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Home My WebLink AboutMiscellaneous - 265 BLUE RIDGE ROAD 4/30/2018co 9 C, Location 164 No. 261 Check # � 7 5 8 Dat6---�/ 0 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee _51 I -J, TOTAL $ Building Inspector w w 0 0 7�; z w CL 0 z U- z 0 (D z 0 U) ;�*ft * *S, loo C: .2) 0 0 (D C) F - C4 cu I LLI C*4 N -0 Q a) LL LLI t Lu < 0 CL 0) C: �p a) CL -C (D C) 0 o .2 cn ".5; 0 a) cL a) 4.1 0 C: 0 > 0 C: < 0 -r- c: r- E o Z 0 C—n CL 3: cn Co 0 _0 a) 0 -C > cy (n cu E 0 0 0 -#-I Lp U) a) m a) a) C/) 0 E 0 0 0) 4— X C: Z3 0 cm (D C) 0 C: 4- M 2 U) 0) Cl) (D 4- U) 0 (D C: NO a) 4.1 U) 4- 0 E I- CU 0 (D cp ip 0- a) m cn -0 c: 6.2 0 > a w F- 0 w CL w U) z 0 Fn - w F - z z w LU F - z 0 L- 0 C-) (D CL U) -S� C:) C) Cf) cu Id 010 N 'cu 0 Igo P4 A a 9 - �; V td OU, P-4 G� q rd 0 g0 Al P-1 0 W 12 FX4 < d) U) 'I poll g. Jo d"o 0 0 4. 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CD UJ tn < 03 z CD L—n 04 Ix z ui < z 0 2 Lu z (n LL w U) wq-� C-4 w < CO Lu w 5: 0 z 0 w z z F - z 0 Q� LL Q) 0 4-J V) z mj 0 z L.Lj LLI C.) CD UJ tn < 03 z CD L—n L'%Storage 6467 Main Street Buffalo, NY 14221 LETTER OF AUTHORIZATION January 20, 2017 RE: Authorization to obtain permits and install signage To Whom It May Concern: This letter authorizes KC Signs, of Londonderry New Hampshire, to secure permits, perform sign installation, removals, and or any sign maintenance necessary for our properties located at: 872 Church Street Ext Northbridge, MA 01534 134 S Policy St. Salem, NH 03079 ,j,A171 Turnpike St. North Andover, MA 01845 73 Pleasant Street Dracut, MA 01826 114 Pleasant Valley Street Methuen, MA 01844 1902 Wellington Road Manchester, NH 03104 120 Spit Brook Road Nashua, NH 03062 11 Integra Dr. Concord, NH 03301 164 Route 125 Kingston, NH 03848 220 Kingston Rd Danville, NH 03819 143 Lafayette Rd. Hampton Falls, NH 03844 44 Calef Hwy Lee, NH 03861 70 Heritage Ave Portsmouth, NH 03801 167 Elm Street Salisbury, MA 01952 6 Smith Lane Londonderry, NH 03053 This authorization is given by Jennifer Jakubowski ' Project Manager and owner Authorized Agent for Life Storage, LP as granted by President a�d CEO, David Rogers and CFO Andrew Gregoire per the attached Letter of Authorization to authorize and sign on their behalf for building permit applications. Owner: Life Storage, LP Address: 6467 Main Street, Buffalo, NY 14221 By: Jennifer Jakubowski Title: Project Manager y� k~� ��-| 8 \l [� �� Th�� ,. �u~` � x�`��r~ \ � \ V `- � -` ' - � ' �` ` Lla_`\^~.~_ -C\- The Commonwealth ofMassachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY Aimlicant Information Please Print Legib Name (Business/Organization/Individual): trT-A Address: V�o , zoy, City/State/Zip-U M&DJQ�CV\ ��A a3Cr,?, Phone#: (()Cr3 4aA-, Are you an employer? Check the appropriate box: Type of project (required): LE]l'ant a employer with _______.pmployees (full and/or part-time).* 7. El New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity, [No workers' comp. insurance required.] 9. 0 Demolition In I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4T] I am a homeowner and will be hiring contractors to conduct all work on my prop". I will 10E] Building addition ensure that all contractors either have workers' compensation insurance or are sole 11. F1 Electrical repairs or additions proprietors with no employees. 12.E] Plumbing repairs or additions 5. 0 1 am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. Roof repairs These sub -contractors have employees and have workers' comp. insurance.t 6. r -I We are a corporation and its officers have exercised their right of 'exemption per MGL C. 14. Other 152, § 1(4). and we have no employees. [No workers' comp. insurance required] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tContractors 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. 1am an employer that isprovidiiigiporkers'compensation insurancefor nzy employees. Below is thepolicy andjob site information. Insurance Company Name: 7-vf% op 10 r <-, "I�\Suy*N OCL bo Policy # or Self -ins. Lic. M 4q��!o Expiration Date: 6A 11 Job Site Address: k�ni �11 City/State/Zip: �)O�ba a& r 4A Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration da -W. Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I'do hereby cerqy under thepains andpenalfies ofpeiyziiy that the information provided above Is true and correct Signatu;�—�XX� f\ QN�A Date: Phone#: N 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I Date. ................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................ ............................................................. has pennissiontoperivim.......", J—n-) whingin the building 0 1 ........................................................................................... .................... North Andover, Mass.* A ........... 1-2-:k .................. 4 ....... F' 26 ee .................... ..... Lic. No ..... ....................... ........................................................... LECTRICAL INSPECTOR Check # 12673 k,4�1 4C Official Use Only . �N (fommonwea& ol Vaijac4woffi Mz� 2.pad..t ol3ire Semice.4 Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS rRev. 1/071 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEA SE PR17VT IN INK OR TYPE ALL 17VFORMA TION) Date: 9/14/2015 City or Town of. NORTH 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 & Num er) BLUE RIDGE ROAD Owner or Tenant S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes F±1 No [:1 (Check Appropriate Box) Purpose of Building SINGLE FAMILY DWELLING Utility Authorization No. Existing Service Amps Volts Overhead Undgrd [] No. of Meters New Service Amps Volts Overhead Undgrd EJ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: KITCHEN REMODEL NEW BASEMENT KITCHEN Completion ofthe followin-a table mav be waived bv the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers K -VA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires Swimming Pool Above E:i In- grnd. grnd. El 119-0. of Emergency Lighting Battery Units No. of Receptacle Outlets 25 No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches 20 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges 1 No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers 2 Heat Pump Totals: Number I I Tons I KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers 2 Space/Area Heating KW Local E] MunicipFl E] other Connection No. of Dryers Heating Appliances KW Security Systeins:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE H BONDF] OTHER El (Specify:) I certift, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: BRIAN LAVOIE LIC. NO.: 28664 E Licensee: BRIAN LAVOIE Signature LIC. NO.: 11648 A (If applicable, enter "exempt " in the license number line) Bus. Tel. No. - 978 815 7263 Address: ' P.O.BOX 2240 METHUEN MA 01844 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. �%XTWTW"10 TIUOTT" A XT0111 X11 A TITW". T -- I- I-- T : - - - - - - - J- -- -- - L -..- I-- �r • '•W ffs The Commonwealth ofMass��husefts Department ofIndustrialAccidents Q. I Congress Street, Suite 100 Boston, M4 02114-2 017 wwwmass-govIdla Workers, Compensation Insurance Affidavit: Builders/Contractors]Elqctricians/Plumbers- TO B1 E MED WITEMEE PERAUTTING AUTHORITY. Name (Busiucss/organizationadividual):. Address: city/state/zip: o Are you an employer? C&c'k tEe apkopriate box. Type of project ()Vqquired): r-1 employelVith employees (ffill and/or part-time).* 7. E] Now construction' .rJ 1:a nployees working for mein 8. modelirig .E] I am a sole proprietor or partnership �nd have no ei _K any capacity. [No workers' comp. insurance required.] emolition I F1 I am a homeowner doing all work mYSCIE [No -workers' comp. insurance required.] 4.[] 1 am a homeowner audwill be hiring contractors to conduct all -work on my property. 1will 10E] Building addition ensure that all contractors either have workers' compensation insurance or are sole ILE] Electrical repairs or additions proprietors with no e#loyees. IiFl Plumbing repairs or additions 5.FJI am a general contractor and I have hired the sub -contractors listed on the attached sheet. Thesle s�b-' contractors ha:4� ur�ployee's and have wo . rkers'con�p. insurance.� 13.EjRoofrepairs 14. Otb:er 6. n We are a corporation and its officers have exercised their right of exemption. per MGL c. 152, §1(4), and we have nQp lo.yees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy iufbrn�ation. T Homeowners who submit " Adavit 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 nam of the sub -contractors and state whether o.r not those entities have if employees. ' thesub-c rsfia�� employees, ey must promde their workirs'comp. policy iramber. —rain an employer Matispio"Pidingwork�rs' compensation insurancefor my emplbyees.' Below is thepolicy andjob site iqformation. Insurance Company Name: 1�f e Policy 9 or Self -ins, Lic. Expiration Date:_ 1111,F11A Job Site Address: 00 5-31 42, City/State/Zip: �4j 10A 0-M I e ir tdate). Attach a copy of the workers' c' pensation-policy declaration page (showing the policy numb r and exp atio' Failure to secure cov6rage as required under MOL o. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the forra of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. dn z�2 fdo 1z ereby certify andpydc; ,bove ,dde's ofperjury Mat the informationprovideda is1rue and correct. - X( / Z — Of _flcia7 flcial use only. Do not -write in this area, to he completed by city or town of - City or Town: Permit[License issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. Chyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone -4 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for the* eipployees. Pursuantto this statute, an employee is defined as "...every person in the service of another under any contract 01 - express or implied, oral or written." An employer is defined as "an individual, partnersWp, asso ciation, corporation or other legal entity, or' any two or more of the foregoing engaged in ajoint enf�rpxise, and including the 'legal representatives . of a deceased employer, or the receiver or tratoe 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 repai work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment bd deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agen�y shall vAthhold the issuance or renewal of a license or permit to operate a business or to constiL act buildings in the comm onwealth for any 4 ; \ . 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-contractoi(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ 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 be submitted to the Depaftment of fAdustrial Accidents fbi confirmation of insurance coverage. Also be sure to sign and date the aifidavit. 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 Acciden-�. �hould you have any questions regarding the law O'T if you'are. r6qu'4'red to obtain a workers' compensatioA policy, please call the Department. at the number listed below. Self-ib:sur6d companies sh.ould'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 r6gardhig 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 �nly submit one affidavit indicating current poli6y 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 maxked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A now affidavitmustbe 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 Departnaent's address, telephone and fax number: The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 oxt. 7406 or 1-877-AIASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia THAYW*-S-T-.-.' 14 Date..:e��.4/1 ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... -e)� �- �.- � "._x .—,& .................... has permission to perform .. ...... . .......... wiring in the building of.....,__ Zh& c"._'AL .......................................... . .... . ....... ...................... . North Andover, Mass. Fd-G.� ............... Lic. NoF,.?. U. � ........ .. .......... . ................................... LECTRICAL INSPECTOR Check# 163 5425 TBE COMMONIMALTHOFMAS&AMUSETIS Office Use only DEPARMEWOMBLES4MY Permit No. — �Ja BOAROOFFIREPREVE7VHONREGULA77ONSR7(M]ZiW Occupancy & Fees Checked ),?4 APPLICAHON FOR PERAILM TO PERFORM ELECMC.AL 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 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the ele rical or escribed below. Locati on (Street & Number) az �� I Owner or Tenant -XO YIV 74X,4_ Owner's Address 514me- Is this permit in conjunction with a building permit: Vyes No (Check Appropriate Box) 1,?1615 Purpose of Building Utility Authorization No. ExistingService 76_fta'W Amps 10 IaA Volts Overhead 1:3 Underground [m] No. of Meters New Service I Amps Volts Overhead =3 Underground 1:3 No. of Meters Number of Feeders and Ampacity .7 1 Location and Nature of Proposed Electrical Work ZC,41a-6 yf4&7X(_ TA7 1AAXdY/ / A4� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground F'round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal f—I Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. HydTO Massage Tubs No. of Motors Total HP OTHER-- - Insumnce0wwaw. r7i YES LQJ, NO ]have submi1edvafidprcdofmwlDdvOffw_ YES ET 1F3uuhaNedrckBdYESpk=mdic*dr )f by drdCkWdrWgA*b(vL P,SURANCE r BOND OTHR oleffie Speffy). F 7,J) (V/ E0naWdVakjeofEbcfticalWc& $ Wc&to&xt ;Z r/7 hpecdm D&RaAxsbd Rwgh FffW FWMNAIvE LimwNd C" S�Ymue Lioeml% BuskmTel.11b. _2 Adless__.�X.o e5e AIL Td NoL OW14MISNSURANICEWArv]3;�lainawaeftdrljmwdDmmthawd-emramecDvaWortsatsunfdegzvaimlasogiodbyNbmad,,MCXMWALam anddAniiyagiamc)Fiftpmmwphcabmwa'mftmg Z*MTxn (Please check one) Owner Agent ED Telephone No. -PERMIT FEE signature of Owner or Agent 1130 4 1 Date .... q.h..&A ..... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies thatl.*S�4 ..... ;;::�d .......................... ........................... has per mission to perform ..... ........................... u i s OV .................................................................. plumbing in the b ................ g No h A dover, Mass. P ............... . .. ....... ......... I . ............... Fe'e3 No. .. .. ... . .... .......... ....... .. �P-L�B I G I N PE OR Check # Date ....... ? X Xt ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ............................................................... This certifies that ... .. Avj ... ... �z has.permis sion for gas installation ... coqk . ..... (Do ....................................... inthe bu—Ildings of ........ .............. ...... ......................................................................... at, w ....... North A e n (C r, Mass. .......... ... ...... �Fee/.�. ... Lic. No ................ sr; ORA ,Check# 10146 URINAL WASHING MACHINE CONNECTION INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES P'NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY DI BOND Mj OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK -ONE ONLY: OWNER D AGENT SIGNATURE OF OWNER OR AGENT Z111 '�\ 1 hereby certify that all of the details and information I have submitted or entered regarding this applicatK� are tru. and acc t t thebe§tofmy!Smo ge and that all plumbing work and installations performed under the permit issued for this application will _ in com ian:cpe Perfirigp rovis] 0 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE SIGNATU�E COMPANY NAME I S CITY STATE ZIP TEL x FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY JOBSITE ADDRESS OWNER'S NAME_ ADDRESS TEL[___ FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: RENOVATION: ff�REPLACEMENT: 01-� PLANS SUBMITTED: YES DI NOD! BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM I DEDICATED GREASE SYSTEM —A DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I FOOD DISPOSER F I FLOOR/ AREA DRAIN INTERCEPTOR (INTERIORT KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES P'NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY DI BOND Mj OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK -ONE ONLY: OWNER D AGENT SIGNATURE OF OWNER OR AGENT Z111 '�\ 1 hereby certify that all of the details and information I have submitted or entered regarding this applicatK� are tru. and acc t t thebe§tofmy!Smo ge and that all plumbing work and installations performed under the permit issued for this application will _ in com ian:cpe Perfirigp rovis] 0 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE SIGNATU�E COMPANY NAME I S CITY STATE ZIP TEL x FAX CELL EMAIL hMS G El LU CL cn to co z 0 a- a - EE LU hMS G i:A The Commonwealth ofHassachusetts Department ofindustrialAccidents I congress Street, S�ite 100 Boston, YM 02114-2017 -www.mass.gov1d1a Compensation Insurance Affidavit: Builders/Contractorsl��ectricians/PlWbers- TO BE MED WITH THE PERMTTING AUTilORITY. NaMe al): )X, (Business/01gaAizationadividu Address: Pn Ph-ne CityJState/Zip: the -Pp6prlate box: Are you an erftp!.Ye�? ck loyees (fall and/or part-time)." employer with _�_�Mp I am a sole proprietor or Partnership and have no employees Working for mein any capacity. [Noworkers, comp. insurance required.] 3.E] I am a homeowner doing all work myself [No workers' comp. insurance required.] 4.FJ I am a homeowner and will be hiring c()Iltractors to conduct all work on my property- I Will ensure that all contractors either have workers' compensation insurance or are sole ., �4, I_ ill- �11- proprietors with no eMP, OYees- s.FJ I am a general c ontract . or'and I have hired the sub-contraotors listed on the attached sheet. Insurance - These sub -c nt,�qt&�'�aW' e��IoYecs and have workers' comp 6.FJ we are a corpor0q# and its * offic6m have exercised their right ofexeroption per MGL c. ' ' 8 1' d�e. [No workers' comp. insurance required-] 1r17 Al(A) anciWehaJV6noen1P0Y - 'Ile "4� 2) Type of project (�e4ulf ed).' 7. El Ndw'donstr6dilOu 8. E] Remodel.ffig 9. C1 Demolition 10 E] Building addition ll.E] Elec�rical r airs or additiPAS ppi pa, . 10-ptm-bing repairs or additions 110 Ko6f rOair� 14. Other - tin li infrratin s6 fill out the section below showing their workers' ompensa o po cY 0 a 0 applicant that ch ' dok�'bbk4l. ni&t they are do a now affidavit indicating such. t Homeo-v�mers who subinij.tbi�'affi�avjt indi ing all work and then hire outside contractors must submit ofthe sub -contractors and state whqthex c�r pot those. pntit�es have ached �n additional sheet showing the name tContractors that check this Box must att ces, they must provide their workers' comp. policy number. employees. If the sub-contractois have employ 4 �"ce -fnr mu empl6vees. Pelow is thepolicy and)ob sit� I am an employer that isprovidingwOrKers compensa information. Insurance Company Name; / P_ A cl� I t Vt 14 _/�� Expiration Date, Policy # or Self -ins. Lie. City/State/Zip- Job Site Address: RL A Attach a copy of the workers' compeiisation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fifto 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 �),_50.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. der thepains an1penalties ofperjur, hat the information Prowded aboy ' and correct I do hereby 9ertffYQun t __40 /Y01 � �167,"e one official use only. Do not write in this area, to he completed by cUy or town official City or Town: Permit/License # Issuing Authority (circle One): i 1. Board of Ifealth 2. Building Department 3. City/Town Clerk 4. Fjectrical inspector 5. Plumbing Inspector 6. Other Phone Contact Person: 1_� i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thek pjflpfby��s. . ..i Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of W�l express or implied, oral or written." An employer is'dbffied as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enf6rprlse, and including the legal representatives of a deceased employer, or the receiv&'6ktrustdd dan individual, partnership, association or other legal entity, employing empl6ype§.. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occu-p�AAt:'6'f 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 b6 deemed to be an employer." MGL c i hapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any aPl)lica-ftt�who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall enter intp any contract for the performance ofpublic -work until acceptable evidence of compliance with the insurance requirements of thi I s chapter have been presented to the contracting authority." Applicants bleasb fill out the Workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if nece�sary, supply sub'contractor(s) name(s), address(es) and phone riumber(s) along -with their certificate('s) of insurance. Limited Liability Companies (LLQ 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 orLLP do'6s have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmationof insurance coverage. Also be sure to sign and date the affldavit. The affidlAvit should be returned to the city or town that the application for the permit or license is being requ�sted, not the Department of IndustrialAccidents. Should you have any' questions regarding the law or if you are req*ed to obtain aw'&kers' compensatioil policy, please call the Department at the number listed below. Self-insured companies sl�ould enter their self-iusuranc*e 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 thai must submit multiple perrait/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 Me for fdure 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industria1 Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia FRYOLATOR L-- I L�AL::j I 9F E FURNACE GENERATOR GRILLE INFRARED HEATER f I LABORATORY COCKS I I MAKEUP AIR UNIT OVEN POOL HEATER . . . . . . . . . . - - - - - - - J ROOM/ SPACE H EATER RQOF TOP U NIT TEST UNIT HEATER UNVENTED ROOM HEATER r- i WATER HEATER 6THERF .-4- - - I- Ile > INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES [1#40' D I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE. BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ER"" OTHER TYPE INDEMNITY E] BOND n—J OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT . /�\ I hereby certify that all of the details and information I have submitted or entered regarding this applicati9fi are t* and accurate to the best of my kn e ge and that all plumbing work and installations performed under the permit issued for this application will bf in compliance wXA rtine isi th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAM� LICENSE# 't/SIGNAtURE MP 03,MGF 0 JPEI JGF D LPGI [I CORPORATION [3# PARTNERSHIP D#E= -11#= I LLC COMPANY NAME: =ADDRESS CITY STATE ZIP Al FAX CELLI, _-_,-=EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA PATE PERMIT # JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TELF—___:7:DFAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: [I. RENOVATION: U ---REPLACEMENT: [ER5� PLANS SUBMITTED: YES NO F—J APPLIANCES'l FLOORS- BSM' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER E::J =1 L:j E:J =J E:� r_—_i =j =j =j [=I I BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR L-- I L�AL::j I 9F E FURNACE GENERATOR GRILLE INFRARED HEATER f I LABORATORY COCKS I I MAKEUP AIR UNIT OVEN POOL HEATER . . . . . . . . . . - - - - - - - J ROOM/ SPACE H EATER RQOF TOP U NIT TEST UNIT HEATER UNVENTED ROOM HEATER r- i WATER HEATER 6THERF .-4- - - I- Ile > INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES [1#40' D I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE. BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ER"" OTHER TYPE INDEMNITY E] BOND n—J OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT . /�\ I hereby certify that all of the details and information I have submitted or entered regarding this applicati9fi are t* and accurate to the best of my kn e ge and that all plumbing work and installations performed under the permit issued for this application will bf in compliance wXA rtine isi th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAM� LICENSE# 't/SIGNAtURE MP 03,MGF 0 JPEI JGF D LPGI [I CORPORATION [3# PARTNERSHIP D#E= -11#= I LLC COMPANY NAME: =ADDRESS CITY STATE ZIP Al FAX CELLI, _-_,-=EMAIL NIN 0 z LLI LLI q* X F- F - CD < w co M LU LLI co z 0 CL < LLI LL CC u w rY -*—N -� The commonwealth ofHassachusetts Q -7-0 - Department of IndustrialAccidents I Congress Street, StWe 100 Boston, MA 02114-2017 v1dia www.mass.go dex�s/Contr�actors/Eleqtricians/PII!Plbers- Workers' Compensation Insurance Affidavit: Buil TO BE FILEWMTH TECE pEp2&TMG A-UTi[ORITY. Name, (Businegs/Orga.bizatiotAndividual): Address: IN IN Phone City/State/Zip: 3 : ecl� app�oprlate box: Are you an erop!oyer? the t 11 1.[P4'am a employer with_J__�"Ploy .. andlor par -til e)'* a, es working f r in in 2.n I am a sole proprietor - partnership dhavenoemploye 0 0 any capacity. [No -workers' comp. insurance required.] 3.0 1 am a homeowner doing all -work myself [No workers' comp. insurance required.] 4.FJ I am a homeowner and will be hiring contractors to conduct all work on my Property. I will ensure that aU contract6is either have workers' compensation insurance or are Sole '' I proprietors withnq'Qpj�Y-6i s.FJ I am a general contract , or'and I have hired the sub -contractors listed on the attached sheet. , '. I I �, .. ".. . ' ' comp. insurance.t These sub -contractors hav6 eipploYees andhaveworkers' 6. n We are a corporatio-A and its. offic6rs have exercised their right of bxemption per MGL c. 152 § 1 (4), and We . haVb no empid'y'6ee. [No workers' comp. insurance required.] Type of project (teq'ifted): 7. 0 Nd*'d6nstr6d�ion 8. E] kemodelliig 9. F I Demolition 10 E] Building addition ll.FJ Electrica I I rpp oradditi9AS mg repairs or additions 13% Ro6f re�airg 14.tj Other ------ showing their workers' compensation policy information. -Any applicant that checksbbk 41 Pid§t are doing all work and then hire outside contractors -Mt submit a now affidavit indicating such T " mii�thi� aM�aA indicating they c� p thoseenti4es� have i I-lomeowneTs -who sub! - . _ �._ _ . d hn additional sheet showing the name of the sub-cOntractors and sta.0 wh4hcr r ot tcontractors that check this b6i must attache t prov ide their workers' comp. policy n—ber- employees. If the sub -contractors have employees, they Mus P . elow is thepolicy andy0h Site I am an employer that is pTOViding'wOrkers , compensation insurancefor My eynPl6yees- information. —7 7o m, red fex_� insurance Compaay IN—D.. Policy # or Self -ins. Lic. #: Expiration Date: 410' - — City/State/Zip ------------------- 1� Job Site Address compensation policy declaration page (showing the policy number and expiratian date) - Attach a copy of the WQFkers' Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a &b 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. A copy of this statement may be forwarded to the Office of investigations Of the DIA for insurance coverageven erd y 'der thepai __ fP at the information provided abo;vr 7tr eandcorrect ye Ins I o here .T o here c tify ker thep .rd T I z rV 15�� 0� T!7�� nnfw fficial use only. Do not write in this area, to he completed by c"Y or town offlciaL OT City or Town: Permit/License issuing Authority (circle One): 1. Board of Health 2. Building pepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thek pnipfby&�. ,;J1 Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of"hiie, express or implied, oral or written." I An employer isf defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enf6rprise, and including the legal representatives of a deceased employer, or the receiv&'& trus�tdd 6 fan individual, partnership, association or other legal entity, employing employpp�.. However the owner of a dwelling house having not more than three apartments and who resides therein, or the oc a�i dfthe CUP 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 b6 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 opdrate a business or to construct buildings in the commonwealth for any applicantwh6 has not produced -acceptable evidence of compliance with the insurance coverage ieq'uired." Additionally, MGL chapter 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall enter intp any contract for the performance ofpublic -work until acce p*table evidence. of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Pleasb fill out the Workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if nece�sary, supply sub-'contractor(s) name(s), address(es) and phonenumber(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. 1�e advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation 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 b eing requ�sted, not the Department of 1adustrialAccidents. Should you have any' questions regarding the law or if you are req*ed to obtain aw"6tkers' compensatioii policy, please call the Department at the number listed below. Self-insured companies shoilld enter their self-insurahc'e 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 ofInvestigations has to contact you regarding the applicant. Please be sure to fffl in the permit/license number which will be used as a reference number. In addition, an hpplicant thai must submit multiple permit/licenso 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 f'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 now 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 Department's address, tel\ hone and fax number: 9p The Commonwealth of Mas&ichusetts Department of IndustriaI Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-A4ASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia z 0 ow IL I- IL z > 0 LU LU c IL LU z z it IL 0 U z I-. lu I-% I— I— I— �� - z 0 u I w I 0 j 0 W w w ul 0 z 0 w t3 M Z w J IL w 0 U) w 0 IL 0 0 LL Z Z 0 0 u w ul w IL w '.. cc W u w m X F- u u w W 0 w 0 0 W z 9 L 0 w w J L z b -o 1p I w I. - z t W w L WL LU LU LU z z 0 0 b -o 1p I w I. - z t W w L WL z z A --a-d 0 0 �jj 0 > .0 � A c > 0 c z z Z191 GI 0 0 z < Z > C 0 > 46 > 0 ;n 0 0 C) -0 M Z r) z z A A r) 8 ;K o 0 0000,0- " I " 6 > z z o o 0 z z L4 0 0 m C) z c > 0 z Z 7K 0 z z z o Z m 0 < z 0 0 3: T T T 0 > 0 z z Z, >Z m c z >m > z > z o > > z , 0 o 0 H H 11 --LLI-LI I I 111111H 0 R c z 0 x r -i >Ox 3: om 0 >Z C. (" 0 ax > � C. (A Mx -J z 0 T (A 0 10 n EL on 9 �A o M Z TAM ��g c 0 - 0 m z I- FWFF� -orm P 0 2 , > , , z > 0 0, (A 1 :2 -4 0 7, m -10 X0 0 0 > x Z 0 a > M > Z --4 X 0 .,6 02 0 0 m z < . 1 z > o 0 c I z z A --a-d 0 0 �jj 0 > .0 � A c > 0 c z z Z191 GI 0 0 z < Z > C 0 > 46 > 0 ;n 0 0 C) -0 M Z r) z z A A r) 8 ;K o 0 0000,0- " I " 6 > z z o o 0 z z L4 0 0 m C) z c > 0 z Z 7K 0 z z z o Z m 0 < z 0 0 3: T T T 0 > 0 z z Z, >Z m c z >m > z > z o > > z , 0 o 0 H H 11 --LLI-LI I I 111111H 0 R c z 0 x r -i >Ox ZM -14 0 >Z z ax T C MMO Mx -J T 0 10 ul O:E laq i m "-I z > MOQ M Z TAM ��g c 0 - 0 m z -orm r!2 0 0 Zq z -1 a r ul -4 > z m -10 X0 0 0 X n z v X 0 0 .4 1 00 FORM U - VERIFICATION FORM 410 0 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** PLICANT: 34fxw 6f9l* f+— fl Phone _�M -10 LOCATION: Assessor's Map Number Parcel /510 Subdivision Lot(s) VISItreet St. Number ************************Official Use Only************************ R E C 0 MUMM4E 10 OF- AGENTS: Date Approved Conservation Admini6trator Date Rejected Comments Date Approved Town Planner Date -Rejected Comments Date Approved Food Inspe r -Health Date Rejected Date Approved A AP -7 ti�'spector ealth Date Rejected Comments ge-c-,-) eg- Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date ,VILLIAM J. SCOTT Director Town. Of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 1,46 Main Street North Andover, Massachusetts 0 1845 In accordance with t e provisions of MGL c40,.S 54, a condition of Building Permit R Number 032 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c I 11, S 150A. The debris will be disposed of in: Facility) Signature of Permit Applicant M7, NOTE: Demolition nermit from the Town 4f North Andover must be obtained for this . project through the Office of the Btfilding Inspector. no 66. 0� 40 k.OARLD OF APPEALS 689-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 5 From; D&M Construction Fax:329-6799 D&M Construction To: Stan Clark Michael Wentworth David Coish Telephone 329-5799 895-6271 12 Orcutt Drive Hampstead N.H. 03841 Page I of 1 Thursday, January 16,1997 3:13:34 PM ZI Revised specifications for Stan & Robin Clark - January 16, 1997 1. E?dsfiiig footings - The existing footings are 55 gallon drunis filled with concrete. 2. Stairs - The rise will be approximately 7.5 inches and the treads will be 11 3. Tie Beams - The 6 x 6 tie beanis will be fastened by lag bolts thru the top plates. Two beanis will be added to the original plans, so they will be 4'o.c. 4. Insulation - Styrofoarn proper vents will ' be used in the ceiling. High density 8" R-30 insulation will be installed in the ceiling. 5. Hurricane clips will be used if they are required by code. D&M Construction Michael i� �entmrth �DMd -i �olstj Tili�hone 329-5799 8ig:E71 12 Orcutt Drive Hampstead N.H. 03841 The following are specifications for Start & Robin Clark, at 265 Blue Ridge Road, North Andover, MA ProposedDeck: 141x2l' 14-4 1 Re -use existing'footings 2L 6 x 6 p.t. support posts, approx. 5'611 o.c. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists 16" o.c. 5/4 x 6 stk cedar decking - with stainless steel screws 4 x 4 cedar deck posts 2 x 4 cedar rail cap 2 x 2 cedar balusters 5 1/2" o.c. 1/2" cedar lattice under deck I set stairs with enclosed risers E Proposed porch: 12'x 14' New 12" diameter x 48" deep concrete piers 6 x 6 p.t. support posts 6' o. c. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists, 16" o.c. 3/4" T & G plywood flooring glued and nailed 2 x 4 walls, 16" o.c. with 1/2" sheathing 2 x 10 headers with 1/2 " plywood filler 6x6tiebeams4'6"o.c. 2 x 10 rafters 16" O.C. .4 C OWK 2 ' x 12 ridge 1/2" roof sheathing 8" galvanized drip edge roof shingles to match existing siding to match existing 9 combination screen/storm door units Interior - <2 30 insulatio ceiling with proper vents 5 41ic�entier tead pine for interior finish 7- 0 A) S*'I'—* ( 17e- (0 _C_ C,4'I P /'_ f ag -b le TO n�:'q-T 96, TZ A ON NJr i v 'cl C)c -'C'4 ' �N 1 5*3 I Qj Oki 77" Qj Oki Town Of North Andover Buildin'g Department 508-688-9545 146 Main St. Town Hall Annex 0 ,10 , Plan Review APPLICANT: P 6 C- DAT Zoning District Use Code Title of Plans and Documents: Request: -d 40 0 / -741n /J ,R,ke��dvised that after review' of -your building permit and or zoning review has'been ,,"_DENIED for)he following reasons: Zonina Use not allowed in District ---FNot in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area -Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By -Law Use requires permits prior to Buil Other Other Remedy for the above is checked below. Dimensional Sign Variance --T`,-.-q;iaI Pemi it for Watershed Review Special Permit for Site Plan Review I -Special Permit for sign Complete Form U sign -offs Coey of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Variance for Sign Other Plan RevieW The plans and documentation submitted have the following inadequacies: 1. Infomnation Is not provided, 2. Requires additional information, 3. Information requires more clarification, A Inf—Mi— i. i--4 r, All -f fk- -k-- 1# 1 1# 17 J Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 127 Affidavit . Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Tranning Plan Fire Sprinkler and Alarm Plan Roofing Plan Plans to scale Utilities Site Plan iFooting Water Supply Sewage Disposal Waste Disposal I -dther l ADA and or AAB requirem-ents j Other Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires. more clarification, 4 Infrirmptinn iq innrlrrP.-f q All nf fha ah� The above review and attached explanation of such is based on the plans and'information submitted.' No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or. other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You nwst file a-nevv lasjilding permit application form and or reqij(V for n review to rec;eive a roval. Z Buil i g ClUpD811irment ON 'al Sianature In a4h Received :De iedie��a fo�� 1 14 If Faxed Denial 9fit P-7- / If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. Water Fee Stats Builders License. Sewer Fee I Workman's Compensation Buildinq Permit Fee I Homeowners Improvement Registration ABbuildin Permit Application J–��omeowners Exemption Form Other I I Other The above review and attached explanation of such is based on the plans and'information submitted.' No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or. other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You nwst file a-nevv lasjilding permit application form and or reqij(V for n review to rec;eive a roval. Z Buil i g ClUpD811irment ON 'al Sianature In a4h Received :De iedie��a fo�� 1 14 If Faxed Denial 9fit P-7- / If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. z O L� .' I � � o r j � � -s � �n � i - 3 _ i �� ?> � o:. "� 3 � � � ,',, - - -', T -i� LZ Iff CIO Ti lj- 05 163 Ok F7- 4z _77 It From: D&M Construction Fax:329A799 To: Stan Clark Page 1 of 1 Thursday, January 16,1997 3:13�34 PM 02 D&M Construction Michael Wentworth David Coish Telephone 329-5799 895-6271 12 Orcuff Drive Hampstead N.H. 03841 Revised specifications for Stan & Robin Clark - January 16, 1997 1. Emsting footings - The emsting footings are 55 gallon drunis filled with concrete. 2. Stairs The rise will be approximately 7.5 inches and the treads will be I V. 3. Tie Beanis - The 6 x 6 tie beanis will befiastened by lag bolts thru tile top plates. Two beams will be added to the original plans, so they will be 4'o.c. 4. Insulation - Styrofoarn proper vents will be used in the ceiling. High density 8" R-30 insulation will be installed in the ceiling. 5. Hurricane clips will be used if they are required by code. D&M Construction Michael Wentworth David Colsh Telephone 329-5799 895-6271 12 Orcutt Drive Hampstead N.H. 03841 The Mowing are specifications for Stan & Robin Clark, at 265 Blue Ridge Road, North Andover, MA - Proposed Deck: 14'x 2 V. Re -use existing footings 6 x 6 p.t. support posts, approx. 51 611 O.C. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists 16" o.c. 5/4 x 6 stk cedar.decking - with stainless steel screws 4 x 4 cedar deck posts 2 x,4 cedar rail cap 2 x 2 cedar balusters 5 1/2" o.c. 1/2 cedar lattice under deck I set stairs with enclosed risers Proposed porch: 12'x 14' New 12" diameter x 48" deep concrete piers 6 x 6 PA. support posts 6'o.c. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists, 16" o.c. 3/4" T & G plywood flooring glued and nailed 2 x 4 walls, 16" o.c'. with 1/2" sheathing 2 x 10 headers with 1/2" plywood Efier 6 x 6 tie beams 4'6" o.c. 2 x 10 rafters 16" o.c. 2,x 12 ridge 1/2" roof sheathing 8" galvanized drip edge roof shingles to match existing siding to match existing 9 combination screen/storm door units Interior - R-30 insulation in ceiling with proper ve - nts 5 1/2" center bead pine for interior finish wired to code V 9 I V-0 'd 9S: 9 T 96, T(7 AON M� A* X. 9 I V-0 'd 9S: 9 T 96, T(7 AON M� --t: 1.24�2. 4ZD Z�j 4 4c:) C:) 120 'J -9 T 96i T. 7 AON --t: 1.24�2. 4ZD Nov 21 '96 16:56 P.02 f 41 4C> CA - 7:> a-- 42i -4� C5 C> —ID 7�3 Qj -- --------- - MASS. 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F) �c 3.. r ,M. > z n 'o > z > Z� 0 � z 0 a > ;r m Z 0 (A 220 , z; m C a > 0 f 0 m z -4 0 > 2 16 o:r 0 00-0,9. 3: m Z 0 z 0 10 0- z z 5z z X v I H I I 10' z < > I c > 0 - > z -0 00 Z�v a 00 'a z m 10 1 0 m m r -i >ox 6) -1 ii U) ZM Lm, -11 > 0 z Z x C Mo > U) u -1 X 0 0 rn MX -q z > x (A 0 MZ2 MOM T M Z. owo m S z r 0 Goo -q z r 0 0 r -q m >*> F::i z m n x 0 0 > z x 0 m 00 FORM U -,VERIFICATION FORM 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 local or state lawl regulations or requirements. .****************Applicant�fills out this section***************** APPLICANT: adW CLAACK Phone 6 S I - 32 Oc'� LOCATION: Assessor's Map Number Parcel Subdivision 'Lot(s) Street St. Number ************************Official.Use RECOMMENDATIONS OFAOWN AGENTS: Date'Approved Consfieivation A"inistrator Date Rejected Commen ts 41L Z e &_11,2 1 0_e_� Date Approved Town Planner Date Rejected Comments Date Approved Food Inspec_tor-Health Date Rejected Date Approved- /�O Le S -0/11c Irl�-�,ector-Health Date 'Rejected Comments Public Works sewer/water connections driveway permit Fire Department Received by Building Inspector Date u t"-.7� cl I 100 14- 49 a? 49 0 14 FLJ C% AfA Of F= F�!S-G=--T- scan -A =2 al %-J CCT- t C=w )�.j C= F=- lc� C=20 1 71 \A.J %-r 11-4 C—.=:p F- =3, fe, t--, rr- CP &-J 0-- \-T-Y T- C -T' t LAND JF- / -7 / cf t ME T % I S J 2d to T % I S El It e �, ot�, "Ji V. -.j bit VAO to El It e �, ot�, "Ji V. -.j bit VAO 1iOME IMPROVEMENT CONTRACTORS RE^G1`11-RO)TION a T_ L�uilding Regulations al -id Stanj ds jr(j of V1 E� A Y' 1 0 YI F' I �3 C o ffl J" Bostorl, Massac�,waetts 02106 V M EN T 0 N T'F� 0 C TO f" R e g s t, T- a t, i 0 V) I 16 121 0 4 Expiratioll 02/12/97 Type, -- PfCrVATE Cor-'�PORATf(')N F-(,)Mlt,-Y POCA-S -- PATIOS INC WIL-L-IOM C. GIANOPO(K-OS 92 S BROADWAY L(iWRENCE MA 01843 P PAID A ' D 6 01 DEPARTMENT OF PUBLIC SAFETY q_ ONE ASHBURTON PLACE, RM 1301 AUG 1695 BOSTON 'MVP2108-1618 P 5 CONSTRUCTION SUPERVISOR LICENSE-.__ D.P.S. Number: Expires: B 11 r-- t I fd A t e - CS 010330 07/19/1997 Restricted To: 00 i =7=7' WILLIAM C POULOS 92 S BROADWAY LAWRENCE, MA 01843 Restricted To: 00 DEPARTHENT OF PUBLIC SAFETY CONSViUMOS SUPERVISOR LICENSE Birthdate: pujberik;'��- Li Expires- -�,0103301,' 07/011997 07/19/1960 e sir' i c t i�d I o': WILLIAH C POULOS �_�'9 2 S BROADWAY LAWRENCE, KA 01843 ibihch bottom, fold , sign on i4ck, and laminate license card. I 'eep top for receipt and cliange )f address notification. go - None 1A - Hasonry only JG - I & 2 family Homes Failure to possess a current edition of the Kassachusetts State Buiildinq Code is cause for revocation of this license. 0 0 OR Town Of North Andover 0 41 Buildin'g Department 508-688-9545 S ACH 146 Main St. Town Hall Annex Review APPLICANT: P 6 F— DAT Zoning District Use Code Title of Plans and Documents: Request: -7,- In -, J ---P-Lease-be advised that after review of your building permit and or zoning review has been DENIED fo-tihe following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Siqn exceeds requirements, Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments in conformance with Growth By -Law Use requires permits prior to Building Permit �+Not _ Other _—]-other Plans to scale Remedy forthe above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indiGating Non -conforming status Copy of Recorded Special Permit Variance for Sign Other Plan RevieW The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3, Information requires more clarification, 4. Information is incorrect. 5. All of the above. Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. 7 Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure 7 Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofinq Footinq Pla Plans to scale Utilities Site Plan Water Sup�ly Sewage DiReosal Waste Disposal Other UF^F I ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant ser,6e to pro��ide definitivp answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file ng permit application form and or requ for n review to r7i roval. 7p Z�;- BuijAKg DVpemeint Official Signature Info��atOn Received -D—Wed -, ic*o-w 113lq 7 If Faxed : Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. Water Fee State Builders License Sewer Fee Workman's Compensation Buildinq Permit Fee Homeowners Improvement Registration Buildinq Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant ser,6e to pro��ide definitivp answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file ng permit application form and or requ for n review to r7i roval. 7p Z�;- BuijAKg DVpemeint Official Signature Info��atOn Received -D—Wed -, ic*o-w 113lq 7 If Faxed : Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the building permit and or request for plan review for the property indicated on the reverse side: "'o. � MAIN& iA� "M Health -fo-�:ing �Wl� ONE, Board Conservation — Depa ment of Public Works Historic Commission — Planning Other Other Dinforr!3I . --- �nnrinrl * Fire Health -fo-�:ing olice Board Conservation — Depa ment of Public Works Historic Commission — Planning Other Other D&M Construction Michael Wentworth David Coish Telephone 329-5799 i§�71 12 Orcult Drive Hampstead N.H. 03841 The Mowing are specifications for Stan & Robin Clark, at 265 Blue Ridge Road, North Andover, N4A- ProposedDeck: 14'x2l' Re -use existing footings 6 x 6 PA. support posts, approx. 5'6" o.c. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists 16" o.c. 5/4 x 6 stk cedar decking - with stainless steel screws 4 x 4 cedar deck posts 2 x 4 cedar rail cap 2 x 2 cedar balusters 5 1/2" o.c. 1/2" cedar lattice under deck 14 -le -15 ? 1-114r—x i I set stairs with enclosed risers — S- t— f�— I 'S IE Proposed porch: 12'x 14' New 12" diameter x 48" deep concrete piers 6 x 6 P. t. support posts 6' o. c. 3 - 2 x 10 p.t. girder 2 x 10 p.t. joists, 16" o.c. 3/4" T & G plywood flooring glued and nailed 2 x 4 walls, 16" o.c. with 1/2" sheathing 2 x 10 headers with 1/2 " plywood Her 6 x 6 tie beams 4'6" o.c. 2 x 10 rafters 16" o. c. /F- A 0 4* -Y - I V) .4A 1% Y, V, 1/2" roof sheathing 8" galvanized drip edge roof shingles to match existing siding to match existing 9 combination screen/storm door units Interior - <:2 30 insulatio i ceiling with proper vents 5 1 �center heacd pine for interior finish 7- 0 A) S" L I C- FIF40 0 0 w, I uwn Ut ciui'in AfWUVef Building Department Review 508-688-9545 Iss C Hu55 146 Main St. Town Hall Annex APPLICANT: DATE: Zoning District Use Code: Title of Plans and Docurhents: iZa—E At Request: A-4 P/ -/-; � -F4easo_be advised that after review of your building permit and or zoning review has been following reasons: Zonina Use not allowed in,.Dist(ict Violation of Height Limitatioi� Not in conformance with Phased Development Sign exceeds requirements Violation of Setback Front. Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space jp6fficient Lot Frontage - -,-- - - Sign requires p�rmits prior to Building Permit Form U not complete by oth r departments Not in conformance with.Growth By -Law Use requires permits prior to Building Permit Other Other Remedy forthe above is checked below. Dimensional Sign Variance Special Permit for Watershed Review ,S�ial Permit for Site Plan Review Special Permit for sign 4- -Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Variance for Sign Other Plan RevieW The plans and documentation subm I itted:have the following inadequacies 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, A W f;— i. i- --f 9; All M fh. h- # # Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details FramingPlan Fire Sprinkler and Alam'�,'� Plan Roofing Footing Plan Plans to scale Utilities -Site Plan Water Supply- I Sewage Disposal Waste Disposal her ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies 1. information Is not provided, 2. Requires additional infon-nation, 3. Information requires more clarification, A i� r All -f th. hh—.. # Water Fe State Builders License Sewer Fee orkman's Compensation Building Permit Fee Homeowners Improvement Registration Building ermit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the BL�ding Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incog;iorated herei�w�eference. The building department will retain all plans and documentation for the above file. You mus anew b permit application form and or request for plan review to receive approval. B forafatioi/Received De 2ied >�g ire in If Faxed Denial Sent If you require assistance please call the abmpe number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met.