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HomeMy WebLinkAboutMiscellaneous - 50 WILLOW RIDGE ROAD 4/30/2018 (2)Location l/�/�r� " i c/ A No. ! 7� Date �oRTM TOWN OF NORTH ANDOVER 00 9 • i ; ; Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ 7 swcHusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ✓ Building Inspector /g -JI- a'�4 1.1 Property Address: � o1l �f �J q 1.2 Assessors Map and Parcel % V Map Number Number: (50N Parcel Numtfcr 0- Na Q^ � 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUR DING SETBACKS ft Front Yard Side Yard Rear Yard Recp#ed Provide Required —+ Provided Re red Provided 1.7 Water SopptyM.GL.C.40. 34) Public ❑ Private ❑ 1.5. Food ZZone Inf_ ion: 1.8 Zone Outside �— o�o 'Gere ❑ Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNS HIP/AUTHORIZED AGENT I!"�1.01 1c; 'IStpCt: e� 3 r,10 2.1 Owner off,�Record �- N YJtoc _ Name (Print) 2.2 Owner of Record: Name Print a 630 Address for Service Address for Service: SPCTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constructio ttpervisor: Address ;�::+ Signature Telephone 3.2 Registered Home Improvement Contractor Z amd t sS a Company Name Cs ogg lkbl� - License Number 41 /©6 . Expiration Date Not Applicable ❑ Registration Number Expiration Date so M z O v n M I C14 ,1 i O z M 90 O r M r r z 0 L SECTION 4 - WORKERS COMPENSATION (M.G.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 buildipg permit. Signed affidavit Attached Yes ...... No ....... 0 SECTIONS Description of Proposed Work check an a ucable New Construction ❑ Existing Building ❑ 1 Repair(s) k,4T Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief opo - jR I ' [ I CRCTION 6 - F_QTTMATFn Vn1VCTV1T1'T7nr.T rncme Item Estimated Cost (Dollar) to be Completed bpermit applicant OMCIAL USE ONLY .. 1. Building A (a) Building Permit Fee Multiplier 2 Electrical d C) 0 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4) qo, 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number A - 111V1�1� JE XWLI i W DL` T.r, I Z" W f=fN I OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 1, Z-OQIn7 o\'tm Lcm- as Own Authorized Ager f subject property Hereby declare that the statements and information on the foregoing application are LTue and accurate, to the best of my knowledge and belief F aL,), W Print Name �-- Signature of U Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' 3 RD SPAN DIMENSIONS OF SILLS DI vIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY 1S BUILDING ON SOLID OR FILLED LAND IS BUELDJNG CONNECTED TO NATURAL GAS LINE R • A W I The Commonwealth of Massachusetts Department of Industrial Accidents Off ce of /nvesdgedons Boston, Mass. 02111 - Workers' Compensation Insurance Affidavit Name Please Print Location: 46 Clty M(A)"k i rn ,�ftPhone # I am a homeowner performing all work myself. I am a sole proprietor and have no one wolidng in any capacity I am an employer providing workers! compensation for my employees working on this job. Camcrarn name: A A- Z nmA A-gS b r Q n o Address • 4-6 Add City: Phone # 1 Policv S Falbre to secure coverape ss required under section 25A or AAGL 152 can lead to the impasAlon of aiminal penaift 06 no up to $1,500.00 and/or one yeah' imprlsom�eat.as r�edl.as_c A.peoarAmInl ohm dASTOP VVDRK.oRM Rand.a.fkw Gf.($1AD.0D)_NA,y apa(ost.me 1 understand that a copy d this statement may be forwarded to the office of Investigations d the DIA for coveraps vsrificadon. I do hereby cerfflyunder the pains and perflNw or perjury that the information provA*d above Is true and correct. Print Official use only do not write in this area to be completed by city or town Adel' City or Town p si []Check d Immediate response Is requfed CI Building Dept ❑ Licensing Board Confect person: Phone # ❑ Selectman's Ofte❑ Health Department 0 Other RLC B= Uexcota.no ur Ansurauuw ..ym..-y 1100 Salem St #55 T.ynnfield, MA 01940 A&2 Associates Saw Wynn Ten 46 Nom.s;r St Malden Maes 02148 MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED RY THE POLICIES EELOW. INSURERS AFFORDING COVERAGE { NAIC # INSIsu-Ra Commerce Insurance 90MER& Mass Workers Camp Seaursu INSURER C INStlnERC: ' V SUR£R E THE POLICIES OF INSURANCE LISTED S LOW HAVE BEEN ISSUED TO THE RJSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY FiMI.KREMRNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOMAENT WITH RESPECT TO WHICH THIS CERnFICATE MAY BE I4gUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE&71?iBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED 8Y PAID C4.AIMS, pQUCY Long Lift IN TYPEOFROURANCE POUCYRAINMR 11tA7@ OATEIEMI)IM A OeMERALUASM 01/09/2004 01/09/2005 —OC--- $1000000 PRi31LSESiE30oLuenrs) s100o000 X COMMERCIAL GENERAL UAJIIUlY $ 10000 CLANS MADE L] OCCUR PERSONALSAMIUMI RY $1000000 GEIERALAIGGREGATE s2000000 08CLAGGREGATEMtAPPUESppR PRODUCTS-COMPIOPAGG $1000000 POLICY LOG AuTonoHLL£ u m1 m OLIMIJINED SINGLE LUT a ANY AUTO ej DOOII.Y IMAM ; 3 ALL OWNED AUT09 (parDm^) 9p%EULEDAUTOS e0MY INJURY a HIREDAUTOS NON MOM AUTOS (per acddeld) PROPERTY DAMAGE i (Pwwddwi GARAQTEUABLM AUTO ONLY -FAAcCMW s ... .. OTHER THAN EAACC $ ..._ . ANYAUTO AUTO MY: A40 $ E%C89mRi®tiitEl.UIWAt JTY EACITOCCt MW4CE S AOUREGATE a . OCCUR 1:1 0tAMINME E � a DS)uCTIIAE I a RETENTION s g won�smlMpevYNJNANO 04/16/2004 04/16/2005 1ToaruulTs r ELEACHACCIDENT $100000 MPLOYM LIABILITY ANYPROPRIMR.PARTNEW OEECtfiNE OF79c EXQLUDEQT E.LOWAM-EABOWYEE s500000 N pets demft whet SF'EfGALPROVIStONStelo+v e.L.aseAse•POLICY UNIT $100000 Q Dl�TSONOF OP6i0.li0rt67UX:fETfM�1V6RCtEm1E%GLUSiONSAm'Jl�i SY tTIiPROY19D31S Separate Gert ordered for holdor from Workers Comp Seaurea I L:C iiiL"-!. L: u:t.It Albert N6 50 Willow iiidge Road N Andover Ma 01845 ST =U0 ANY OF VW ADOW MtRIPM POLMIM !E CANCR-U I SEFOW rAg EMRATWN DATE TNS. = t8$ WO MINER WU ENDEAVOR TO OW DAYS VJU7M NOTICE To "a L8Rl89 W HOLDER NAMED TO THE LEM WT AMAIRE TO DO 00 WKIL saves NO 08L4ATION M UAN UTY OF ANY 9M UPON TRE INGIJA , tis AMM OR TAFRESEMM& North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 3� (Location of FLA— Signature ilit) of Pe it Applicant DfbL . Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U - LOT RELEASE FORM 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 or requirements. "APPLICANT FILLS OUT THIS SECTION APPLICANThl PHONE_ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET5-0 SO VJ c Gu) (LJg,� ST. NUMBER OFFICIAL USE ONL LRECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 Jm T o�✓�aaaaclu�eei�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR' Number: CS 081108 Birthdate: 04/25/1967 f Expires: 04/25/2006 Tr. no: 81108 y Restricted: 00 ZAW WYNN TAN 46 HOME ST MALDEN, MA 02148 Administrator ✓fxe �om�no�uura�.i a�✓�aaaac�ivae/fia Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 136996 Expiration: 9/25/2006 Type: DBA A AND Z AND ASSOCIATE$ ZAW-WYNN TAN 46 HOME ST. ZZ.__,., —moi ,� MALDEN, MA 02148 Administrator z O F=4 rr O C C E • m m� Ap 0 2 MA cm m jAzip N _mom o fl �t y C co 0 � yre _ = O cm c - fA O . Z cc`moo d CQQ Go WCO Z=.. -0t .r.. ui � .y O � c 2 � v N O • + CW.3 m p_W.1E C CO2 'a 32 CL z= Go W m a yCLS O cF. m z 0 w w a O 12 R v cm C CO2 O H O O 'E m m 0 CD CL CD 3.0 CD OIS i Cc �a O= C V CcO co C Z CD C.� CLy c C _ C— C cc y $ w a c� o o w o c4 v :� U q w x o c4 G w" x W o rs: � is, . c o m c o 04 C w" � w� 0 � cn 0 cn O F=4 rr O C C E • m m� Ap 0 2 MA cm m jAzip N _mom o fl �t y C co 0 � yre _ = O cm c - fA O . Z cc`moo d CQQ Go WCO Z=.. -0t .r.. ui � .y O � c 2 � v N O • + CW.3 m p_W.1E C CO2 'a 32 CL z= Go W m a yCLS O cF. m z 0 w w a O 12 R v cm C CO2 O H O O 'E m m 0 CD CL CD 3.0 CD OIS i Cc �a O= C V CcO co C Z CD C.� CLy c C _ C— C cc y W . c o m c c� o ` O N O a W C3 ♦: :'dam A +O+ c 10 • Y A O d 10 E.SN .O . O F=4 rr O C C E • m m� Ap 0 2 MA cm m jAzip N _mom o fl �t y C co 0 � yre _ = O cm c - fA O . Z cc`moo d CQQ Go WCO Z=.. -0t .r.. ui � .y O � c 2 � v N O • + CW.3 m p_W.1E C CO2 'a 32 CL z= Go W m a yCLS O cF. m z 0 w w a O 12 R v cm C CO2 O H O O 'E m m 0 CD CL CD 3.0 CD OIS i Cc �a O= C V CcO co C Z CD C.� CLy c C _ C— C cc y Date.../�..� TOWN OF NORTH ANDOVER PERMIT FOR WIRING s •� • SAcNUS� Thiscertifies that............................................................................................. has permission to perform . �./�/�......:..... �....... `T. � .. 4......l :................... �.... � � wiring in the building of �iXL� S L %�� ................t..:........................................................ at �6 �%�/ E Pi l l�.l orth Andover, Mass. Fee.- 2 '.:fi Lic. No r�.%��r�....... .... Check # VL ELECTRICAL INSPECTOR - 7- I L1E UUMMUIV VYPAL I11 UP' I . (JIVNEY I S' Office ✓ Use only DEPARTNLFVTOFPIIB CSAFM Permit No. I30ARDOFFIREPREVIV770 RI�UTAT70NSS27C�1�Z12 (XI Occupancy &Fees Checked APPLICATION FOR PERMIT T PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7 _ o S Town of North Andover The undersigned applies for a permit to perform the Location (Street Ow e � r Tenant Owner's Address To the Inspector of Wires: described below. Is this permit in conjunction with a building permit: Purpose of Building Yes 1:3 No F-1 (Check Appropriate Box) Utility Authorization No. _ Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 'To ks r.& 1< Q A CPU a. t. No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 1:1round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pum s . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW El Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER h%uarltreCownr-RnuantlDthet Vwrnm&dWamdusousGffwdLam IhaNea�Liabt7rtykmm=Po ymckxirgCmrtpke& Coverageorits tialepvalmlt YES ED NO Ihavestdxridedvalidproofofsmr0theOffim YES j� YycuhaNechedzdYESplewmda&thetypeofoDveWby INSURANCE M box BOND r7 OUIER [::] rewe may) Wodaostait h>SspearonDaeReWestdd Signed u nder•Tie anak rs of pmjtuy. FIRMNAME Exphfion D& Estimatcd VakreofE7earical Work $ Ro* I Final LiomwNo. Licerwe L i r.r tk e - t -k- e3 w sigtlmure 7. QL �•o OJ L o=No r 3 `r `'� 4 7 Bus¢essTel.No. Arjdim 1 n;�t4.l N • Qu o:.z,� _ r�r W o z r -rr Ak.TUNo. 4,f) - 4TH - gT 4 C, C I+) OWIS'SINSURANCEWANFR;IamawmeftitheLiomtsedoes nothavetheirmnar comWoritsbyMamdusemConalUws arldthatrrrysgrlatiaeon thispeurritapplicx�alwai�thisregttitarlmlt (Please�.check .one) Owner M Agent Telephone No. PERMIT FEE $ Signature ot Uwner or Agent h 111E (,UMMUNWhAU11 UP' U!.k 1ae,11 S Office Use only r DEPAR731W SAFETY Permit No. BOARDOFFIREPREYFNI70 iUGUlAT70NSS17(112M Occupancy & Fees Checked �� P Y APPUCATTONFOR PERAff PEUOPEECELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH MASSACHUSSTTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date T 6 7 . O Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electri al ork described below. 1 Location (Street 6 Owner Ir Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building Existing Service AmpsVolts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes ED No ED (Check Appropriate Box) Utility Authorization No. Overhead Underground No. of Meters Overhead Underground No. of Meters No. of Lighting Outlets No. of t Tu No. of Transformers Total KVA No. of Lighting Fixtures i Pool Above 11 Below Generators KVA anti around No. of Emergency Lighting Battery Units No. of Receptacle Outlets f Oil Burners 4 No. of Switch Outlets o. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Tbtal Tons No. of Detection and o� No. of Disposals No. of Heat JV6tal TANI m ANa . Tons K . Initiating Devices No. of Sounding Devices No. of Dishwashers Space Aiea fileating K No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devi. W Connections No. of Water Heaters KW No. No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP Com P11ts� 3 t1DftW#MX7 .s�C=TdlLaws aartc LdAtYLsPOkYulcid%C Vi& ortSmb9arrialepwWat YES NO vafidpDdofsametbdV011ice YES �) ]fyoulla drelWYES,pk�eIItacalelfit PA]ecfby baL BOND OMER �L�J(Aease�Y) EstirrwdVakreofEbcaital Weds $ IrrspeMmIX *Recltres1ed Raigh Fatal RmkimcfpajuT. U y LimwNa l hl �. Signature L�,•.• `i ro.� t L;oatseNo 'C 3 '7' 947 Tel Na v4 64 o AItTdNa 4�r)-*?J- g?4 e C WAIVER, IamatsalelludleLiaxsedoesmthatetheir>Sua=aAeWorilssubslarriale#vdlaltasracliWb5lNbm mMGaxdLaws rn the parrit applicaoiorl waives dic tac}Iirarlalt ne) Owner PERMIT Agent a 1 Telephone No. FEE $ HE ure o Wrier or Agent Date... � .. ........... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ..... ................... ....... ...... ...(..:. "..... .......... has permission to perform .G...✓....11.. , ... ..... .... ..... f. v wiring in the uilding f � :��...... . ........................................ at ........ ........ C ......... ... Orth An over, M Fee U..:.4:4!.... Lic...7��..... .' ./... J ELECPR1cAL INSP R 4v/ Check # 5 5 8 3_�� ��2