HomeMy WebLinkAboutMiscellaneous - 268 REA STREET 4/30/2018N)
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... OA�Dav ..... I ...................
has permission to perform .......... P ............................. t .....
wiring in the building of ... ........... ...................
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at . ....... ��v ...... tMe
... A-5 . ................................. INorth Andovei, Mass.
Fee ... LK6 .. . .... Lic.Nolz!�?(.7 4 .............
ELEmicAL I;�;�
Check#
929S
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:012 M2ssachusefts Electrical Code Amendments 527 CMR 12-00 § Rule 8: in accordance-withthe,plovisions OfUG.L. c. 143,'§ 3L, the
appointed pursuant to M. CTI c. 166, § 32, an
irm. or corporation stated on the permit application. Such entity shall be responsible for the
electrical permit shall be issued to the person, f n tor of Wires
on the prescribed form. After a permit application has been accepted by an I spar
Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications she be ad'
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of-ongoiRg construction activity, and may be-deemed-bythoTnspector-of-W.ires abandoned.aad-imvalidMe�—
or she lies detennined tli�t the authorized work 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 QhaDLer2410% Of the A7Gts of 2010 and extended by S I ections.74 and 75 of Chapter 23 8 of
the Acts of 2012. The purpose of this act is to promot6jobl-growth and long-term economic recovery and the P '
purpose by establishing an automatic four-year extension to cert ermit Extension Act finthers this
limited exceptions the Act automatically dxtends, ailrpermits -and licenses concerning the.use or development of real property. With
for four years beyond its othe�wis 0 appli
"in effect or existence" during the q cable expiration date, any permit or approval that was
ualifying period beginning on August 15, 2008 -and extend-ingthrough August 15, 2012.
e.
Fermit/Date Closed:
LaPermit Extension Act — Permit)D"
ate Closed:
*** NOte:)Reapply for new perm)�ff
&. connamima 0/ va&� officialuseonly
a; Permit No. 929-.5--
Vfimm 2erarlAwd ol-cL Sm&.a Occupancy and F . ee Checkcd
BOARD OF FIRE PREVENTION REGULATIONS [Rev- 1/07] (leaveblask)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AH work to be performed in accordance with the Massachusetts Electrical Code QVMQ, 527 CIVIR 12.00
(PLWEPRNTNNKORYTPEALLBVFORMA77OA9 Date: -3 / Z -q, Z / 0
City or Town ofi /V 0 .14 /1 /1 o U e a, To the Inijector of Wires:
By this application the undersigned gives notice of his or her mitentim to pelform the electrical work described below.
Locatioia (Street & Number) a (, 2 V
Owner or Tenant 114 A 5 C- J) 't
Owner's Address S A n Zc-
Telephone No.
Is this permit in conjunction with a building permit? Yes No [:] (Check Appropriate Box)
Purpose of Building n CAj-jt--!/ ( n'(, Utility Authorization No.
Existing Service -4- Amps Volts Overhead F1 Undgrd El No. of Meters
New Service -t Amps Volts OverheadEl Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work. 6u 1 fl Z- S e a, A-& OU41 W
Completion ofthe followine tabk may be waived by the Inmector of Mires.
No. of Recessed Luminaires
No. of Cefl.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators RVA
No. of Luminaires
Swimming Pool Above In-
grnd. gmd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Off Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No-7of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat PumpTMEE
Totalis:
Qrjous
KW
of Self -Contained
DetecItion/Alerting Devices
I I
No. of Dishwnhers
Space/Ares Heating KW
Localo Municipaj 0 Other
Connection
No. of Dryers
Heating Appliances KW
S S
ecu 'k = or Equivalent
NM
No. of Water
Heaters KW
0.0 No. of
Signs Ballasts
Data Wiring.
No. of Devices or Eauivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications W -
No. of Devices or Z'umlyiTent
OTHER:
Estimated Value ofElectrical Work:
Attach ad&twnal detail ifdesired or as required by the Impector of Wires.
(When required by municipal policy-)
Work to Start: Inspections to be requested in accordance with IvIEC Rule 10, and upon completion.
INSURANCE COVERAGE: I Tnless 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: INSURANCEj2 BOND [I OTHER [] (Specify:)
I certt&, under ihepains andpenaldes ofperjury, that the inforntadon on A& applicadon is hue and compide
FIRMNAME:BuddY Electric Inc. - LIC.NO.: 12017 A
Licensee: Vincent B. Landers JrSignature LIC.NO.: 23684 E
(7fapplicablk enw 'Imnipt" in &e ficense iumber Une.) Bus. Tel. No-- 97 8 - 97 5 - 2F4 5 5
Address: 24 Colgate Dr X.Andover. Ma o1845 Alt. Tel. No.:
*Per IvI.G.L. c. 147, s. 54-61, security work requires Department of Public Safety "S" License: Lic. No.
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 the (check one) [] owner 0 owner's agent
OwnerfAgent 9") ?
Signature Telephone No. -37 6- o 17 E.RMIT FEE. $
-ILe 6 FP
The Commonweirith of Massachusetts
Department Of rndustrial Accidents
Office Of I'Mesligations
.600 Washington Street
Boston, AL4 0211,
www-fftas&gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
vlicant In brmation
Name (Business/Organizafion/Indi-�idual):
Address:
City/State/Zip:_
& C_ -T,7 C ,
Phone#:_ �,D, g 7 1-2 S-- '�/ q S- 5—
Are you an employer? Check the appropriate box:
E��I am a employer with - a,
4, 1 am a general contractor
2.[]employees (ftffl and/or part-tirne).*
1 am 2 sole
and I
have hired the sub -contractors
Proprietor or partner-
ship and have no employees
listed on the attached sheet
"fhese
sub-cOntractors have
working for me in any capacity.
NO workers' cOmP. insurance
workers' COMP. insurance.
5. [] We are a corporation
3. Elrequired.]
I am a homeowner doing all
and its
officers have exercised their
. work
myself [No workers' comp.
right of exemption per MGL
c. 152, § 1 (4), and we have
insurance required.] t
no
employees - [No workers,
POMD.
Type of project (required):
6. E] New construction
7. Remo&hng
8. Demolition
9. [] Building addition
10- Pffectrical repairs or additions
II-ElPlumb mig repairs or additions
12.0 Roof repairs
13. F7 Other
*A -Y =Plicanit that checks box in must als, �
ill vut the sectiom_ bei -ow EhMing
I _s. co
submit this P__;on
t Homeowners who In __ P__ :=at
affidavit indicating they are doing all work and then hire outside o,t,,tors _.._y =fb On.
�Contmctors that check this box must attached an additional sheet showing the name of the sub_ on must submit a new affiddvit indicating such.
c tractors and their wl--, — I-,-- - I
-A-ULL,
Uffl UJ7 employer that is Providing workers I compensation
information. Ins"rancefor MY employees. Below is thepolicy andjoh site
Insurance Company Name:_ /0 P- /i AJ e- 4-1z r
Policy # or Self -ins. Lic.
Expiration Date: /A / , i
Job Site Address- 0- 1-,( City/State I /Zip:__Po . /J_ X) jot. L,
,
Attach a copy of the workers' compensa/tion Policy declaration page (showina 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 ci
of up to $250.00 a day against the violator vil Penalties in the form of a STOP WORK ORDER and a fine
- Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
— uY —1-uiy unaer me Pains andpenaides ofp"'J""' '"t te information Provided above is frue and correct
c;_�._ / ) =— - -
ione
Offwial use only. Do not write in this area�
to be completed hj, ci�, Or town off
lciaL
City or Town:
Issuing Authority (circle one): Perinit/License #
L Board of Health 2. Building Department 3- City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspe . ctor
6. Other
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 pe--rson 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 t1he legal representatives of a deceased employer, or the
receiver or trustee of an individuaL partnership, association ox- other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartraents and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintemance, 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 operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of coinpliance 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 affida-vit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) 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 be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be stwe to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permait or lie-ensse is being requested, not the Department of
Industrial Accidents. Should you have any questions regardiag 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 offici�lly 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 per-inits 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 Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
vrvrv7.rnass..o,ov/dia
1=
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Thursday, October 08, 2009 10:36 AM
To: Hughes, Jennifer
Subject: FW: Septic - Soil Test Application - 268 Rea Street
Attachments: SKMBT60009100810110.pdf; imageOO1.gif
Hi Jennifer,
The attached is a soil test application for review. I will bring a hard copy over to you for your reference. Let me know
when all set. Thank you. (ZD
Yo, / �' A , z , F-'4
Pamela DelleChiaze
Health Department Assistant
TOWN OF NORTH ANDOVER
Health Department
1600 Osgood Street
Building 20; Suite 2-36
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 - Fax
pdellechiaie@townofnorthandover.com - E-mail
http://www.t wnofnorthandover.com - Website
Notes:
ff copied to BOH Members - Reference Copy Only - no response requested at this time
From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com]
Sent: Thursday, October 08, 2009 11:12 AM
To: DelleChiaie, Pamela
Subject: Septic - Soil Test Application - 268 Rea Street
Tracking:
�_ - f
DelleChialie, Pamela
Subject: FK Septic - Soil Test Application - 268 Rea Street
Start Date: Thursday, October 08, 2009
Due Date: Monday, October 12, 2009
Status: Not Started
Percent Complete: 0%
Total Work: 0 hours
Actual Work: 0 hours
Owner: DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Thursday, October 08, 2009 10:36 AM
To: Hughes, Jennifer
Subject: FW: Septic - Soil Test Application - 268 Rea Street
Attachments: SKMBT60009100810110.pdf
Hi Jennifer,
The attached is a soil test application for review. I will bring a hard copy over to you for your
reference. Let me know when all set. Thank you. J
Pamela DelleChiaie
Pamela DelleChiaie
Health Department Assistant
TOWN OF NORTH ANDOVER
Health Department
1600 Osgood Street
Building 20; Suite 2-36
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 - Fax
Pdellechiaie(cD-townofnorthandover.com - E-mail
hftp://www.townofnorthandover.com - Website
1
cid:image001.Pna(ZD-01 C9A6EB.C8D1 3910
Notes:
If copied to BOH Members — Reference Copy Only — no response requested at this time
From: noreply@townofnorthandover.com [maiIto:noreply@townofnorthandover.com]
Sent: Thursday, October 08, 2009 11:12 AM
To: DelleChiaie, Pamela
Subject: Septic - Soil Test Application - 268 Rea Street
El
FW: Septic - Soil
Test Applica...
-z—
Date 2
� v
or�
0 TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
o- Buil ding/Framel Permit Fee $21
CHU
F ndAtio kwke s So, C)
Other Permit Fee sz,� 9, 6 0
i- '6s, 'to
Biilding ec r
FERHIT-NO.
EIPS
p
APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. 1, /PAGE I
MAP +40.
LOT NO.
12 RECORD OF OWNERSHIP IDATE
BOOK '.PAGE
RZONE
SUB DIV. LOT NO.
�PURP.SE
'LOCATION
A 511,
6WNER'S NAME MQ r ---c3 iT 4F
,O-/W-NER'S
OF BUILDING
Zq /"(j �N,6D
NO. OF STORIES
ADDRESS
NCI, �AN-QGVtV
BASEMENT OR SLAB
ARCHITECT'S NAME L,--t'IZF-
OF FLOOR TIMBERS IST 2-,,- to 112NO 3RD
'BUILDER'S NAME
PA Q I,- �A
PAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DI ' STANCE FROM STREET
151STANCE FROM LOT LINES - SIDES "REAR
qjj�,POSTS
GIRDERS
AREA OF LOT FRONTAGE
EIGHT OF FOUNDATION -or-HICKNESS
IS BUILDING NEW
-61ZE OF FOOTING
Irs BUILDING ADDITION
OF MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
qS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
'I'S BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
4S BUILDING CONNECTED TO TOWN SEWER
I
�LS BUILDING CONNEC TED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 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
Z_`DATE FILED 313 1 A3
RE OF OWNER OR AUTHORIZED
F E E f / 0 / / -
PERMIT GRANTED
4-
19
A UG'
,,,�nw - 0 -- ISA
0 �!R TEL 0
�voll�j I R. T E L.'#
Z,-P,!ATR. L!C.
3 PROPERTY INFORMATION
LAND COST
11VT. BLDG. COST (-7
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
NUILDING INSPECTOR
BUILDING RECORD
OCCUPANCY 12
SINGLE FAMILY S.-ORIES
MULTI. FAMILY OFFICES
APARTMENTS 1-1
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
--
INE
HARDW D
3
1
2 13
CONCRETE BL K.
BRICK OR STONE
PIERS
PLA STER
WALL
UNFIN.
3 BASEMENT
AREA FULL
FI . B M T' AREA
V, 1/2 3/4
FIN. ATTIC AREA
t!O B M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
B
1
3
DROP SIDING
WOOD SHINGLE�'—
—
—
-�ONCRETE
-E—ARTH
ASPHALT SIDING
ASBESTOS SIDIN�i
AARDNIJ D
COMhACN
VERT. SIDING
ASPH. 71LE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MAS5—NRY
ATTIC STRS. &
FLOOR_
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR
,�DEQUATE NONE
10 PLUMBING
5 RO F
GABLE
GAM REIL
HIP
BATH 13 FIX.)
-�Ip
MANSARD
TOILET RM. (2 FIX.)
F LAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SH I NGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
M DERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
U R�N:�
TIMBER BMS. & COILS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS__
AIR CONDITIONINdG—
RADIANT H'T*G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B*M'T 2nd
I st I -id
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
. . . 4
��z.,a_ ...�
FORM U - LOT RELEASE FORM I
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*****************
-",e
APPLICANT: �1. CIA Phone
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street 2 A, o St. Number
************************Official Use Only************************
RECOMEENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
1� Date Approved
To;wn Plannerki Date Rejected
Comments
f A
mck
Food Inspector -Health
Septic -Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Date Approved
Date Rejected
Date Approve d (6 A)
Date Rejected
Fire Department
Received by Building Inspectd,�r_ Date
COMMONWEALTE OF y
LASS.
CITY OF LAWRENCE
u-��th tha r)rovis' Ch
3.0yis 0� aptez 210, Sectl0P - L -he Gener
Laws and Anendipentts t-heret t4ce � - - 5 Of 4 r- -
0 no'. is hereby civen t -hall "he business ox
�A VAA T, (Na
of Businew
I's cc)j)di)c-,,--ed at No. W Street,
by the foilow inc PersOn (s) Partnershar,, of COZporat-lorl. in Lawlence, Mass
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rl~°xr correct an, errors in rn�r nameor �uure��. ,
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0816502634 ^
'
`
YOUR TELEPHONE NUMBER BEST TIME TO CALL DATE OF THIS NOTICE* 11-27-92
EMPLOYER IDENTIFICATION HUMBER; 04-3170856
' FORM NUMBER: SB -4 ^
TAX PERIOD: N/A �
. �
`
INTERNAL REVENUE SERVICE
` ANDOVER MA 05501 ' PAUL M MATOSIC
' PAUL M M4TUSIC ASSOC
^ 632 LUWELL 6T
LAWRENCE M4 01841
PAUL to. MAIOSIC
Piesident
PAUL M. MATOSIC ASSOM�"��`
CONTRACTORS/ ENGINEERS:
632 LOWELL STAEET
LAWRENCE, MASSACHUSETTS 01841
(508) 687-0661
Mr and Mrs. 3.01. Mukherjee of 268 -Rea St, North Andover, MA
agree to plans job #21 Paul M. Matosic Assoc. to construct one
16FT BY 20FT addition to their existing home.
The addition will consist of two rooms approximately
1OFT by 16FT each. One(l) room i.� a utility room, and one(l) will
be the new kitchen. The existing kitchen cabinets will be removed
from the existing location and reinstalled in new location as
shown on plan job:,�21. The rooms will be constructed on existing
16-1PT by 16FT deck, in rear of house with rei nforced posts to be
4'011 unler -,rade to meet builling inspectors requirements. Both
rooms will have electrical and plumbing as shown on plan. 1,11oor
covering tile/or paint and or carpet to be by Mukherjees, the
owners of the home. The,total cost of the above work includes
labor and material is $17,900 to be paid as follows, $7,500 at
ag.-reement to contract and 11,7,500 when addition is framed and
closed in.from weather. The balance of $2,900 due when -,Aro,-,.k is
completed.
The addition is estimated to take approximately four weeks
not including rain days, or delay due to revisions requested by
the Mukherjees, the home owners.
SI G N
DATE
�-V
4
r,
TOWN Of 110HUL AllUUVElt
14CEKLY TIME" SLIP
D.CPARMICNT-
EMPLOYEE LllDlllG
.DAY NIGHT SITE OTILER HOURS
MEETING VISIT TAKEN
SUNDAY -
MON DAY
TUESDAY
14EDNESDAY
-iii�J,L%5 DAY
FRIDAY
SATURDAY
TOTAL
"M "WilottAl
EMPLOYEE SIGNATUELC
DEPT. IIZI%D SIGNATU11C
Is.
CERTIFICAtE OF USEA-OCCUPANCY
Town of North Andover
Building Permit Nuynber 3 8 8
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 268 REA STREET
MAY BE OCCUPIED AS ADDING TO 'KITCHEN - & UTILITY RM. IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED To Dr. S.C. Mukherjee
268 Rea St.
17)
ADDRESS No. Andover, MA
Building Inspector
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PLUMBING & HEATING
Lic. #20667 Tel. #(508) 521-0262
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BRADFORD, MA 01835 t I �01161§1110
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Date ............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
01
Ar- � / I - li /—
cmus
This certifies that ...... ......
has permission to perform .................
plumbing in the buildings of 11 .............
at ... r ............. North Andover, Mass.
Fee. Lic. No,, 1- . I :.Z . ............... ; ................
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
NORTH ANDOVER BUILDING DEPARTMENT
27 CHARLES STREET
Tel: 978-688-9545
Fax: 978-688-9542
DATE:-()��v6w 41 ?-004-
ADDRESS OAA- 0
ZONING DISTRICT: 9 �)
TYPEOFBUSINESS:
BUILDING LAYOUT PROVIDED: YES 0
AVAILABLE PARKING SPACES:—/V,/A
ZONING BY LAW USAGE: nYE S NO
BUILDING INSPECTOR SIGNATURE
r,�v u's C�, / � ev-k /s L's, / /?cc t4f
z
Location
No. 1,F 2/9 Date �7- Lf%/
TOWN OF NORTH ANDOVER
P
M
Certificate of Occupancy $
Building/Frame Permit Fee $
s CHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
'17870
Building inspect
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
7 77 7
BUELDING PERNUT NUMBER: DATE ISSUED: ;7
SIGNATURE: PrfAw�
Building Commissioner/Inspector of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
�6 gea- S -i-
1.2 Assessors Map and Parcel Number:
6 � i� - '0 0 z -_7
Map Number Parcel Number
ovpw Wk
1.3 Zoning Information:
Zoning Dim—ric—t Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (11)
1.6 BUIELDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Provided
1.7W&ter Supply M.G.L.C.40 54) 1.5. Flood Zone Information:
Public 0 hivate 0 Zone — Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORMD AGENT
H1810ric Uistrict: Yes —No
2.1 Owner of Record
Name nt) Address for Service
A
Signature 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:
6
Address
t
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable
Company Name
Regi tion Number
Address
Expiration Date
I Signature Telephone
M
M
z
0
1 - 7-�
1i
0
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90
0
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I SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 6 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this—ap;lication. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Pro chevck
posed Work (check
applicable
New Construction 0
Existing Building 0
Repair(s) [I _P_1�
rations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
f) V1
'4 �', , [,-/!:) xvo
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to
Completed by _permit applican t
CL4JL USE, Y,
1. Building
/--5-0 C)
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
.3 Plumbing
Building Permit fee (a) x (b)
1120
-4 Mechanical (HVAC)
5 Fire Protection
-6 Total (1+2+3+4+5)
L �;—,q 0
Check Number
SECTION 7a OWNER AUWiOR ZA ION TO BE COMPLETED WIRN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNUT
as Owner/Authorized Agent of subject property
Hereby autborize to act on
My b in all matters rel i e to or authorized by this building permit application.
f
;)w
Si ture of Owner Date
0 UTH
SECTi/N 7b OW R/AUTHORTZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/A ent Date
-NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOOR TIMBERS 2 ND 3 PD
-SPAN
-DINIENSIONS OF SILLS
-DINIENSIONS OF POSTS
-DRvIENSIONS OF GUZDERS
HEIGHT OF FOUNDATION THICKNESS
-SIZE OF FOOTING X
-MATERIAL OF CHEVINEY
-IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED To NATURAL GAS LINE
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in:
-ocaJ6n of Facility)
J(Z=.
Signdture 6f PEWmit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
D. Robert Nicetta,
Building Commissioner
978-688-9545
978-688-9542 Fax
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER MA 0 1845
HOMEOWNER LICENSE EXEMPTION
Please print
DATE �2- q -o4 -
JOB LOCATION —_7 ( 0 K RIA 6 3 c,o - 0 / z
Number Street Address Map/Lot
HOMEOWNER ___T;�L C -F
tA (q A
Name J i
PRESENT MAILING ADDRESS 2- � V Re M-
I ?- � - b 9 C6 -5-11 C-)
Home Phone
1/7
State
':�Y-350 -11tr
Work Phone
c1f �r-
Zip Code
The current exemption for "homeowners" 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 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, one or two family dwelling, attached or detached structures attached or detached structures
accessory 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 North Andover Building
Department minimum inspection procedures and requirements and that he/she will comply with said
procedures and requirements.
HOMEWOWNER'S SIGNATURE
APROVAL OF BUILDING OFFICIAL
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