HomeMy WebLinkAboutMiscellaneous - 360 FOREST STREET 4/30/2018 (2)Date. .l 1.:.J...(.�...... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
` s s
This certifies that
has permission for gas installation ... r.I................ .
in the buildings of ... !.......................................
at ........
i ..... , North Andover, Mass.
Fee......... Lic. No........... ..........................
GAS INSPECTOR
Check #
3k' :7
V
MASSACHUSETTS UNIFORM APPLICATION FOR PtHM► I ► U uU vnart I I Inu
(Print or Type)
MA Date // 20_L Receipt# /� Permit#
/e- 4 1>-v
= Building Location OwneesNamel ,e-, `G4 ;Oee Lt/
Map; Lot: Zone: Type of Occupancy
New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑
installing company Name EASTERN PROPANE & OIL, INC.
Address 131 WATER ST DANVERS MA 01923
Estimate Value of Work:
Checkone: Certificate
Corporation
❑ Partnership
Business Telephone 800-322-6628 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter `'-n�����
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes,O--- No ❑
If you have checked 4s, please indicate the type coverage by checking the appropriate box.
A 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Checkone:
Owner E3 Agent❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information I have submitted (or entered) in above 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 provisions of the Massachusetts State Gas Code and Chapter -1 42 of the Ge I Laws.
By Type of License:G�
Plumber Sig aturefdf Licensed Plumber or Gas Fitter
Title Gasfitter
Master License Number_
City /Town Journeyman
APPROVED (OFFICE USE ONLY)
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installing company Name EASTERN PROPANE & OIL, INC.
Address 131 WATER ST DANVERS MA 01923
Estimate Value of Work:
Checkone: Certificate
Corporation
❑ Partnership
Business Telephone 800-322-6628 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter `'-n�����
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes,O--- No ❑
If you have checked 4s, please indicate the type coverage by checking the appropriate box.
A 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Checkone:
Owner E3 Agent❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information I have submitted (or entered) in above 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 provisions of the Massachusetts State Gas Code and Chapter -1 42 of the Ge I Laws.
By Type of License:G�
Plumber Sig aturefdf Licensed Plumber or Gas Fitter
Title Gasfitter
Master License Number_
City /Town Journeyman
APPROVED (OFFICE USE ONLY)
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3 57 Date......./
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... `..%.... :.
has permission to perform ........ /..J�..f?:Z .....
wiring in the building of ......�F' h 0 ('0
........f....................................................................
at ......,���. J......�:`_:_..... , Orth Andover, Magi's.
Fee ... �.�v. ��(�. Lic. No. ....
Z
ELECTRICAONSPECTOR
Check # %�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
U
Commonwaallli o` Mae9acItWelb
2epar(n►enl of3ire Servicee
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Onl
Permit No.
Occupancy and Fee Checked
Rev. 11/99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wurk to he perfornic(i in accotdance with the Massachusetts Electrical Cade (,IEC), 527 CMR 12.00
(PLE.I.SE PRINT IN INK OR TYPE :l LL INFORM, 1770N) Date: q,_ ! q — 0/
City 01-1,011,11 of: /V.. -4 0 V 4-y-- To the Inspector of JVires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street R Number) '3 j,0 �oVZ10SA- S- .
Owner or Tenant
Telephone No.
Owner's Address g _
Is this permit in conjunction with a building; permit? Yes ❑ No � (Check Appropriate Box)
Purpose of Building;
Existing Service Amps / Volts
New Scrvicc Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of deters
No. of Meters
Completion of the 1611m •inc ruble prop be waived b►• the Inspector of (vires.
No. of Recessed Fixtures
No. or ceii: Susp. (Paddle) Fans
N No. o Total
Transformers KVA
No. of Lighting Outlets
No. of not Tubs
Generators KVA
No. of Lighting Fixtures
Above In-
Swimming Pool r►d. r►d.
o. o ► Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAILN•IS
No. of Zones
No. of Switches
No. of Gas Burners
Mo—, o Detection aad
Initiating Devices
No. of Ranges
No. of Air Cond. Tonal
No. of Alerting Devices
No. of Waste Disposers
[leaf Pump
Totals:
ung er
'Pons
..•_�
No. of Self-contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ IVlumncipal ❑ Other
Connection
No. of Dryers
Healing Appliances
g pp K�1
Security Systems:
No, of Devices or Equivalent
No. of Water KW
Heaters KW
t o. o t o. of
Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Batl►tubs
No. of Motors Total IIP
Telecom mu n i ca (ions Wiring: No. of Devices or Equivalent
rOTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVEILIGE: 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 EdK BOND ❑ 91'IiER ❑ (Specify:)
Estimated Value of Electrical Work: ISSOO 00 (When required by municipal policy.) (Expiration Date)
Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 ee•rtift•, under the pains aird witalties of pe'r'uip•, that the informatiorn on this application is trite ant! complete.
I IIL�[ NAME: ��` vh Sa s g` S�w�ei t cvC, LIC. NO.:
Licensee: �,l f,. -4 4 Signature ��, _ _ LIC. NO.: )5Z `t C? 3
(If applicable, enter "cc •rpt .. in the lice ►s nn mber me.)
f( �s �l Bus. Tel. No.:79y - 4r32' -0i -v r
Address: to Q -r uA
Alt. Tcl. No.:g7P 1-1-2 S?Gt'
OWNER'S INSURANCE WAIVER: I atn aware that Licensee docs 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 ❑ owners at;en t.
Owner/Agent '.
Signature 'Telephone No. Fffil-RMIT FEE: S A-dcl
�N° 2 U 9 8 Date ........................::: '...l.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .................................................................................
has permission to perform " ....
.............................................................
o ,t
wiring in the building of .r........... .�.
................................................................
at ?. .4.:� ,North Andover, Mass.
........ ........ .....,_.................................
Fee:,�?.. ". ...... Lic. No! ' ' ............ _........................................
.. ... ....
ELECTRICAL INSPECTOR
Check # `'�`�� � ���� `�' (/
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Sl\_ Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
FrD�.Official Use Only �1
,�
mit No.
pancy and Fee Checked
11/99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrica..
l Code MEC), S27 CMR 12.00
(PLEASE PRINT' IN INK OR TYPE ALL INFORMATION) Dat —' y - U
City or Town of: 0 . % 6, NQ.,r To the Inspector of Wires:
By this application the undersi;ned gives notice of his or her intention to perform the electrical work described below.
. _ _
Location (Street & Number)
Owner or Tenant Fes/
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Sem ice Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Yes ❑ No X
Telephone
(Check Appropriate Boa)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
bra u.�al„r lir,✓ryL
Conrnletion nfrl,e inllnudno tnhle .,,.,,, { e-;. d t,,. ,7.,, T__- ..trr:
No. of Recessed Fixtures
_ ___ _• _.__ .___-.....n .-.,.-
No. of Ceil.-Susp. (Paddle) Fans
...... yr .•....amu ✓Y ...c IIU
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Sjvimmin Pool Above n-
g ❑ ❑
o. o Emergency ig ung
b a
grnd, 2rnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners INo.
of Detection and
Initiating Devices
No. of Ranues
No. of Air Cond. Total
Tons
No. of Alerting Devices
b
No. of Waste Disposers
(Heat Pump
Number ITons
I
IKW
INo. of Self -Contained
I
I
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW. .
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances
5ecurrty 'stems:
N o. of Devices or Equivalent
No. o Water KW
Heaters
Ito. o o. o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hvdromassaae Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
o-1
.4tiach additionoi deloil ifdesired, oras required by ilte Inspector of lf'ires.
INSURANCE COVERAGE: Unless waived by the oN%mer, no permit for lite performance of electrical work may issue unless
the licenses provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The
undersigned cenifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
'
3Estimated Value, of Electrical Work- /) . i � (When required by municipal'policy.) (Expiration Date )
Work to Start: '- �" 0 1 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certifi" under the pains and penalties of perjury, that the information on this°application is true and complete.
FIR 1 NAME: ADT Securitv Services 111 Morse Street, Non4od. MA 02062 LIC. NO.: 1333C
Licensee: John S. Bassett SignatuDt l
(If applicable, enter "exempt " in die license nunther line.)
A d dress:
OWNER'S INSURANCE WAIVER: 1 am llWare drat lite Licensee does
required by law. By m�• signature below. I hereby waive this requirement.
Owner/Agent
SicnaturcTelephone No.
5e- LIC. NO.: 1533C
Bus. Tel. No.: -
Alt Tel. No.: 603-594759nlresi
not have the liability insurance covera?e normally ONLY
1 am the (check one) ❑ owner ❑ oi�mer's agent.
PERMI T FEE: S .3.5• D 0I
Nq
a ILI\
Off" Use sty_
In uht (filmmonwtttiih of fffiafiarh mrm Permit No.
Ef:)jrtlTt7Ilt'Iitl Qf P1I1111L T. (tfettl Occupancy Y Fee
BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 L 3190 peeve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ;
All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12.00 f
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
T& or Town of --NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below. a
Location Street 8 Number
Owner r Tenant/GcX i�e%�D cn'
Owner's Address 36Z, SIYL-
13 this permit in conjunction with a building permit: Yesv No (Check Appropriate Box)
Puroose of Building / �! �/
'"� Utility Authorization No.,
Existing Service AmpsVolts Overhead :_l Undgrnd Q No. of Meters
New Service Amps _J Volts Overnead _ Undgme No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work %t w� dnc� r'
No. of Ligating OutletsI No. of !-lot ':=s I No. of Transformers Total
KVA
No. of Lighting Fixtures i Swimming Pcoi Abcve.— in. f—
grr.o. _ grnb. I Generators KVA
No. of Emergency Lighting.
No. of Receotacte Outlets I No. of Oil Burners I battery Units
No. of Switch Outlets
No. of Ranges
Nil. Of, Disposals
No. Of Oishwasners
No. of Dryers
No. of Water Heaters
No. Hyoro Massage Tubs
OTHER:
No. of Gas Earners
No. Cf Air C--r.c. Totai
Cris
No.of Heat 7bai .otat
Purn-cs :ons KW
SoaceiArea Heaur.o Kk'/
Heating Cevtces KW
KW INo. of No it
Signs ?a lass
No. of Motors -otai HP
FIRE ALARMS No. of Zones
No. of Detection and;
Initiating Devices
.:
No. of Sounding Devices
No. of Self Contained
OetectionlSounding Devices
Local '— Municipal
Connection _,—Other
Low voltage
Wiring Alej
, d
INSURANCE COVERAGE: Pursuant to the reouirements or -Massac-users ;enerat Laws
I have a current Liability Insurance Policy inctuoing Comc:eiec Ocerations Coverage or its substantial eouivaient. YES 1—d --'NO = I
have suomitteo valid proof of same to the Office. YES AVO = If you nave checked YES. please inoicate the type of coverage by
checking the appropriate box.
INSURANCE SONO = OTHER = (Please Saec:ha)
Estimated Value'g-a-0 of E!ectncal Work S � �•
(E, ,pirauon Deist
work t S CrV —Z-7 —IF? 1 - 7 G"rl a CGL'/
o fan Inscec:ion Date Aecues:ec:
FIRMunser ;2i Pe aitie of �-e(s n/
FIRM NAMEn�—� � SQ<, iZ . E
Licensee
ig
Rough b � Final
UC. NO. !4
UC. NO. — Z may.•
Address
�G��i�S'M �ao22�f 6Jole.2 eAu. Til. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee Coes not have the insurance coverage or its Substantial equivalent as re•
guirso by Massacnusetts General Laws. ano that my signature bn ;rite hermit application waives this requirement. Owner Agent
(Please check onel-
Teieonone No. PERMIT FEE S
(Signature of Owner or Agentl
!2 1255
�iORTN
S cm
Dated:.?..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
8
..........
This certifies that ... k: ... ( ......... ......... o.!� .......................................
(1/
has permission to perform _.<�
.............
. ................ ........
wiring in the building of ... .................. ...... ...... .........................
it
at ..... ....... ...................................................... . North Andover, Mass. co -Cu�
Fe&�................. Lic. NqA.IZ�F............... ................ ................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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Town Of North Andover
Building Department
146 Main St. Town Hall Annex
508-688-9545
Project:
°` •� ~�� FREDERICK W. DEKOW
. n
360 FOREST ST
NO. ANDOVER MA 01845
APPLICANT: DANA A. SANDGREN ,SSACHUSEt
10 VAN NORDEN RD
WOBURN MA 01810 DATE: SEPTEMBER 27, 1997
RE: BUILDING PERMIT FOR SUNROOM & DECK
Title of Plans and Documents: BUILDING PERMIT APPLICATION & BUILDING SKETCHES
BY BUILDER
Please be advised that after review of your Building Permit Application and Plans that your
Application is DENIED for the following reasons:
Zoning
Use not allowed in District
Not in conformance with Phased Development
Violation of Height Limitations
Sign exceeds requirements
Violation of Setback Front Side Rear
Insufficient Lot Area
Insufficient Parking
Violation of Building Coverage
Insufficient Open S ace
Use requires permits prior to Building Permit
Si n requires permits prior to Building Permit
Form U not complete by other departments
Not in conformance with Growth By -Law
Other
Remedy for the above is checked below
Dimensional Variance
Special Permit for Watershed Review
Special Permit for Site Plan Review
Special Permit for sign
Complete Form U sign -offs
Copy of Recorded Variance
Information indicating Non -conforming status
Copy of Recorded Special Permit
Other
Other
Plan Review The plans and documentation submitted have the following inadequacies:
1. Information Is not provided, 2. Requires additional information,
3. Information requires more clarification 4 Infnrrnatinn i¢ inrnrrc 4 F All .,f rhe ,i—
# - -
- -- --..#
Foundation Plan
Plumbing Plans
Subsurface investigation
Certified Plot Plan with proposed structure
X 3 Construction Plans
116 Affidavit
Mechanical Plans and or details
Plans Stamped by proper discipline
Electrical Plans and or details
X 3 Framing Plan
Fire Sprinkler and Alarm Plan
X 3 Roofing
Footing Plan
Plans to scale
Utilities
Site Plan
Water Supply
Sewage Disposal
Waste Disposal
Other DEMOLITIION
ADA and or ABBA require
Administration
The documentation submitted has the following inadequacies:
1. Information Is not provided. 2. Requires additional information.
3. Information requires more clarification. 4. Informatinn is inrnrreCt r, All of 4hu mak,
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
uildin a t. Theatt documAnt titled "Plan Review Narrative" shall be attached hereto and incorporated herein
buil ing d r# t it r i d documentation for the above file. You must file a new building
the s'., "
~� 9/22/97 9/27/97
Building Department Official Signature Application Received Application Denied
_9/29/97_
Denial Sent
Referral recommended:
If Faxed :
Fire
Health
Water Fee
State Builders License
Sewer Fee
X 1 Workman's Compensation
Building Permit Fee
Homeowners Improvement Registration
Building Permit Application INCOMPLETE
Homeowners Exemption Form
Other
X Other BUILDING DEPTT
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
uildin a t. Theatt documAnt titled "Plan Review Narrative" shall be attached hereto and incorporated herein
buil ing d r# t it r i d documentation for the above file. You must file a new building
the s'., "
~� 9/22/97 9/27/97
Building Department Official Signature Application Received Application Denied
_9/29/97_
Denial Sent
Referral recommended:
If Faxed :
Fire
Health
Police
Zoning Board
Conservation
Department of Public Works
Planning
Historical Commission
Other
X BUILDING DEPT
cc: William Scott
Town Of North Andover "°"•;bra Project:,
Building Department
146 Main St. Town Hall Annex
508-688-9545
APPLICANT: P V-Tmat Rt -1
DATE: �' r-_ A 71
L-0orJ)u21JIiVAl- sIV-oI
RE: r3u►u-�, r'►s a twn k,,-- + =cyyt su,, l2&ser 2, �/4^
Title of Plans and Documents: e3. l✓. �4-Pr�,Ce r> r"il•, 1 mac, is [ t��,u� fF--jr+/yt-3
Please be advised that after review of your Building Permit Application and Plans that your
Application is DENIED for the following reasons:
Zoning
Use not allowed in District
Not in conformance with Phased Development
Violation of Height Limitations
Sign exceeds requirements
Violation of Setback Front Side Rear
Insufficient Lot Area
Insufficient Parking
Violation of Building Coverage
Insufficient O en S ace
Use requires permits prior to Building Permit
Sign requires permits prior to Building Permit
Form U not complete by other departments
Not in conformance with Growth By -Law
Other
Remedy for the above is checked below.
Dimensional Variance
Special Permit for Watershed Review
Special Permit for Site Plan Review
Special Permit for sign
Complete Form U sign -offs
Copy of Recorded Variance
Information indicating Non -conforming status
Copy of Recorded Special Permit
Other
Other
Plan Review The plans and documentation submitted have the following inadequacies:
1. Information Is not provided, 2. Requires additional information,
3. Information requires more clarification. 4. Information is incorrect. 5. All of the above
#
#
Foundation Plan
Plumbing Plans
Subsurface investigation
Certified Plot Plan with proposed structure
Construction Plans
127 Affidavit
Mechanical Plans and or details
Plans Stamped by proper discipline
Electrical Plans and or details
Framing Ilan
Fire Sprinkler and Alarm Plan
Roofing
Footing Plan
Plans to scale
Utilities
Site Plan
Water Supply
Sewage Disposal
Waste Disposal
Other
ADA and or ABBA requirements
Administration
The documentation submitted has the following inadequacies:
1. Information Is not provided. 2. Requires additional information.
3. Information requires more clarification. 4. Information is incorrect. 5. All of the above
# 1
#
Water Fee
State Builders License
Sewer Fee
I Workman's Compensation
Building Permit Fee
Homeowners Improvement Registration
Building Permit Application
Homeowners Exemption Form
Other
Other %-
u
The above review and attached explanation of such is based on the plans and information submitted. I definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein
by reference. The building department will retain all plans and documentation for the above file. You must file a new building
permit application form and begin the permitting process.
Building Department Official Signature
4? -:;L-7 - X1'7
Denial Sent
Referral recommended:
-7
Application Received
If Faxed :
Application Denied
Fire
Health
Police
Zoning Board
Conservation
apartment of Public Works
Planning
Historical Commission
Other
cc: William Scott
Plan Review Narrative
The following narrative is provided to further explain the reasons for denial for the building
permit for the property indicated on the reverse side:
::Ja
1 I
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d. 'nut
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AS i'{ IIi1H \ :1) �I k # � r �'i Y l a i 11 1 i� fir' G
I{ �. i v....:: J1{��I'. .n>F:.'{ . . 1.5{��•k LN� r,i ��. SF}�.�1 fF4n!t .. i -.'Lkl IIA. A 1 •-i-�: .�.� �1�..'.� + :':
�
f
Town Of North Andover
Building Department
146 Main St. Town Hall Annex
508-688-9545
Project:
FREDERICK W. DEKOW
360 FOREST ST
��M�-• NO. ANDOVER MA 01845
APPLICANT: DANA A. SANDGREN ;'SScHUS,
10 VAN NORDEN RD
WOBURN MA 01810 DATE: SEPTEMBER 27, 1997
RE: BUILDING PERMIT FOR SUNROOM & DECK
Title of Plans and Documents: BUILDING PERMIT APPLICATION & BUILDING SKETCHES
BY BUILDER
Please be advised that after review of your Building Permit Application and Plans that your
Application is DENIED for the following reasons:
Zon
Use not allowed in District
Not in c
Violation of He' ht Limitations
Si n ex
Violation of Setback Front Side Rear
Insuffici
Insufficient Parkin
Violatioi
Insufficient Open Space
Use r ea
Sign requires permits prior to Building Permit
Form U
Not in conformance with Growth By -Law
I Other
:)nrormance with Phased Develo ment
seeds requirements
ant Lot Area
I of Building Coverage
sires permits prior to Ri flirlinn Permit
not complete by other departments
Remedy .for the above is checked below.
Dimensional Variance S ecial Permit for Watershed Review
Special Permit for Site Plan Review Special Permit for sign
Complete Form U si n -offs Copy of Recorded Variance
Information Indicatin Non -con, ormin status Co of Recorded Special Permit
Other
Other
Plan Review The plans and documentation submitted have the following inadequacies:
1. Information Is not provided, 2. Requires additional information,
3. Information requires more clarification 4 Information is incorrect. 5. All of the above.
y
Foundation Plan
Subsurface investigation
Construction Plans
Mechanical Plans and or details
Electrical Plans and or details
Fire Sprinkler and Alarm Plan
Footing Plan
Utilities
Waste Disposal
ADA and or ABBA requirements
Plumbing Plans
Certified Plot Plan with
116 Affidavit
Plans Stamped by prof
Framing Plan
Roofing
Plans to scale
Site Plan
Other
Administration
The documentation submitted has the following inadequacies:
1. Information Is not provided. 2. Requires additional information.
3. Information requires more clarification 4 Information is incorrect 5. All of the above.
u
Water Fee State Builders License
Sewer Fee X 1 Workman's Compensation
Bu"
din Permit Fee Homeowners Im rovement Re
Buildin Permit Application INCOMPLETE Homeowners Exem tion Form
Other X I I Other BUILDINr, rnFpTT
structure
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
uildin a t. The att docun*nt titled "Plan Review Narrative' shall be attached hereto and incorporated herein
buil ing d t 'I r d documentation for the above file. You must file a new building
t the
Building Department Official Si nature -�. 9/22/97 9/27/97
g Application Received Application Denied
_9/29/97 If Faxed :
Denial Sent
Referral recommended:
Fire
Police
Conservation
I Other
cc: William Scott
Health
Zoning Board
Department of Public Works
Historical Commission
BUILDING DEPT
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FORM U IAT RELEASE FORM
INSTRUCTIONS: This fora► is used to verify that
approvals/permits from Boards and pe all
have been obtained. partments necessary
landowner from compliance ��, not relieve thehavinq jUrisdictiop
regulations or re Y applicable loCali t and/or
requirements. or $tate law,
****************Applicant fills out this se
APPLICANT; tion***,�****w*******rt
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LOCATION: Assessor's Map Number Phone �?�;
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Subdivision Parcel
Lot(s)
Street
************************St. Number:36()
Official use
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RL'COMMNDATIONS OFTOWN AG
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t/ is nspector-Health
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Date Rejected
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Date Approved
Date Rejected •
Date Approved
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Public Works
sewer/water connections`
driveway permit
Fire Department
Received by Building Inspector
'' Date
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Town of North Andover NORTIy ,
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OFFICE OF ��E, 3? y�` °•°
COMMUNITY DEVELOPMENT AND SERVICES °
30 School Street `.
North Andover, Massachusetts 01845
WILLIAM J. SCOTT SSAcmus�
Director
MEMORANDUM
To: File
From: Richelle Martin Conservation Associate
Date: September 18, 1997
RE: Form "U" Inspection @ 360 Forest Street
On September 16, 1997, this department inspected the above referenced property
after receiving a Form "U" proposing to construct a sun room with a deck. After
walking the site completely, wetlands were found to be present in the southernly
most portion of the lot. The proposed addition will extend out off the back of the
house 16 feet. This addition will be constructed 84 feet from the edge of the
wetlands, and will cause no negative impacts to the wetlands. Therefore, the
homeowners (Donna and Fred Dekow @ 682-5997) will be allowed to construct
this proposal without filing with the Conservation Commission. The proposal is
not in the floodplain, as investigated in the Flood Insurance Rate Maps.
CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
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1. Fill out Building Permit application completely, and sign.
2. A copy of the plot plan with the existing building and additions
proposed drawn to scale.
3. A complete set of plans drawn to scale.
4. A copy of the contractors State Builders Lic. And Home
Improvement Reg. Number. If homeowner is doing the work then
he must sign homeowner exempt off davit.
5. A form U- Verification form must be signed by' Conservation, Board
of Health and Town Planner if in the Water Shed District.
6. Assessors map and parcel must be on permit application and o
PP n
Form -U Form.
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_t�s.�-----/-----'�-
location:
Cily wawrn phone#
E] I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working iii any capacity
0 I am a -sole proprieto , era contracto , or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date 6 9
Print name l 1 ape-, A S t =z Phone # -3
official use only do not write in this area to be completed by city or town official
city or town: permit/license # riBuilding Department
oLicensing Board
check if immediate response is required OSelectmen's Office
pHealth Department
contact person: phone #; C]Other
(revised 3/95 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", 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 section 25 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, 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits 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.
=Z c MR -E
City or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's
The
a :r ::' :!..• ..
De13nrt,-n-zq
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone 4: (617) 727-4900 ext. 406, 409 or 375