HomeMy WebLinkAboutMiscellaneous - 273 REA STREET 4/30/2018I
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Date .... Z- / / /V
N2 3 j'- .........................
"OR""
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
......................................................................................
has permission to perform ..... ---/, , , ---- -"�- Z),
..........................................................................
wiring in the building of ......
................................................
a at ...... ........ / ................... .......................... . North Andover, Mass.
Fee.z�-Z' .......... Lic. No.f.: ... f�) ................... ...........................................
ELECTRICAL INSPECTOR
Check # (1 2 -
WHITE: Applicant
CANARY: Building Dept. PINK: Treasurer
Official Use Only
Permit No.
rD& CO3MW09V",4LqYf OT 5W,4SSqCffVSEqTS
Department of ftbfic safety Occupancy & Fee Checked. lb2
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AJI work to be performed in accordance with the Massachusetts Electdcal Cride 527 12:
C7 �
(Please Print In ink or type all information) Date 2
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
I— f --'I.
Location (Street &
Owner or T
Ownef's Address f -
is this permit in conjunction with a building permit Yes )0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
E)dsting Service-----------------AmP$ voits
New Service , Amps__VoitS
Number of Feeders and Ampacdy__M_
Location and Nature of Proposed Electrical
Overhead 0 Undgmd 0 No. of Meters
Overhead 0 Undgmd 0 No. of Meters
%,/, r- -% C& 1,rc-4— 00 6 ef-I
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent Es.) 0
have submitted valid proof of same to the Office YES - NO - Ifyou have checked YES please indicate the typES �'c�omeragie =by checking the appropriate boy-
INSLRANCE = BOND = OTHER = (Please Speci -416 /,V -:z
Estimated Value of rilectfical Work �57do (Expiration Date)
Work to Start !21 h �qz& Inspection Date Resquested Rough __Final
Signed under thgXenalties of perju
FIRM NAME 21,e- -A, �-- LIC. NO. -C JQ 2,ST—
LIC. NO. 0 2X-';�-
7Bus. Tel No.
��a-X&22 Aft Tel. No.
AddressA 21 "el
OWNER'S INSURANCE WAIVER: I am iwatre that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one)
Telephone No. PERMIT FEE $ ��2
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above 0
In
No. of Lighting Fixtures
Swimming Pool gmd grnd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
_7
No. of Oil Burners
Battery Units
No. of twitch Outlets
-�? L)
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
SpaceJArea Heating
KW
Detection/Sounding Devices
0 Municipal [] Other
No. of Dryers
Heating Devices
KW.
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wirina
No. Hvdro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent Es.) 0
have submitted valid proof of same to the Office YES - NO - Ifyou have checked YES please indicate the typES �'c�omeragie =by checking the appropriate boy-
INSLRANCE = BOND = OTHER = (Please Speci -416 /,V -:z
Estimated Value of rilectfical Work �57do (Expiration Date)
Work to Start !21 h �qz& Inspection Date Resquested Rough __Final
Signed under thgXenalties of perju
FIRM NAME 21,e- -A, �-- LIC. NO. -C JQ 2,ST—
LIC. NO. 0 2X-';�-
7Bus. Tel No.
��a-X&22 Aft Tel. No.
AddressA 21 "el
OWNER'S INSURANCE WAIVER: I am iwatre that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one)
Telephone No. PERMIT FEE $ ��2
(Signature of Owner or Agent)
F
Date .............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... r I , ) ( t / /
.................................
has permission to perform ... 1.
................................
plumbing in the buildings of ... ...................
at. . ............... I North Andover, Mass.
Fee. Lic. No. .... ....... .......
PLUMBING INSPECTOR
Check #
4 55 2
i10 -
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location 2? 73 �'e,4 Sq"
Owners
Date
Permit #
Amount
Type of Occupancy
New El Renovation Replacern ent 13 PlansSubmitted Yes M NO ['-I
(Print or type) Check one: Certificate
Installing Company Name ;�>Xzvim r-
0
Address ;2 ic a/ , . 11 Partner.
--, Sa 16,-,— AJ, 0 _?c7 7? e,7'
Business Telephone Firm/Co.
Name ofLicensed Plumben
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insur-ance policy Other type of indemnity 11 Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature 777 Owner, Agent
r
I hereby certify that all of the details and information -I have subt4itted (or entered) in above application are true and accurate to the
best of my Imowledge and that all plumbing w6rk and installations performed under Permit Issued for this application wi.11 be in
I -
compliance with all pertinent provisions of the M seac—hu-s-akStat lenflair �Cod and Chapter 142 of the General Laws.
By:
,�Ignaturq of Licensea MuTo�p,
"�-yjJe of Plumbing Lid�ge
Title
1 6- 1
City/Town Der Master Journeyman
APPROVED (OFFICE USE ONLY F�
I
Location
No. *
Date
1401tTh TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ ev
C"
Foundation Permit Fee $
L Other Permit Fee $
$
TOTAL
Check # / �Ivv 2,
'-Building lnspecll�rr_
U
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
, APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
M
BUILDING PERNUT NUMBER: DATE ISSUED:
SIGNATURE: 13 /0
Buildine CommissionerAmeector of Buildings bate
Civil
��KIWVL I JL%J1,q I
I J Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
lo r V? r
1.3 Zoning Information:
g D i ���gbrid opos Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (iff)
1.6 WELDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide Required Provided
Reglured Provided
l -C.40.1 54)
0
1.5. Flood Zone Information:
1 Zone Ocitside Flood Zo..
1.8 Sewerage Disposal System
M..iip.1 0 On Site Disposal System J(
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT
2.1 Owner of Record
iW6 zeowi ska.
Name (Print)
sl?exellv- 3 S/,
Address for Service:
Signature
Telephone
2.2 Own& of Record:
Name Print
Address for Service:
Signature
Telephone
- 1 -114 3 - 4-014a, I RUCTION SERVICES
3.1 Licensed Construction Supervisor:
z
Licensed Construction SupeiVisor:
9 r e,,
Aalf '96,
biddress
;ignature Telephone <71T_
A"A,V rl";u )
;.2 Registered
,ompany Name
iddress
Contractor
Not Applicable 0
CS ox�a
License Number
06-1191,03
Expiration Date
Not Applicable 0
/N,�7)
Registration Number
//V �
og,:/, Expiration Date
�2
SECTION 4 - WORKERS COMTENSATION (KG.L C 152 §-5c—(6)--]
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ...... 4 No ....... 0
SECTION 5 Description o PE2osed Work (check applicable)
-T�� rations(s) Addition 0
New Construction 0 Existing Building 0 Repair(s) I-e—
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
cfwo
I SECTION 6 - FSTIMATM (-0NqTR1TCT11nN rnQTQ I i
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
4 .. .... . "15
(a) Building Permit Fee
Multiplier
VIM', PEN
N
M
L Building
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
S 00
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
4/0-5�- 069
Check Number
-Xx��"��JLJLWI'q IAJ "Z 'U%jivIrl�n ILE" WrMfN
OWNERS AGENT OR 'CONTRACTOR APPLILES FOR BUJIDING PERNUT
11 1 as Owner/Authorized Agent of subject property
Hereby authorize gutl Zio,
to act on
My behalf, in all matters relative to work-authoiized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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
11�11�117wjl �
Print
Dafe
P URIVI - U - ]-�" I 1kL1-iEAZ)h V URIVI
INSTRUCTIONS- This form is.used to verify that all -necessary approval I permits from
Boards aud Departments having jurisdiction have been obtained. This, does not relieve the
applicant and or landowner from compliance with any apphca*bl6 requirements.
1 6 0 a a a a 0 a a a a a a W.0 0 a 0 0 0 0 0 a a 0 11 a 0 a 0 0 0 9 a 9 a a a a a a 0 M.n a a 0 a a a a a 0 a a a a a 0 10 a a a 0 a 0 a a 0 a a a a a
APPLICANT PHONE
ASSESSORS MAP NUMBER
SUBDIVISION
LOT NUMBER - J/7
LOTNUMBER . . .
STREET' CA STREET NUMBER
... woo masses a Samoa 9 0 am Susan N&ssNffis�1vS0x go.
OMCIAL,USE ONLY a a
I mass now no as a am a a 0 so a 0 an on on Em'sa a so an 0 a as a 0 0 a an on ..
R.ECONgvffi-NDATIONS OF TOWN AGENTS
Susanna 0 Wasson on 0 ...
DATE APPROVED
i,���CONS�ERVA-n�ONAD�MWE�TRATO�R DATE REJECTED
COMMENTS
DATE APPROVED
TOWNPLANNER
CON84ENTS
DATE REJECTED
DATE APPROVED
FOOD INSPECTOR - HEALTH DATE REJECTED
/6 DATE APPROVED.
,�,�SEPTIC -INSPECTOR- IM6-LTH DATE REJECTED
CONINffi-NTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRrVEWAY PERMIT
DATE APPROVED
FIRE DEPARTNfENT
DATE REJECTED
CoNaENTS
RECErVED BY BUILDING INSPECTOR DATE
Town --of North Andover
Building Department
27 Charles Stmet
North Andover, Massachusetts 0 1845'
(978) 6.88-9545 Fax. (978) 688�-9542
DEBRIS DISPOSAL FORM
01 tAoR
-ft. a 0 16
0
0
to
La
A H tui
In accordance with the provisions. of MGL c 40 s 54, and. a condition of
Building permit.# the debris resulting from the work shall
of in a properly licensed solid _w be -disposed
aste disposal facility as defined by MGL c II, s I 56a.
The debris will be disposed of in /at:
L LS ��Iem
Facility location
Signature 6 Applic
2/ 0
Date --------
NO . TE.- A demolition permit from the Town of.North Andover must be obtained for t'il
project through the Office of the Building Inspector. his
BOARD OF BUILDING REGULATIONS
00 - 35,000 d enclosed space
License: CONSTRUCTION SUPERVISOR
(MGL C.1 12 S.601L)
1A - Masonry only Number CS 075668
1 G - 1 & 2 Family Homes
Failure to possess a current edition of the Birthdate:- 04129/1963
q Massachusetts State Building Code Expires: 04129/2003 Tr. rio: 75668
is cause for revocation of this license.
Restricted To: I G
MICHAEL D LIVINGSTON
57 HOOK RD
AUBURN, NH 03032 Administrator
DIG SAFE CALL CENTER: (888) 344-7233
HOME IMPROVEMENT CONTRACTOR
Registration:
License or registration valid for individual 106877
use only before expiration date. If found
return to: One Ashburton Place Rm 1301 lype: Private Corporatio
Boston Ma. 02108
BUSINESS CONDITIONS
TO THIS
CONSTRUCTION CONTRACT
This contract, dated Jan 19, 2001 is by and between:
Dennis Leonard & Sheri Bacheller
273 Rea St.
North Andover, MA 01845
Blackdog project code LEONA-001
(hereafter referred to as OWNER), and
Blackdog Builders, Inc.
Your full service Remodeler
5 Kelly Road, Unit 2
603 898-0868
(hereafter referred to as CONTRACTOR). Work will be performed at:
1. GENERAL
This contract is for the following work and materials to be performed by the contractor on the property address shown
above. The project is generally described as follows:
Kitchen & bath remodel
The contract consists of this document, any plans, the itemized estimate, the specifications, and the Construction
Contract.
2. PRICE
The total price for the work agreed upon is $105,064.83. Payment terms are set out below in Paragraph 6. We
may withdraw this proposal if not accepted within thirty (30) days.
3. STARTING AND COMPLETION PROVISIONS
a. The work will begin on approximately 01/08/2001 and will be completed, absent unusual circumstances, on
03/30/2001 providing this proposal and any relevant product related proposals are accepted when presented. Projects
requiring two agreements (one for construction work and one for bath or kitchen product) will not be slotted into the
schedule until both agreements have been executed. The dates reflect our present workload. Projects are assigned
a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on
the completion time of the project that immediately preceded yours.
4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW
a. All work to be done under this contract will be in accordance with the county codes. The contractor shall obtain all
necessary permits and pay all required permit and plan fees from the contract sum, unless otherwise agreed. Does
not include any fees which may be incurred for a variance if required. Contract price doesn't include any unbid items
required by the local building official.
15. ENTIREAGREEMENT
This contract consists of the documents defined above, and constitutes the entire agreement of the parties. It can be
modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this
agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of
every other document that OWNER has signed during the contract negotiation.
SUBMITTED:
Carl T. 11
Designer
Blackdog Builders, Inc.
ACCEPTED:
Dennis Leonard Wheld BVe&ller
ALL INTERESTED PARTIES:
D A T E : ': ��' - :: -' '2 -&"/'
DATE:
DATE:
MAKE SURE ALL INTERESTED PARTIES TO THIS CONTRACT HAVE
RECEIVED THEIR COPY OF THE
RIGHT OF RECISSION DOCUMENT
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
rName Please Print
/t//� 0,3071 Phone I # r0-3) TV-OeO
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
0 e--, I J i C-71 f / 0
Com vany.narnw.
AddEM
C i P -C. Phone*
kid Sdetion 25A.or-MGL 152 can . leadlo%th imp
Fa-jiureta secure coverag as reqU ;under osition of -criminal penalties of,0 fine up t6 $f,sm
an(Vor one years, iMprisonment-as-wen as-cmLpeawfim-m-thelarm-dasTOP�W.ORK-ORDERmd affine-ofj$100-001-a-dayA
gainst me- I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage ve rification.
/ do hereby certify under the
Print
�V//
that the information provided above is true and coffect.
official use only do not Write in this area: to be completed by city or town official'
.# rl-4-?) 91*1-&� e
City or Town PermiUUcensing
Building Dept
E]Check if immediate response is required Licensing Board
'Selectman's Office
Contact person: Phone C:] Health Department
Other
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Location
No. Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
Argo
CHU
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
.4.4
10920
C"
CU
Building Inspector 9
Div. Public Works
-�APPLICATION FOR PERMIT TO
OUILD — NORTH ANDOVER, MASS.
PAGE 1
2 RECORD OF OWNERSH P DATE 1300K
lPAdE
SUB DIV. LOT NO.
sON
57
_0 - WNER*S
PURPOSE or AM+ftq"44j. F-
6", fo
NAME
All,
NO. I STORIES
OWNER'S ADDRESS
Bak
L/
20 3, A64 ;5 7
BASEMENT OR SLAB
ARCHITECT'S NAME
-------
SIZE OF FLOOR TIMBERS IST IND
BUILDER'S NAIA�E
3RD
SPAN
DISTANCE TO NEAREST BUILDING f
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
GIRDERS
HEIGHT OF FOUNDATION THICKNESS
DISTANCE FROM LOT LINES SIDES REAR
AREA OF LOT FRONTAGE
IS BUILDING NEW
SIZE OF FOOTING x
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
19 BUILDING ADDITION
VFIS BUILDING ALTERATION
tA416
N G��
V���DWILL BUILDING CONFORM TO REQUIRE�MENTS (6F CODE
IS BUILDING CONNECTED TO TOWN WATER
IS BUILDING CONNECTED TO TOWN SEWER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED 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 MUS� CONFORM TO STATE FIRE REGULATIONS
�PLANS MUST BE FILED AND APPROVED By BUILDING INSPECTOR
DATE F!'ll
WGNAT RE
I - �
PERMIT GRANTED
19 — Q ?
3 PROPERTY INFORMATION
LAND COST
M.Cos
EST. BLDG. COST
EST. BLDG. COST PER SC. IrT.
IILE U. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
-MapRCTOpt
/OWNER TEL #
CONTR. TEL. #
CONTR. LIC. #
H.I.C.# -
BUILDING RECORD
�Cy 12
THIS ECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
Lease print)
DATE___.:Z/,7_o 11-7
JOB LOCATION- KeA ST -
Number Street Address
Section of town
,)MEOWNER" I)(-NNlf> 4emhr,
Name
f 314c4,ep,
e Phone
69" W Mo .3'0 8� (zpo d IIS-(,)
Work Phoie
,'RESENT MAILING ADDRESS 3 Ar, -A s 7-
Alork A�)oVzjr M/A_
City/T wn ---------
State Zip code
The current exemption for "homeowners" was extended to include owner
-occupied-dwellings of six 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 109.1.1)
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 tqbe�, a one to six family dwell-
ing,.attached or detached structures accessory t.o such use and/or farm
.:;truEtures. A person who cons,tructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to -the Building Official, on a form'acceptable to the Bulding Official
that he/she shall be responsible for all such work performed under the'
buildilng permit. (Sectioh 109.1.1)
1he undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.
Phe undersigned "homeowner" certifies that he/she understands the Town of
�orth Andover Building Department md-nimum inspection procedures and
,�quirements and that he/she will comply with said procedures and
equirements.
10MEOWNER'S SIGNATURE
\PPROVAL OF BUILDING OFFICIAL
'40te: Three family dwellings 35,000 cubic feet, or larger, will be
_C�quired to comply with State Building Code Section 127.0) Construction
:untrol.
I