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HomeMy WebLinkAboutMiscellaneous - 37 SULLIVAN STREET 4/30/2018 (2)XV Location No.— Date ,.ORTq tiTOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ 71, 6 2 ('. ass R y� Foundation Permit Fee $ R Other Permit Fee $' Sewer Connection Fee $ g JjVater Connection Fee TOTAL Building Inspector Div. Public Works i. �) ,tom 77Location r 6% U L L 1 illify -5 No. " Date0*1'`• NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ �a Building/Frame Permit Fee $ Iva �ssACMUSEt F,Qundation Permit Fee $ f .40 �f�i Pee $ Sey-- Connell $ Water CCA Fee $ � SIV $S�i .rye 1 Building"Inspector Div. Public Works F _ NO:&: �..^',,�_APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. �,�� ��f ✓ P1�CGE 1 MAP nJO.,- j G `j-j%�t9T NO. �T 2 RECORD OF OWNERSHIP iDATE BOOK PAGE Z�NE I SUB DIV. LOT NO. _ LA,/,),) --c — LOCATION �. I_V ! a� PURPOSE OF BUILDING - OWNER'S-NAM`E� �v/J>J' L NO. OF STORIES SIZ��i�/•�� 6� ot- is OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME BUILDER'S NAME _ j� �'j�p �; Tii `�' �,u� J-� SIZE OF FLOOR TIMBERS 1ST _; ' ` v 2ND !_g/ D 3RD J' / .7�J1 SPAN DISTANCE TO NEAREST BUILDING Oy DIMENSIONS OF SILLS DISTANCE FROM STREET/ y •' POSTSo[Jl S DISTANCE FROM LOT LINES - SIDES / REAR (� % " GIRDERS dabe eT AREA OF LOT fGJ FRONTAGE, j HEIGHT OF FOUNDATION THICKNESS Cp IS BUILDING NEW Y� J SIZE OF FOOTING X .IS BUILDING ADDITION `.�/ O MATERIAL OF CHIMNEY J,C�f IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED ILAND V WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y"� J i IS BUILDING CONNECTED TO TOWN WATER iv / BOARD OF APPEALS ACTION. IF ANY %�/ 0 IS BUILDING CONNECTED TO TOWN SEWER. f D _ - IS BUILDING CONNECTED TO NATURAL GAS LINE 0 INSTRUCTIONS SEE BOTH SIDES am i Y1'M� PAGE 1 FILL OUT SECTIONS I - 3 FDA FE = r, 'o PAGE 2 FILL OUT SECTIONS 1 - 12 DUL FRAME TGRM11 ; Q u ELECTRIC.METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUS; BE FILED AND APPROVED BY BUILDING INS . r� f, ,-- � 7 i DATE FILED v - / SIGNATURE OF OWNER OR AUTHOR FEE PERMIT GRANTED 19 t - Y AUG 28Ica 6 -?—f a-7 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST) EST. BLDG. COST PER SQ. FT. 47 if lA EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES, GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS __ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE B t 2 I3 CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA 1/1 '/p 1/1 FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN (� 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B 1 2 3 �_ _ _ DROP SIDING WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARDVj D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BILK. -WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR _ ADEQUATE NONE 5 - OOF 10 PLUMBING GABLE HIP BATH 3 FIX. GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT 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 I 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 GASrE IL B'M'T 2nd 13rd µ,O ECTRICl/ HEATING .' i " orlfflm ._ ' ...... , AM 273,E (� FORM U - LOT RELEASE FORM 7 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***************** u.�i�7'C' tr"1'z6!'. cup✓T +Ti c_ APPLICANT : �i k G ri FoNt Phone LOCATION: Assessor's Map Number / d Parcel Subdivision Fa RAIV A Lot (s) Street wRo / /< ( % St. Number ************************Official Use Only************************ RECqMMENDATIONS OF TOWN AGENTS: ' Conservation Administrator Date Approved Date Rejected Comments `°' YJ d �---- Date Approved To Planner Date Rejected Comments ,4 n 4j&j Date Approved Health Agent Date Rejected Comments —T Public Works - sewer/water connections - driveway permit -PJX,,.; , e Fire Department ?i U Received by Building Inspector AUG 2 8 1992l�,t Or G3 5. w 00 01 V) 0 LtJ W ccu. 7 0 ci Z CY 7 0 rN IU W uj LU M rn U.1 LL tj O ct W 00 X. -J D 'z 7. w ca n 0 Cc f , 7 0 W > V) 16 Ui 0 "e U n, ( r� Q U.1 W W (T T aU) z 7 T 't 0 41 C) 0 w LU 0 —4 0 2 CD Q -0 T 111 C) C) LLJ 01 1-- In Z (\_ 1, Z 0 O 07 G3 5. 00 01 V) 0 LtJ W 7 w ci Z CY 7 0 rN IU W ii in 5. 0 o 7 Z CY 7 0 < LU M rn U.1 LL tj Ld -'I ct W ?-!I J_ I-) 'z 7. T- Z LLI Do I-- W > V) 16 Ui 0 —4 CD Q -0 T 111 C) co LLJ 01 1-- In Z z 0 CD ui V) a.. . . . . . . . . . ...... m 0 04 trl i tz to Si 2 log m Icz W O 1 CL 1 z W ? I.- c� O O > z � W Q log Icz 109 1 1 I.- O W p W Z H Z W W Z Z 0 p z iCL n TUA O z v H T m u m t C L � L 0 L m Y E °� W '` E o c D c c ¢ U ii Q ii cr (n U. t= U. m cE LU cim rJ �•` A �. C.4 ~ e u Q ° e O9:z • 04 • z O U" H a oa � • _ •— iiA Ari 3 3 > L.LJ � O.i t+ *.+ y � il Z) hV CL 'o�,-a s**� LLJ 7 Ca K i 'a_ = u y c e N a t v.. L1.. po •o ° 9=i �-CL C z o to CL. ° v of Z 'W = ' til F••� s S a � C1 > A. 0 i A r. 04 • h s, 010 i.:i �Z :z t= km m IrW W66. in - cc: 99 LU z LU T C� E l0 J L � J L U W Co •�- l0 u L j W LU> O 010 i.:i �Z :z t= km W66. in 99 LU C� E l0 J L � J L U W Co •�- l0 u L j W o O Y c O o o m ii o ii E cc U ii a: x to oC m (1) 010 i.:i �Z :z t= km H .= a E` 4V � L s � v C E c a a - H Q C � CL o v V m W W a � D CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 404 (1992) Date MAY - 1994 THIS CERTIFIES THAT THE BUILDING LOCATED ON LOT 5 SULLIVAN STREET 437 MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE IN ACCORDANCE UNDER WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. W'" CERTIFICATE ISSUED TO Whi tP Birch Const, Tn 380 Essex St. s�• ADDRESS /rT awrPnc p MA acHuss lam+ Building Inspector 4, li I G f l HOHTIy ° TOWN OF NORTH DOVER PERMIT FOR GAS INSTALLATION This certifies that ............... has permission for gas installation . 14: f ... �r.`h.Ir ���... . in the buildings of ..... ................. . at ... r....CF ... Norlh Andover, Mass. Fee. 3G.1. Lic. No. Aedt-f.? :. ..... I;INSPECTOR Check # % 6619 b G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Noe e 4 h J() I/ Mass. City, Town Building AT: Location Date % i° if, n Permit # — Owner's Name ST e Ur– a 4; Type of Occupancy:—. New ,CdJ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ trent or i ype) Check One: Installing Company Name TncnnCPnd Oil CO-, Tnr ® Corp. Address 27 Cherry Street ❑ Partnership nan�Tar , MA 01923 � ❑ Firm/ Company Business Telephone 978-777-0701 Name of Licensed Plumber or Gasfitter Certificate I hereby certify that all of the details and information 1 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/ Agent 1 have a current liability insurance policy to include completed operations coveratte. ❑ By Title City/ Town APPROVED (OFFICE USE ONLY) TYPE LICENSE: ❑ Plumber ® Gasfitter ❑ Master 0 Journeyman �nnn�mm�m�nm�nn trent or i ype) Check One: Installing Company Name TncnnCPnd Oil CO-, Tnr ® Corp. Address 27 Cherry Street ❑ Partnership nan�Tar , MA 01923 � ❑ Firm/ Company Business Telephone 978-777-0701 Name of Licensed Plumber or Gasfitter Certificate I hereby certify that all of the details and information 1 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/ Agent 1 have a current liability insurance policy to include completed operations coveratte. ❑ By Title City/ Town APPROVED (OFFICE USE ONLY) Signature 6Xicensed Plumber or Gasfitter License Number �� TYPE LICENSE: ❑ Plumber ® Gasfitter ❑ Master 0 Journeyman Signature 6Xicensed Plumber or Gasfitter License Number �� Date ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ....... z, - plumbing in th buildings of at,,2 2 ... — -\ 7 ' ... ........ North Andover, Mass. lk \0 Fe ...... Lic. No. C;2C9 !INSPECTOR -~PLUMB' �G '*''*' 4 Check # 7926 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 37 f f,, Z'r ovol 44 Owners Name Date / (r 2 ejO S? Permit # 727 —7 Type of Occupancy Amount NewLU Renovation Replacement Plans Submitted yes No ' Ti TVTTTT r... \a 11"L Vl LYPC) Installing Company Name _f Check one: Certificate Corp Address 26 Ir W&e�� ❑ Partner. Business Telephone `7 _1-776. n Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checkin a appropriate box: Liability insurance policy n Other type of indemnity ❑ Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ El 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Mass huse s State ]umbied ging de. and Cha r 142 of the General Laws. By. ignaure 411�14 um er Title Type of Plumbing License City/Town cq j q'a6 icense umoer Master El I APPROVED rocs USE o�vr.,Y a 11, Dat.ZL.f..'Ig ......... TOWN OF NORTH ANDOVER mapPERMIT FOR WIRING \. Thiscertifies that ............................................................................................. has permission to perform..,- .................................................... wiring in the budding of,��......................................................... at -,.-.;..%...X_ .:�t f........ z ................ North Andover, Mass. FeU........... Lic. No'�............... ElEcmcAL Imp lCheck # /"//;? -k Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No.�1�' and Fee Checked[Occupancy Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),,527R 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: r "/b k City or Town of. NORTH ANDOVER To the Inspecto' r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) �3 142%2� /7 J Owner or Tenant �. J Telephone No. Owner's Address (n 107 Q - Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Buuamg Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work:_ ./I/ �0 ��� ��f0/ �P� r l�� uauuconai aeiau y aesirea, or as required by the Inspector of Wires. Estimated Value of Elec ical Work: Z�CV (When required by municipal policy.) Work to Start: �. Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO RAGE: '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 pat s and penalties of perjury, that the information on this application is true and complete. FIRM NAME: —� LIC. NO.: Licensee: CCS i�. �j /�:�lJ�I Signature LIC. NO.: (If applicable, enter "exempt " in the h ease n mber lin . Address: j �`/ 0;v, a/ y- j Bus. Tel. No.: Alt: Tel. No.: z *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 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) E] owner Downer's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $.F C-, 6'% y "-.A I,, Arlir,.19 The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Tdrashington Street Boston, MA 02111 t' : www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaplicant Information Please Print Legibly /j / Name (Business/Organization/individual): __ // [:' h / /) •�O t7 ��� Address: /0 5� %Ol✓� P� `e/� -� City/State/Zip: 4p���l� //t.3 D/pZ_/ Phone Are you an employer? Check the appropriate box: 1. 131 am a employer with Z _ 4, ❑ 1 am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. Q New construction 2. ❑ I am a.sole proprietor or partner_ listed on the attached sheet. x 7• ❑ Remodeling ship and have no employees These suit -contractors have 8. Q Demolition working for mein any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9, ❑;Building addition required.] officers have exercised their 10. ntfectrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No-worke'rs' comp. c. 1.52, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13 Q Other comp. insurance required..] —Jr aFY«�Tlt MUL CMUCKs oox 8 t must also Fitt 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. Lie. #: -��� /tj )� Q y Expiration Date: Job Site Address: 7, ale it ,r, - 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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date. /z -h 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions T 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 uthority"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 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` he 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 tine. City or Town Officisis 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 permittlicense number which wilI 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 bum 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 Investiagationis 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5 -26 -QS www.mass.gov/dia