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HomeMy WebLinkAboutMiscellaneous - 36 LINDEN AVENUE 4/30/20181 i 0 o rn N N r Q zo o o o ^' z o o mz z P 0 9522 i r TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..%l► i�1R' ............. t. has permission to perform ... leem (/.✓.r..,.. 7-e .�G✓ ... . plumbing in the buildings of .J -4 -An .i!h�4./s71n ......... at .�. a . &1-744911/� ........ .....�ohover, Mass. ......... Fee . 0... Lic. No...` PLUMBING INSPECTOR Checkµ -p, 0,/, www. ruskin. com MASSACHUSETTS UNIFO/Rf�M. APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK E % PERMIT # CITY U 7 �+ MA.TAJ004OWNER'S JOBSITE ADDRESS L 1 N AeN NAME -le,?-Al Bert 4&l & P FAX OWNER ADDRESS L[kh0- NO - � JiOIEL TX' FAX TYPE 011'r OCCUPANCY TYPE: COMMERCIAL P EDUCATIONAL ❑ RESIDENTIAL* PRINT CLEARLY NEW: ❑ RENOVATION*kV REPLACEMENT: ❑ PLANS SUBMITTED: YES r-1NO El FIXTURES -1 FLOOR BSMT 1 2 3 4 5 6 7 8 .9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER' FOOD DISPOSER FLOOR / AREA DRAIN ` INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER rvl ov>e w -re e 3 D INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. YeskNo ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent 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 Chapter 142 of the Gener 1 Laws. PLUMBER NAME �OS-e- L ' /ul/AoZ—Q��� SIGNATURE LIC # j GP I MP ❑ JP Efr' CORPORATION ❑ # PARTNE 4&_ COMPANY ME A Al:( DDRESS: O CITY cAI (P,�C, STATE JVC� ZIP dl EMAIL ----_ TEL.q li' �s t S ' o"5 V CELL —' FAX w F O z o E -4 a z a Q w o- - a Z❑ z O y > El W ~ CIO Qn � W O LU O F a 4t: z LU 4 Q W w N d LU fx OW w Q C7 zo a a � U x CL F CL Q Y LUN H LL C O z z 0 F U W a O a • x • o x . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: UQcc rQ_a.0 A,(Ct, 01 Phone#: Are you an employer? Check the appropriat box: 1. ❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] 1 employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. E] Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation 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' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address ' a L i". ' 1 i� City/State/Zip: J� A1,t Ly -el L2 , 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. 1 do hereby certify under thepains dpenalties of perjury that the information provided above tru� andcorrect, Signature: /�L--�� Date• 2 I Z 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 Contact Person: Phone #: i 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 carry 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 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 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 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. # 617-727-4900 ext 406 or 1-$77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia o a w a cujm m c � J i W c a i U d • O • • • _Im coa m 0o to m o - p No ° ® c .� c, m Oc �p c Im O O r _c 2 v vi NM o a a b r c o` = O 3 w c v l� r O Fc W ir Or O c m L.t • T+ m w v Ob. _ ,-+ 0 � N�H C i \ a. 00. r 0 W�C = Q v alu r oA +0«� �mm Q0> ` V VE_c rA N w WCL c r a• t0 V 10 y a ui "49O F c0 O c C - O p W Y tri W m e O 7 IL tce La a _ m a m 3 w -a 2 TOWN OF NORTH ANDOVER Building Department 1600 Osgood Street Building 2- Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: �`� ' 9 TEL #: ADDRESS: COMPLAINT TYPE: Electrical: Plumbing: Gas: (2EE) Property Owner: Address: 3 (p L c " 06,4/ )/4 V,6 Other: �aSSt ��� �cc G.�r c l� 0,0 "T, , o, i3 D ISIy #qd / N 6- �9-rzi G - Signed: C o w s L• RxI44 /, E Ift)/� Complaint Form - Revised 6.2007 Office of the Building Department Community, Development and Services 0 . 1600 Osgood Street North Andover. Massachusetts 0154 Telephone (978) 688-9545 FAX (978) 688-9542 December 16, 2009 Jean Benjamin 36 Linden Ave North Andover Ma 01845 RE: 36 Linden Ave. Please be advised that on several occasions the Building Department has asked you to remove your deck that was illegally built without permits after a STOP WORK order was placed on your property. Failure to downsize the deck as requested to a stoop and steps only, was required by the building department on to comply with North Andover Zoning Bylaw Front Setback of 30 feet. Failure to remove the porch in 30 day Starting January 1St 2010 will result in a fine not to exceed $300 per day. Additionally it also appears you may have renovated the interior living space without obtaining the proper electrical and building permits as required by Massachusetts State Law. 780 CMR 5110.1 Permit Application. It shall be unlawful to construct, reconstruct alter, repair, remove or demolish any detached one two family dwelling; or to install or alter any equipment for which a provision is made or the installation of which is regulated by 780 CMR 51-99 without first filing a written application with the building official and obtaining the required building permit and all other required permits therefore. 10.13 Penalty for violation Whoever continues to violate the provisions of this bylaw after written notice from the building Inspector demanding the abatement of a zoning violation within a reasonable time, shall be subject to a fine of three hundred dollars ($300). Each day that such violations continue shall be considered a separate offence. You have multiple violations observed. Sincerely, Gerald Brown Inspector of Buildings 7368 Date .. Yl :!,l./. � ...... . ? MORTM Of �..ao 3r ° a° TOWN OF NORTH ANDOVER O D PERMIT FOR GAS INSTALLATION ` SACHUSESS� This certifies that .. D. -t ./I ... P ....................... has permission for gas installation .. g • 13 ..................... in the, buildings of ... -'.X* ....................... at .... �... ti.� .e. �:...? �, c ....... , orth Andover, Mass. Fee. Lic. No. 4e . ...... GS INSPECTOR Check # ,l��� A MASSACHUSEM UNDDR- IAPPUCATONFORPERTNUTO DO GAS F rING (Type or print) Date NORTH A.NDOVER, )MASSACHUSETTS Building Locations New �] J A� /i✓ /7 �/1"� Permit # Amount $ Owner's Na/mey J �4�/6-f y x Renovation Li Replacement LT Plans Submitted n �5 (Print or type) (� —� �� Check one: Certificate Installing Company Name Corp. Address O��� _ � � Partner.. Business Te ephone[j--Firm/Co.- Name Firm/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability .Insurance policy or it's substantial equivalent. Yes No If you have checked yes, please in ate the type coverage by checking the appropriate. box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1.1.2 of the :Mass. General Laws; and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 ----,--.-.., .......... LL -"v"1 I,AVG JUuum ,�LXu kor-eereaJ in above application are true and accurate to the - heat of nn knowledge and that all plumbinv work and installations pctii under:r Pt 'ucd for this application will be in compliance with all pertinent provisions of the Massachusetts State ,as C de and�C 4'2 of the General Laws. By: Title Cityv'T6wn =APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitt � - 0 Plumber �T 6�/ 0 Gas Fitter Ptcense A umber 0 Master 0 Journeyman v� fri n `c4 O T+ U z Cn F �x 0 F cn H O Q ] r� y a >P G C4 � ° o CA SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T II. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR L. •a 8TH. FLOOR Ef (Print or type) (� —� �� Check one: Certificate Installing Company Name Corp. Address O��� _ � � Partner.. Business Te ephone[j--Firm/Co.- Name Firm/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability .Insurance policy or it's substantial equivalent. Yes No If you have checked yes, please in ate the type coverage by checking the appropriate. box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1.1.2 of the :Mass. General Laws; and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 ----,--.-.., .......... LL -"v"1 I,AVG JUuum ,�LXu kor-eereaJ in above application are true and accurate to the - heat of nn knowledge and that all plumbinv work and installations pctii under:r Pt 'ucd for this application will be in compliance with all pertinent provisions of the Massachusetts State ,as C de and�C 4'2 of the General Laws. By: Title Cityv'T6wn =APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitt � - 0 Plumber �T 6�/ 0 Gas Fitter Ptcense A umber 0 Master 0 Journeyman Location �,44 � No. v Date N° o TOWN OF NORTH ANDOVER Certificate of Occupancy $ 0 Building/Frame Permit Fee $ S SACMUS Foundation Permit Fee $ ttqp Other Permit Fee $ ` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector $ 9519 Div. Public Works PER10r NO. e 0 l r APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT O. CATION J1.0CATION l 1`id p4Ave I p A Nd p ii er PURPOSE OF BUILDING )4-7, b o� ✓� 1t�ar5 S, fzQ,Aturbs l*NER'S NAME P,kLOS- f C , Se. VHlCl1IR, j6!l NO. OF STORIES SIZE WNER'S ADDRESS 3% h j de 14 Ave: hipIIA AigACjveR BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD ,9LDER'S NAME kN a Sl- C` e `1�,,.y IOR _TR � C!7 `�V ,6yF SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OA AUTHORI D AGENT F E E PERMIT GRANTED 19 11 3 PROPERTY INFORMATION LAND COST EST. Bim. COST©®, EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TELJ CONTR. TEL. # CONTR. LIC. Al H.I.C. 1l BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY.-. MULTI. FAMILY "�FFESS APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR 3 PINE HARDW D— PLASTER DRY WALL UNFIN. FINISH 1 2 13 CONCRETE CONCRETE BL K. BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL FIN. B M AREA _ V. '/I 1/1 FIN. ATTIC AREA N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH HARDW'D COMfAC;N ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I- I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT 11 SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS B'M'T 2nd _ ELECTRIC NO HEATING 10 13rd THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. 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NELSON. DIRECTOR In accordance with the provisicn_s of c .1C. S 5.1, a condition of Building Permit Number is that the dctris resulting from this work shall be disposed of in a peepedv !'c rsc: se lid waste M^osai ,aciiir: as c:c*--ncd 150". by ,tiiGL c III, S J The debris will be disposed of in: /� )- t GgeeH kouse r WGoaeN MNTeg,Al, ANd. #4ss y y1ViNsr 8 iTHyAo 13 v -ea t #3 000'A RJ.,Mefhavli,Ma, mal` dtRe�N�louse� wo deffNlk�'Pt2i�1. �r�d glass, 9iv�nr %r� PALA, MARAA-KI /13 Sa+Nd Arlo, t?d GCDT0N3 MAL ;�. tiOR GI aCalt'e� J LL % R R��tY�tci4se 444 POOH �ACCV,49V_asci. P7 MaKs ro1j ;a. , ),A,W eOCE Alb, U Sicnature of P.mit Appli n "t . Date :TOTE: Demolition permit from the Towa of :forth Andover trust be obtained for this project through the Office of the Building Inspector. Ih