Loading...
HomeMy WebLinkAboutMiscellaneous - 50 KEYES WAY 4/30/2018 i Q _� '�� No 9608 Date AbIz .aln TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSA Hu This certifies that . . .t ` . . . . �. `� . . . . . . . . . . . . . . . . e.r,, VI Jt'A has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u plumbing in the bIildings of . . `��`� "'. . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . .. N rth ndov ass. Fee. �P .Lic. NoJ' 1 ! .!�!. . . . . " . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' ^�GLn CITY .__ �/', i� - '_ MA DATE. _C' _/z - - PERMIT# JOBSITE ADDRESS Q OWNER'S NAME �jo,<t_le POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Q RESIDENTIAL 0� PRINT �/ CLEARLY NEW:[❑ RENOVATION:Q REPLACEMENT:E3 PLANS SUBMITTED: YES Q NO -_; FIXTURES Z FLOOR BSM 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) - I_ KITCHEN SINK LAVATORY ROOF DRAIN r— SHOWER STALL SERVICE I MOP SINK TOILET _ . r URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING F=F77i OTHER INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO Q IF YOU CHECKED YES,PLEASE INDICATE TH E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY __ OTHER TYPE OF INDEMNITYE] BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in c2n-10ai ce, neat ptpvision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# _L i i NATURE MPQ/JPQ CORPORATION Q# PARTNERSHIP Q# LLCQ#C COMPANY NAME ADDRESS Ve �_ P(..,:) l . _ S �1 to N 1. CITY rBQ'Ab -©- STATE ZIP I Q�gs TELF_q _ �' FAX CELL . MAIL 1 r The Commonwealth ofMassachusells Print Form i Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Roberto Flaiani P.H.D Address: 15 Dorian Drive City/State/Zip: Bradford,MAD1835 phone 4: 978.556-5617 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' comp.' t.. 9. ❑Building addition insurance. [No workers comp.insurance p 10.El re required.] 5. F! We are a corporation and its pairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[]Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:Macdonald&Pangione Insurance Policy#or Self-ins.Lic.#: 08 WEC VT7745 Expiration Date: Job Site Address: 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 MGI,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 certi under the !ins and enalties?Le ffjug that the in ormation provided above is true and correct. Silure: -- ._ ---------- __- _...._--____-_---. _-._.___._.. _- ---_.----.-_-.-Date`.._.__.. _. __.__.._ .... Phone#: 978-556-5617 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r i 1 fr j� 1° COMMONWEALTH OF MASSfiCHUSETTSl y 6 i } . LICENSED ASA MASTER PLU BER ': . . ISSUES THE ABOVE LICENSE TO r ROB'ERTO: FLAIANI 15 ,DORIAN DR BRADFORD MA 01835=8503 `I r 13471 05/01/14142654 -.. i r 1 i . r COMMONWEALTH OF MASSACHUSETTS' noym LICENSED AS A MASTER PLUMBER. ` ISSUES THE ABOVE LICENSE TOi i ROBERTO FLAIANI j 15 ,DORIAN DR BRADFORD MA 01835-8503 ' . 13471 05/01/14 1426.54 l r CONTROL H 3 3 8 8 0 6 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws a'amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. i I 9 CONTROL# H 3 3 8 8 0 6 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of,correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. i I 1 Date • .�LTcb 1' • TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .�- has permission for gas installation . in the buildings of. ��. )P� L.. . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . at . . . . . . N rth Andove ass. Fee -1� . . . . Li c. No.l?5`f1.1. . . . . . . GASINSPECTOR Check# 8350 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MA DATE 2 CITY PERMIT# JOBSITE ADDRESS,-. .:OWNER'S NAME GOWNER ADDRESS _'TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL' EDUCATIONAL T RESIDENTIAL,1�14` PRM CLEARLY NEW: RENOVATION: REPLACEMENT: NO PLANS SUBMITTED: YES i. --4 I APPLIANCES I FLOORS— asm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOIATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER LINVENTED ROOM HEATER 4r WATER HEATER J OTHERz. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES _6 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND ! OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true ande to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application YAII be in cornian .Tf a1 Pertinent Trovi§ion of the la)mth v Massachusetts State Plumbing Code and Chapter 142 of the General Laws. LICENSE#)j3y7j PLUMBER SFITTER NAME' LA�qN i SIGNATURE JGF PARTNERSHIP LLC' MGF LPG[ ION MP MGF JP CORPORATION COMPANY NAME -C'. .3ADDRESS'..17S CITY STATEN ZIP ,,TEL' FAX ICELUC ,_17�57��EMAIL' A r\1 1161 1 -C, T'he Commonwealth of Massachusells Ott f c�rrr a In Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 T www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electeicians/Plumbers Applicant Information Please Print Legibly Hanle(Business/Organization/Individual): Roberto Flaiani P.HD Address_ 15 Dorian Drive City/State/Zip: Bradford, MA 01835 Phone#::978-556-5617 Are you an employer?Check the appropriate box: 4. I general contractor and I Type of project(required): 1.❑✓ I am a employer with am a g 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurancerequired.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Macdonald&Pangione Insurance Policy#or Self-ins.Lic.#: 08 WEC VT7745 Expiration Date: Job Site Address: 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 cerci under the ains and enalties ef u that the i!formation provided above is true and correct 71 Signature: __..._ ,__ ___ _._. _--_ . _. .__ _______ _. .._._ _ Date Phone#: 978-556-5617 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Yil I i � r /r /r i 'e r COMMONWEALTH OF MASSACHUSET $' -� C. P B A LICENSED ASA MASTER PLUMBER ISSUES THE ABOVE LICENSE TO y : ROB'ERTO. FLAIANI jaj1 f . kid 15 .,DORIAN DR �. t, BRADFORD MA 018358503 : 13471 05/01/14 , 142654 t r a ' c, • ../ ® p('� .. - CONTROL� i 4fig 338806 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Prof+ ional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify ' g y your board of,correct name or address to.insure proper mailing of next 'Renewal Application. Always refer to your License number. This license is subject to the provisions of the General Laws as'amended.it is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. i I O � niH 4 h •, •e .:., Town of NORTH ANDOVER 0 BUILDING PERMIT INSPECTION REPORT ISSUE PERMIT NO.: PROJECT: 5isy �T4" 3 S4 a fe� IS J ATE: O � UNIT NO.: FLOOR: WING: BUILDING NO.: REMARKS: Excavation-depth and soil conditions Framing- Other: Date: 4—S— (9f Date: Date: Inspector oAA (&� Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: 4- (01 d) Date: Date: Inspector 'jrm / ( Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector C` ire Dept- il burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspector Form#995 Action Press,685-7000 I Town of North Andover HORTM OFFICE OF 3?oy' 1�O0 COMMUNITY DEVELOPMENT AND SERVICES p * s 27 Charles Street AL �o North Andover, Massachusetts 01845 �9ssncFHuS���� WILLIAIM J. SCOTT Director (978)688-9531 Fax(978)688-9542 CHIMNEY APPLICATION AND PERMIT DATE . PERMIT # / LOCATION LDL Lk t i a OWNER'S NAME dot BUILDER'S NAME MASON'S NAME_Q O N-DY �(xor-: MASON'S ADDRESS MASON'S TELEPHONE (pn-2, ' MATERIAL OF CHIMNEY lr k ` (j\()C V- ! �L v, INTERIOR CHIMNEY EXTERIOR CHIMNEY I NUMBER AND SIZE OF FLUES__A 9 X THICKNESS OF HEARTH ( `I Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE SIGNATURE OF MASON !&6„I.A,4 cp U)rj\-¢i,- CONTR. LIC. # 3 EST. CONSTRUCTION COS /CONT CT PRICE PERMIT GRANTED FEE c;2 v ROBERT NICETTA, BUILDING �NSPECTOR- INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Locations No. DateG� MORT� TOWN OF NORTH ANDOVER Of tt`•e ,•,h•0 3: i • O i Certificate of Occupancy $ JA�N�S<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee 641 $ TOTAL $ Check # 3 9Z �' r 4 ' " 4 Building Inspector Sent bj G fj 1 C' .0 f 1 7 iC 47 5 4 e OF WCH Ji ca S KEYES WAD+ gat m7 e LOT 4 E4L'V..=15,7,ol FG UNOA T,10,V EA SEMEN T lu, 6-0 jew C/cc' FOUNDATION LOCATION PLAN rrummur simxruw Shoo* cowofts M amm Awwmwn or fw 'w,' --L4&&* or= "jQV 0oMpMX= OY WENT- JAMES CARROLL OM Wl 00"MY AW OrWR AS Wyb"la% LAM&fAXW0nX THIS CAMYXArlom fS MADE AND LJUITED 040M OF CQMXMW�EM) ftl1 70 THE ABOVE CUEW, 17"""W "U Wr at 4OW dy rAf aMNT a*ANY POMM 07MM MMM MAT OLrF4#"AAVvCUM-T MW YrK ww"EN PDAMM Of Gnmavalm & saw W� L OCA 17ON: SMSM STREET L 0 7 4 fumcbffir rAw mwAw 4 rK owrowmn� rami-Y Or CHMT?UXWN# SM W- A&ANY UMAUrMaQ= Ur NORM ANDOVER, MA 12 AftWM=CMW4waM &sum r#xa w MMVMSMK/M 'cat rAf UMW""M W Or rOM 2%W#X OR ANY WFW- MMM CMrAMV UMtft SCALE; 1 60' DAM. JUNE 14, 2001 PROFrsscft#L Dowiva CHRISTUNSEM &SERGI Udo $U#47M too awro sr. 0:8m TFL .670-47i-mo or awnsn"Am &Sim &a DRAWING No. 00003o1e ORT#i Town o ....W. 4 , dover 0 'A No. '1 / 9 / LAKE O\ dover, Mass., COCHICHE WICK V� RATED P`P�t�S ACHUS FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ...APAW.....ANA' ......,'R #// d� has permission to excavate and pour foundation at .. . Q.. I1p"Y.T.4..... for the purpose of..1Q., 001 t.a s.13AA0.;a.,1s„� �I.. r....smst%....*R(Pa 1 4rV(4L The person accepting this permit must return to the office of the Building Inspector a certified plot plan show B of building thereon before Foundation will be inspected. M 16 ' leaf eO, VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ....... ............ ................................................... BUILDING INSPECTOR Location 1r�fl 1T l'y�S No. 191 Date MORTh TOWN OF NORTH ANDOVER 0 F 9 4 Certificate of Occupancy $ Building/Frame Permit Fee $ s sACNUs Foundation Permit Fee $ n Other Permit Fee $ TOTAL $ �S Check # 3� 1016 IRA Q ✓ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED:/Zz ^„U C SIGNATURE: ic BuildingJ� Commissioner/I Ctor of Buildings Date SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: sf'N�e t;jA�Y e J �� \ Map Number Parcel Number J J 1.3 Zoning Information: 1.4 Property Dimensions: ZWtng Efistrict Proposed Use Lot Arei(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supph,M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public -X Private 0 Zone Outside Flood Zone Municipal i8( On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) V Address for Service: Q� Signatu n, Telephone 2.2 Owner of Record: \ i �- Name Print Address for Service: M Sienature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: I C� �1 12" ` '1 n&UY e.C f t U( G' (, License Number// C Address (f � ( S V Expiration Date Signature Telephone 7 1 i 012 j 3.2 Registered Home Improvement Contractor Not Applicable ❑ Compare Name Registration Number Address _ Expiration Date Siznature Telephone ff N 0-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result ial of the issuance of the building permit. Signed atlidavit Attached Yes....... No.......0 SECTION 5 Description of Proposed Work check all applicable) New Constntction Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Outer ❑ Specify Brief Description of Proposed Work: l ON.S7,rvwc-T 7�t/0 Woo C) H00;;r W/TH AP, GARP SECTION 6- ESTIMATED CONSTRUCTION COSTS Item Estunated Cost(Dollar)to be OFFICIAL USE ONLY Completed bypen-nit applicant 1. Building 171 UUQ (a) &tilding Permit Fee So Multiplier Electrical (b) Estnnated Total Cost of 0V 0.- Constr=6011 3a� l C ? Plumbine y oda.- Building Pennit fee(.l X (n) r 1 Mechanical(HVAC) 5 Fire Protection U 0 0, 6 Total (1+2+3+4+5) �L/ 0 0 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner/Authorized Agent of subject propend iiereh. authorize to act on behalf. in all matters relative to work authorized by this building Pennit application. �Iemattlre of O%%iier Late SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION — ,as Owner/Authorized Agent of subject proper' Hereh% declare that the statements and information on the foregoing application are true mid accurate, to the best of 111v knowledge and belief N�- Ari doverR'e-dy r , Crtes A ` dcr-ol! Print Nal} /J/ -- � ���;cum. ' S/7/O;r Steltature of O"iier/A ent Date T—� ` NO. OF STORIES a SIZE { y( qp BASEMENT OR SLAB 7 em ea — SIZE OF FLOOR TIIvMERS l la 2 x Ia 3RD x /0 S RkN DIN-iENSIONS OF SILLS x DIINgNSIONS OF POSTS x Dr\IENSIONS OF GIRDERS G X /U HEIGHT OF FOUNDATION THICKNESS jp " SIZE.OF FOOTING X ..IATERJ,kL OF CHRviNEY L3 / k IS BIJU,DING ON SOLID OR FILLED LAND Sow IS BUILDNG CONNECTED TO NATURAL GAS LINE PS r / Building Value Calculation - for Property at..... LOT#4 �I r� _� � qxS' .,5- i4•.'�'�, @! � ,Yrs �L � 'Y� i_k Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 25 16 400.00 65 $ 26,000.00 Brkfstnook 15 7 105.00 65 $ 6,825.00 Dining Room 16 16 256.00 65 $ 16,640.00 Family Room 24 16 384.00 65 $ 24,960.00 Study 17 16 272.00 65 $ 17,680.00 Living room 24 16 384.00 65 $ 24,960.00 Garage 39.5 23.5 928.25 35 $ 32,488.75 Entry 14 16 224.00 65 $ 14,560.00 2nd floor foyer 16 14 224.00 65 $ 14,560.00 Sunroom 16 12 192.00 65 $ 12,480.00 mudroom - 65 $ - Walkin closet 16 12 192.00 65 $ 12,480.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 11 6.5 71.50 65 $ 4,647.50 Bedroom 1 26 16 416.00 65 $ 27,040.00 Bedroom 2 17 16 272.00 65 $ 17,680.00 Bedroom 3 20 16 320.00 65 $ 20,800.00 Bedroom 4 20 16 320.00 65 $ 20,800.00 Bedroom 5 - 65 $ - Bathroom 1 9 7 63.00 65 $ 4,095.00 Bathroom 2 16.5 15 247.50 65 $ 16,087.50 Bathroom 3 15 8.5 127.50 65 $ 8,287.50 Bathroom 4 7 9 63.00 65 $ 4,095.00 Bathroom 5 - 65 $ - , � 1 GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. /A/,h��id�ayel-AedJt� C���. Z6�t fey Ps i�l,�y 6S ,V Permit Applicant Property address Map/Parcel G �G- 77-:2- Applicant's 7aApplicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understandthat my interpretation ofthe exemption status is subjeetto review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 ofthe North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more ofthe following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as ofthe effective date ofthis bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 ofthe Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all ofthe conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy ofthe units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes ofthis section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 410 permanent reduction in density(buildable lots)below the density permitted[under zoning and feasible given the environmental conditions ofthe tract,with the surplus land equal to at least tet buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction.dedication to the Town,or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent r parcel on the effective date ofthis Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETER-MINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED a BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXENLPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS GRS R REFUSE BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION /? FROM CHARLIE CARROLL PHONE NO. 941 261 7353 Mar. 22 2001 12:11PM P6 BUILDING DBPAF,7 MN7 DEBRIS DISPOSAL FORK! In accordance with the provisions otmry 'c'40 S 54,a condition of Building Permit number Is that the debris rest tdng form.this work sb4 be disposed of Lia properly U=nse d solid wase disposal facility as defined by MGL c 11,S 150A " The debris wig be disposed of iia: CJ UM `j'r fti — W4S" r !� �GEf�9Ec� L•f 1 rY`7 nl�rV R+� S''i';=;�ivisna Location of Facility Siguattue of?5rrr it AppUcant Y. �.. Date NOTE; Demolition permit from the Towa of North Andover mus be obtained for this project,through the Office of the Building Dmpt etar M i The Commonwealth of Massac,,usi is Department of IndustriaG.�ccrdents GF, of Investigations =— Boston, Mass. 02 111 Werker.3' Compensation Insurance A',idavit Fle_sz Faint 'C _ Phone T I am a hcrnecwr.er performing all work myself. am a sole proprietor and have no one wcrkine in any capac:iy am an emolever Providing workers' compensation fcr my employees working on is job. �anv name: - �'�- 17V1�00,✓L-K �ti��}SS. Fhcne1' �S`e . 77 V Co. C`G`��D l�s✓RR�/<'r' GR �'h Pclicv T /WW C r U �,I I G i -:r.cane name' Phone Wince Cc. F�lic� T secure -verge as recuiree urger Sec-.:en Z°.A or iMGL 15_can lead to the imccsition er cnmiral penalties cf a Fine up to si.°Co.co _Fieears'jrrcrscrr-.e.n.t as•.veal as c:vii penalties in Uhe norm(:-,-a STCP'NCRK CRCER and a rine cf(S',00-00) a day Z53inst me. i _. cer<_:are that a ctcy d;tips staterrert Tay to fcrNarceC to the Office cr Invesugaucns of:he GIA,cr ccverare veriricatien. -ere:y c_rry un =r rhe ins and,-enalt;es of p ry that 'he innt rmaticn prev ded accve is.,! and ccrrec:. -a re nate -ame 1t c� r PSFhcne co not write in this area to to ccmcleted ty c::y cr xwn c';cia P=rmit/Uc2nsirc Ct Euddirg Geer -1:<., rrr^eciare reszv. !se is required Ej L'c:.nslnC Ecard Sa!ecrman's "r,`rc- °hcr^e f-'e�ltit GeN2rt,nc^r Ot,�er FORM - U - LOTRELEASE .WORM 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. t■■■■■mr■mot■■■■■■■r■■■■■■r■t■■■amp■s�■■rri■r■r■■.■rr■■■■■■■rr■■■rr■women■■■r■r r■• APPLICANT MwA At - R ctl.t q Cy r[i PHONE 7�b My`7-70 f ASSESSORS MAP NUMBER �ys LOT NUMBER t S��C�'ctar ' u SUBDIVISION I '� LOTNUMBER I STREET i\e- SA y STREET NUMBER SO �■■■rr■■■■■■■■■r■ ■■r■■■r■■■■■■■r■Osman son■■■■■r■■■■rr■■r■■■■■■■■■■r■■■■■■■■ OFFICIAL USE ONLY $■■■■■■■■■■■was now■■■■■■■■■■mass r■■man■man■r■■■■■■■■r■'■■■■■■■■■■■■■■■.■■■■■■■ . RECOMMENDATIONS OF TOWN AGENTS I■ss.r..r- ■P■■■/was WON wows■■r■■rr■was■■rrr■rrr■r■Wasson■rrrr■r■r70own.. ■■■■■■■s DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMvEN'IS �� D ?' DATE APPROVED P DATE REJECTED CO DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED CONRv[E-NTS f� PUBLIC WORKS—SEWER/WATER CONNECTIONS —O DRIVEWAY PERMIT 6we _p I hQ DATE APPROVED FIRE DEPAR DATE REJECTED CO O ENTS RECEIVED BY BUILDING INSPECTOR DATE t REQUIREMENTS FOR FORM U SIGNOFFS BY BOARD OF HEALTH To be filled out by the Wlicant and submitted with the Form U 1. What is the proposed project? Deck pool addition ew house other 2. Are plans attached? Yes No (For additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3.. Is municipal sewer available at this location? No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes �o 5. Is the location served by private well? Yes 6. If this project is an addition and the house is served by a septic system,has there been a Title 5 inspection done recentlythe tics stem? on e se P Y Yes No 7. If,yes, is the inspection report on file at the BOH? Yes No i I i i i f s- 1 7 If _ - ��� �ommanu���fi o�v�ltxzsaC�irrsellif i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 063503 Birthdate: 07/19/1965 Expires:07/19/2001 Tr.no: 2852 Restricted To: 00 ' I JAMES V CARROLL 12 PIPERS GLEN L.•E r� / .-I ANDOVER, MA 01810 Administrator t t z I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I I Checked by/Date I I I TITLE: PLAN NO 29421 CITY: Reading STATE: Massachusetts HDD: 6573 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-22-2001 DATE OF PLANS: 6-27-00 PROJECT INFORMATION: ADDITION TO EXISTING HOUSE FAMILY ROOM COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER. MA 01845 COMPLIANCE: Passes Maximum UA = 52 Your Home = 48 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ---------------- --------------- ------------------------------- -- CEILINGS391 30.0 0.0 i4 WALLS: Wood Frame, 16" O.C. 320 19.0 0.0 19 GLAZING: Windows or Doors 42 0.350 15 ______ ____ ---- ----------------------------- COMPLIANCE STATEMENT: The proposed g ro osed buildin design described here is s consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet- the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the esign load as specified in Sections 780CMR 1310 and J4.4. �J Builder/Designer ___ Dates` ��/ joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ) I Rated output capacity of the heating/cooling-system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. 1 1 SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in. ) : I I PIPE SIZES (in. ) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I I CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hotwater pipes to the following levels (in. ) : I I PIPE SIZES (in. ) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 I 1.0 1.5 2.0 1 140-160 0.5 I 0.5 1.0 1.5 1 100-130 0.5 1 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- i 1067 APPLICATION FOR`;WATER SERVICE CONNECTION {_. -ago North Andover, Massa Application by the undersigned is hereby made to connect with the town water main in Street, . subject to the rules and regulations of the Division of Public Works. The premises are known as No. '-'" Street or sub 1ivision lot no. 77 `fes f Owner w_ ,. .Address - i Contractor . d ress [\`' p Iicant's Signature l� �lwo PERMIT TO CONNECT WITH WATER, MAIN - The Board of Public Works hereby grants permission to` � h �� �. to make a connection with the water main at {' Street subject to the-rules and regulations of the:Divis on,of Public Works. i Board of Public Works i By— Inspected Inspected by Date i See.back for rules and regulations s i J O 1667 I APPLICATION FOR SEWER SERVICE CONNECTION I _ North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in Street, i subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street or subdivision lot no. Owner Address Contractor A ress I r pp icant's Signature 1 I ' R PERMIT TO CONNECT WITH SEWER MAI ` The Division of Public Works hereby grants permission to .� l � to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works :� 67 Y B /L tel/ �- V V Inspected by Date See back for rules and regulations O DPW 347 Date ....fes..-1— .....5-1-0/ NORtN TOWN OF NORTH ANDOVER RECEIPT tgS�CHU This certifies that.... r 1. .......4C.. has paid..........*................. .......... ............... .. .... ... for....... Receivedby....................... ........................... Department.....................—RL ......k4 14--s........................ WHITE: Applicant CANARY:Department PINK:Treasurer ORTH Town o 4,.... ,o Andover. p No. - A No, ndover, Mass.,LAKE ADCOC Mi C KE WICK RATED P'P�,`�� 7SSACHUSE IT FOR EXCAVATION AND FOUNDATION ��A THIS CERTIFIES THAT ...APIC9 �4d .....AN..�.................... .... ./ �. --.. ...... 'jJ11 ............... has permission to excavate and pour foundation at ..x49 3...... for the purpose of..l DOrn�.S .! A'11��.3.. SII.. �t.r....S1 /1��.�.!�i...."12 rV�*W The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. 16S P 14 4 l c O, � VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. C ' 6W.00 .................................... BUILDING INSPECTOR NORTH _ Town ® �� 4Andover + O .Y.sr L'•4• ^� No. ° E o dover, Mass., �J COC MICMEwICK V '7 RATED PPS` "`C, '9S � BOARD OF HEALTH Food/Kitchen Septic System PERMIT T DN� � � BUILDING INSPECTOR it yr THIS CERTIFIES THAT.... ........................ ............ V ............... .... ........ ...................... Foundation f S/ has permission to erect.............. ...................... buildings on . ............................... Ar. .. 's...... y Rough Chimney to be occupied as �� ��S /I...� r.. I V I ...................................... htmn 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, Alteration and Construction of Buildings in the Town of North Andover. M ` C P 1 4 4004QTo PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. R°"�' Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. ry Smoke Det. SEE REVERSE SIDE II Location No. _ / /� Date NORTN TOWN OF NORTH ANDOVER F 9 rrJ Certificate of Occupancy $ ss CMUs Eta Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check #� 4 _ 5 :1 Building Inspector i --- __ - -- — - - - - --— - -j {iORTy 71T6! TI'Y4FJ 4SS4CteU5k CERTIFICATE OF USE & OCCUPANCY 'OWN OF NORTH ANDOVER Building Permit Number /(/1 / Date 6 1) THIS CERTIFIES THAT THE BUILDING LOCATED ON S �` `� '' /C y S t,(),4 MAYBE OCCUPIED AS 5 //: y l� f 1/�lyIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /0/0-00Ai 15 /a /3 .4 M s � 3 DS dI/ UD�IZ CERTIFICATE ISSUED TOCZU a-e2 A2e d /6 C 'Z' , )oo a-o e,4 ,eK J�c� Building Inspector NORTH Town of over 0 No. ;+ L A E o dover, Mass., COCMICMEWICK V RATED PP�t-`C5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 0�A • Foundation has permission to erect.............. ...................... buildings on .� �� a'3 m............_......................... ....... .. ............. �Zm�'4��nzel4y" / i to be occupied as � P"" 3z S i3AY% l 4� � � !�h V rs1O'0te.9 � C p ............. ............................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final/m/1` 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. ` P 1 4 400Q -Te s PLUMBt�SPECTO VIOLATION of the Zoning or Building Regulations Voids this Permit. ��` �` PERMIT EXPIRES IN 6 MONTHS 1 y 1 UNLESS CONSTRUCTION STARTS ECTRICAL SP✓/y1F/!e o -� IL . Q .. . . .. ....... ................. ....... BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove , No Lathing or Dry Wall To Be Done FIRED TMENT j Until Inspected and Approved by the Building Inspector. Burner G Street No. SEE REVERSE SIDE Smoke Det. t Town of North Andover o� NORTH q� tLe° '6 Building Department "'.'6 0 27 Charles Street 0 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ' ' y � � T O COC ILN♦WKw 1' SSACMUSttt� APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ADDRESS LOT NUMBER SUBDIVISION 3C. (16 DATE REQUEST FILED 17 DATE READY FOR INSPECTION 1,.0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE f OFFICM USE ONLY ROUTING CON kgWnd DATE aa5hL PL TE_ o� D.P.W. -WATER METER 1 TE - 2S -0-Z D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRION INSPECTION REQUEST DATE. SIGNATuREApwtAuTHORIZATION