building appurtenant thereto shall not bm ause 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 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 tiie 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." Applicants Please fill out the workers' compensation, affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) 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 LLC or LLP does have empiyees, a policy is required. Be advised that this affidavit 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` he 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 numberlisted below. Self-insured companim —should ent-*hex Self' insunanoelicense number on &e* appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes provided a space at the bottom of the affidavit for you to fill out in d -a 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 or permit to bum 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 Commonwealth of Massachusetts Department of 1ndustzial Accidents Office of Investigations 600 Washington Street Boston, MA 022111 TeL # 617-727-4900 ext 406 or 1-8.77-MA.SSAFE Revised 5-26-05 Fax 4 617-727-7749 wwwmws.gov/dia r�• CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER fs pr Building Permit Number 280(11!29/2004) Date: June 30, 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 257 Chestnut Street " MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Jose Lopes 257 Chestnut Street North Andgver MA 01845 oor Of W, Bonding inspector NOR7N �,s ....•� TEMPORARY THREE MONTH CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 2 8 o (i 1/ 2 9/ 2 0 0 4) Date • Auau s t 18, 200 6 THIS CERTIFIES THAT THE BUILDING LOCATED ON 257 Chestnut Street MAYBE OCCUPIED AS SINGLE FAMILY DWELLING ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY.: ON THE CONDITION THAT THE EXISTING SINGLE FAMILY DWELLING AT.J57 CHESTNUT STREET CERTIFICATE ISSUED TO: IS RAZED BY NOVEMBER 30, 2006. Building Inspector 1r CO) m 0 y d C y CO) C2 Z06 y 0 o v [;7 20) c• CL y a� � o m o p CD CL `� o cr m CD CD o C z r cn l J 0 cn 2 0 C O s awl Q c mCO2 =�=� CL It IT Sr CL m �� �Iomy p m y r =• m a � Z owe) • ar 0 r rrS Q < CD V ,om CD G1 ti =s Q �a ti40 4 no M + O m ' �h 0 r dam. O { C O� a Mq z 0 9l� )mq 0 .1 ?—" �T4....6,er0 c«t 0,4rnu 01 11 4r2 SACHU794*�,09 • Ci 40 N APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # ADDRESS/LOCATION OF PROPERTY: a5l C�� ► Map -1 p p Parcel Lot Number 2q SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (6) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED RO!JTING CONSERVATION PLANNING 00 ( VI Pce �qv'J 0 P L'' 1j' DPW - WATER METER F�`� SEWER/WATER CONNECTION NOTE r" DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST File: OC form revised 2006 DATE: MAY 6,200S REVISIONS: SCALE: 1 INCH= 40 FEET 01 40' 3( MAF 275 ( THC) FIN(: FRANK S. GILE S SURVEYING 50 DEERMEADOW ROAD NO. ANDOVER, MA 01845 TEL: (978) 683-2645 FraiikGilesSurvey@comcast.net MAP 98C. PARCEL 7 0 HILLSIDE ROAD RANK S. GIL. 0 OF VSs F 0 1713 RDFESS��aPv "AND SUMN CHESTNUT STREET ZONING DISTRIC MIN. AREA = 25,000 S.F. MIN. FRONTAGE= 125 FT MIN. FRONT SETBACK = 30 FT. MIN. SIDE SETBACK = 20 FT. MIN. REAR SETBACK = 30 FT. PLOT PLAN OF LAND LOCATION 257 CHESTNUT STREET NO. ANDOVER, MA. DRAWN FOR JOSE LOPEZ 60. PARCEL 142 JNTEIRO WAY J-EZZL JEAN I) P 60, PARCEL 141 CHESTNUT STREET RGAN, JOHN A 1ARY E MORGAN [at this plan and sun-ey was donetill accordance with ural and Tedmical Standards for the practice of Land in the Conunonwealth of assachusetts. RANK S. GILES II lic. 441713 THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. 'D n6 c IUl T m rn r- X D Dm c _ D Z� z I I z � -" rn O (-)ICU D z z 3 O r- u 70 70 CO m m z z C m m m T- c N N OD � N 70 I I I I I N 00 p O w X _ X u, O x x° I x m -� --I N N z O W O N m 70 3 rn A cn 70 'D n6 c IUl T m rn r- X D Dm c _ D Z� z I I z � r. rn rn O z a a . 0 29'-p„ 19'- ----------------------------� 1 ------------ ------ - -- - - - - -- - - - - - - - -I GARAGE FOUNDATION 6'-31' I _61 I 6,_3" GARAGE FLOOR PLAN Ak 112" 112" ly SECOND FLOOR PLAN at GARAGE A a lo' -I• s 8 I �f' n F �O b71 NDn r DO T TN = D _ T r �O_ m T rm X (( mzA O D N C� O m A OE u n z Om A A • o n m O D V C, D hN A N vA A O Uz z m D 3 SS • E �� O A D c 0 D C, A Nm O ^ p O AD N rn D m m O O m D m < N E <m rn z A � NO T rn N U T TT i ti� � i ti U lP.y i IDT \ \ I �F r E C• zz r \ T E D\ N Ar L C n C' D \ m r o I\ p I \ i, C`C A )o - O r OC w O m \ I i X z C < < _-0 T m \ Om Q m (D p zm c— E \ 1 C% =Ow N A N C r m O m I I .4 Am vy D O O A A > p I Z m l C' O Z , \ i , i — — — — — — — — — — — 1 , I TN v v .D z in cn C � E m r Ty O G OO z Z_ C' z z O z = m N A E � m � Z z D U m n DENCO ENGINEERING STRUCTURAL ENGINEERS 17 MALCOLM HOYT DRIVE NEWBURYPORT, MA 01950 V: 978.462.5822 F: 978.462.5823 Structural Calculations as per Commonwealth of Massachusetts Building Code for One- and Two -Family Dwellings For Steel Garage Beam 257 Chestnut Street No. Andover, MA May 15, 2008 Prepared By: 4 -- Daniel W. Smith, E.I.T. Reviewed By: Kenneth Dennison, P.E. PROJECT: 257 Chestnut Street, No. Andover, MA PAGE: Garage Beam CLIENT: Jose Lopez DESIGN BY: DWS JOB NO.: 05208 DATE: 5n5noo8 REVIEW BY: KFD Steel Beam Desion with Gravity Loadinq Based on AISC ASD 9th INPUT DATA & DESIGN SUMMARY BEAM SECTION => W12X26 SLOPED DEAD LOADS woL,1 = 0.156 kips / ft wou = 0 kips / ft PROJECTED LIVE LOADS vvLL,1 = 0.52 kips / ft w" = 0 kips / ft CONCENTRATED LOADS PDL = 0 kips PLL= 0 kips BEAM SPAN LENGTH L 1 = 24 ft CANTILEVER LENGTH L2= 0 ft, (0 for no cantilever) BEAM SLOPE 0 :12 (0= 0.00 0 ) DEFLECTION LIMIT OF LIVE LOAD ALL = L / 360 BEAM YIELD STRESS Fv = 50 ksi THE BEAM DESIGN IS ADEQUATE. ANALYSIS DETERMINE REACTIONS, MOMENTS & SHEARS R2=0.5 cosB+1VW Li+ cos9+IV= (Ln+0.5L2)Lr+PL1LL2 8.11 kips a., wo, l R1 wCosa., L,+(Cos 0+w,j., ILz+P—R2 = 8.11 kips JJ X1 = 12.00 ft X2 = 12.00 ft X3 = 0.00 It a> Ix S. rT bf tr tw 204 33.4 1.72 6.49 0.38 0.23 i SI ope i= R, I T - -- --- - L' i A- Mmi,, 0.5 Cosa+wu, L2+PL2= 0.0 ft -kips o- 2 _� 1(X1+X2) - Mu�- cos9 S+tv�., — 48.7 ft -kips � r-- Vma� = 8.11 kips, at R1 right. MMin BENDING CAPACITY (AISC-ASD, F1.3, page 5-46) 1= Mar(L2 + X3) = 0.00 ft, unbraced length (MI)+('.�_AL Cb=1.75+1.05 2= 1.75 since M, iso M2M2) r7 = 1.72 in , A, = 2.47 int Lc— M/N 76bf 20000 5.81 ft — F1.' ldlAf)F1.)= 102000Cb 12000Cb — 1179 L„ = MAX r: FY 0.6(d/Af)FY S'0000Cb _ L3 = r. F, — 19.15 ft Y ft (1Fbi, 2 Fy(I/r>)2 —MIN 3 153000OCb Fy 0.6Fy — MIN 170000Cb Fy _ N/A (I /r,) Fn2 = 2 0 Fn3 = li1%i1r(Tid 1200Cb 0.6Fy = NIA AI� > 0.66F,. , for 1 <_ L, 0.6F,. for L<<I <L„ Fn — MAX (Fm Fn3) for L„ < 1 < L: MAX (Fns Fn3) for 12'L3 fb =MW /Sx = 0.0 ksi < LOCAL BUCKLING (AISC-ASD Tab. B5.1) bf I (2tf) = 8.54 < 65 / (Fy)0.5 = [Satisfactory] d / tW = 53.04 < 6401 (Fv)o.5 = [Satisfactory] MMex BENDING CAPACITY (AISC-ASD, F1.3, page 5-46) 30.0 ksi = 33.0 ksi Fb [Satisfactory] < = does not apply for top flange continuously braced without cantilever. N/A NIA fb = Mm'x /Sx = 17.5 ksi < Fb = 0.66 Fy = 33.0 ksi [Satisfactory] SHEAR CAPACITY (AISC-ASD, F4, page 5.49) f„ = Vmax/t,yd = 2.9 ksi < F„ = 0.4 Fy = 20.0 ksi [Satisfactory] NINE CAMBER AT DEAD LOAD CONDITION L = L r/cos 0= 24.00 ft, beam sloped span a= L2/COS 8 = 0.00 it, beam sloped cantilever length P = PDL COS 8 = 0.00 kips, perpendicular to beam W1 = wDL, r COS 19= 0.16 klf, perpendicular to beam W2 = wDL.2 Cos 8 = 0.00 kit. perpendicular to beam Pa2(L+a) w,L3a+wza3(4L+3a) Ar-nd_ 3EI — 24EI 24EI 0.00 in, downward perpendicular to beam. USE C = 0/4" AT CANTILEVER. paL2 Sw,L4 wzL2a2 Amid = — + — = 0.20 in, downward perpendicular at middle of beam. 16EI 3 84EI 32EI USE C = 1/4" AT MID BEAM. DEFLECTION AT LIVE LOAD CONDITION P = PLL Cos B = 0.00 kips, perpendicular to beam W, = wLr..r Cost B = 0.52 kit, perpendicular to beam w2 = wLL,2 Cost B = 0.00 kit, perpendicular to beam _ r Pae (L + a) — w,L3a + w2a3 (4 L + 3a) cos B = Orna L 3EI 24EI 24EI rPaL2 + 5w,L4 w.L2a2 cos B = OM`d — L— 16EI 384EI _ 32EI 0.00 in, downward to vertical direction. 2L 2 / 360 = 0.00 in [Satisfactory] 0.66 in, downward to vertical direction. L, / 360= 0.80 in [Satisfactory] e a�va�iaiL11.1/V♦L'l� ..:OFFICE OF BUILDING DEPARTMENT * 1600 Osgood Street Building 20 Suite 2-36 North Andover, Massachusetts 01845 A Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings '.. Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please DATE: 5-- 0d\, - $ JOB LOCATION: 7 Cee (0 39 Number Street Address Map/Lot HOMEOWNERo���G.,,,,� 1-o�,cZ 5�7 �o�. 98-1 Name - Home phone Work Phone PRESENT MAILING ADDRESS—,,15-7 �11N� PMc�,a,rer Ma.`sS 0 �8�Q 5� City Town State Zip Code The current exemption for -homeowners" was extended to include owner-oxupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned -homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that helshe will comply with said procedures and requiremems. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Rid 10.2005 Form Homwwnm Exemption BOARD OF TPE.V-S 699-9541 C0.\SER%'.V1'10\ 68R -953q ITE.1L'1'Ii 6xg_gt�p PLANNING 6F8-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston, MA 02111 M 5www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 3t, -Y— Uro Address: .67 City/State/Zip: (\ , . -(A a , Phone #: T 7 $ 6'03\ 96-7 7 Areyou an employer? Check the appropriate bog: 1. El 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-conhractors have working for me in any capacity. employees and have workers' fNo workers' come. insurance comp. insurance.$ required.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):., 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. El Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: _AZ,_ 144 4 Date: Phone #: 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 11 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 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,opera'te.-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 of public 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 -contractors) name(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 LLC or LLP does have employees, a policy is required. Be advised that this affidavit may 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 or permit 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 6.17-727-4900 ext.406 or 1-877-MASSAFE Revised 1122-06 Fax # 617-727-7749 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: dose ,Z Site Address: print Town: N Applicant Phone: 97,F S-0 cg,? 7 7 Applicant Signature: � ,(3 �� Date of Application: 6_- 7- O e NEW CONSTRUCTION: (choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS o].o Z8 _SF 100 x 1 �; b - A DA40 = 7i 1$ % of glazing MAXIMUM MINIMUM O tion 1: �_ PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING Ceiling or / MAXIMUM Basement Slab Fenestration Ceiling and Exposed floors Wall Floor Fenestration exposed Wall Floor Wall Perimeter AFUE HSPF SEER U -factor floors R -Value R -Value R -Value R -Value a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R -value over the entire ceiling area (i.e. not compressed over exterior walls, and including any access openings). ❑ SUNROOM - An addition or alteration to an existing building/dwelling unit where the total R -Value addition. and Depth R-10, National Appliance Energy Conservation Act 3 5 R-3 8 R-19 R-19 R-10 (NAECA) of 4 ft 1987 as amended, minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: v REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2) v REScheck-Web which can be accessed at http://www.energycodes.gov/rescheek/ ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS OVER 5 YEARS OLD* *Buildings under 5 years old must use option #1 or #2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) o].o Z8 _SF 100 x 1 �; b - A DA40 = 7i 1$ % of glazing (b) Glazing area equals/ 6,p SF b a If glazing is = 40% use the chart below. If glazing is > 40 % proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS / MAXIMUM MINIMUM Fenestration Ceiling and Exposed floors Wall Floor Basement Wall Slab Perimeter R -Value U -factor R -Value R -Value R -value R -Value and Depth .39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R -value over the entire ceiling area (i.e. not compressed over exterior walls, and including any access openings). ❑ SUNROOM - An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to 0 out Consumer Information Form (found in Appendix 120.P) Attorney Ralph R. Joyce 121 Collins Landing, Weare, NH 03281 Tel. 603-529-0264 Fax. 603-529-5420 January 2, 2007 Town of North Andover Gerald Brown, Inspector of Buildings 1600 Osgood Street North Andover, Massachusetts 01845 Re: Jose Lopez 257 Chestnut Street Dear Mr. Brown: Please accept this letter to evidence our discussion of recent date. Mr. Lopez appreciates your extension of his temporary occupancy permit on the above premises and recognizes his obligation to remove the old dwelling located thereon. He has undertaken this obligation by disconnecting the gas, water and electricity. He has stripped the kitchen and bath facilities and only the shell of the building remains. His could not finish the job with his work schedule last fall and will undertake the same again in the spring when his full work contingent is back. Mr. Lopez appreciates the consideration shown him to date and will continue to cooperate with your office. Best wishes for the new -year. Jose Lopez, By his Attor Ralph R. Joyce j a r y I 0V Ir• r Permit No. - 0/ 0 r Occupancy R Feu Checked APPUCATTONFOR PERMIT'TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE wrrH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMA 12:00 J rO (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. (� Location (Street 3 Number) tD- S% C r 1 e n J 4 Owner or Tenant <S e- �-) 0 e S Owner's Address -ScLey- C- ls this permit in conjunction with a building permit: Yes[3-No 0 (Check Appropriate Boa) Se Kt/p Purpose of Building Utility Authorization NP �' I Existing Service Anipe� Volk Ov Underground a No. of Meters New Service Amps KVotta Overhead Underground ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work lrh4 e v bowa A/,,/ No. of L3ghdna Outlaw No. of Hot Tube of Tre w tmm Total KVA W of Ughtins Picture Swimming Pod' AboveBelow In Oertertton KVA No. of Recepteela Outlaw slowd- No. of OU Bunn No. of En-sency Lighting Denary linin No. of Switch Outlaw No. of On Homers FIRE ALARMS No. of Zones No. of Randa No. of Air cad. Tota Ton No. of Debetiao and No. of Dispoeds No. of Haat Told Told Po Ton KW Initiating Devka No. of Sou Bina Device No. of Diehwaehere Space Ana Netting KW No. of Self Cbawhwd Des-dordSoundhg Devices lccd� Municipal� q No. of Dryer Hewing Device KW Comtections No. of Water Heat=KW Na d Na of Sims Bdhnk No. Hydro Mwaae Tube No. of Moron Total HP }> L=xet Puts wt)d es}im=ftdWh di>asCim=dI w a lhateacaaettIiet*iosaioeF*ykrYidrBCY 1 aribs+tdoweghdat YES NO Bharestftrrbdv&ys ddsaiit lD11!GfflZ Y$9 a)cuhmecfiededYfl4�pleaidrntaiegRda by iC OM The foo > Do E�lrt�tdV"cfHect4calwak $ WodcbSmtt _ . �°' �✓ _ itttp�artDesltec}trated Ragh Firul FEMNAME sr k LimmNo. _ Imam Btts =TdNa AkTdNa owlet'sIlVSi1RAI�EWANFRIanawaetietiheLicateeht�Alei�aiisnoeonaagealtsttb�>aelegtivslQtasrec}iedbyMt�ds>aesGaleallawa atddtatrrp+sBteraerndisptm�appio�anwei�eafi:regiie�nt ❑ (Please check one) Owner � Agent Telephone No. PERMITFEES 7W A 64�c—� ep 4 4 — cr►� gQ ti, Date... %. .�.�.�.... �?.. . Of ,AORTH 1� Z TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..' ! :. %�...... .-..... .. ..... ...... . %%. has permission for gas installation ................. . in the buildings of . r-- .— ...-......................... . /- at ..::. l......r........ .� ..... ,North Andover, Mass. Fee.,,—', .... Lic. Nol.-�fir' ;�.�.':-:^� . r.. ............. GAS SECTOR Check # / ri i r G IASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFn nNG rdn(w Type) �` Q - t ►� , i . , c�i ...0 .Mass. Date �i - ► 20 �� ' Pemdt MAding LoCat w ?L L C' ��) Ownera Name 1 L •, -� - �_ WMIM ReftOAlatlOn ❑ Type of Occupancy .� • • � i t ; Q Replacement ❑ Plans &,&n1tted: YesQ NoXl Installing CompanyName r -1 t ..9 : 0" i :S,. Check one: Certificate Address Corporation z C. kci C) ❑ Partnership Business Telephonel- ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter i r t ',4 %,,-+ I t c INSURANCE COVERAGE: I have a curr iabtlity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ N you have ed yes. please Indicate the type coverage by checking the appropriate box. A IhbiUty Insurance poikyx 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 Signature of Owner or Owner's Agent 1 hereby certiy that all of the details and information I have submitted (or entered) in above application are true and accurate to the gest of my knowledge and that d plumbing work and installations performed under the permit issued for this ap� I be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General By TmeDf Ucense: umber cen r or Gas Fitter Title Gasfitter er License Number ?�5 _- Cily/Town Journeyman �. j•ORTI h::, A`• •' �, Zoning Bylaw Denial Town Of North Andover Building Department <'=4 400 Osgood St. North Andover, MA. 01845 Phone 978488-9545 Fax 978488.9542 Street:C h,e5.4 N 4/ i 8 "n/Lnt- % 3 I q-1VsE- /-c�P-4 � S v b / cj, f AAti' Date / � / / � / d 5— - Please be advised that after review of your Application and Plans the your Application is DENIED for the following Zoning Bylaw reasons: Zoning K - Item Notes Site Plan Review Special Permit Item Notes A 1 Lot Area Lot area Insufficient Lot Area Variance F 1 Frontage Frontage Insufficient { 5 2 Lot Area Preexisting $ ial Permits ZoningBoard 2 Frontage Complies Large Estate Condo Special Permit 3 Lot Area Complies Ll�e S 3 Preexisting frontage R-6 Density Special Permit 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed y e S G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Com ies 7 5 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 I All setbacks comply k c s 1 Hei ht Exceeds Maximum 2 Front Insufficient 2 Com ies `� 5 3 Left Side Insufficient 3 Pree)dsting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexists setbacks 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies c1 r 5 D Watershed 3 Coverage Preexisting 1 Not in Watershed y 5 4 Insufficient Information 2 In Watershed d Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking A 1 In District review required 1 More Parking Required 2 Not in district y 5 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre'existing Parking Remedy for the above is checked below Item 6 Special Permits Planning Board from 0 Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Con r Housing Special Permit F- 1 Variance W 00 F -z r �' � u rq Continuing Care Retirement Special Permit $ ial Permits ZoningBoard Independent Eklerl HousingSpecial Permit Special Permit Non-Conformin Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Special Permit preexisting nonconforming Watershed Special Permit The above review and alfactted explanation of such is based on the plans and Wwnabon subiniitted. No definitive review and or advice shall be bawd on verbd explanations by the appicant nor stall such verbd WWrdions by the appicent Serve to provide definitive anewsm to the above nsaora for DENIAL. Any lnaoaxwm, misleading irfamotion, or odw subsequsrd changes to the infanWon subinlftd by the gVimit stay be Wa rWe for ibis review to be voided A the ftmbon of tta Building DgWt1nent. Tha dfadad docunwtt titled'Plen Rwiaw Nwratba' shallbe daehsd a w do and inearporand herein by nfennce. The buiding department will retain dl pieta and documentation for the above fie. You must Sea new building Pam appy form and begin the pemiiN process. Building Department Official Signature f& / D 5- Applicafion Rieceived /o/3v— Appl" ion Denied Denial Sent: If Faxed Phone Number/Date: ld3a Maine Jo400 uo!ss!wux)O leMX)is!H vuluusld 94mM o!14nd 10 4u9 U01WA UOD PAWS Buluoz X "god 4480H OJU :ol Ppb :ap!s owanaj otp uo powmpu! AvedoJd ayl Jol puuod /uo!ieo!ldde gog Jol le!uep Jol suosm otp u!eldxa jaypn j of papnad sl ammmou Bumollol a41 •APWeN MOIAGa U91d IT 7L y o -vi PifiYcy �yo� oj"V �J�v�'7 y A"ft"Mw um :ap!s owanaj otp uo powmpu! AvedoJd ayl Jol puuod /uo!ieo!ldde gog Jol le!uep Jol suosm otp u!eldxa jaypn j of papnad sl ammmou Bumollol a41 •APWeN MOIAGa U91d ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ius seews for mkiii Use ow BUILDING PERMIT NUMBER: Q� DATE ISSUED: /; `~ / SIGNATURE: Building Commissioner/In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: (� 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 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 10' 343 a d U, 30 3c' 1A 8 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: _ Public 0 Private ❑ Zone Outside Flood Zone ❑ 1.8 SeHerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic yistrict: Yes hi 2.1 Owner of Record Name (Print) Address for Service Sig atu a V 0 Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable _ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date nature Telephone 'V T M r l 0 ^i 0 z M 90 0 a.� M H 0 O z r= o a �c C M- m 0 -�e a H c 3 c o w 0 0' u 0M 2 , w Q1 m u0 C � n � C j ICU m a c 0 0 w IM � o c '0 c 3E N LL a !� m O z °Z L !D 05. =as N WD W o a a a a a w W v a o o c W `° °o E o wo' cn cn CL g 0 11 z z 0 U 91 W O O• L Z o. O y � C I C� O A a p G 00 �E m m CD O� 3.0 O O 0 O L � �a cm< C cc CL 0 as c Z CL C.) h O C c y D 0 U) V) W ce W U) 'mc �0 0 c« Mr- �QM�a : CD IL Z O CF �! o m CL t co '" m_cm gels C Lm O �' N v, ? 0 3 cm Co ECD cO v 0 z� :'�►o� mZ m w .0 co x ma -c w m 0 W C BIZ c H W O CLI E `5.0 C.3to W aha =.�am g 0 11 z z 0 U 91 W O O• L Z o. O y � C I C� O A a p G 00 �E m m CD O� 3.0 O O 0 O L � �a cm< C cc CL 0 as c Z CL C.) h O C c y D 0 U) V) W ce W U) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT14 OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,:. 'r. '•l Y G -.. ... 'i.'.2; n.yri..«Y. X: ay �S BMDING PERMIT NUMBER DATE ISSUED: SIGNATURE: Building Commissi2REEanEeLxr of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Historic District: Yes No 1.2 Assessors Map and Parcel �ip� Map Number Number: 0 Parcel Number 2.2 Owner of Record: Name Print Address for Service: 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area 50 Frontage ft 1.6 BUILDING SETBACKS ft Not Applicable 0 Front Yard Side Yard 3.2 Registered Home Improvement Contractor Rear Yard Required Provide Required Provided ReqWred Provided Address Expiration Date Signature Telephone 1.7 Water Supply M.G.I-C.40. 54) 1.5. Public 0 Private ❑ Zone Flood Zone Infomntion: outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record JoSe�� L-ov Y.Z-- Name (Print)4Address for Service WJ TOA 2871 40�turc Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor. Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone go rn X a. Z O rn z rn 90 O r v rn r r Zso G) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. 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 ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) Accessory Bldg. ❑ I Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION CncT.Q I to provide this affidavit will ❑ 1 Addition ❑ Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number ar,a.iivi% is vWPlrl(Aulnlll(1GA11gJA 1U 1$h I;VMYLE1EV Wt1Ef4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property 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 r-- I, m% 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 �J Pratt Name Si ture of`OwnejkAAnt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS iST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Ir Location No. c�-) U Date TOWN OF NORTH ANDOVER • �L 9 Certificate of Occupancy $ ; J� Building/Frame Permit Fee $ Foundation Permit Fee $ G 0 Other Permit Fee $ 1 ` TOTAL $% `> .� Check # �� a �/ Building inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r4ft I" Iul j BUILDING PERMIT NUMBER: DATE ISSUED: ,,. . SIGNATURE: Building Commissioner/Ing=tor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 3 :e 0,. , 0,3,0 Sr 155) ZoningDistrict Proposed Use Lot Area s� Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3o' 313 Q) d0, 30 3a' 80 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SEUTION 2 -PROPERTY OWN EKSHW/AUTJt101 ZED AGENT nR.)MIC DisinCt: Yes NO 2.1 Owner of Record �JOS2 o��h L -o�yx— p�S Name (Print) Address for Service: 9 766,M 5 Sig atu a Telephone 2.2 Owner of Record: Name Print Signature SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Address It Address for Service: Not Applicable License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date . • f 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 ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 11 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: eae ��, 3 f3� i o) S 7Ca G/ ,<1 &�c %r w c' S 4't"' I i l ,1- Fr,u Y- Dw-e i G c 'f � /C R L Y 4 C,7 P 4.1 Cv &11ie A,l &,L, 6� (S Sod h�C ►"� SF,CTION 6 - F.STIMATRD CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL, USE ONLY 1. Building �^ (a) Building Permit Fee Multiplier 2 Electricalr� (b) Estimated Total Cost of Construction 3 Plumbing O Building Permit fee (a) x (b) / �/ ��9136 4 Mechanical HVAC .1 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 behalf, in all matters relative to work authorized 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE CY BASEMENT QR-6t7M- SIZE OF FLOOR TIIVIBERS 1 2 RD 3 SPAN DIMENSIONS OF SILLS Qr-- DIMENSIONS OF POSTS A DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X . d MATERIAL OF CHIMNEY IS BUILDING ON SOLID 6n LTT " B E1444- IS BUILDING CONNECTED TO NATURAL GAS LINE P, w9m , s 0 0 Cd 0 o am a Lid a O � � H z a � W um OC40 : o o O C ; c Q v o. c .� to 7 N N N c L- O1 W N o 0 5 N e a -c°v c _ o c 3 cu 3 N °U) o O .:3 o19 nu . i v W 2 -� — c coc a) LU o- LL oC o .. � u ma) V �E � W Q a o a c m a c Vi Vf C O V O O N LV C m t W E' o C r cLLJ t- E x U a) a) 0� N O N a. s o. 5 as LL Cl N_ N t .tom- o %- w Z O L 0 Ql U > m , A a u. ci o w w 2 U C w a w a -C p r�4 G i=. a w a U ra w w u w" c� w w' A fa�rr W y C rA o 2 cn v O cn Lr r O ,2 �1 0- co *!.L - `Z 3 y 4D3�pp R C m H C • � Amo h 0 OcyQ m3o ca Z r :o`o � o. ` O C _ d +r o H C#* •'c'~ •yLLJ a= IS C W E czi C.3 o. c 0 = w �W 32 10 ��s t- z $ a0.. m E Mat y N c cm M Co m 0 CM c QC N m w O Z O 5 CD zip CM I O h O �� m m � f+ 3.0 m L M O CL cma c cc CL 0 v ��v G3 C.0 Z � V h O C C C h 0 U) U) W w U) uonotWsuoD3o a81ego ut alq?suodsa21 ❑ a eo dd Iq R �' aoH :ameli Auedmoo a3sQ uopendxg auotldalaZ !S .taqumN uopMslSag ssatppd ,C q!q!suodsog 3o mlV i auieH „. aleQ uorl"dxg ouotldalaZ am3�tS JagtunN u0petls!2ag SM�PPV Al!I!q!suodsad3o saw amell aleQ uopei!dxg ouogdalas attt;t !S JagtunK uojv4s!2a*d ssalppb :autem ❑ algeogdde loll MOIamleaBiS algQ uoijp- !dxg .mqumK uopegs!`dag :ssoippy ,Cltl!q!suodsag 3o eat :atuell auotldala jL M1ppd :autell :Mlgwvpaials!soH 1'5 ��_��W���yyy -� lox ❑....... ox ❑....... IOA paq*BW 1!nePBe.Pou !S lrml u!pltnq agl3o aousnsst og13o litimp oql m llns�j ll!M ltn8pg;e SUP ap!noid of ainpa •uogaogddu snp ql!m pou!mgns pus Moldmoo oq lsnut ltnapq;a .austnsul uopssuedwoo sta31JoM' F, p x r _ety 4. M'r F �•. � p l /(may o l 0 o -f - 3 , F o °off' s�9S 009 ON 0 70 ,d o w) 8 Li coosh 4 �,/ A MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-30-2004 DATE OF PLANS: August 30, 2004 TITLE: 257 Chestnut Street, North Andover, MA PROJECT INFORMATION: 3000 sq. ft., 28x40 main box, 16 ft. family, 2 car ttrAje*-- COMPANY INFORMATION: Jose and Josephine Lopez COMPLIANCE: PASSES Required UA = 593 Your Home = 530 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value ------------------------------------------------------------------------------- U -Value UA CEILINGS 1384 30.0 0.0 49 CEILINGS: Raised Truss 130 30.0 0.0 4 WALLS: Wood Frame, 16" O.C. 2977 11.0 0.0 265 GLAZING: Windows or Doors 407 0.320 130 DOORS 40 0.350 14 DOORS 38 0.490 19 FLOORS: Over Unconditioned Space 1500 30.0 0.0 49 HVAC EQUIPMENT: Furnace, 86.0 AFUE HVAC EQUIPMENT: Air Conditioner, 10.0 SEER ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date •MAScheck INSPECTION CHECKLIST M3ssathusetts Energy Code MAScheck Software Version 2.01 257 Chestnut Street, North Andover, MA DATE: 8-30-2009 Bldg.l Dept.l Use I CEILINGS: [ ] I 1. R-30 I Comments/Location [ ] 2. Raised Truss, R-30 I Comments/Location I Insulation must achieve full height over the exterior wall. I I WALLS: L l I 1. Wood Frame, 16" O.C., R-11 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.32 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.35 Comments/Location 2. U -value: 0.49 Comments/Location FLOORS: 1. Over Unconditioned Space, R-30 Comments/Location HVAC EQUIPMENT: 1. Furnace, 86.0 AFUE or higher Make and Model Number 2. Air Conditioner, 10.0 SEER AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required om the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed i using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual ( or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant I below 40 1.0 1.0 1.5 1.5 [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 1702180 0.5 I 1.0 1.5 2.0 ( 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only) ------------------------- I Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE 7 30 "meq JOB LOCATION Q'3-7 �0 0 39 _ Number Street Address Map / lot "HOMEOWNER 'J05< t Name Home Phone Work Phone s PRESENT MAILING ADDRESS of 7 eA�.ss , o t'sCFS City Town State Zip Code The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC 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 exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Permit Applicant 973 (z, 0110WS5'7 c,1s 7 (-,,c .39 Property address Map / Parcel Applicant's Phone Number 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 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. - 'X_ This is an application fora building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of 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 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens 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 part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density 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 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 and 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 a building permit ( 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 Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER 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 OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. -30 - oLF APPr1CWS STGNAWRE DATE TM§WRM TO BE AIVACIIED TO THE BUILDING PERMIT APPLICATION AJ -e- to 2aiE_ Ota FORM U - LOT RELEASE FORM el3�o- 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE 97S (o81 0 (o S LOCATION: Assessor's Map Number %'o F PARCEL 2'y SUBDIVISION r LOT (S) STREET c�S T C�c. � v \ Sl • ST. NUMBER-�5 7 *****************************************OFFICIAL USE ONLY*********************************** AGENTS: CON ERVATION ADMINISTRATOR DATE APPROVED /D-4- DATE REJECTED COMMENTS�I,VD/�1lj�S X/ TOWN COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECY6R-HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT j FIRE DEPARTMENT �� "�`t' �i �1'e" Z_e&' k RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Location No. r Date A;C��� N0w,rN TOWN OF NORTH ANDOVER f �q Oi�ao y . L 9 Certificate of Occupancy $ sACMUs tis Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 53 j + l �y/ �' Building Inspector c -n s� FOUNDATION LOCATION PLAN CLIENT: JOSE LOPEZ THIS CERTIFICATION IS MADE AND UMITED TO THE ABOVE CLIENT. LOCATION: NO.ANDOVER, MA. SCALE.1 ! 100' DAT£:11/9/04 I CER77FY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED. (THUS CER77FICA770M DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS.WETLANDS.EASEMENTS. ORDERS OF COND/TIONS.£TC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOYE.EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRIS17ANSEN & SERGI INC AND ANY UNAUTHORIZED USE IS PRON911M.CHR/ST7ANSEN I TAKES NO RESPONSIBKITY FOR THE UNAUTHORIZED WING OR ANY INFOR— MATION CONTAINED HE MICHAEL CHRISTIANSEN & SERGI PRO� SURV 160 SUMMER ST. HAVERMILL.M4. 01830 TEL 978-373-0310 11 02004 BY CHRISITANSEN # SERGI INC s N0.:04010001 Date ............. ".° �' :1�, TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SSA US r7 This certifies that ......................... .."J ........... . Chas permission to perform :................................... plumbing in the buildings of .................... ............... .........................'� ~ . , North Andover, Mass. Fee-. .47...... Lic. No../...... . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer M\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date 19� Permit 1i Owner's Name /&. Type of Occupancy i✓ S+ D E ti -n r-1 l___ New ❑ Renovation ❑ Replacement 2 SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4THFLOOR �� STH FLOOR 6TH FLOOR 7T7THFLOOR ��— BTHFLOOR ��— FIXTURES Plans Submitted: Yes ❑ No ❑ Z Z N Y Q W N Y Z N J Q N ¢ Z Q ¢ JO N W N ~ W N i- U N 0 0 ¢ d W ¢ W=< W W s 3 3 o z 3 x J m ml al of J FIXTURES Plans Submitted: Yes ❑ No ❑ Z Z N Y Q O Z }" > N U Q ~ N Z O O O 2 4n W W ¢ O a O _ 3 J N ¢ ¢ ~ J O ¢ O U. S = 0 }' Y Z d 0 0 0 0 Z Z d W LL X W d 3 0 s Q f- J H J U.I d 0 ¢¢ =la a a a `s O ¢ < i- to -tailing Company Name P1 O Me -r Q - -'jr'I (r m t4 T A e () Check one: Certificate ldress �.)(') C04cj4Mt4&) pj ❑ Corporation /Yl E % N I! ) , yy l A �❑.,, �Partnership Business Telephone 11 ;f z -C/177 1 firm/Co. Name of Licensed Plumber ' �-4 f; r3 r=,P T 1 r • INSURANCE COVERAGE: I have acurrent Viability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes o If you have checkedrtes, please indicate the type coverage by checking the appropriate box. 1A.liability insurance policy kd 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: Signature of Owner or Owner's Agent Owner El Agent [I 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 issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum . g e and apter ofthe oral Laws. re of Licensed Plum r Title Type of License: Master % Journeyman ❑ City/Town APPROVED 0 IC U ONL License Number_3-; z 0 z 0 `z s r a` N b 0 z to Date..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .................. ......................... . has permission for gas installation .............................. in the buildings of .......................................... at ................................... . North Andover, Mass. Fee......... Lic. No........... GASINSPECTOR Check # ' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING tPrint or _—ype6 " Mas7s V G Date /D — /%- o20D/ Permit # Building Location V" -,fOwner's Name 0-41ZV Type of Occupancy /-PSI,yPiX New ❑ Renovation ❑ Replacement � —Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET U Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No U If you have checked rimes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy K 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: Signature of Owner or Owner's Agent owner[] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu�gte to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene - s. (/ i Type of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 8697 City/TownJourneyman APPFidVEO O FIC _ S ONLY NMI SO MEMO "M "WEEMEMINEMNIMMERIMMEM MEMO MEN NOMENEENNEENNE son SINK _01MORIONOMENINEEN ONE NONE no Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET U Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No U If you have checked rimes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy K 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: Signature of Owner or Owner's Agent owner[] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu�gte to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene - s. (/ i Type of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 8697 City/TownJourneyman APPFidVEO O FIC _ S ONLY Z O_ f- lu w CL N Z N N w a 0 0 m a z o H U � • a z I n z• F- r LL N J p z o O � r w, U � W n W 0 z a z_ Q a ¢ O O IL w D m 3 z G O IL O W r w m v a IL Q Ld w Q w z z o H U � • a z I Location 211& r ` �y i ��. + �� 1 No. ���� Date NORrM TOWN OF NORTH ANDOVER= Certificate of Occupancy $ * Building/Frame Permit Fee $ s�cHuse Foundation Permit Fee $ Other Permit Fee ' ;� $ /1G Sewer Connection Fee $ M Water Connection Fee $ TOTAL $ f_ r� _ I +j-;=',- Building Inspector i Div. Public Works PERMIT NO. J APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING 6WNER'S NAME M NO. OF STORIES / SIZE OWNER'S ADDRESS Z G r _ BASEMENT OR SLAB ARCHITECT'S NAME ', f SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �,4.y e)to c ®N�l S SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY / IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS /n/ SEE BOTH SIDES X0, c- Uo v?7 -4 I � ,;a %4 1-7, 1 &% �% PAGE 1 FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED FEE 4(4,nC3 PERMIT GRANTED 41ta 19 S 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /�� EST. BLDG. COST PER BQ. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # ^� CONTR. LIC. # H.I.C.# ., BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S-'ORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ PINE d 1 2 ( 3 CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 14 1/2 1/1 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES B _ 1 2 �_ 3 _ _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDNPJ'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR I_ WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD I TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL E'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. X11 cr ad s ° v00 w A z m cc c :3s g m c x w z m c, boa � w a w m m a°' u w UJ) w d m M° a°' w w d w w v as z cn o ;� cn uj am T � c �-- 0 C E m c L C o s Q • c H O O 0 y C r O co cm z o I w v Q •� cc y •� m m CCD uj CJS z Ree 0 CD C) O CDco .CC R � r- R O Q� R N Ea CL gM< S C Cc R R v J -� CL cm o a CO) Z CD zCD N CL CO) _ R O D C Cr R N : O O V w C103 � m Z_ ID : c Rc M m CL C2 h N =m3 O N C Cc c ea Cl N O O Amo 5 rM4Dm v =:s C* c c O Q -p aN73 o= m Q CM3 Jf CM3 a o .... o m c Q ED � cac m c o = oor p N CIO oma~ tv s m m w c W dt C C3,0103 Z C.3 a cat s _ G a i O CL T � Q z C E c L C co Q O 0 y co cm z o I o � Q •� cc y •� m m CCD uj CJS z CL 0 CD C) .�... .CC R � Q� R C C CL gM< S C Cc R R v J -� CL cm CO) Z CD zCD V CL CO) _ R C C R C103 � Z_ Z z CL -p" ' �: il!!fe to possess a eorrent COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY O11186h rsettsStateamild(Ae + OF ONE ASHBORTON PLACE DJD eD�rsefor teroaattJOn MASSACHUSETTS BOSTON, MA 02108 - r 1tt'J�/3Jleesse. EXPIRATION DATE L I CENSE a SUPERVISOR CAUTION C-8/1 9/199 j RESTRICTIONS EFFECTIVE DATE LIC -NO. FOR PROTECTION AGAINST THEFT, PUT RIGHT THUMB NJ^JE o/fin%!7� J277C4 PRINT IN APPROPRIATE C'_ ANTHONY R 14AVA R RC i BOX ON LICENSE. SS 4 0117-32-726 4 RFD 461-36 ECGARTJ-4.4 4A '12539 BLASTING OP RS T IN TO. Prroro,`s �F_I�n JUD 1� ren 1� �) � NOT VALID ONT'L Sv NE -D BY' �CENSEE AND OFFICIALLY IGHT: STAMPED - OR' RE OF THE COMMISSIONER OB: ,8/19/19//43 ` DOCUMENT MUS"—z ..i IEDONTHEPERSONOF i � � IGNATURE S��e����y� GNA r� ;•,` ,\ HOLDER WHEN EN - N•CrHE^nS'�AAGEDWTHISOCCUPATIOItISSIONER OT HERS OF UCENSEE - ,,1/ I �l N Gi - PER -MIT NO. t APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP NO. LOT NO. I 12 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONEZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING/ �A/� _ _ na_ OWNER'S NAME NO. OF STORIES SIZEj q OWNER'S ADDRESS /I� BASEMENT OR SLAB ARCHITECT'S NAME^M SIZE OF FLOOR TIMBERS IST .� 2ND 3RD BUILDER'S NAME ..c,�a-.-Q.... SPAN _a'� x�" rc�,0 DIMENSIONS OF SILLS 0--- its-•---- . DISTANCE TO NEAREST BUILDING !f_ / . _1 DISTANCE FROM STREET iao0.0.4.M+dl POSTS DISTANCE FROM LOT LINES - SIDES REAR co " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS 16 f� VV I�' IS BUILDING NEW yA--",' _ SIZE OF FOOTING X IS BUILDING ADDITION 0._x_9, ,'�` �µ�N MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ©_ •/�� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILLED AND APPROVED .. [BAY `BUILDING INSPECTOR Y DATE FILED /CZJ- [n /7 %.S SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E n 2,'i d PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST EST. BLDG.COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ' 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 'NV1d 101d S30V"1d38 SIH1 'O3SOdW1213df1S '013 'S39V21 -VE) 'S3H:)UOd H11M 'SONIO11f19 d0 SNOISN3W14 10VX3 C3NV S3N11 10-1 WONA 30NV1S1a C3NV 107d0SN01SN3WIa 1DVX3 MOHs-LsnW N01103S SIH1 Z L ADN Vd (1000 l 011033b ONlalins 0NIIV3H ON -IP'E I j t FP -6 1•W.9 D181J313 110 SWOON 10 'ON L SVO S831V3H 11Nn O.1.H 1NVICV4 ONINOI110NOJ SIV _ S83"Vb DOOM SOdVA SO S.1.M lOH WM31S _ 'SIOJ '8 'SW9 1331S -S10J V 'SW9 b39WI1 'Ndnd SIV lOH 03J804 3JVNdnd SS313dld _ 1SIOf COOM 0NIIV3H it II ONIWVMI 9 OCVC 3111 SOOId 3111 S3Sn1X13 N8300W 0NIJOOd 1108 _ 83MOHS 11V1S `JN19Wnld ON 13AV80 B SVl 31VIS _ NNIS N3HJLIN S30NIHS LOOM S3I0NIHS 1lVHdSV JASO1VAVl 13SO1J S31MM C3HS ��T31 1V13 I'XI3 LI 'Wb 131101 Gd VSNMW WIIC 'Xld E H1V9 dIH 319V0 ON19Wn1d 01 1001�NoN 5 �I 3 0 11 SOOd 801S3dns ONISIM 3WVSd NO 3NO1S ASNOSVW NO 3NO1S 'N19 83CNIJ SO 'JNOJ _I SOOlJ V 'SS1S JI11V 3WVS4 NO NJIS9 ASNOSVW NO NJI89 3WVH NO OJJn1S ASNOSVW NO OJJn1S 3111 -HdSV ONICIS '1S3A N01^IWOJ ONIGIS SO1S39SV t,,(Jd VH ONICIS 1lVHdSV H1dV3 S310NIHS LOOM 313SJNOJ ONIGIS SIJdV09dVID SSOOII 6 II S11VM is N3HJ11N NS3COW S3JVld 3SId V3MV JI11V 'Nld V38V .1.W.9 -N13 WOOS CV3H 1.W.9 ON 1/1 14 %i llnd V3SV 1N3W3SV9 E — — E L — 1 — _— 2 N13Nn 11VM ASC 131SMld III--- S631d 3NO1S SO )qJIS9 'N.19 313SJNOJ C M(JdVH 3NId 313dDNo5 HSIN14 IJOIN31NI 8 NOILVCNn01 Z N0u:)n211SN00 S1N3W1SVdV _— S3JI33o kl]WV3 I1lnW S31S0!S I I A11WVd 310NIS Z L ADN Vd (1000 l 011033b ONlalins Date .... .. ��•�� ....� J — NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING A'.o �,SSACMUS� J -' This certifies that...........................� "= %�'~ �—.G.•.%.., ..�.......................................................... Ls s permission to perform ' wiring in the building of...............: .:. - s �............�:!�...................... , North Andover, Mass. Fee ... r.y...... Lic. No r2r�G / - , . ::.....�..........::.................................:..:.:..;......... ELECTRICALINSPECTOR ms's Check . '�)ICJ 1: y I' oC I� r I' r L 0c p Fees Checked 7c-3 9 HEMEMEMENNEENOM APPUCA71ONFOR PERMTl 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) Date Q J Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) J C k e's -� n 34 Owner or Tenant TO .S L (pe --S Owner's Address S0,r` N<, Is this permit in conjunction with a building permit: Yes[:yNo (Check Appropriate Box) Purpose of Building J " e �''� • VV Utility Authorization N�' Existing Service Ampa� olts Oveifiead Underground a No. of Meters New Service Amps volts Overhead Underground ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IV HC)t*40 AhGV No. of Lighting Outlets No. of Hot Tubi W of Trnafonners Total KVA No. of Ugbdng Fixtures Swimming Pooh Above 1:1 Below Oenerataa KVA ground Bound No. of Receptacle Outlets No. of Oil Butnna No. of Emergency Lighting Battery Unita No. of switch Outlets No. of On Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air ContL Total Toro No. of Detection anal No. of Disposals No. of Heat TOW Total pumps Toro KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Asp Heating KW No. of Self ConWned DeteaiaJsounding Devices Local Municipal Other��� No. of Dryer Heating Devices KW E] Connections a No. of Water Hewers KW No. of No. of Siam Ballads No. Hydro Musep Tubs No. of Motor Total HP OTHER- ]hs,xarto coves% PawwiD hezq mtmbafI 1wnd><r ftC=dLm a Q Ih=aa=1Lie *ha:uraePbic =idrVYES NO I- - ta Ihmesu6rrtimdvsidpoddsanelotlreO�ot: Y1�3 If}whatedzdtedYKpk=irica;g etm eofamwby BM OUM [D PAW** T e Jon I& Bli 6, Dale F�dVatleefF]ecttical Wadr S wakbsa<e °! i^-' DateRec}rs�d Rao Ant FMMNAME A/11 d JW5V LictrwNd &d=TdNb, Af.TdNa ONV1�R�sIIVs[JRAN(�:WAIVIIt;IamawaelhatdreLioened�r,Bt, h�a Iheitla>tsnoCeoaaageerlsa>b�ridaglivalaitasrex�iredbjrMesatclx�aC,aleralLawa and that mp+s�terae rn cite petm'tt appicatim waives ttis rec}ierlmt (Please check one) Owner Agent Telephone No. PERMIT FEES r