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HomeMy WebLinkAboutMiscellaneous - 32 HARWOOD STREET 4/30/2018 32 HARWOOD STREET 210/007.0-0017-0000.0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING bi BUILDING PERMIT NUMBER. O DATE ISSUED: SIGNATURE: —"I Building Commissionefflng=tor of Buildings Date z SECTION 1-SITE INFORMATION O -1.1 Property Addr 1.2 Assessors Map and Parcel Number: `1 NdMap Number L Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide RecItlired Provided Re red Provided v 1.7 Water SupplyM.G.L.C.40. 54) 1.5. Flood Zone Infom ation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ on Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDAGENT "i"iC'i;c DiSt(lm n'nx f Record 2.1 Owner o J1 � ` 1-177'/z 1 1(i C)G' V Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si nature Telephone 9090 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: !I' / License Number Address Expiration Date am Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ M Company Name Uum Roofing, /( / 5�2e ( PO Box 637 Registration Number r Add No. R ading. MA ` ` r Expiration to . nature _ Telephone • 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 buildi5a permit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Pro osed Work check an a 6cable New Construction ❑ Existing B Ming ❑ Repair(s) ❑ Alterations(V i ❑ Addition ❑ AccessoryBldg. ''-❑, Demolition. ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by ernuit applicant 1. Building (a) Building Permit Fee Multiplier - (:/�jsn3 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 OG('J Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER as Owner/Authorized Agent of subject property n7 Hereby authorize_ L� /,&J. z to act on My behalf,in all matters relative work authorized by this building permit ap lication. Signature of OwnerDate It SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and intormatit5d0k 1t'&6?1fqpel�c(,"ion are tn:e and accurate,to the best of my knowledge and belief PQ °ys: J37 No Reading IIIA Q i 864 Prill eI // / — S4nature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 15 24D 3 RD SPAN DIMENSIONS OF SILLS DIlvIENSIONS OF POSTS MvIENSIONS OF GMDERS HEIGHT OF FOUNDATION _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUELDING CONNECTED TO NATURAL GAS LINE Town of _ RAndover ® _ - . ;.. 10 No. ti d .�.. ar, F . LA E dover, Mass., co LA ��. ADRATED PPS\ -`C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........so ...... .............. .. ............................ ..................................................... Foundation • has permission to erect..Yacc ...................... buildings orml....... .... ........ ...... .. .. ... ... ... Rough to be occupied a Chimney provided that person this permit shall in every respect conform to the terms of the application on file in Final this office, and to the prf the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ELECTRICAL INSPECTOR ST Rough ............................................ .......................................... Service ,. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. op =SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by NIGL , t19S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 QA. The debris will be disposed of in: (Location of F citity) Signature of Permit Appli ant Fire Department Sign off: Dumpster Permit Date The Commonwealth of Massachusetts Department oflndusirial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Duval Roofing, LLC Name(BusiimslOrganizarioMndividuai): PO Bnx 627 Address: No. Reading, iMA 01864 City/State/Zip: Phone Are yo employer?Check the-appropriate box: Type of project(required): I. I am a employer wither---- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time). have hired the sub-contractors 7. Retnodelm 2.❑ I am a sole proprietor or partner- listed on the attacbed.shect. i ❑ g ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance- 9. ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. e. 152,§1(4),and we have no 12.e- repairs insurance required.]t employees_(No workers' 13.❑ Other comp.insurance required.] Any applicant that ebecks box#1 must also fill out the section below showing their workers'wn4msaaon policy information 1 Homeowners wbo submit this affidavit indicating they art»doing an work and than hire outsWc oma Tactors must subs*a new affidavit indicating such tContractors that check Ibis box must attached an additional sheet showing the acme of the rub-coutrsctarx and thek wort m'comp_policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: c� �jl� Policy#or Self-ins.Lic. #: / GeV Expiration Date: (_3 A .fob Site Address:y ) City/State/Zip: �d Attach a copy of the workers' compensation policy declaration page(showing 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 Cmc up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci r the pains and penalties of perjury that the information provided above is true and correct Si Da e: Phone M '-7 7 SK Oficial use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/Ucense# Issuing Authority(circle one): L Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: -- '� Page o. of Pages Builders License # 58443 Home Construction Reg. # 109288 DuvaIAL RoOfing, «C (781) 944-1994 (978) 664-5557 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PROPOS LS E TO 1 DATE -666 STRE /VA,t` V, �nAMI 49 CITY,STATE ANDZ CODE JOB LOCATION /1 n c p r We hereby submit specifications and estimates for: r Recommended Optional Ell Ire Ur t �u !n -t (L L P r ��r (Included in price) (Not included in price)` •t/ Rip& Remove all shingle debris from roof&job site: ❑ 1 layer Clylayers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. pr Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown u' Install ICE&WATER underlayment along horizontal eaves,valleys, sidewalls and sky-lights&chimneys Install premium base sheet underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles ❑40 year ❑50 year ❑ Lifetime See manufacturer warranty policy for more details ✓� Install new aluminum.vent-pipe flange(s) yr Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing •/' Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑Soffit-ventilation ❑Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts - i ! ./ Other7 e r LV y /Gt ,,n 'Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. E "xopast hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ / / (1) ). Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature ' - 1 o'y -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within � i1 days 4 The Commonwealth of Massaehuststts Department of ladustrlal Accidents office of Investigations 600 washington Street Boston,MA 02111 wwmmassgovlaw Workers'Compensation Insuranoe Aff ftvit:Burflders/ContractorslElectjidamMiumbers A licant Information --r-lase Prue Ljobly Duva Roofing, C Name(Basia�pniratiowwividw ._ ._PO RO�'t�7 Address: No, Reading, VA 01864 City/Statelzip: Phone#: Are yo employer?Cheek thrappropriate box: Type of project(txgnired): 1.Erl am a employer with 4. ❑ 1 am a general contract and 1 b. ❑New coasttaction } MV10yes(full and/or part-time}.• have hind the sub-contraams 9. Q Remodeling 2.[1 1 am a sole proprietor or partw- listed on dun aitarhod sem. have wship and hcmpkYm These sub-cont racaors have 6. p Dcmounon working for me in any Capacity. wolkCw'COMP.ism 9- ❑Buiidiug a"idon [No wtrrlrers'comp-inmanamce s. Q Weare a omporation and its of�i=have exercised their 10.Q lslectmical repairs or additions 3.[3 1 am a homeowner doing all work tight of oxemodu tier MGI. 1 LE]Phtmbing tepafrs or additlong myself:[No workers'cone. c.152.$1M and are have no 1 n�airs insumm r teffcd-)t employ-(No wo*ers' 13U Other camp.inantnw*"mired.] ;Any appo mt that cbeft boot Be ttatsrtdw 8A vat tba=Wn below dwwi4 tbelr worbas•ammPeawfim rawY' Homwwat a wbo suAmit this atBdavh iadiert ft they=doins am wm k=0lea hive outside oott>nctras umA subrmt a mw dl&vit id&nting such tContraetots that check this box a"shaded an additional shag d owAn fa sari of eW wbMVECIM sad the$madras'aom{>:p0r=7 iRfotttlatiM I am an eag6yer that is proWftg workers'coatpensadox haum iw for my emptoyus Bctow b AcpabV end job abe iaformwiwL lasaram Company Name: Policy f or Self.Lic.X: 3 3 (JA Zzc Job Site Address: City/StstefLip:/W Attach a copy of the worker eompewation policy declaration page(showing the polity number and expiratlan date). Failure to secure oovemge as mpdred tmdet Section 25A of MGL c. 152 can lead w the inlpoai M of aiminal Penalties of a Cine up to$1,500-00 andlor one-year imprisonment,as well as CW permute in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a aapy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vetifieation. do hereby cerci , r rhe paint and pomMes of pedury Aw the lnfonr adore pr ovikd about Is tats and correct Ojrtd f use only. Do not write is this area,to be completed by city or town qfftd&L City or Town: Permlt/Lictwe# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrm m Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other 9 Q ')4 Date. 31.0. . . . MORTp TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 544 s � �• a SACNUS� toSYYl f Q " This certifies that t tr z- . . . . . . . . . . . . . . has permission to perform •. . . . . . . . . . . . . plumbing in the buildings of . .V t' . . . . C". . .�. . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . .t✓ . .�:�v`�.(l.t�;c�o . . . . . . . . . . . . . . .. North Andover, Mass. . .1. Fef.'10-�J. .Lic. No..a.5 6 .1.). . . . . . . PLUMBING INSPECTOR Check # (6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town• �QcTe%G� MA. Date: Permit# Building Location:—a+ Q Owners Name: .Q Type of Occupancy: Commercial[] Educational❑ Industrial❑ Institutional ❑ Residential [] A New: Iteration:❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED 2 Z SYSTEMS LU y N O 0.N' y d tn a aLU o 0 Qm Ln to �~ W Q 0 _Z O d Q x w O LL d 4 Z cC ' z W ' a � Q LU N F- d _ O a O O o w w `3 Z ° LL S d 0 sS " " F d3�., >wx oo Y N moo v oy w m -SUB BSMT. Q 3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4'FLOOR 5T"FLOOR i 6T"FLOOR 7T"FLOOR e FLOOR S+ Fn$i^llrri ame,: 1 { lO-A •P•r(} Address: City/Town: Out)tT ❑Corporation �+' Stater Business Tel:• 1b_ ��ts_ 05 t Fax: El Partnership �1�� ' Z���dg 3 � OF Name of Licensed Plumber: �p � L . ��_ INSURANCE COVERAGE: have a current Iia_ bility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No If you have checked Yes,please indicate the-type of coverage by checking thea El liability insurance policy.[� Other t ppropriate box below. ype 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only >i nature of Owner or Owner's Agent Owner El Agent IF]1 hereby certify that all of lthe details and information I have submitted(or entered)regarding this application are true and Knowledge and that a!1 p!!�mbing work and installations performed under the permit issued forthis app►ication will he in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 0;the Gen Laws. a ecurate to the best of my � S 3 Type of License: :►e 3 Plumber a e of lice er -� Y/Town M-1 aster 'PROVEJourne D(OFFICE USE ONLY) yman License er: I - I 795 Date.. . . . . ... . �' TM Cf WOF14, TOWN OF NORTH ANDOVER • " PERMIT FOR GAS INSTALLATION �1SSACNU5ES r. This certifies that . 5= 16 4.: Pu Z has permission for gas installation . °�. �'z s Y".•. D in the buildings of . . .V1.Y.-n. . .� `n ! . . . . . . . . . . . . . . . . . . . . . . . . at . . . . : �VL.. ? ?�. . �. . . . . . . , North And ver, Mass. Fee.S�•oa. . Lic. No. 6.�.+. . . . . . . . GAS INSPECTOR Check# �- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Cit /Town:_-- -!-- ----o--- ----- MA Date:_ Permit# 1/5 9_!---- ------ Building Location: T-__ D_>l� _ Owners Name:_ V1 14 —� ------—__- Type of Occupancy: / Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential e New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES IY w w Y fn z U) N L) m x J V ~ to M w W Lr) W z H Q z O Lu = O H fn Z Nw W Lu m 0� Q a Iw— w � o- X � > cn 0 z to C7 w U) 0 Q x V a w wl__ x Q W w w z cn x w f-• W a w w tY LLJ > V w z J I— 1— O z J U' LL. x w w w w z LU >- to -J Q Q m w O z O ~ HF- O w Q W w w Q > O O w z LuQ Q Q V O 0 W 0 c� x x J 0 a W I— > > O SUB BSMT. BASEMENT 1 FLOOR __2'FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 1H FLOOR 8 FLOOR t q - -��e fC� Check One Only Certificate# ` Installing Company Name: �_�1 ,Cir(QVeZ U/►�lkjrvt _ ❑Corporation Address:_ ' o' ____ City/Town k-CW) 'L�C-2 _ State:J�� ------ ----- _ Partnership —-------_ Business Tel:—on -ReS_iro __ Fax:— � ' Zi78" _ 3/ - --- [1Firm/Company ------------- Name of Licensed Plumber/Gas Fitter: aSC L• q/LQU eZ INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes Al ❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy V Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only -------------------------------- Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapte 142 of the General Laws. Type of License: By �` --=------- tuber c G s Fitter atur lumber/Gas Fitter Title _ aster CitylTown —_—_--_ Journeyman -_ APPROVED OFFICE USE ONLY �P Installer License Number: COMMONWEALTH OF MASSACHUSETTS IN My AIVU bH�ra I 1 CRJ LICENSED AS A MASTER PLUMBER I ISSUES THE ABOVE LICENSE TO: t I I JOSE L MARQUEZ 3 PO BOX 1 . LAWRENCE MA 01842-0001 r 13561 05/01/12 780633 LICENSE NO. EXPIRATION DATE SERIAL NO. I I COMMONWEALTH OF MASSACHUSETTS " <� —"I'1�1'F'L—l7`I`ilt°li L•l•(� H IV L7—��1�1'7��27c� LICENSED AS A JOURNEYMAN PLUMB R ISSUES THE ABOVE LICENSE TO: JOSE L MARQUEZ PO BOX 1 ~ a LAWRENCE MA 01842-0001 ,i 25611 05/01/12 780634 LICENSE NO. EXPIRATION DATE SERIAL NO. I� Location 3 3`/ /J A r2 w o d No. I1� 1 Date 3 ` t D NORT" TOWN OF NORTH ANDOVER Off"...° ,.,ti 3? . O� s^ Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�CHusa 9 Foundation Permit Fee $ Other Permit Fee $ ! TOTAL $ Check # 16219 `0A `6-n _ Building Irpector Town of North Andover �� tkORTH Building Department 27 Charles Street 0 • ,-' North Andover, Massachusetts 01845 R _ (978) 688-9545 Fax(978) 688-9542 � C6[NKN4wKN 1• APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS 3 Q-3 1 N. A2 W(0 o't � LOT NUMBER M- R IQ( .SUBDIVISION DATE REQUEST FILED 3 - I o). -a(P Q 3 DATE READY FOR INSPECTION W < <t C Q-L TEN(10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. -WATER METER DATE D.P.W. MUST INDICATET WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION RE ST DATE. SIGNATURE/DPW AUTHORIZATION s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location S Date Owners Name Permit# (,I- f mount T e of Occu anc A New 0 Renovation Replacement Plans Submitted Yes ❑ a No FIXTURES SLRFLqm BdiS>ErEW Date NORTH o TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING one: Certificate �SSAI— Corp. This certifies that . . "' . . . G? . . . . . , artner. 00, has permission to perform . .. !f—� i�-� !.o �. . -� �.-. . . Firm/Co. plumbing in the buildings of . . . . ./1�f—�.-�-Y::�—�-�. . . . . . . . . . . . . . . . . at. 3 • .r- 4 • . . . . . . . . . . . ra' . . . . .. North Andover, Mass. Fee �. . . . .Lic. No.. . . . . . . . _. . . . . '. and 30 PLS B NG INSPECTOR Check # 41V 093 does not have any one of the above 5164 lication 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 Massachus State P bing a and Chapter 142 of the General Laws. fBEy: o icense maer itle 'Type of Plumbing License ity/Town icense um er Master �i Journeyman F APPROVED comics usB ONLYL..J 364, 6; TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....z.. ............ ................................. has permission to perform .................................... wiring in the building of.... ................................................. .... ........... North Andover,Mass. —7�. ....Z�................. ... ............ ........ F e e% 5............. Lic.No. ............. .... . .. .............. ELECTRICAL INSPECTOR Check # 27W CYIMVIONWF4LTHOFAL4MatII.S'EM Office Use only DFPARTAMTOFPUBLIM ++7Y Permit No. &,/, �/� BOARD OFFFREPREVKW0NREGUL H0ASV7aM1ZO Occupancy&Fees Checked APPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12,00 FEASE PRINT IN INK OR TYPE ALL INFORMATION) Date M eC44 12, 0 2— Town Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to p11 elIrform the electrical work described below. Location(Street&Number) 3!q 4A,14D V Q p t> �-r Owner or Tenant Je.,nM&i Owner's Address CQA(A E Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service1 v4 Amps ZV/Z4 Volts Overhead U Q -- nderground No.of Meters New Service Amps_ Volts Overhead Underground 1:3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -Lk)1Ql1J4 TD 71J.0 pro yrl- fr64e-J a eA. No.of Lighting Outlets No.of Hot Tubs No.of Tm nsfortners Total No.of Lighting Fixtures Swimming Pod Above Below Generators KVA K VA ground around No.of Receptacle Outlets .y, No.of Oil Burners Na of Emergency Lighting Battery Units No.of Switch Outlets I No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Taal Total No.of Detection and * PUMPS Tofis KW Inifiating ces No.of Dishwashers Space Area Heating KW Na ofSounding Devices r No.of Self Contained Detection/Sounding Devices Mo.of Dryers Heating Devices KW Local Municipal Other No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER (r�rYtoeCo►eag�PI>buartblhetequierrta*stflvla�dsse�Galaallaws [I eatanatliab�tylrts�rarel�CyiY3udrigCanplaie Co►tt�Qitssiostaiia}dgitialest YES NO Iha�estixnilled�didpoofdsarebtlle011ic�YFsr' ( f Ifyrtlta+ec#aeeltallylS,pieasea�s�etbetype� by �lhe 4, box ' I4"'IIRANC E3 BOIL O: OTHM Q .. . 1 Valueol*ckW Whk S NoitebStart IrtspeaivnD�eRe4testadt&h Fil®t_ NWNAMElt1�� ► i t�v L;v L;oaseNa �3 S 9%- ioaisee_ /'! (4 i4'0 Signame Lioet>seNo —� 3 S g Z BasinessTd.Na � �/S- G� / �0 Oa,kME-A b o w LAI. G/�71pw l�1 AIL TeLNa f?d-Gam?- pS IWNERSIINELJRANCEWANER;IammvaaegmttheLiosisecic Abe$teamsanoeoova�eatitsst>i ecga�elttd�rec taedbYMassadssotsGalaaiLaws Id tlr�trmysignattsern this ptm�aQpllratia,waits this m4mm-at 'lease check one) Owner Agent Telephone No. PERMIT FEE S� cue (It.a:atm�.lnuurttl�` � 'a`s�r�ru� ` = DEPARTMENT OF PUBLIC SAFETY-'DIVISION OF FIRE PREVENTION' ^ 1010 COMMONWEALTH AvaNu[. BOSTON Y ' —o - i y or own ate ot issue) CERTIFICATE OF COMPLIANCE CHAPTER I48, SECTION 26F, M . G . L. This Certified that the property located at ,;L — Y- has been equipped with approved smoke detectors and was found to be in .compliance with Chapter 148 Section 26F, Massachuse s General Law. V Inspection/TestingcompLeted on Inspe ee Paid : Head of Fire Department (60) days a�%cT_- Cia t2 .O155U8. . (Seller' s Copy) 14 Location _ No. `7� Date „oRTly TOWN OF NORTH ANDOVER i Certificate of Occupancy $ ,sSACHUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U t Check # Ci Li 8 r 15357 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING i BUILDING PERNIlT NUMBER: ` DATE ISSUED: C � SIGNATURE: ' Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /k�Oy�� Map Number 6' �Nu 1.3 Zoning Information: 1.4 Property Dimensions: ZoninitDistrict Proposed Use I•Lot Area Frontage(A) 1.6 BUILDING SETBACKS tt . Front Yard . Side Yard Rear Yard R Provide Provided Provided 1.7 water Supply M.G.L.C.4o. 54) 1.5. Flood zone Infoin ation: l.8' Sewen go Disl—1 system; Public 0 Private D Zone Outside Flood Zane ❑ Mroicipal ❑ On Sito Disposal:System ❑ SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT 2.1 Owner of Record ff Name( rmt) Address for Service Signature U Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable. 0 Licensed Construction Supervisor: License Number Addregs Expiration Date Signature ' Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Si nature Telephone � 1 j 1 SECTION 4-WORKERS COMPENSATION(XG.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 emit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work checkau a ncabte New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: u-elf 14ECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by t a licant 1. Building �a A5 (a) Building Permit Fee .1 Multiplier 2 Electrical (b) Estimated Total Cost of IOOD d Construction 3 PlumbingBuilding Permit fee tl x(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 jj-� 0 Check Number SECTION 7a OWNER AUTHORIZATION to BE COMPLETED WHEN OWNERS AGENT OR CON CTOR APPLIES FOR BUMDING PERMIT I, (,AAA as Owner/Authorized Agent of subject property Hereby authorize r e to act on My be�h , ' all matters rel ive to work autho ' ed by this building permit application ` 1 Q Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Ok- /� 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 /-< -4 m 4 Print Name � � ` � � � � � o Signature of Owner/Agent Date NO. OF STORIES SIZE ! BASEMENT OR SLAB SIZE OF FLOOR TDABERS 1 sr 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 , NorrT Town of North Andover Building Department M A 27 Charles Street #, r North Andover, MA. 01845 ' D. Robert Nicetta 'ss��►ns`{' Building Commissio ner (978) 688-9545 .•. 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE © Z JOB LOCATION d / Number Street Address M /lot •'HOMEOWNER NSFne. Home Phone Work Phone PRESENT MAILING ADDRESS J City Town State p 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 HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intendsto reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory 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 No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL ACORD CERTIFICATE OF LIABILITY INSURANCE DATE TM� 03/07/2002 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NORTH ANDOVER INSURANCE AGENCY, INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 WAVERLY ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NORTH ANDOVER MA 01845-2415 INSURED INSURER A:NATIONAL GRANGE MUTUAL Hurley, James M. DBA Mr. Rooter of No. Andover INSURERB: 79 Brookfield Street INSURER C: INSURER D: Lawrence MA 01842— INSURER E: COVERAGES 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/Y DATE MM/DD/Y A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 500,000 CLAIMS MADE a OCCUR MPJ49809 08/30/2001 08/30/2002 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 A ALL OWNED AUTOS M9J49809 07/01/2001 07/01/2002 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS / / / / BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY / / / / EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ EMPLOYERS'COMPENSATION AND X TORY LIMITS ER E.L.EACH ACCIDENT $ 100,000 A W2J49809 08/30/2001 08/30/2002 E.L.DISEASE-EA EMPLOYEE$ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS F-978-688-9573 CERTIFICATE HOLDER ADDITIONAL INSURED'INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT TOWN OF NORTH ANDOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Main Street INSURER,ITS AGENTS OR REPRESENTATIVES. AU _ EP TA`IV North Andover MA 01845- ACORD 26S(7/97) ©ACORD CORPORATION 1988 INS025S(9910).01 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL 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 c11, S150A. The debris will be disposed of in: ` V avi W, (Location of Facility) Sign tur ermit Applicant -3 Date NOTE: Demolition permit from the Town of North Andover must be obtained this project through the Office of the Building Inspector for NORTH Town of " Andover No. y al o � LA ` O dover Mass. O 0 'p COC HICKE WICK AERATED BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT..... R.-YjQ /¢ BUILDING INSPECTOR.......... ........ . .. ..................................... ........................................ """"""""" Foundation ` has permission to erect...R LEGAL NOTICE Date At*&" 4- 470oZ. Article , Section of the Zoning Ordinance WHEREAS, violations ofArticle 1 , Section I/O 11 of the Building Code have been found on [Article , Section of the Code these premises, IT IS HEREBY ORDERED in accordance with the above Code that all persons cease, desist from, and STOP WORK at once pertaining to construction, alterations or repairs on these premises known as 3+ 14Aftt..Weao� St. — 2�� T-'AAVo2 All persons acting contrary to this order or removing or mutilating this notice are liable to arrest unless such action is authorized by the Department. BUILDING OFFICIAL w \+ c �l r i� 1.1�1�1.1mini