HomeMy WebLinkAboutMiscellaneous - 38 BRIGHTWOOD AVENUE 4/30/2018 (3)I e <'
MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFiTT1NG �r e
(Print or Type)
lyK I Mass. Date )
1Permit # j
Building Location a Owner's Name S
I
TyjV
pe of Occupancy
New ❑ Renovation ❑ Replacement W Plans Submitted: Yes❑ No.&
G
installing Company Name A-1 SERVICE CO .
Address P.O. BOX 755
LOWELL, MA. 01853
Business Telephone 508-937-2529
Name of Licensed Plumber or Gas Fitter RICHARD R . DUCHENEAI I
Check one: Certificate
❑ Corporation
❑ Partnership
LTJ Firm/Co. 14952
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes $Z No ❑
If you have checked ye, please Indicate the type coverage by checking the appropriate box
A liability insurance policy KI 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.
Check one:
UiiinatUre70wner orvwner's Aaent owrwr❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in ap n true and aqc urate to of my
knowledge and that all plumbing work and installations performed under the ap on m ce with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of e
TyDe of License:
Trite 15 Gasmfltterr ature of V n Plu or Gas . i er
City/ToW ter License Number 10806
sDoc/Fn ncci�c i is n�ii Journeyman
Y
■■■■■■■■■■■■■■■■Room■■■■■■
■■■■n■■■■■■■Mt■■■■■■■■t■■■■■
NONE
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No
. ..
■■■■■■■■■■■■■■■■■■■■■■OMIKE
Name of Licensed Plumber or Gas Fitter RICHARD R . DUCHENEAI I
Check one: Certificate
❑ Corporation
❑ Partnership
LTJ Firm/Co. 14952
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes $Z No ❑
If you have checked ye, please Indicate the type coverage by checking the appropriate box
A liability insurance policy KI 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.
Check one:
UiiinatUre70wner orvwner's Aaent owrwr❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in ap n true and aqc urate to of my
knowledge and that all plumbing work and installations performed under the ap on m ce with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of e
TyDe of License:
Trite 15 Gasmfltterr ature of V n Plu or Gas . i er
City/ToW ter License Number 10806
sDoc/Fn ncci�c i is n�ii Journeyman
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HORTh
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TOWN OF NORTH ANDOVER
Of<«�e
�r ' PERMIT FOR GAS INSTALLATION
�,SSACMUSES
CU
This certifies that . : / .. S.�r� v tc. c... .
has permission for gas installation ...P-11 U. l r, r. . .. . ......... It
in the buildings of ..S. 154 .................. . . . . . .
f nuc.
at ... «S:.. �./. P �. .� ............ North Andover, Mases.
Fee.Lic. No.]. 4? t.. ............ ............ '.
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
cLuc {
r
Location 3
No. ` / � Date
NORTH TOWN OF NORTH ANDOVER
f41
9
Certificate of Occupancy $
s °mob+„»�. '� • _
NUs <�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # /-7p7
Building Inspector
M
O•
.-_ - e
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REM
RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
__
M
BUILDING PERMIT NUMBER:
w "'
r� 77
11 )'[1k 103210,
/ y7 q DATE ISSUED:
SIGNATURE:
Building Commissioner/122REtor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
•/3� 1�riaA:2 as 'o
Lid-
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
® ryey-
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
ReqWred Provided
662
1
6 ,
3 v
1.7 Water Supply M.G.1-C.40. 54)
Public ❑ Private ❑ Zone
1.5. Flood Zone Information:
Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSIDWAUTHORIZED AGENT
2.1 Owner of Record
&yj� i�cren (r�o
Name (Print)
ri aht- c� ,due
Address foam Setvi e :
Signature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
r:
3.1 Licensed Construction SU,0&)-,0rAr-1T
1,477 v
Licensed Construction Supervisor:
,Vf ress
Signature
Q� V
Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature
Telephone
00
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SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
QFFICL! USE QNLY
Building
^� n0 `
v{ !1
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee dal X tb1
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
c ` FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
v APPLICANT I 1 aPrP J V OUd PHONE( V
ASSESSORS MAP NUMBER
SUBDIVISION
c/
LOT NUMBER
STREET� lJq�7 �Ll �o ti"W�%ZU STREET NUMBER �O
$...■..■Y■....■ ■ ■■...........■■..r..................■�............... r..■
OFFICIAL USE .ONLY
RECOMMENDATIONS OF TOWN AGENTS
no
�l 1 DATE APPROVED t
�----ONSERVATION ADNIMSTRATOR
DATE REJECTED
i I
COMMENTS k �' \` ,yJ 5 -. E c A
DATE APPROVED
TOWN PLANNER —
DATE REJECTED
COMB& -NTS
DATE APPROVED
FOOD INSPECTOR - HEALTH DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED"
COMMENTS
PUBLIC WORKS — SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CONSENTS
RECEIVED BY BUILDING INSPECTOR DATE .
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Date :- 15.9 ? - (v -,->—
TOWN OF NORTH ANDOVER
0 0
PERMIT FOR PLUMBING
This certifies that 4
has permission to perform_....:._..;.,._.,., ,4� . .........
plumbing in the buildings of . .....................
at-?: . .. ., NortirAndover, Mass..
fo
Fee eQ " c,
(,1. .1. . . Li No. ........
Check # -- "IV ?
5126
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
KIWIOwners Name
of
te4l'�
Date �� 2
Permit # c S / cP-*
Amount A3
New Renovation Replacement Plans Submitted Yes No
FIXTURES
(Print or ) Che nCertificate
InstallingCompay Name -� o�
Addressy r le,, Av Partner.
Business Telephone - (o Firm/Co.
Name of Licensed Plumber: "/-/,j V Od l `n5
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy � Other type of indemnity El
❑
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 1:1 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 installa 'ons performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachu t tate Plumbi Cod ndChapter 142 of the General Laws.
By igna ure o1 1-1censea Flumoer
Type of Plumbing License
Title 16
City/Town LicenseNumoer Master Journeyman ❑
APPROVED (OFFICE USE ONLY fa
Y'
Date ...... .......... .
i
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .. ......', ...! .. ...f.,.. �...... d T y...
has permission for gas installation !.... !-:....:✓ -:... ..... .
in the buildings of ...'`.. '::.: ........................ .
at .......................... ..:: ..-. North Andover, Mass.
r Fee. .) .... Lic. No� ........
/ / v GAS INSPECTOR
t,
Check # 7
3; 27
MASSACHUSETTS UNIFORM APPLICATON FOR PERK Ur TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER,, MASSAC/HUUQSE, TTS
Building Locations - - - � 9 ��/J ' ! ooj Permit # 9�'f
I AAA Owner's Name
Newf�L Renovation ❑ Replacement ❑
Amount $
Plans Submitted ❑
(Printor type) r-�—Gj I 11� L�- All
Address
14
one: Certificate Installing Company
Corp.
❑ Partner.
Business Telephone / yam- 72-2- ❑ Fimi/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑
If you have checked M, please indicate 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 142 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 ❑ 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts StatglGas Code and ChjLpter 142 of the General Laws.
(City/Town
(OFFICE USE ONLY)
Signature of Licensed Plumber Uz-(>as Fitter
❑ Plumber / (
r-1GasFitter Licenserllu Ger'
Master
ri Journeyman
•
3RD. FLOOR
(Printor type) r-�—Gj I 11� L�- All
Address
14
one: Certificate Installing Company
Corp.
❑ Partner.
Business Telephone / yam- 72-2- ❑ Fimi/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑
If you have checked M, please indicate 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 142 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 ❑ 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts StatglGas Code and ChjLpter 142 of the General Laws.
(City/Town
(OFFICE USE ONLY)
Signature of Licensed Plumber Uz-(>as Fitter
❑ Plumber / (
r-1GasFitter Licenserllu Ger'
Master
ri Journeyman
3557
66+4
Date.. /� C -Z'
........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... ****
has permission to perform -: F. ..........................................................................
wiring in the building of
..........................................
at ..... ........ 4� North Andover, Mass.
— �IX***"*"**'**'***********"'* / )
Fee /,�i� ........ �...Aic.NoA��.
Tk� ... . .............................................
ELECTRICAL INSPECTOR
Check #
r
0
{
urticia se n y7
Permit No.
�ee«s oa �udllc Saaety Occupancy & Fee Checked
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 )—Z 7 Z9 1
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform a electrical work described below.
Location (Street & Number
Owner or Tenant KA r n
Owner's Address L./11ti r ' 1
Is this permit in conjunction with a building permit Yes 1�( No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 60 Amps v v Voits. Overhead J� Undgmd ❑ No. of Meters
New Service �(/l J Amps-12u!A-1oits Overhead Undgmd ❑ No. of Meters
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work Q
1 / A. I v%A V,A —J— 'i too; .1 re) .Pi!fP0 4- dAIJf.J-1J'9 t -- i,-) V.L4,71tN1CloC 'All 0 in -IJ <1C
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalentES NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type o coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify)
(-�- f2 ZY.-) (Expiration Date)
Estimated Value o—E7nWork InectivD
ate
Signed under the P it' of rju
FIRM NAME
LIC.
NO.
47
C -As. Tel No. 7i�C� .? '{lU
Address Alt Tel. No.
�7 P �^
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have:the insurance coverage or it sub tin�ivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
(Signature of Owner or Agent)
Telephone No. PERMITTEE $
—
- - —
- -Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑ In ❑
No. of Lighting Fixtures
Swimming Pool
grnd ❑ grnd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
i
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di osal
No.
Pumps Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
wiring(�
No. Hydro Massage Tuds _
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalentES NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type o coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify)
(-�- f2 ZY.-) (Expiration Date)
Estimated Value o—E7nWork InectivD
ate
Signed under the P it' of rju
FIRM NAME
LIC.
NO.
47
C -As. Tel No. 7i�C� .? '{lU
Address Alt Tel. No.
�7 P �^
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have:the insurance coverage or it sub tin�ivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
(Signature of Owner or Agent)
Telephone No. PERMITTEE $
r�
W
ri
QUITCLAIM DEED BK 5447. PG 2
1, MARY SACHUK, of North Andover, Essex County, Massachusetts
for consideration of ONE HUNDRED NINETY TWO THOUSAND AND 00/100
($192,000.00) DOLLARS
grants to KEVIN GOOD and KAREN J. GOOD, husband and wife, of 38
Brightwood Avenue, North Andover, Essex County, Massachusetts, as tenants by the
entirety
with quitclaim covenants
A certain parcel of land with the buildings there situate in said North Andover,
being shown as New Lot B on a plan of land entitled: "Plan of Land in North Andover,
Mass. owned by Mary Sachuk" Scale 1" = 40', dated June 7, 1995, and recorded with the O
North Essex District Registry of Deeds as Plan No. 12655, to which plan reference is W
made for a more particular description.
NORTHERLY ninety-five and 70/100 (95.70) feet by land
now or formerly of Ferrulo;
EASTERLY one hundred forty-five (145) feet by Brightwood Avenue;
SOUTHERLY eighty-nine and 47/100 (89.47) feet by New Lot 'A',
as shown on said plan; and
WESTERLY one hundred forty-five and 13/100 (145.13) feet
by land now or formerly of various owners,
as shown on said plan.
Containing 13,424 square feet, more or less.
For title see deed of Pearl B. Playdon dated June 9, 1954 and recorded in the
Essex North District Registry of Deeds at Book 792, Page 451.
Said New Lot "B" is also shown as Lots 15, 16 and 17 on a plan of land entitled:
"Highland View Park, March 1906, Scale V - 50', R. W. Seaman, C.E." which plan is
recorded in Essex North Registry of Deeds at Book 230, Page 600 as Plan No. 0358.
Executed as a sealed instrument this oq>% T4 th day of May, 1999
Xitness Mary Sach -
14A V 28 599 rPT
COMMONWEALTH OF MASSACHUSETTS rn
Essex, ss.. May �'Y 1999 Z N
Then personally appeared the above named Mary Sachuk acknowledged that she
executed the foregoing instrument as her free act and,/deed, before me.
Q�
otary Public Apmenic J. Scalise
R-ENC'IE- My commission expires: 2/18/05
REG 0�4
jePM
000
FEE
5H