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
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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
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CASTRICONE ROOFING & SIDING CO.
31 Court St, No. Andover, Mass. 01845
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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.