Loading...
HomeMy WebLinkAboutMiscellaneous - 30 WENTWORTH AVENUE 4/30/2018Of Location- �� (Z�� No. -?L;,/K7 Date TOWN OR NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ c Check #�� 13 .� 5 4 �j ~�—Bui d ng Inspe for v 2 w TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: do Buildin ommissioner/I for ofo@&Idings Date SECTION 1- SITERMATION 1.1 Property Address: V� Q✓XA �4zC� �—"\ \1. 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. weer of Record _ \ Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: rSignature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name r� \ Registration Number Address d / co Expiration Date St nature Telephone Ix SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Desch tion of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) V I Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: U SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beCLAti Com leted by permit applicant4, USE ONLY, �• 1. Building i (a) BuildingPermitFee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print me _ 1-1 — —//& 'Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIlVIENSIONS OF GIRDERS - HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE P The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of/nyestJgatlons 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have e followin workers' compensationpolices: Failure to secure coverage as required under Section 25A of MGL 152 can lend to the Imposition of criminal penalties of a fine up to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of n STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oflice of investigations of the DIA for coverage verification. I do hereby certify under lire pains and pen ties of perjury Mat the information provided above is true and c rrect. Signature_ Com—t Date v Print name � Ct. VR -,i1 r�4C— 6 Phone N official use only do not write in this area to be completed by city or town official city or town: permitilicense N _ OBuilding Department OLicensing Board check if immediate response is required oSelectmen's OlTice 0I1ealth Department contact person: phone N; 00ther I- J 10.1 may. lie. a d c w � .••. r'r b� � ,. � o m .po. � LiZ'f O . • � f7. �� z o 0 Mario Cas icone, Prop. e Tel, .682-4266 CASTRICONE ROOFING & SIDING CO. 31 Court St, No. Andover, Mass. 01845 m m m m 0 F to y 'O C d = O CO)CD n n Z CO) CD O CL r �• � ? c CL S y � o � o � CD CD O C7. CD CDo CD w w C CD y CD C O y CC C=D .7 CO) O O O Cl) • CD O CCD b m ON 0 C_ CD CD Z O_ CD O to O c cc CD co O CLN 0 N H m -• fA ® Q O.O�o =:*o0 CAcin� N m .w c 7 0� w — C O N =r® O O O ZS.C.,. O N O CD "0 In CLaom ,w .� =: n� CD CL m N m N ad: �.0 CD: : CO) ® 1 : CD:: C-1CD: moo: CD N CD ,.: O : 05'. CD .'S N : CD W o, m n� nom: C, c CD: C3 O• w N CD CA N O O CO2 C) m 1'1 m CO2 2 5 d o � � Ittai z =? a? cp � ?. t a z ?? aGc ,� r p'- O ora O z W Cam ►, z rn r.. C O a. tz O M 0 Q03, 1 M� • N2 2654 Date ... /A/ TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........................... .............................................................. has permission to perform .....(ntA ... I.. (.,.ef �........ ,,Airing in the building of .... ........................................................ at .........:7. 6 ..... !j. ....... North Andoydr, Mass. .......... Fee .... Lic. No. ........... INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C�ammoltweal� o� li%as�ac�iudelff Oflicial Use Otll 2epar1nten1 o/.re �ervic¢e Peitnit No. - BOARD .OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 11/99) Ime blank) APPLICATION FOR PERMIT TO PERFORiVI ELECTRICAL WORK All work to be performed in accoidaneC with the hias5aCllusetts Electrical Code (ME4fir 12.00 (PLEASE PRINT IN INK OR TYPEALL IN%'ORM 17ION). llatc: Cityot•'�'oivttof: To the lrr.rpects: By this application the undersigned gives notice of his or her intention to erform the electrical work described below. Location (Street S Number) �. Owner or'I'enant Telephone No Otyner's Address (�a„_a �, _ ca, Is this permit in conjunction ivith n buildiub permit? Purpose of Building Yes ❑ P. No ❑ (Check Appropriate 13ox) Utility Aulliorizalion No. Existing Service Amps 1 Volts U1 cnccad❑ Undgrd ❑ No. of Meters New Service Amps / N.ol(s Number of Feeders and Arnpacily Oycrhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: o. o m ergency Igtang rnd. rnd. N No. of Receptacle outlets No. of Oil Burners V r .. - No. of Recessed Fixtures No. of Ceil.-Sus t. Paddle Faus J ( ) •••••r�...u,acuU),Incllls Mot*ol11"!/'L'S. No. of Total Transformers KVA No. of Lighting Outlets 6 - _ `lo: bf llul'I'ubs � . Generators IiVA No. o[ Lighting Fixtures. Swinunittg Pou) Aboti c ❑ In- ❑ b o. o m ergency Igtang rnd. rnd. Batter ' Units No. of Receptacle outlets No. of Oil Burners FIRE ALARMS No: of Zones . No. of Switches No. of Gas Burners No. of Detection and . Initiating Devices No, of Ranges No. of Air Cond.l Tons ' No: o[ Aller -thug Devices No. of Waste Disposers heat Pump Nun��cr :I :ons K1V _ ___;_ - - _R0. of Sclf-Contained -Totals: — . . Detection/Alerting Devi ccs No. of Dishwashers Space/Arca Heating KWLocal ❑ Municipal - Comtection Other No. o[llrversHeating Appliances ltl1: Securit}'Stents: No. of ll'ater No. of No. of - _ .-- No. of c ccs orF uivalettt -_ - vi hlcatcrs K Si/)ms Ballasts Data li iring: No.orDevicesorE uivalent No. IlydromnssageBathtubs No. of Motors Total 111' I' clecomtnlurtications Wiring: No. of Devices or E uivalent OTHER: V. XiLlr_ 42 ......... ......uynul uelau v neslrea, or as rcruh•ed by the /nspector of ivii-cs. INSUILANCE 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 issuin. office. CHECi QNE: INSURANCE ❑ BOND ❑.- MIIER ❑ (Specify:) (Etpiration Date) Estimated Value of Electrical Work: (1VI required by municipal policy.) Work to Start: (�� Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 Certify, 1111 der the /hilt.• andlienalries of pc►jurr, that the ilrforn ntinn a!t this nitplicativ» is true and complete. �. IrllZill NAME:%� 7) C f &C�LIC.NO.: �. Licensee: j Sibnntu c LIC. NO.:, (lfOpp tic culel 'e.icrnp! ntheliccltsen mberJuteJ - ) ;Wdress:- Alt: Tel itio c aj OIVNER'S INSURAN C)✓ 1VAI\ 1 I2: I ant_at�arelltitt the Licensed lloe�s trot hmi the liability_rnsurance cov Il -e normally required by l:B), my stttnatutic below, i J this rcdutrcti cnl 1 gin the (clicck one) ❑ otv r ❑ owlict s aoont On•ucr/Abcnl .. ,. .. ,.. FelepltolleNo _..: ._..._,_;: l'1iRAl17TLE: S --- L OCT -17-2000 11:34 PAYROLL EXPRESS 19786920914 P.02 ........................................ ........ �.:..:<:. ..:.....:. :.eco .:.�. w •Y: a .:::.......:...... DATE rDOJYY MM RD I ) T C3F LtBlilYY SUI, . ........ ...._._ ._.__..._._ .I.N :... ....::...:.. ::....... . ,:.......::...:..:..: 08/07/00 PRODUCER 5 : $ ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HERITAGE INS AGENCY INC AND CONFERS NO RIGHTS UPON THE CERTIFICATE FALTER _ R. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR DRAWER 219 8 THE COVERAGE AFFORDED BY THE POLICIES BELOW. 90 PARKER ST COMPANIES AFFORDING COVERAGE GARDNER MA 01440 COMPANY EACH OCCURRENCE A CONEXCO INS AGENCY INC MSUREO � COMPANY G F A INC e COMPANY P O BOX 4011 C WESTFORD MA 01886 COMPANY __.. WCTATU.IMITS T' D ER— . ..... .. ..... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 'IHE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED' ORMAY PbHIAIN. IRMSUgANCE AFFORDED BY THE POLICIES DESJ A19F;o' HEaE(N' IS �JSJECT i6 ALL- iE iEFiMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO L'� TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ;POLICY EXPIRATION I DATE (MMMONY) , DATE IMMJOD/YY) UMTTS GENERALLIAlIIJTY ;CLS0557019 12/03/99'12%03/00 GBryERALAGGRF.CATF " S X ...... f_ COMMERCIAL GENERAL LIABIUTY I .._ ,52,000,000 PRODUCTS - CO*�P+OP ACG s2,000,000 i CLAIMS MADE �� OCCUR .. .. ... PERSONAL & ACV INJURY S 1 , 0 0 0 , 0 0 0 OWNER'S d CONTRACTOR'S PROT CACH OCCUR RENCF 61 000 000 .. FIRE DAMAGE (Any one tile) 5 5 0, 0 0 0 ( MED EXP An ono C -60c,) 5 5,000 I AUTOMOBILE LIABILITY ANY AUTO (:OMFJINED SINGLE LIMIT S ALL OWNED AUTOS 600lly INJURY SCHEDULED AUTOS Ic'er wsonI HIRED AUTOS I BODILY .INJURY NON -OWNED AUTOS (Par SpCidem i .1 I DESCRIPTION OF OPF.RATIONS(LOCATIONSIVE►G=WSbEOAL ITEMS — y TOTAL P.02 . ........ ...._._ ._.__..._._ I + I PROPERTY DAMACF AUTO ONLY . EA ACf.aOENT 5 : $ RAGE LIALITY GABI . � ANY AUTO _OTHER YHAN At7TO ONLY; _ EACH ACCIDENT 8 AEGATE a ET(CESS UABIUTY EACH OCCURRENCE $ (UMBRELLA FORM I AGGi+E[;ATE g ... »» !OTHER THAN UMBRELLA FORM I 5 WORKERS COMPENSATION AND I I __.. WCTATU.IMITS T' II f EMPLOYERS' UABIL.IZY ER— . ..... .. ..... -I ELTORY EACH ACCIDENT ' THE PROPRIETOPY INCL I EL UISEASE•POLI(:Y LIMIT F PARTNERS/EXECUTIVE OFFICERS ARE: ! EXCL ! 6L oISEASE•EA EMPLOYEE " S OrNER � I t I __.—._, .. • .1 I DESCRIPTION OF OPF.RATIONS(LOCATIONSIVE►G=WSbEOAL ITEMS — y TOTAL P.02 3225 Date.:.!?.. c7••••• MORTM TOWN OF NORTH ANDOVER ' py ,ao ,s,hOp p PERMIT FOR GAS INSTALLATION U1 V d This certifies that ... ? �� . !....`... .. .. • • • • • • • • • • 9z has permission for gas installation .....�.�' .`/. ...... • .. in the buildings of .. %?f4.! .............................. at .. .v.. •` �• v �� • { •4 • • • •_. North Andover, Mass. Fee.. Lic. No...GI.�. GG(AS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP 9 1, % QrJd� 4ASSACHUS ffl ON FOR PERNLIT TO DO GAS FrFMG or print) tvvxIH ANDOVER, MASSACHUSETTS Building Locations W Permit 9 3.,P, ),�)'� Amount S J^ Owner's Name P",:�,. New ❑ Renovation Replacement ❑ Plans Submitted ❑ (Print or type) ,y Check one: Certificate Installing Company Name , t4 171 Corp. Name of Licensed Plumber or Gas Fitter ixl rtz> 'eu 4 ❑ Partner. ® Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate t_he type coverage by checking the appropriate box. Liability insurance policy X Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver:: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent L,._ -L-. _ _L. -L __ _ Check one: Owner ❑ Aoent ❑ .1.7 ,. - ­ —1 -a113 u„u ui,virnauon i nave suomineo (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts �F'a e Gas Code and Chapte;,l42 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 19 ?.,Q 0 ❑ Gas FittericL ense Numoer L__.! Master Journeyman • r�������������������� (Print or type) ,y Check one: Certificate Installing Company Name , t4 171 Corp. Name of Licensed Plumber or Gas Fitter ixl rtz> 'eu 4 ❑ Partner. ® Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate t_he type coverage by checking the appropriate box. Liability insurance policy X Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver:: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent L,._ -L-. _ _L. -L __ _ Check one: Owner ❑ Aoent ❑ .1.7 ,. - ­ —1 -a113 u„u ui,virnauon i nave suomineo (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts �F'a e Gas Code and Chapte;,l42 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 19 ?.,Q 0 ❑ Gas FittericL ense Numoer L__.! Master Journeyman R 3 7 Ur' 9 ��7'pv- 0 -2-- Date ... .. . .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................... .......................... has permission to perform_.:........„ ..............— ................................................. wiring in the building of ....... ....... (—I.. .............................. at . ? ....... 14orth Andover, Mass. :.,j......... ........................................................ Fee .............. Lic. ... ...................... McmcAL INSPECTOR Check # 'A Commonwealth of Massachusetts Department of Fire Services WON BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 5 /1 �or,, Occupancy and Fee Checked [Rev. 11/99] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL%YFORMATION) Date:_ 3 bot City or Town of: yi> N VO\JCR, To the Inspe or jWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 20 Wa 1 VwR- R A\15 - Owner or Tenant KPRR l.%�-L_ P, PATrY Telephone No.578`12-06 Owner's Address 3o WfcN'C u JoR1 N ME Is this permit in conjunction with a building permit? Yes ❑ No RL (Check Appropriate Box) Purpose of Building 2 E S i Dc IJ f1 R L Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location ano Nature of Proposed Electrical Work: u t� ,. • Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Completion of the following table maybe waived by the Inspector of Wires No. of Recessed Fixtures No. of Ceil(Paddle) Fans Total Trans.-Susp. Trsformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA ;No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. [JBatte o. o mergency Lighting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of No. In Detection and InDetection Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pum Totals umber ... ... ons KW .................... ........................ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers 'Y Heating Appliances KW Security Systems: 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 Wire. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unles! the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The • undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjuty, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Peter Manzelli It Signature ` —� LIC. NO.: A 16199 (Ij'applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-589-9611 Address: 99 Main Street Westford, MA 01886 Alt. Tel. 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 ❑ owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: $ 35,0 Inspection Request Peter Manzelli II is requesting a Rough /inspection to be performed. at Name: —RGR EL. i3, PAIS% Address: WCN�-WOVV A4�s Phone: SR#: Date: 613 6 Thank you, Peter Manzelli II Phone- 978-589-9611 99 Main Street Fax- 978-692-86581 Westford, MA 01886 M4 ` �3 C. 143 Sec. 3L Board of Fire Prevention Regulations; Rules Relative to Electrical Wiring and Fixtures: Any person installing for hire any electrical wiring or fixture subject to this section shall notify the Inspector of Wires in writing upon completion of the work. The inspector of wires shall within five days of such notification give written notice of his approval or disapproval of said work. A notice of disapproval shall contain specifications of the part of the work disapproved, together with a reference to the rule or regulation of the board of fire prevention regulations which has been violated.