HomeMy WebLinkAboutMiscellaneous - 443 BOSTON STREET 4/30/2018 443 BOSTON STREET j
210/107.D-0109-0000.0
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Location y q:3 -�)Q %16 AJ-!!:V
No. -3 Date a' 1S' U 3
01 ~ORTN TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 90
ACNUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �� J
1 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATfa OR DEMOLISH A ONE OR TWO FAMILY DWELLING
N_ M
BUILDING PERMIT NUMBER. DATE ISSUED:
SIGNATURE:
Builcrng CommissionerflpsREtor of Buildings Date Z
SECTION 1-SITE INFORMATION I
0 1.1 Property Address: 1.2 Assessors Map and Parcel Number:
L'�l09D ,�' rdq
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: v"
Zonis District Proposed Use L.ot.Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard-
Required Provide RaIttired Provided Required Provided
v
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rn
2.1 Owner of (Record t ' `,
�/•Jo�rr� �f7�(�EL.L_ AND Co��l �[ 3 �pS�/J �T NOATk An)lov+ 1I'{ N
Nam (Print) fjA0 N&-e LL Address for Service:
g �ZS2
SignatureTelephone (�
2.2 Owner of Record:
W
Name Print Address for Service: O
r
M
.Signature Tele hone
'SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
Address
Expiration Date
Signature Telephone r•
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name M
i; Registration Number r
Address r
Expiration Date �q
Signature Telephone Y)
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that ali necessary approvals/permits fr<
Boards and Departments having jurisdiction have been obtained. This does not relie
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION
APPLICAN700`lf eve ��Yt� r b r\ (( PHONE eI7 7 q1{ ZS (0 2
LOCATION: Assessor's Map Number I �� b ' PARCEL l O 9
SUBDIVISION LOT(S)
LOCATION:
L 05 ()N rS J
ST.NUMBER .q� ?J
OFFICIAL USE ONLY ";;;�
COIEC END TI T N AGENTS:
N ADMINI ATOR DATE APPROVED 1 p
DATE REJECTED
� 1
COMMENTS_r'eLe,,,_,_ F lest ata–lo 71/ s IUAeC
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
lh�
SEPTIC INSPECTOR-HEALTH DATE APPROVED. 0
DATE REJECTED
eQ_OMMENTS
PUBLIC WORKS-SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
—_
Revised 9197 jm
µORT1y.
Ot
O
Town of North Andover
Building Department
27 Charles Street
gSSACHUSEt�
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE I �j ' 1 LA
JOB LOCATION l B o s 7 6 m
Number Street Address Section of Tc
"HOMEOWNER sp�Mk
Number Home Phone Work Phoi
PRESENT MAILING ADDRESS AA DOVE L VY)i P
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings
of 1 or 2 units and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section (108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s)who owns.a parcel of land on which he/she resides or intends to reside, on which of two
there is, or is intended to be,a one family dwelling, attached or detached structures
accessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,
a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the
building permit. (Section 108.3.5.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned"homeowner"certifies that he/she understands the Town of No.Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said pre cedures and re w ements.
HOMEOWNER'S SIGNATURE V_eV
APPROVAL OF BUILDING OFFICIAL
Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with
State Building Code Section 127.0 Construction Control.
Revised 4.30.03
Home owner Exemptions Form
Town of North Andover of t40 oT 1
.t'41:� q•ts.�
Office of the Conservation Department o �, - -- r 0�
Community Development and Services Division
Heidi Griffin, Division Director ;
27 Charles Street �RSSACHU
North Andover,Massachusetts 01845 Telephone Julie Parrino p one (978) 688-9530
Conservation Administrator Fax (978) 688-9542
Modification to Order of Conditions
The NORTH ANDOVEA CONSERVATION COMMISSION agreed to accept
Applicant: ; f
asn'lUodificaYionto the Order of Conditi ns issued in File 242- dated s
c and`
recorded in Book# and page
Issued by the NORTH AND ER CONSERVATION COMMISSION:
On this of dj before me personally appeared Scott Masse to me
day m nth/yr
known to be the person described in and who executed the foregoing instrument and
acknowledged that he/she executed the same as his/her free act and deed.
Notary Public My Co ission Expires
A receipt from the Lawrence Registry of Deeds must be submitted to this office showing
that this Modification has been recorded and referenced to the book and page numbers.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-953-5
Town of North Andover aF tt°os b Rte.
ra•,d . ,_•, e
Office of the Conservation Department 0. - - r
Community Development and Services Division * t y
Heidi Griffin, Division Director
27 Charles Street 4SsacHuse
North Andover,Massachusetts 01845. Tele hone 978 688
Julie Parrino p ( )
978
Conservation Administrator Fax ( ) 688-9542
Modification to Order of Conditions
The NORTH DOVER CDNSERVATION COMMISSION agreed to accept
Applicant: /.. m���> .
c�
..
as a Modification to the "-del.of Condition issued in File 24 - jDtf dated AlZand
recorded in Book# and page
Issued by the NORTH ANDOY R CONSERVATION COMMISSION:
On this of_` e?c _before me personally appeared Scott,Masse to
day ontWyr
known to be the person described in and who executed the foregoing instrument and
acknowledged that he/she executed the same as his/her free act and deed.r
Notary Public My Cdnmission Expires
A receipt from the Lawrence Registry of Deeds must be submitted to this office showing
that this Modification has been recorded and referenced to the book and page numbers.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
NORTiy
Town of
0
No. �Q
O Ly LAK . dover, Mass., 3
COC HICHEwICK y1'
ORATED ? C7
7 U BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
C 0 TO (.1
BUILDING INSPECTOR.
THIS CERTIFIES THAT ... !�r!.....�.... ........ .4.,�A�. ! .. ...... ... .q.!4..3
Foundation
I � • N •
has permission to erect..... .. p1 ............. buildings on ....... ....... .....5............................................. Rough
to be occupied as C5 O N e •N �O ` Q• ro ��'1 0 AP !-t Chimney
............ ....................................... ....... ...................0............................. ........................................ y
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, iteration and Construction of
Buildings in the Town of North Andover. 10*7 -b / p dt PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final .
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRU O ELECTRICAL INSPECTOR
� Rough
. ..... ..... ......................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Y
Location
No. �7 Date
MooT:�h TOWN OF NORTH ANDOVER
3: i. ••OCL
Certificate of Occupancy $
��s' •E<� Building/Frame Permit Fee $
^C MUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL
A
Check # ��
17881 7,7
.Building Inspe,11(Ir
4
1
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r .: �.� '� _ ¢ § fps ,ti., - •x
BUILDING PERMIT NUMBER. DATE ISSUED: 's O X
SIGNATURE:
Building Commissioner/I for of Buildin2 Date Z
SECTION 1-SITE INFORMATION IO
1.1 Pr erty Address: 1.2 Assessors Map and Parcel Number:
iallo� 1210 0 10c7
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Reqfired Provided Required Provided
J_
v
1.7 Water SupplyM.G.L.C40.' t54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private ❑ v Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORMDAGENT !S OCICDistrict: Yes O rn
2.1 Owner of Record
Name(Print) /Address for Service:
Sig ature Telephone
2.2 Owner of Record:
Name Print Address for Service: O
Z
rn
Signature Tele hone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
/�j[J l� '' G O
Licensed Construction Supervisor. V�ROO I�n� C1 / /
P.O.Box 637 License Number
NorReading MA on
Adak fh 0186.4 ���5—
y��_41 Eviration Date �
Signature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑ v
Company Name Duval Roofing ! rn
ti
i
Regstraon Number
P.O.Box 637 r
Address Noft ea ll1g,MA
' U l tl�9 / Expiration Date (Z ^�
Si ature Telephone G
.°'a°"°' 3cx'4,+x �+C. »z ca•�z �Irr,y �,' �+:;� �C4�`�' rar » t°.u. , .s :._:,;� ,�......,.,,
PY a t�
0��� Page No. of Pages
proposal Builders License # 58443
Home Construction Reg. # 109288
Certa i nTeed/Certifi cation # 1911
DuvalAWL
GAF Certified Master Elite
THE Roofin
P\0DFI G g
COLLLECTIO (781) 944-1994 (978) 664-5557
CertainTeed C'1 "The Areas Oldest Roofing Company"
P.O. Box 637, North Reading, MA 01864
PROPO TT �^ /
STREET //n�� „ ATE/® /�
f 3 00.0
0..v JOB NAMEV ��G//
CITY,STAT AI D ZIP CO T JOB LOCATION
/i over
We hereby submit SO ificatiips and estimates for: f Recommended OptlOnal e
0o r (� �IIri,
9w qd�t f {l^ _ (Included in price) (Not included in price)
• Rip& Remove all shingle roof&job site: ❑ 1 layer ❑2 layers ❑3 layers or more
• Repair/or Replace any roof decking; not to exceed 50sq.ft. / i
• Install 8”aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill, white or brown ( Gi0.,u
• Install ICE&WATER underlayment along horizontal eaves, valleys, sidewalls and sky-lights&chimneys
• Install 30#felt underlayment between roof deck and roofing shingles -
• Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year
1r Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles _
0 40 year ❑50 year
❑60 year ❑Lifetime
e
See manufacturer warranty policy for more details
Install new aluminum vent-pipe flange (s)
✓ Chimney(s)-counter-flash and re-step existing flashing
❑Cut& Install new lead flashing
Ridge-vent/exhaust vent with low profile design,hidden by shingle caps
' ❑Soffit-ventilation 0 Roof louver-vents
• Seamless style aluminum gutters-custom fabricated at job site
_ ❑downspouts, ❑aluminum leaf guards__
NORTH
Town oItf
Andover
No. J?7
C% LA 6dover, Mass., 1-4. 5tote
COC
MIC NE WICK
7,9 RATED P"'
H BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT............................................. ........................................ .............................. ........ Foundation
has permission to erect......................................19'Ouildings on...013........ 0.40&*0.0.1-00-a.......... Rough
0
to be occupied as I ....... Chimney
I n Final
-ihis.per.... "'*F**""*'**"**""*"*"*"***'*...... .......***'****'***......
provided that the person accepting this sha in every respect conform to the terms of the applica*ti*o'*n*'*o***n**file'*i"
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
,Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCMON $ ELECTRICAL INSPECTOR
Rough
........................................................ Service
XV5X... ...............................
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
nal
RDisplay in a Conspicuous Place on the Premises — Do Not Remove Fi
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensedon Insurance Aifidsvit
Name Please Print
Name:
Location:
City Phone #
I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
I am an employer providing workers'compensation for my employees working on this job.
CompaMt nam2: 00
Address
Insum.Co.
pal it �U 73o1c S S�
Comoanv name:
Address
City: Phone#
Insu[ance Co. Policy#
Failure to secure coverage ar required under section 23A or MOL 132 can lead to the Imposition
and/or one years'Imdl
prisonment.as_WeU.as_d� .panamesin Am lro m J&A.STOP YOW ORDER ands fins of.($1II0.Cq_aAW apairnt me. IOD
understand that a copy of this statement may be forwarded to the Office Of Invsstigsdons of the DIA for coverage verification.
I do hereby certfy underA Ins and penalties of pedury that the Informeam provided above is arae and consct.
SignatureDate
Print name Phots ft ro Ff-Ps S
Official use only do not write in this area to be completed by city or town offidaf
Cfty or Town P ensi
ng
[]Check i*Immediate response is required
Building Dept
❑ Licensing Board
p Selectman's Office
Contact person: Phone#k 0 Health Department
I] Other
t
NOTICE z W NOTICE
N F
n
TO TO
V >
a
EMPLOYEES EMPLOYEES
0,9M '41-
The
gThe Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that.
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
ONE TOWER SQUARE
HARTFORD CT 06183
ADDRESS OF INSURANCE COMPANY
(7PJUB-73OK535-4-04) 02-17-04 TO 02-17-05
POLICY NUMBER EFFECTIVE DATES
m—
ARGEROS INS AGCY INC 360 MAIN STREET
READING MA 01867
NAME OF INSURANCE AGENT ADDRESS PHONE#
a� DUVAL, KENNETH P DBA 184 PARK STREET
DUVAL ROOFING
NORTH READING
MA 018G4
EMPLOYER ADDRESS
a,
m
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
^
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
006208 W20P1G02 TO BE POSTED BY EMPLOYER
r pp DD 9
92e T�anvnzo�t�tre��i o�'/favx�/uevella
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 058443 I
Birthdate: 12/10/1966 i
Expires: 12/10/2005 Tr.no: 10052
Restricted: 00
4NETH P DUVAL
BOX 190/72 NORTH-ST
EADING, MA 01864
Administrator
✓�ie 'C�o�ninzo�araP�.U.�L o�✓liLaddacsuiOP.l�`6
ri
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 109288
Expiration: 4/9/2006
Type: DBA
DUVAL ROOFING:4
Kenneth Duval
72 NORTH ST _.. �✓
N.READING,MA 01864 Administrator
7SEP
� Commonwealth of Massachusetts
City/Town of 2008
System Pumping Record TOWN OD HAND ER
LTPREAA
g` Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System Location-
forms on the
computer,use
only the tab key Address
to move your
cursor-do not Citylrown State Zip Code
use the return
key. 2. System Owner:
Name
IL 1 Address(if different from location)
Cityrrawn State}� \3—J 1Gr ZiZi oCode
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) '®r-ge—ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. system Pu By: I
Name vehicle License Number
Company
7. Location a contenySwernosed:
Signatureer Date
t5form4.doc^06/03 System Pumping Record^Page 1 of 1
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FRAMING CONNECTOR GE�,TWFFN RinGF GFAM:
RIL?GF GRAM & RAFTF-I:S. -- -__-_ 2 - 1 3/ 4" X 14" MICRLOLA.M LVL - ---_-_._-_
5/ 8" CbX PLYWOOD - -- --
ROOI' 5HF-ATHING PROVIDE "CLOSURE WALL":
2X10RAFTl<R5 2X4AT16"O.C.
AT 16" O.C. 1/ 2" CPX PLYWOOP 5HFATHING
GULPING VV AP
5bING TO MATCH FXI5TING
TYPICAL I;AVF5 PF-TAIL:
FASCIA & SOFFIT TO MATCH rXI51ING R-30C FIGFRGLA5 SKYLIGHT
CONTINUOUS SOFFIT VF-NT IN5ULAT1ON
POUGLF TOP PLAT; I
METAL DRIP t�t2GF II 2 X 6 AT 16" O.C. TMATCH IXISTING
ICF/ WAT1;R SHIFLI�
FAL5e RAFTER
-ti U5F FRAMING CONNECTOR
4 X 4 WOOD _I FOR P.AFT�R TO PLATT; FA5TI;NING
AT t;ACH FNI2 I I t2OUGLF 2 X 8 HFAPF-R.
RII2GI; GI;AM. CONT1NUOU5 ALL 51I2F5.
TYPICAL I;XTF-0O�WALL: I I PF-AM: 2 - 1 3/ 4" X 9 1/ 2"
51PIN6 rO MArCH F-4511NG 1/ 2" GWG ON II MICROLAM LVL
PUILPING WP.AP I X 3 STI'.APPING
I/2" Cnx PL.YWoot7 SNrATHlN6 I I SCREENING 4 X 4 W0012 POST
2 X4 Ar J6" O.C.
lR-13 r-IC3 P(AL.A5 IN5ULA-nON WOOD WINNOW SILL I
POLY vAi'o�C3A1?I?IE1? GALVANiZFb POST ANCHOR
1/21' 6VO 4" CONCRFTF SLAG I I
"POLY" VAPOR GARRIrR I I PROVln1✓ "THERMAL GR�AK"
I GFTVI-FN FOUNDATION
FINii(dLLC `�!�J'� r' ti & SLAG,
�• ,/}'• 1•� jj
2SLAG SPAT"
8" COMPACTI;n
" RIGib FOAM INSULATION
Z GP.ANULAR 13A5 -
POUR P CONCP.r--T1;
,:.• �'� FOOTING & FOUNPATIO �
2 # E: - - - -
TOP & GOT.
14- - - -
0
NE-L-1:9 CONFIRM--.,/ PLAN5 FOP
AI2FQUATI; SOIL
GEARING CAPACITY A /MOR IGZ L L P151P�Ncc
44� Po5foN 5TP\��f
NoPTH ANPOM Ah
5c&L d/4" - P-0" PAS: 6/221 03