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Miscellaneous - 34 SUTTON PLACE 4/30/2018
� ? q Date.... ja.f.. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ' �sACMUSt� �� ��R�r✓ ��r/ This certifies that n� n ... has permission to perform T�,e�--::�:.9 wiring in the building of ...... 4.. . .............................................. 3 f .. , North Andover, Mass. Fee ...... ��`� Na�� avrr� /j ............... Lic. No.............. ................tJ.. ....�?.i!� ..... ELECTRICAL INSPECTOR Check #J``�S�' 8663 s 1P • Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. f�Lc3 Occupancy and Fee Checked lev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: . 3 - Z,6j - p City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)�- Owner or Tenant (`J i; 5 h a kl.. U v7� Telephone No %"16j ,6 Owner's Address Is this permit in conjunction with a building permit? Yes ` ❑ (Check Appropriate Box) Purpose of Building n�, j r; , No Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: r. t No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires -- No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. of Water ICS' Heaters No. Hydromassage Bathtubs o. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Abd e ❑ No. of OR Burners No. of Gas Burners No. of Air Cond. Tc Totals Space/Area Heating KW Heating Appliances KW No. of No. of Sims Ballasts vin table may be waived b the Ins No, of Total Transformers KVA Generators KVA o. U1 Emergency Lighting Battery Units FIRE ALARMS_[No. of Tones No. of Detection and Initiating Devices No. of Alerting Devices Wires. Local ❑ ivnumclpal �i CnnnPetinin F-1 Other p ivo. of Devices or E uivalent Data Wiring: No. of Devices or Equivalent No. of Motors Total HP co ITelemmunicati No. of Devices Attach additional detail if desired, or as required by the Estimated Value of Electrical Work: (When required by municipal policy.) Inspector of Wires. Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE 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 issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties o Pf perjury, that the information on this application is true and complete. FIRM NAME:.. 1 f' 11 ," �% / v^ . LIC. NO.: Licensee: 1. Signature1q, - (Ifapplicable enter "exempt' in a license numbe line.) 1� �/�,tll 'l• !��—LIC. NO.: Address: t%L Bus. Tel. No.: ST G L t Alt. Tel. No.: 'Per M.G.L c. 147, s. 57-6 1, security work requires Department of Public Safety "S" License: Lic. 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) [Vowner -- El agent Owner/Age Signature/ / 1,�.t�l Telephone No i7 7E (�j J S ; PERMIT FEE. $ .V A Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Tfrashington Street Boston, MA 02111 r i www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers At Piicant Information Please Print Legibly Narrie (Business/Organization/Individuai): Address: City/State/Zip: Phone #: . Are you an employer? Check.the appropriate box: 1-13I aro a employer with 4• ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* 2. E3I am a.sole proprietor or partner. have hired the sub -contractors listed on the attached sheet. _ 6• ❑ New construction 7• ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demoiition working for me .in any capacity• [No workers' comp. insurance workers' comp. insurance. 5. ElWe are a corporation and its q• ❑ Building addition required.] 3. ❑ I am a homeowner doing officers have exercised their 10. ❑ Electrical repairs rap •rs or additions all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself, [No•workers' comp, insurance c. 1.52, § 1(4), and we have no 12. Roof ❑ repairs required.] t q ]. employees. [No workers' I3•0 Other comp. insurance required.] rr - • ••••• �. �o x fa mus[ arso nu out the section below showing their workers' oompensatior policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors; and their workers' camp• policy intnrinadon. 1 ant an employer that is. protriding:workers' compensation insurance for HV employees: Below it the policy and job site information. Insurance Company Name: Policy # or Self -ins, Lic. #: Expiration Date: Job Site Address: City/Stite/Zip• 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 fine 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 4, �� Contact Person: Phone #• Information and Instructions 'fir .a Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner -of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance 'coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the comm-onwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested, notthe Department of Industrial Accidents. Should you have any questions regarding the law or if ydu are required to obtain a workers' compensation policy, please call the Department at the nu rnber. listed below. Self-insured companies should ent- their self-insurance- license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating -current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of'the affidavit that has been officially siatnped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance far your cooperation and should you have any questions, please do not hesitate to give as a call. The Department's address, telephone and. fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7744 Revised 5-26-115 www.mass.gov/dia ' A. March 25, 2009 Sand Castle Construction L. Lassard P.:O. Box 1.946 .. Seabrook, NH 03874 Re: 34 Sutton Place North Andover, Ma Mr. Lassard, ,This letter is to inform you that your contractual commitment to perform electrical work at 34 Sutton Place has dome to an end. As of March 24, 2009, I will complete the remaining electrical work. I will hang the ceiling light fixtures and add the electrical outlets as required to complete inspection. Tank, you Joseph Terranova 3 Sutton Place North Andover, MA 978 69T=5002 �a35 /0—�� Date.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHU This certifies that ............... Z, ....................................... hSpcripission to perform ........... 4 ...... .............. .............................................. , wiring in the building of ... ..................................... & ...... at ...... J` ............................... North Andover, Mass. Fee. Lic. No.. .7.1 . .. .............. ili.......... c-riicAL INSPE Check # Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. a 97) Occupancy and Fee Checked Lev. 1/07] newoP ►.is„v� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: // 41 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) \3',l 1^�ZgYI �r � G, e— Owner or Tenant / {s lv'�•�r �"j�/,� / „_ r „ Owner's Address Is this permit inconjunction with a building permit? Yes Purpose of Building ry No Ll (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑/ New Service Amps / Volts Overhead Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No, of Meters a2 �u.«.,..uelat[ y aestrea, or as required by the Inspector of Wires. 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. INSURANCE 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 issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the p ' ns and penalties of erjury, that the i rmation on this application is tr nd complete. FIRM NAME (� el _ J. LIC. NO.: --_ Licensee:Signature L C. O.: !� (If applicable,'em " empt "int license.. umber 1' e.) Address: y _ > B e `No.: ^ ` Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License:Lic. No. , OWNER'S INSURANCE WAIVER: I am aware that the Licensee dos 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: $ a MA 4 M .e'j The Commonwealth of Massachusetts >^Y 1 �l Department of Industrial Accidents i•. Office of Investigations 600 Wash inion, Street r - Boston, MA 02111 I :- WM W.l72ass.g ovldia Workers' Compensation Insurance .Affidavit - Are you an employer? Check the appropriate box: l .❑ I an a employer with 4. ❑ I am a general contractor and I (employees (full and/or part-time).* 2.,Q'I have hired the sub -contractors am a sole proprietor or partner- 'ship listed on, the attached sheet. $ and have no employees These sub -contractors have working for me in any capacity.workers' [No workers' comp. insurance comp. insurance. 5. ❑ We are a corporation and its required.] 3.❑ I am a homeowner doing all work officers have exercised.their right of exemption MGL myself. [No workers' comp. per c. 152, § 1(4) and we have no insurance required.] t employees. [No workers' comp. insurance required_] *Anv A—li—t t6.,rl.-1. ti...., 4f, Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . S. ❑ Demolition 9. ❑ Building addition 10:0 Electrical repairs or additions 11.7 Plumbing repairs or additions 12.❑ Roof repairs 1.3.0 Other t -- -- ___ •••• � •• � ,` snowing their workers' compensation policy information. riomeowners whe submit.titis affidavit indicating liiei are ciuing eel .=.t:r:; Nett hire outside contractors must submit a nnw sinuavii indicating such. tContnictors that check this box must attached an additional sheet showing the name. of the sub -contractor and their workers' comp, Policy inforntation I am ann employer that is providing workers' compensation insurance for ng) employees. information Below is the policy and job site Insurance Company Name: Policy # or Self -.ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: 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 fine 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 co_v_erage.verification. 1 do by -certify u Web p nd penalties ofPC1lurJ'az the Phone #: provided above is true and correct Of use only. Do�iot write in this area, to be completed by city or town officiaL Cite or Town: (( Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information o.nd Instructions • Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an enTloyee is defined. as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and inciudin.g the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall.not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state o r Vocal licensing agency shall withhold the issuance or renewal of a license or permitao operate a business or to construct buildings in the commonwealth for any' applicant who has not produced aceeptatbie evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an,. LLC or LLP does have - employees, a policy is required. Be advised that this affici:avit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the lava or if you are required to obtain a workers' compensation policy, please call the Department at the narribenlisted below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitAicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burnleaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8:77-MASSAFE Revised 5-26=05 Fax # 617-727-7749 vvu w-mass.gov/dia March 25, 2009 Sand Castle Construction L. Lassard P.O. Box 1946 Seabrook, .NH 03874 Re: 34 Sutton Place. North Andover, Ma Mr. Lassard, n' 03D79 -/V0 This letter is to inform you that your contractual commitment to, perform electrical work at 34 Sutton Place has come to an end: As of March 24, 2009, I will complete the remaining electrical work. I will hang the ceiling light fixtures and add' the electrical outlets as required to complete inspection. Th you r Fioseph Terranova 34 Sutton Place North Andover, MA 978 691=5002 Location 7 �G Ij P, No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 8 Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Ii Building Inspector CU Div. Public Works W O 0 u 4 0 N F Z W Y W m 0 > O z W a C LL 0 ►- i Z y 0 0 < 0 a Cz N W u J J 0W < z a Z p a J > O m J J � m J < N 3 m � z w OIa 0 a 0 u ` Y f 0 a N .J UA IINm � H J 3 Z o V O j V 2 z Q- Q W N ` N N L AA LL rZ 0 O ! aC W > W Z 3 FI- l9 ` @ m O c Z 0 W 0 '� Z_ o '1 Ir W m i F �0 N � 4000 0 to W y 0 J Z W 1111 N a N O W U. 0 I O N W 0 d O z < m W N to m 3 9 0 0 W W Wt7 W W 0 L ti d IL V) A. V i s a m_ 0 Z Om v u u a Z r V IIL L to L W W` a F 0 0 0 O j o 3 o 0 3 L W m m u W W � F < O r W Z O Q < Z N 0 < to to F W. ~ p Q Z N u W z O W z O < ' W W Wm a w i, W W O 0 u 4 0 N F Z W Y W m 0 > O z W a C LL 0 ►- i Z y 0 0 < 0 a Cz N W u J J 0W < z a Z p a J > O m J J � m J < N 3 m z 0 0 u � f H a N .J UA L f � H J 3 Z o V O j V 2 M � ` N N L rZ 0 O ! FI- f N N � Z F 1[ d g 1111 p 0 0 m J 3 9 0 W W W Wt7 W W 0 L ti d V) A. LL t i s a m_ 0 Om u u u L W W` a F 0 0 0 L o 3 o 0 3 y m m m u J z z C z J ;O 00 < et J W W W Wm a 0 O O D W O 0 u 4 0 N F Z W Y W m 0 > O z W a C LL 0 ►- i Z y 0 0 < 0 a Cz N W u J J 0W < z a Z p a J > O m J J � m J < N 3 m r vi I z < W N 0 i u � f a a N .J UA L f � H J 3 Z o V O j V 2 M � ` N N L t 0 O ! FI- N N � F F f 1111 p 0 0 I J 0 ^ N f m Wt7 W W 0 L V) A. LL t r vi I z < W N a a a .J UA � H J 3 o o V O V V 2 V m m 00 01 0 A 0 m D z T N N H y 1 o T N o n O NO = O N IT�I TT z m OO CA DxfnTo 0 n N DQ A Oy D 0 m A D^m m m Z 0 O N y ^ i Z ~ A x -� x O A y~ o ~ A f 0m DZ �zo cm K 0 p w (AA `^ G D D o n xl0 D m 0 0 � c Z 0 ccpomomopa A r m W A�ZZ N D m n n n m x O T T o D v n n n A 00 0 y C t o A 3: c 0 0000 Z Z O 0 2 0 0 i L A O� A m m w Z D j n;ZZz� oZZ0 3 0m O �n�3 3 Gov 00 D o -- OmmODN z� n s ; Z�c > <{ Z A Z; O r m y < m z N z Z 0 1 0 ji 0 11_L1 I N D Dnx n 3T_TT c0T2'ai .� 0v -. 00pp0 l0 0-z z T<DDZ TO T; Z om Am C D Z ~ Z 0 Z Y D A O Z 0 D D N H N x ^ ^ + N '" z � A n m S I l f N Z D D Iei l Ia z m 00 3 r Y ki 0\ cd �¢ O A cz Q C Q o ti E ' cn o C7 2 ► ] a C � w° c�° y U � w a O H w O w a°' w � O w U W w cG° e .5 cn � C: x 0 U ¢ ° p2 c w w w A �i W m' z cn v Q ° 0 cn 0 uj z m c CD c v 4 c ` CO2 cc r�+ C ©� O ac aR R CD C . L C �+ c y ' G � y Ea L CD C m cm t c5 CDa y C .� L 0 G V r E T• aCD rt/ L C. �mm O ?—, y H m 3 = C1� � y r' y y C ca ER o V: m O y m m v :tt o a CD c r c, y o C., o c oCD c a _ `m `m c N :a ►- oo -- m y .r cc M�m .�— r. C N CL= LL. LD Cc R C Z cc E EcDy o v m c-0= c �_ CD = R � � H •O ►— z aLm 6 O co O co L O O v Z co 0. O W C C I co C cm CA co ECD 0 CD m m co O co 0 0 O Oco Q �Q O Cc V Gp C Zts O V y C O C_ O C4 0 W i� U} O O � U v J w 0 C/) � Z 6 O co O co L O O v Z co 0. O W C C I co C cm CA co ECD 0 CD m m co O co 0 0 O Oco Q �Q O Cc V Gp C Zts O V y C O C_ O C4 0 77- tiont: U)&r'40C-N0NC0lJRT STEENSEKE & SON'S, INC. Fac (603)196,2601 VdIce: (603)196-2974 to: Sarbana Clague at: Steenbeke't - Salem Page 3 of 6 Wednesday. July 10, 1996 4:38:26-9M Job I Truss Truss Type Qty 960710D I A I FINK Anjoorian Construction Stee_rilbeke&Sons, Inc. 3.300 s May 261995 MITek Industries, Inc. Wed Jul 10 16:33:05 1996 Pagel 14 17-8 2 A-0 , -------------- 1-6-0 4Y.4 3. 5.00112 2A 2 _1_1 3x8 M zx) 3X4 S�iC 7599 -- ---- ---- — + ..24-0.-0 . .. ...... ?_2.10 3x8 = ------ - - - - -- Plate Offsets (X,Y): [1:0.0-0:0-0-61, [5-6-b 3: b-.O-dj LOADING (psf) SPACING20 SSI -(In)(loo} I/defl PLATES GRIP TOLL 45.0 016tes lncre6te7A 45 (L, L) 0. 0.61 20 817 999 M20(20ga) 169/124 TCDL 10.0 Lumber Increases M 1.15 BC 0,44 zVeft(TQ, _ 0.29. 8/7 960 YES VV pi6 BCLL 0.0 Rep Stress Incr 0;58 1 i 1r%(TL) 0;08 5 n1a Matfix), -I�mi� BCDL 10.0 Code I hjth ILL deft = 300 Weight. 87 (lbs) .......... . ------- . ...... LUMBERA N 8 ACI G:. TOP CHORD 2 X 4 SPF 2100F 1.8E C! 'ORD 0ORD Sheathed or 2-11-13 on center purlin spacing. CHORD 849:6 BOT -3-0.5-6.6-3-0, 1-10:6-3-0. 9-10:6-3.0, BOT CHORD 2X4,SPF2l00r,1,8E. WEBS 2 X 4 SPF -S Stud il )t4:6-3-0, &7:6-24-0. 1W REACTIONS (Ibs/size) 1=1709/0-548,=170910 $ Max Horzz 1 =-25(load -d6ie` 2) Max Uplift 1==248(laad day 4} 5M;248(load case 4) FORCES 2W_� ' TOP CHORD 1-41=-3060, 2-3=!Oj BOT CHORD �6=2829, 6-7=1838, 1 , '64 A-5 3060 5=6=2829,8 1838, 838, 9.10 1888, 1 10=2829 WEBS 2-10=-699, 3-1 0='960' 81-6tt' 6.07 4-6 -699.. NOTES 1) This truss has been designed for thewlnblbadi generated by 100 m,p;h.'winds at 25.0 feet above ground level, using 10.0 p.s.f. top chord dead load and 10.0p.s;fbottom`.C'hofd dead load,�50,0 Miles trom hurricane oceanline, on a category I enclosed building, of dimensions 45.0 by 24.0 with expoture'.0 (ASCD 7-93):' Lumber Increase 1.33, Plate Increase = 1.33. Both end verticals are exposed. LOAD CASE(S) 1) Lumber Increase=l.l 5, Plate Inerease 1.15 Uniform Loads (Ibs per ft) Vert: 1 -2=-1 10.0, 2-3=-110,0, 4-5=-110.0, 5-6=-20,0, 6-7-20,0,7-8=-60.0, 8-9-20.0, 9-10=-20.0, 1-10=-20.0 Concentrated Loads (lbs) Vert: 1 =-I 46.7, 5=-146.7 JUL 17 199s it D`A't;F DENONCOURT STEENSEKE & SON'S. INC. FaX: f603) T-662601 Voice: (603)i'r96 2574 TO: Barbera Clegue at; Steenbeke's . Salem Page 4 of 5 Wednesday, July 10. 1996 4:39:21 PP' Job Truss Truss Type j dtY • 'PIY IB SCISSOR,TRU Anjoorian Construction I960710D ! L_.. _..__ -._._ .._ _-- Steenbeke &Sons, Inc.'3.3001f, May 26.1995 MITek Industries, Inc. Wed Jul 10 16:33:28 1996 Page 1 _4.7-15 1> 5 OD 12 r3k4 > 3x4 zt 2x4 `r y_ �_� -. `` 2X4 , �.�„"'' -~"i,..-•�'.-'"`- tt 7x'15riV17 $ = ^' r._.,�"'�_w ��;$;1-�---� _ d r--- zd 1 1 > } 3A2='3.00-1 3x12 = r-r i Plate Offsets (X,Y): LOADING {psf) SPACING'0 0 G�51 IOrRL; (in) (lot) Udefl 1 PLATES - - GRIP TELL 45.0 - Plates Incfeasr: 15 i TC 0 83 Vtit(LL) 0.69 9 410 I M20(20ga) 1691124 TCOL 10.0 Lumber lndrease t 15 ` Y BC . 0,75 Vert(TL) 0.99 9 284 M16(16ga) 122/90 BCLL 0.0 Rep Stress Incr FsYES, WB4 0 52°' H�rz(fL} 068 7 n/a BCDL 90.0 Code Ti'i} MSt1'Length 1 LL defl = 300 Weight: 90 (lbs) LUMBER - 3r BitACINO TOP CHORD 2 X 4 SPF 210bi 1:8E i _ > ` "= TOS' CHORD Sheathed or 1 11 15 on center pur►in spacing. BOT CHORD 2 X 4 SPF;2100 CSE BOT GHORn 1.10:6-3-0; 9-10:6-3-0, 8-9:6-3-0, 7-8:6-3-0. WEBS . 2 X 4 SPF -S Stud "BXVBt`' 8aV' W2 2.. X 4 SPF 2400F r REACTIONS (lbs/size) 1 167710 5 $ 7 167710 5 $ " Max Horz 1 26(Ioad case 3) �' Max Uplift 1--248(load case4); 7=•248(load case 4} FORCES l - 4 7. 2 3=-6067 3 4= 46' 3° 4 5=-4553, 5 6=-6067-,' 0=-6487 TOP CHORDA -2= 6 3 , BOT CHORD 7-8=6079, 84-i5451- 9 ' O: 545, 10-60i9 WEBS 2-10==305, 3-10--458 3 is 1104, 4 4=3086 a 9, ,-1104, 5.8=458, 6-8=-305 x NOTES - 1) This truss has been designed,for+he wind-Idads generated by 100.0 in p.h. `winds at 25.0 feet above ground level, using 10.E p s f. 6p chord dead load andf10.0 p.s:f bottom chord dead load, 50.0 miles from' hurricane dS banilne, on.a category enclosed -building; Of dimensions 45.0 by 24.0 with exposure C (ASCE 7=93} Lumber Increase 1 33; Plate thcrease = 1.33: Both end / verticals are exposed. r`` ' 1i. W. LOAD CASES) Standard :r - i t� N N .;UL 17 1996 _ xi. 2a Y z'mm: DAVE DrEMONCOURT STEEN9EKE $ 50N'$. INC.F4k. {G0v86 6tf1 Veice; sol) 795-m4 To: gdrbara Clegtfe at: Steenbeke's Salem Pepe 6 of 6 Wednesday, July 10, 1996 4A0:16 PV f JobTruss Truss Type Qty Ply i W ' 4 z 960710D C SCISSORTRUSS 11 1 I Anloorian Construction Steembeke &Sons, Inc. 3 300 s May 2 99 MiTek Industries; Inc. Wed Jul 10 16:34.37 1996 Pagel. -d_Q 5.5�t5 ��60� �u-rl 20-ao 11 -4-0 1-d_0 5-F-115 9 4-6-1—^ 5-5-15 d -U 45 = , '3 ; ' S 00 [12F 2x4 ", 2x4 z I'2 a ..,�` 4 '�TJ Y� .-/ ._. _• 8x12.51A�f16 ~1 ' 87 0 bI ✓'-' Ib i 3 0b4125 3r.12 := 30 2 } k -- ----- __ ... 10.0-0 +"F Plate Offsets (X Y) (1 0 0 11,01 �� (3 0 a�o,0 43 { 0 01;0 1 3) (6%0-0-0 0-2-121 LOADING (psj SPACING 20.0 CSI 1' DEI=L . (in) (loc) i/defl I PLATES GRIP TCLL 45.0 Plates Increast; 11'5 1 TC 0.70 Vert(LL) 0.52 6/5 455 M20(20ga) 169/124 TCDL 10.0 Lumber Increase 1 A5 .,'BC 0:'78 Vert(TL) 0.74 6/5 315 I Ml6(16ga) 122/90 BCLL 0.0 Rep Stress Inca Y1=S VVB 0:30 Horz(TL) 0,44 5 n/a BCDL 10.0 Code TPt l Min Length / LL defl = 300 I Weight: 68 (Ibs) LUMBER '4 , BRACING TOP CHORD 2 X 4 SPF 2100F 1,,8E k TOP CHORD. Sheathed or 2-4-11 on center purlin spacing. BOT CHORD 2 X 4 SPF 2100F 1.8E'r" SOT CHORD 1-6:6-3-0; 5-6:6-3-0. WEBS 2 X 4 SPF -S Stud hlrxcett' W2 2 X.4 SPF -S No 2�ff' REACTIONS (lbs/size) 1=1417!0-a-6 5-141 r"10-0 8 Max Horz ' .1=21(load. Max Uplift 1� 214(Itad ca''4), 5 214(load'caselj FORCES TOP CHORD 1 2=4$25, 2 3- 3715;;.3 437-1, {4 5= 4825' BOT CHORD M=4533; 1-6=4533 a WEBS 6"-969, 3.6=2356.4 6 99' tt NOTES h k 1) This truss has beers designed f6 tale wIIi"d 'era ed by 100 o t1�:p;h, winds at 25.0 feet above gibund level; using 10 0 p.:f top tlolu�t ea d load.;antl r 10.0 (i'i.f b6ttorn chord dead load, 50.0 miles 600 hurricane ocearlllne, ot":j'Gat g2iiy 1 ehdlosed bUJ1dIhg, of,dlmensions 45.0 by 24.0 with exposure C (ASCE 7 93�> Lutniaer li�erease =; 1 33;'PI'ate Increase =' 1.33. Both end verticals are exposed.. r=� LOAD CASE(S) Standard I- \ E i i JUL 1 7 199 e: rn o0 4 rn 12 =v r p '' C 14 ca ME v c _ NJ. r w o 10 n o - 20 { g y a :1031" r o z x :ik xo Cp i m a m o aamC> r^ C> CO O N a m t'_ S a n ry �p W i Ilk '_ cri FORM U - VERIFICATION FORM , INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: J. � T�r�� w 416)v4 Phone Sap. 6$11- Ary 41 Z LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) _% l Street 34( S4,'7 QfV VO(AC e- St. Number ************************Official Use Only************************ RECO NDATI OF TOWN AGENTS: 7nserva n Administrator Comments - t , M� - Mj��w _WmM_� Town Planner Comments _]CY-�,✓\ t q l� c= Food Inspector -Health �A�o' c � Septic Inspector -Health WCv Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved , 7// 21,� Date Rejected Date Approved q Date Rejected Date Approved Date Rejected Date Approved `� ► (� C, Date Rejected M I ,lr��(�111 Received by Building Inspector � __ `_ �- _ tl11' �- •' � Date JUL 1 7 1996 � H�- ------------ ---._...._5 - _Lr -a t -A 2 F LOT Ai 5 JUL 1996. --- ST-YS.e. t 34 EVIGARA-GEII FX/14 =___S LITTON PLAC� LA�l __7 Gl- G66-.bw 43- CeNTkAL SrkF-LT,:' GLIETT GxCl,"AlIN Vim ,1 Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) Map and Parcel: Purpose of Application (check below) Phon Nu b rof Ap licant: L.-IOrngle Family _ Two Family Mat 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. 'This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existe a as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits;, and the Development Schedule does not accommodate issuing a building permit in that Year, oi;e building permit will be issued per Year per- Develcpr,. nt u,.til zuch'Lime as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or n , is rounds for refusal by the Building Department to issue a Building Permit. Signature of O ner 6r Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. JUL 1 7 not: __"� �7�'P'i✓�.�.,":�"c.[:w+,.r-�-rte.-^"..�...+�.,r•_..:v--, v�+_....� ....,� .. ration 9 3 — � Date 0"', V/5;3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee(w/'q' $ ',g Connection Connection Fee $ O,�iroo� connection Fee $ �':_ TOTAL $� =� �jn 6375' IAII' )- Building Insouto Div. Public Works � )I FICIa U1:: 1\1.'I,I:AI.S lel ILDING C:()Ntii :I tVA'1'1()N IWAIAII 1'I.ANNIN( i r. .; . � . t� ��•� 1 � t11 NORTH ANDON"Elt111\•I: ill JN 1 11- 1'LA,NN1Nt'. 1)1;V1i1.011Al1:N"1' KA :I Nl I I.P. Ni I .tit )N• I )IM: )1 t ' CHIMNEY AI'f'LI('AI-ION ANO I'l1311l- t•:�nlll.a��b���•r: LI:I�;�:u I11ra•11•:1J1)1.1:; (lil illili!i•l i r!i ATE_ — _—��, pL1tM1'1'. # 93^ )CATION �,_3 y �SSc; 7`T� ✓l. piA C� LINER'S NAME: 1ILDER'S NAME: iSON' S NAME: %SON'S ADDRESS: ISON' S TELEPHONE: JERIAL OF CHIMNEY: i6zc- iFERIOR CHIMNEY: F`" °--� _ LXI ERI OR CHIMNEY:y IM BER AND SIZE OF FLUES: J7 `� /,0 IICKNESS OF HEARTH: ,:,Zt (jivDi1)>.ey an. (Ii/LepCace con(jo l i ,gu . Zom been nece-bed: .TE: - ��lq l9 14 GNATURE OF MASON: 'IT GRANTEDgy :*d-usi— .T NICETTA ANG INSPECTOR T $MPECTEU: r:IARKS: i�(emClt.f:3 ur .t.11e tulle cull! Ii((VC -uICC.3 colli FLL�aS f �peg SOLID BLOCK ItEQU1REA) 6 375' THIS PERMIT MUST GE UISPLAVLU 014 111E I'IZLlll <L_)' G Of}ice Use Only, �. 01 he If0n1MDnWe# of ffla�gathugetts Permit No. +i3epartmerrt ITf Vubt[L �ufetq Occupancy &Fee Checked _T- 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7JcP 3 —5� QM or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) t -5 Ste ` Owner or Tenant Owner's Address f Is this permit in conjunction >with a building permit: Yes No ❑ (Check Approorriiate Sox) Purpose of Building v5� Utility Authorization No. Existing Service � Amps�� Volts Overhead ❑ Undgrnd No. of Meters New Service Amps ____/ Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Pr used Electrigal Work may! o J� oyS P Total No. of Lighting Outlets No. of Hot Tubs I No. of Transformers KVA Above, In - No. of Lighting Fixtures Swimming Pool grnd. grnd. ❑ I Generators KVA No. at Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges I No. of Air Cond. ions Initiating Devices No. of Disposals No. of Dishwashers No. of Dryers Nu. of `Nater Heatars K%1V No. Hvdro Massage Tubs No.of Heat Total Total Pumos Tons KW Space/Area Hc�,tting KW Heating :Devices twV No. of No. of Signs_ Ballasts No. of Motors Total HP ` OTHER: a ' ?. No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal r^ Other Local Connection Low Voltage Wiring INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _ I have a cu' nt Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO I have submitted valid proof of same to the Office. YES = NO : If you have checked YES, please indicate the type of coverage by checking the appr tSriate box. INSUIRANCE _ BOND _ OTHER _ (Please Specify) (Expiration Date) Estias m ted Value of Electrical Work 5 Work to Start Inspection Date Requestea: Rough Final Signed under the f perjury: en�alyti,es FIRM NAME /' / /a°r� fry'/ o a i�Ld� LIC. NO. �u Licensee Signature LIC. NO. - j Bus. Tel. No. G Address %I Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit applicateon waives this requirement. Owner C Agent (Please check one) Teleohone No. PERMIT FEE (Signature of Owner or Agent) x•5565 1. Date ..... TO lAfi // TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... .. ..... ................................ has permission to perform ............. wiring in the building of .... rtke.R.4.Av�n .............................................. at ........ ................................ . North Andover, Mass. Fee... kw'd Lic. No. ............................................................... ELECTRICAL INSPECTOR • WHITE: Applicant CANARY: Building Dept. PINK: Treasurer W - 2656 Date .IQ. 40 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING $SACHUS This certifies that ...... ........................... has permission to perform. A. FT ..... Av�i ................. ... wiring in the building of .. .......... !;&�Q.2*- .q ................................................ ...................... North d Mass. Fee.Z-00 ........... Lic. NoV)161. M' ..... .7 ...... ............... F. LECTRICAL INSPECTOR l,-reasurer WHITE: Applicant Qn—ARY: Building Dept P,IN('T' GOLD: File BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J Date Received I o ?,- e Date Issuep 0 b SSS N IMPORTANT: Applicant must complete all items on this page LOCATION' tA�Yl' Print d PROPERTY OWNER1 >^ print MAP NO;_LO PARCEL: ZONING ' DISTRICT: -Historic Dastrict yes no r Machine Shop Villageyes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne famil Q Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands - Watershed district ater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Types r Print Clearly) OWNER: Name: 6.. Q_ {tea r-'�l riG�nOVd� Phone: '97F CQ�I � � ,;L- r Ilk Address: 0 Ll R&u- N . A—vud o e - - CONTRACTOR Name:_ =Phone: ,Address: Supervisor's Construction License; Exp, Date. Home _Improvement License: Exp: Date ARCHITECT/ENGINEER H (, C i P.Y1Zi bV44-4� Phone:9-79'gI 7��_ Address: �-Z e f uttbe r L4 e_ a at u Ci, iM+ Reg. No. FEE SCHEDULE: BOLDING PERMIIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ IS"O 0 0 FEE: $ (z2 Check No.: ����fl_-) Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund of AaenVOwner 7 11 ��� �s�e ot__contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer V Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS —7 CONSERVATION COMMENTS HEALTH 'xSOMMENTS Reviewed on Reviewed on . Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments ing Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Us ood Street FIRE DEPARTMENT Temp Dumpster on site,.. yes no Located at 124 Main Street Fire Department si+gnatureldate COMMENT Dimension Number of Stories: Total square feet' of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine f NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department. The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location 3 X) 7;, 094- z No. c�; Date /0 ' b NORTN TOWN OF NORTH ANDOVER •` oy F ` Certificate Occupancy $ r ��� of s'•^� • tt�• ACMIs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 15 6 2 _....� Building Inspector M N a pu $ w W v cn U ►a ° o w o pG v U G is. w A. ocz w u. AG o w w oco w v� ii a p o w G w z pG co cn v Q E cn aJ O F. z 0 U 2 OR 0) f O �+ O v s Z co CL O h D C �O pm c co._ y OCD O m m CD O.G O 0 O e_3 o a ca CCLCD � CL. O C C Z CD V CO)0 CL cc C c U3 0 LLI 0 wi LLI U) W W 19 ujW U) ' C O ' m C O C V O i C CO) O C 'r O v G. p, C Cc m C ;= O N " m CL N E c CD c N R O L 43�p CA cm m J Cc= N O N m �a N ii Sm N O ca 20 , o a o `ca O OO F- CD O' ~ ~ s+ 'd= O ~ N C W •E v -c ZS Of WE COD a CA o� o.o = �O = W y O. aJ O F. z 0 U 2 OR 0) f O �+ O v s Z co CL O h D C �O pm c co._ y OCD O m m CD O.G O 0 O e_3 o a ca CCLCD � CL. O C C Z CD V CO)0 CL cc C c U3 0 LLI 0 wi LLI U) W W 19 ujW U) The Commonwealth of Massachusetts l Department of Industrial Accidents Office of r `, ��� �• � _ Investigations �•'� ;` 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: , yO/,n p� /i - ( /Vi Phone Are you an employer? Check the appropriate t 1. ❑ I am a employer with 4. ❑ employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5• ❑ ''3required.) I am a homeowner doing all work llmyself. [No. workers' comp. insurance required.] t I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. We area corporation and its officers have exercised their right of exemption per MGL C. 1.52, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. E?1luilding addition 10:❑ Electrical repairs or additions 1 I .❑ Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑ Other t• ••v-rr••-•-^• •••�• •-••��•.� ��n n , ,,,,,,, asv uu oui me secnon oetow snowing their workers' compensation policy information. 1'IOnteOwnCCS who Subliilt this $%il'tfiVlt Iltdit;fitiftb tits}' arc d0iitg ail -work amj then hire outside corarac ors Must submit a new affidavit indicating such. $Contractors that check this boa must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. / am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. MY l Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address:_iJ St4.* -z (DCity/State/Zip: , t (?'Vr ( �� 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 fine 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct 1� n Lam- D Phone #: Gl 21 &9 1 '7-b D a — Official use only. Do not write in this area, to be completed by city or to wn official City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3 6. Other PermittLicense # City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or, building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit:to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of , insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitflicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Gerald A. Brown Inspector of Buildings Please pfiM DATE: �° a TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 i HOMEOWNER LICENSE EXEMPTION JOB LOCATION: jq Sw,�*2r rJ IQ-c--e— N HOMEOWNERc f&-; 1 ZeXi Name Street Address /� G "l � 0 Home Phone Telephone (978) 688-9545 Fax (978) 688-9542 T Map/Lot szo-l- q -�g -z'i 3-401 Work Phone PRESENT MAII,ING ADDRESS i%1YL I✓ 1Q t The current exemption for"homeowners" was extended to include owner -occupied dwellings to 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 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 to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not , be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, Hiles and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Honvowws Exemption 110ARD OF 1PPEAI S ('tR0541 CONSERVATION 688-9530 1IE_U.:I1i 688-9540 PLANNING 689-9535 f VA City Town State Zip Code The current exemption for"homeowners" was extended to include owner -occupied dwellings to 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 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 to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not , be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, Hiles and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Honvowws Exemption 110ARD OF 1PPEAI S ('tR0541 CONSERVATION 688-9530 1IE_U.:I1i 688-9540 PLANNING 689-9535 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. 'SCALE:1 "=40' DATE:10/01/2008 Scott L.'Giles R.P,L.S. Frank_ S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. THE ZONING DIST. IS R3. 25 50' ASSESSORS MAP 60 PARCEL 113 , - LOT #4 PLAN #5709 'N. E. R. D. 25,050 S. F. 21' l A EXIST ADD. EXIST. HSE. GARAGE FND. #34 __24' 125.00' SUTTON PLACE I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE ��a�tH OF v` THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE o S WITH THE ZONING DETERMINATION OF ZONING '' N . 93972 ,� f�tS?ER�� BYLAWS OF CONFORMITY OR NON -CONFORMITY ���'AL LAS NORTH ANDOVER WHEN CONSTRUCTED.. WHEN BUILT©? m8 + CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE) "=40' DATE. 1010112008 Scott L. Giles R. P. L. S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. THE ZONING DIST. IS R3. 125.50' ASSESSORS MAP 60 PARCEL 113 LOT#4 PLAN #5709 N. E. R. D. 25,050 S. F. +/- K N O N EXIST. ADD. EXIST. HSE. GARAGE FND. #34 _24' 1i Q - 125.00' SUTTON PLACE I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE N OF A r THE OFFSETS OF THE BUILDING INSPECTOR ONLY"�� SHOWN COMPLY AND SUCH USE IS FOR THE " S WITH THE ZONING DETERMINATION OF ZONING N . 13972 a� � BYLAWS OF CONFORMITY OR NON -CONFORMITY ECISTER�� ,®a�� ���� NORTH ANDOVER WHEN CONSTRUCTED. WHEN BUILT