The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 28 MIDDLESEX STREET 4/30/2018rl) C6) Location C5�,5 D),l No. Date 712 )0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,Ts Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �,4 I/ .. Check # Y 17428 .1AA1 (K,z,� /BuilCing Inspector -6 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT I APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 2 BUILDING PERMIT NUMBER: DATE ISSUED: /7 SIGNATURE: /Y / / - V 1 BWIZ7'Commissionefflnspector of Buildings Date SECTION I- SITE INFORMATION I 1.1 Property Address: 2 !F5 W, 1.2 Assessms Map and Parcel 03 L Map Number Number: Parcel Number 1.3 Zoning Information: Zoning Dia;�d Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (11) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard RcqWrcd Provide ReqWred Provi&d ReqWred Providcd 1.7 Water Supply M.G.L.C.40. 54) Public 0 private Zone 0 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal 1 1, Sewerage Disposal System: 0 On Site Disposal System 0 . . —, . . I SECTION 2 - PROPERTY OWNERSHMIAUTHORIZED AGENT I 11,)LU11U UIZ:MILA. Tt5.j INU 2.1 Owner of Record 1) Lt L) 0 ft Cj A- - e V Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: ignature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 z2n, "D 6—ul z Licensed Conkruction SupeAsor: (060112 License Number Aadress �7 4,, e A1 v1 /�P/ 3 -5� Expiration Date Signature Telephone 3.2 R&stered Home Improvement Contractor Not Applicable 0 Comt�nyName r Registration Number Address Expiration Date Signature Telephone Ma M X z 0 A SECTION 4 - WORKERS COMPENSATION (AG.L. C 152 § 25c(6) I 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 ....... 0 No ....... 0 SECTION 5 Description o Proposed Work (check applicable) New Construction 0 Existing Building JV' Repair(s) 0 Mterations(s) 0 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: I SECTION 6 - FSTIMATF11 CONSTRITMON cnqT.q I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL.USE ONLY I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) Z0 Mechanical (HVAC) .4 5 Fire Protection .6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT.. as Oxvner/Authorized Agent of subject property Hereby authonze to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION 1, - b , 4�7 as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are tnie and accurate, to the best of my knowledge and belief 7*0 nj ar Print N Signature of 01�vner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS i ST 2 No 3 RD SPAN DIMENSIONS OF SULS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS MGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERLA.L OF CHIMNEY IS BUILDING ON SOLD) OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE P Vropozat Page . of Free Estimates 105 Haverhill Street Fully Insured Methuen,MA01844 THOMPSON'S ROOFING (978) 691-1355 Shingles — Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE DATE David Bodenrader 6-19-04 STREET JOBNAME 28 Middlesex Street CITY, STATE AND ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: StriD off. -all r_o _--s-hia- le.s_.-on -of � _g Renall all loose plywood and if,any need replacement it will cost.$50.00 a sheet Install aluminum drip edge around roof line Apply ice and water shield 6 ft. up all along edge Apply 151b.,felt paper on rest of roof area Reshingle with a 30 year Arhcitect shingle Install new flange around soil,pipes Cut in new lead chimney flashing Install a ridge vent Remove all work related debris'' 30 year warranty on material, 5 year guarantee on labor construction lic. #060112 improvement #128612 We propo9t hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Six thousand two hundred dollars($ 6,200.00 Payment to be made as follows: $2, 000.00 down Z balance upon completion a All material is guaranteed to be as specified. AJI work to be completed In a workmanlike manner A according to standard practices. Any alteration or deviation from above specifications Involving riz extra costs will be executed only upon written orders, and will become an extra charge overand 9 above the estimate. Ail agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Insurance. Our workers are fully Note: This pro��may be _A K W-41-- #; I I 6A 4 1 0 y WL raWnLJYUSI n0&acG8pLVUWjLFjj days. 21creptance of propont—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made asZutlined above. LDate of Acceptance: Signature C E R T I F I C A T E 0 F L I A B I L I T Y I N S U R A N C E THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I DATE 06-16-04 (MM/DD/YY) PRODUCER PELHAM INSURANCE SERVICES INC 122 BRIDGE STREET THIS CERTIFICATE IS ISSUED UPON THE CERTIFICATE THE COVERAGE AFFORDED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER BY THE POLICIES BELOW. 122 BRIDGE STREET PELHAM NH 03076 - I N S U R E R S A F F 0 R D I N G C 0 V E R A G E INSURER A: Nautilus POLICY NUMBER DATE (MM/DD/YY) INSURED INSURER B: Associated Industries of MA Thomas Doyle DBA DBA Thompson's Construction & INSURER C: 04-15-04 8 West St. Salem NH 03079 INSURER D: $1,000,000 $ 50,000 INSURER E: I CLAIMS MADE I OCCUR - LI�ULJ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES -DESCRIBED 'HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Rehabilitation Program TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION POLICY EFFECTIVE POLICY EXPIRATION Methuen MA 01844 LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [XI COMMERCIAL GENERAL LIABILITY NC330578 04-15-04 04-15-05 EAC . H OCCURRENCE FIRE DAMAGE (Any one fire) $1,000,000 $ 50,000 I CLAIMS MADE I OCCUR MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $2.000,000 $1,000,000 [XIPOLICY [ ]PROJECT E ILOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I I ANY AUTO ALL OWNED AUTOS (Each accident) $ I SCHEDULED AUTOS BODILY INJURY (Per $ I HIRED AUTOS �erson) BODIL INJURY I NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT -'$ E I ANY AUTO OTHER THAN EA ACC $ 1 1 AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE $ I DEDUCTIBLE $ $ I RETENTION $ .WORKER'S COMPENSATION AND EXI WC STATUTORY OTHER B EMPLOYER'S LIABILITY E.L. EACH ACCIDENT $ 100,000 AWC7012214012004 04-21-04 04-21-05 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Roofing at 74 Somerset St., Methuen, MA for Nellie Montefusco ULK1ir1UA1L HuLDER [XiADDITIONAL MUREU: IN�URED LETTER: CANCELLATION UPI/) Page 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Methuen Housing THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED Rehabilitation Program TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION 41 Pleasant St. OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Methuen MA 01844 REPRESENTATIVES. AUTHO;RVIIE EPRESENTATIVE Fax: Pat 978 681-9421 UPI/) Page 1 of 2 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 license . d solid waste disposal facility as defined by IVIGL c 11, S 150 A. The debris will be disposed of in: C �' LW-eP 0 CA19 E � (rz�, 4, yv P_ (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Jndusttial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Mame Please Print a Location: -e Y Cily >�AtdIC)LIeA Phone # I am a homeowner performing all work myself. F� 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. :5,6 �-- V a e) Address Oty.le- 701211 '-(O-LOd V Company name: i Address Cily: Phone #: Insurance Co. Poliev # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 andtor one years' imprisonment -as -w-ell-as -civil,penatties inlheJbrm d-a-S-T..OP.W.ORK.,ORD.ER..atid..a fine -of.($10.0.00)-aday against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under tpq pains and penalties of peijury that the information provided above is true and correct. 9 - 2 Print name :TA-& VVI W- 4z Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permitil-icensing Building Dept [3Check if immediate response is required 0 Licensing Board r-1 Selectman's Office Contact person: Phone F-1 Health Department F-, Other (A m m x m m x co m m co CD a z CD 0 06 CD 06 cr CD 0 CO) 10 CD CD LIM,% cop) CM) col CA CD 0 CD :p CD CD CO) z CD CD w a =r -4 c -1 0 x a cr go E -L 0 So ce CL m CL m . c Z cr-O co 0 Oomw m = CL 0 CL m a CO3 a C42 P-0 0 6*4 jE =rm a ;; - a 19R a 0 z :5. sc: 1 0 MC2 0 CD COO =r C=2 75t 2L CL aCC3 co 0 C=,r cc n CL '04 a - co cco cn AV . Er �ftgw 0 ir bi Im j 14 =5 ON C% =r CIO IL co cn cn Ir 2: 0 m 0 m 0 0 6**4 0 ;.Tl ro Ov (IQ 0 :3 C/) 'Ol 0 )Nq 0 .62 5 3 Date. ..3 1 TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION ,TSACHU This certifies that .... fialre4lt 44 ....... ......... -lbstallation . has permission for gas ....... i n t h e b i 1, dd ii n g s o f ............. North Andover, Mass. at6;. Fee. Lic. No./,5.--A00 . ..................... GASINSPECTOR WHITE: ApplIbant CAN R;-: Buildi.g Dept. PINK: Treasurer GOLD: Fig _4 . MAS!jACHUSETTS UNIFORM APPLICATION FOFJ PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date �uilding' Location e Permit #-22S3 Owners Name New Vl/ Renovation Replacement _] Plans Submitted F I X T U R =--'z (Print or Type) Check one: Certificate Installing Company N-3me 41 Corp. Address 7- Partner. Firm[Co. Business Telephone: -Name of Licensed Plumber or Gas Fitter- 72AIel" f Insurance Coverag Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [:E� Other type of indemnity F__j Bond E] InsuraAce Waiver: 1, the undersigned, have been made aware that the licensee of this c1pplication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent El i hcieby ccrtiry " ail of the destils and information I haye tubmitted (cr entercd) in above application are true and accurate to the best or my knowicdge and that all plumbing work and InscAllations pctformcd under'Permit itsued for this application wil.!Ate-Lrt compHart- -ith 69 PctUn-t provisicru or the Pdass2chusetts State Gas Code ind CbAptcr 142 of tho Cencul LAwL By Title City/Town: APPROVED (OFF[Crz USE ONLY) 7A'PE LICENSE: Plumber Gasfitter Mastz� Signature of Licensed. Plumber o�- Gasfitter ense Number monism INEENNIONSION MONSOON ON! 0 MENOMONEE ME I MONISM MWM, MEMEENNEMON .1=0 MEMENEEMENE MENSOONOMMEMME MEMO (Print or Type) Check one: Certificate Installing Company N-3me 41 Corp. Address 7- Partner. Firm[Co. Business Telephone: -Name of Licensed Plumber or Gas Fitter- 72AIel" f Insurance Coverag Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [:E� Other type of indemnity F__j Bond E] InsuraAce Waiver: 1, the undersigned, have been made aware that the licensee of this c1pplication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent El i hcieby ccrtiry " ail of the destils and information I haye tubmitted (cr entercd) in above application are true and accurate to the best or my knowicdge and that all plumbing work and InscAllations pctformcd under'Permit itsued for this application wil.!Ate-Lrt compHart- -ith 69 PctUn-t provisicru or the Pdass2chusetts State Gas Code ind CbAptcr 142 of tho Cencul LAwL By Title City/Town: APPROVED (OFF[Crz USE ONLY) 7A'PE LICENSE: Plumber Gasfitter Mastz� Signature of Licensed. Plumber o�- Gasfitter ense Number Ce The Commonwealth of Massochu�etts ter -it Dcpartmcnt of Ptiblic Saftry BOARD OFnRE PREVENndN REGULAnONS S27 CMR IZ-00 �/90 occwpar-cy ree'chtci,44 APPUCATION FOR PERMIT TO PERFORM ELECTRICAL WORK A11 %vrk to b -c p"rmed In accordance with the Mauschuserts EJectrkal Code. S27 CHR 12:00 (PLEASE PRIn iN nTK OR TYPE ALL INYORMATIOH) Date ? -_ — �p 11-1 City or Town of V 4 --el _1C To the Inspector of Wires: _A__ A -61a - The une-prsigned applies for a p-ermit to perf'orm the electrical vork described b -c -low. 2— Loc-ation ('trect Number)_ Owner or Tenant 41,4-VIZ2 Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Nrpose of Buildink /��2 'A/ /,/I -Y14 Utility Authorization NO. Existing Ser -.ice An s Volts New Siervice p Undg"rdc No. of !^'ets�ts__ Amps 7*61 Volts Overhead Q--Undg7rd El No. of F4te-,s Number of Feeders and Ampaci Location and Nature of Proposed Electrical Work No. of Lightixig outlets 'Zo. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Panges Nr of Disposals -10. of Dishwashers No. of Dryers NO. of Water Neaters No. Hydro, Massage Tubs NO. of Hot Tubs Above Swimming Pool grnd. No. of Oil Burners No. of Gas Burners No. of Air Cond. tons Eeat Total Total No. of PUrP3 Tons YW Space/Area Heating KW Heating Devices KW KW No, of No.-Fr— Signs Ballasts No. of Motors Total HP No. of Transformers 10 ta XVA Generators KVA NO. Of Emergency Lighting Battery Units iiRE AIMM No. of Zones NO. Of Detection and Initiating Devices No. of Sounding Devices NO. of Self Contained Detection/Sounding Devices Local El Municipal — ConnectionoOther I,ow.voltage INSURANCE COVETAGE: Pursuant to the requirements Of liassachusetts Central Laws I have a current it Insurance Policy including Completed Operations Coverage or its-ub3tantial equivalent. YES df�g 8 1 have submitted valid proof of same to this offic e. YE!�El--"O 0 Ii you have checked YE�i please indicate the type of coverage by checking the appropriate box. INSURA.NCE MJ0`ND C] MUM 0 (Please Specify) Estimated Value of Electrical Work S (Expiratio-n—b—a 'FeT Work to Start )r _/ In 3pection Date Requested: RougW, elA%O�V-- Final Signed under the penalties of perjury: FIRM NAME LIC.. NO. Licensee. S-11 I A/ Signature. LIC. NO. �Alt. Tel. No. - Address B63. Tel. No."�4( OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts GoeneralUW3. _.nd that my signature on this permit p aP lication waives this requirement. Owner Agent (Please check one) -:7 - 5ignature of Owner or Agent) Telephone No. PERMIT FEE - ',3', TO 2927 I'M00 '�s CMUS Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... .. ! ..... .......................... e,6.7 ................. ... ........... has permission to perform ....... .� e /? C.) ................................. wiring in the building of .......... ndec ............... 4 .......................... c� ....................... : at ..... Q..� ......... ................ . North Andover, Mass. Fee.�.4 ............ Lic. No Iq .... . .... ............................................................... ELECTRICAL INSPECTOR C 03122/96 15:44 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File