HomeMy WebLinkAboutMiscellaneous - 535 CHICKERING ROAD 4/30/2018 (8) BUILDING FILE
I
Date.-.- I.°L......b.3.
�10RTM
°� TOWN OF NORTH ANDOVER
�r •`,� .
p PERMIT FOR WIRING
�SS�CHUS
1 This certifies that � C
. ...
...........................................
:has permission to perform ...... � C �' 4—
wiring in the building of....
..................................................................
��P.!`�. .C?.ti?...................................................
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at.....t......................................_..3.... ................. Co(NArth Andover,Mass.
, ..... Lic.No A`�M �`
Fee.. .�.....' ....... .. .. .............. ............... .....................
�? ELECTRICAL SPEMR
Check # c) 3 V
1: 371
Official Use Only
wry, i a Permit No.
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 C R 12:
(Please Print in ink or type all information) Date I
To the Ins or (Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below..
Location(Street&Number . S35 v t L 16-e v"
42
Owner or Tenant
Owner's Address
Is this permit in conjunction�hauilding permites ❑ No (Check Appropriate Box)
Purpose of Building Ci r)� ! V it J l ' Utility Authorization No.
Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters
New Service Amps Vorts Overhead ❑ Undgmd ❑ f^ No.of Meters
Number of Feeders and Ampacity v �
Location and Nature of Proposed Electrical Work
i
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ In ❑
No.of lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ran es No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Di sal No. Pumps Tons KW No.of Sounding Devices
No./of Self Contained
No.of Dishwashers SoacejArea Heating KW Detection/Sounding Devices
❑ Municipal ❑ Other
No.of Dryers Heatinq 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 equivalent YES= NO =
have submitted valid proof of same to the Office YES= NO = �chQck�Y S lease indicate the types I rage ng the appropriate box
INSURANCE = BOND = OTHER = _(Please Specify)
�._ (Expi on D3
Estimated Value of Electrical WorkE
Work to Start inspection Date Resgirested Rough Final—
Signed under the Penalties of perjury: /Q/�l
�J�t� Vec� i /
FIRM NAME LIC.NO
h� �-
Lkensee J Signature LIC.NO.
s.Tel No
Abdress l� �l l Ci lc-en/,,- k0j, Att Tel.No.
Z/
OWNER'S INSURANCE WAIyj=R: I am aware tha a Licenses does not have the insurance coverage or its substantial equivalent as required by Massac setts
General Laws.And that my.ognature on this permit application waives this negu)rement. Owner Agent (Please Check one)
Telephone No. PERMIT Ii EE $m,
(Signature of Owner or Agent)
4297 z
Date.... ,1
v t NORTH 1
TOWN OF NORTH ANDOVER
' PERMIT FOR WIRING
;�SSACMUS�
This certifies that .. .. � Z
has permission to perform ......, !� v`!��.. ....:. .............
wiring in the building of.........,f� `P a�/T�`?....... ............................................
�at.... 71�1. ...... ..................rOli:�•....... .....:...... . h Andover, S.
a �r
U
Fee.. sv.,!)..... Lic.No ......7 ............ .... ... Fri.. ...r
ICALINSPE R
Check #
THE COA MONWF.ALTHOFMASSACHUSETlS Office
DEPARTAMWOFPUBLUS4MY O -a.-
� .- Permit No. _
BOAROOFFIREPREVF1P ONREGUTAHONS527CtY 12W
Occupancy&Fees Checked t
"x .
APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant ���ldy,
Owner's Address
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) .
Purpose of Building Utility Authorization No. _
Existing Service Amps _Volts 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
No.of Lighting Outlets O No.of Hot Tubs No.of Transformers Tota!
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
C/ ground ground
No.of Receptacle Outlets of 1 Bu rs No.of Emergency lighting Battery Units
ee
No.of Switch Outlets G
No.of Gas Burners
No.of Ranges O No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal OEher
Connections
No.of VAter Heaters KW No.of No.of
Signs Bailasis
No.Hydr6 Massage Tubs No.of Motors Total HP
;1
OTBER-
RSAZ oeCoVeM@C.RnMttDt cmgm� C*MalLaws
IhawaamotLmbkyhlauu=PobCymdndmgComplee Comag-,crgsstibstatdequivabt YES NO
Ihaw9kn Wdvafidproofcfsmretnft0ffi a YES r-T If)mbavedxckedYES,plemmdc&thetypeofeovwg,-by
II�CE BOND OFJTIQZ ---- .. -
ictoStatt ✓ .� �►aledVaixdE7ee"Wc&$
Woi
I ,D&Rectd Rough / 0 3 rail
SigraedunderaieP perjtny.
E1RMNAME G%` oU LioaiseNo. y
ucenseo�� ri c'/,f.�lc/77�G9` Sip�hue LiMWNO
Busff=TdNo
4drhf cc Alt Tei No.
OWNER'SP4SURANCEWAIVER;IamawatethattheLiegedtiesrathavetheirrstuancecDmyageoritsst�tialegwvalertasreg medbyD4a%admgcmCfneralLaws
'>nd thatmysgr�ueonthispeurutapplication wars tlbstegtinzrr�t
Please check one) Owner ® Agent '
Telephone No. PERMIT FEE
Signature of Uwner or Agent
3,
"C mm
9N,AEALTF1 O .:' AI HUSETZT .
f.
v
:bP El EQTR:IClA,NS
AS' A R�6 JOURNE1r�1AVN ELEC f R`rLI
4 ISSUES THI LICENSE TO
MICHAEL WDAMOUR : .
.9 WALKER ROAD C
`
:,, .,APT 2 :,..� ' ;' :> .• . . ��.
!NORTH ANDOVER MA 01845-192
t .
46129 E 3715
• dy
Location S-35- C h` c K e f j ti q fed
No. 31 e) Date C/-
MORIN TOWN OF NORTH ANDOVER
, p
Certificate of Occupancy $
410
S'••° Eta' Building/Frame Permit Fee $
ACHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #16
V 2 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLINGMa
BUILDING PERMIT NUMBER. DATE ISSUED.
rc rn
31
ic
SIGNATURE:
Building Commissioner/I for of Buildings Date Z
SECTION 1-SITE INFORMATION IO
1.1 P erty Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
TIZ�S
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 Required Provided Reqwred Provided
v
1.7 Water Supply M.G L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System D
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m
2.1 Owner of Record ,
z- e
ame Print) Address for Service:
Z" a�/ ���_G Dov X / lam
ILA-
Si ture Telephone��
?2Oit /-S 1 "C- /?--
2.2
.2 Owner of Record: jtkk 5 r
e
Name Print Address for Service: O
Z
m
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 1 90
3.1 Li nsed Constriction Snugpervisor: 0)1*,� Not Applicable ❑
Licensed Construction Supervisor: t 2 756 / O
Q ,
S (0
.lLicense Number
f U l I /V
ddress 3 D
� _ ,
6 9/V, 1
�0 Eviration Date
Signa re Telephone yt!
3.2 Registered Home Improvement Contractor Not Applicable v
Company Name m
Registration Number
Address
Z
Expiration Date n
Signature Telephone v/
i
SECTION 4-WORKERS COMPENSATION(XG.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.......❑
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:L
V A- p X 1 ST 61U)i V JoLV A.0 d on
I�,t.7� `�� I�-C e ri�e•u 11 1_e���l'r '�/� - � yam_ � -
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be (}I?FICUSE ONLY,
Completed by permit applicant
1. Building r (a)(a) Building Permit Fee
dD Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)X(b)
4 Mechanical(HVAC) ---�
5 Fire Protection
6 Tot +2+3+`4+5 _'N"3 Yo 0 Check Number
ON 7a O ER A OR=PLIJS
TO CO WHEN
OkVHERS AG OR jQR B#IPJIYM T
Z
as Owner//fit of subject property
�e + (>
y autho ize Y N/S / l l ' UA- to act on
e in all matt tiva4r aut orized by this build it applicatio /i'e_..�
-7!2Si is of er — " 2�
15 f Date
SECTION 7b OWNER/AUTH RIZED AG NT DE TION
1, 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 1ST2 No 3RD
SPAN
DIMENSIONS OF SILLS
DM ENSIONS OF POSTS
D`Iv1ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHFgNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
The Commonwealth of Massachusetts _
� d
Department of Industrial Accidents
Office of Investigations
Ic Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name: '
Location:
City Phone #
I am a homeowner performing all work myself.
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.
Company name: C S - LXA e--1-r\A S4 ) M` c o C6 t p e<-A d e\
Address `�3 S'%JC6A Sk;e f-k
City: N`'f 4"k A-\—L U t!t/ , fk 0 �"�� Phone 0 d
Insurance.Co. f �H et +" ��� �� I I�n C� r !,"Lliolicv# b R--�3 u a `T91 X T) — L(- a�
Company name-
Address
City: Phone#:
Insurance Co. Policy#
Failure to secure coverage,as required under-Section. 5A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00
andlor one years'-irnprisonme v�etf_s civil.penafties' Aheimm- fes PTOP W._ORK ORDER and_a fine_of.(.$100M)-aday.1gainst.me. 1
understand!fat a copy of this tatement may be fo ed to the Office o tnvg of the DIA for coverage verification.
I d�here6y certify under the pains and pe f erjury that the information provided above true andy.
Signature Date --OQ— 2,
Print name k L& t i% xl Lu— Phone.#��
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensinq
Building Dept
OCheck if immediate response is required 0 Licensing Board
0 Selectman's Office
Contact person: Phone A ❑ Health Department
Ei Other
1
SUNALLIANCE
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6R23UB-789X971-4-02)
RENEWAL OF (6R23UB-789X971 -4-01 )
INSURER: ROYAL INSURANCE COMPANY OF AMERICA ..
NCCI CO CODE: 80136
1.
INSURED: PRODUCER: r
MINCO DEVELOPMENT CORP INTERNET INSURANCE AGCY
231 SUTTON ST 522 CHICKERING RD
N ANDOVER MA 01845 •NORTH ANDOVER MA 01845
Insured is A CORPORATION
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 09-01 -02 to 09-01 -03 12:01 A.M. at the insured's mailing addresss.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
d_
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
item 3.A. The limits of our liability under Part Two are:
N— Bodily Injury by Accident: $ 500000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 500000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT WC 20 03 06
m
D. This policy includes these endorsements and schedules:
o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
0
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
a Plans. All required information is subject to verification and change by audit to be made ANNUALLY.
DATE OF ISSUE: 09-05-02 WC ST* ASSIGN: MA.
OFFICE: ORLANDO-ROYAL 829
PRODUCER: INTERNET INSURANCE AGCY 753XF
021584
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 init,.Y34e ,
4e"'
.-- I
(Loca ' n of F ility
C-
�z-c-t�
ignature f Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
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MAR. 2 21593
2
MAKERAYMENTS TO THE COMMONWEALTH OF MASSACHUSETTS BILL NUMBER 2584 RE
TOWNI�OF NORTH,ANDOVER TOWN OF NORTH ANDOVER Loc: 535 CHICKERING ROAD
P:,. O..;:BOX 1247. OFFICE OF THE COLLECTOR OF TAXES Id: 071.0 0033 0000.0
NO. ANDOVER, MA 01845' Your Preliminary Tax for the Fiscal Year 2003 Deed/Legal : 87 105
.M-F .8:30-4;30;11-1 TO, 7:30PM beginning July 01 2002 and ending June 30 2003 Land Area: 1.52 (ac)
'TAX 688- 5 R
95 0/ASS 688-9566 n
o the property described i w
t e s as follows:P Pe
Y
„ R : ' »>aUE ; ' :First Amount Interest Second Amount Interest 1H
1-TAX 2.461.86 0.00 2-TAX 2.461.86 0052.45
CP 64.36 0.00 CP 64.37 0.00
AUG l. X002 Afi�QUNl:«:>;
NOV 1l X002 A�1011NT:::::':;:;..::;: :.::;..:.:::: :� 526i23..
I.! :::.::>::;;:..;.;:.;;;;;;;;>;:.; .
E
ESS X REALTY TRUST
AX :;:;P�.:............;;;;;;:<.:.;:.;:.;:.;:.;;:.;;:.;;:.;:.;:.;:.;;:< ,052 44.;:.:
LOUIS P MINCCI IC
U JR,
TR
231 SUTTONT
S REET
NORTH ANDOVER
MA0184
5
AM NT I3EIE 1 !0112002.....:::....: 2 526 23
-DETACH HERE• . . . . DETACH HERE . • . • . DETACH HERE . . . . • DETACH HERE - - - - - DETACH HERE • • . . . DETACH HERE-
SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Interest at the rate of 14 per annum will 2584.RE
accrue on overdue a ents fr m the edue
Ym t
P
;:.:.iSC�L.;YEAR.,20�3.;: 11r±Sra7��:.:::;;:.;:.:<.;:.,<:::
date until payment is made.
SP.::l4S fl.... .:.::.::::::S:.;Q52. 5.::.
G:. . 0a2:< ti�JQ13NT::.::.::.:::.:::.::.::.:::.::.:::.::2,
:PRIOR AMOU >:.11LED<>> < » »«> 6`:::<>
OUNT.. 2..52 .i.....
..............................................................................................
.............................................................................................
..............................................................................................
TAXES PAID > ><> > >»><<<« <5 052:::4......
Ah10ll.:::.;T.:.::U.,RDI :.:<;.:
>AtOliN1`>DUE: 011002
,52....... ...
ESSEX REALTY TRUST
Loc: 535 CHICKERING ROAD
Parcel Id: 071.0 0033 0000.0
.............. ... _.------------------------Th s..form approved by.the_Comm.i_ssi.oner of Revenue
._,MAKE,PAYMENTs TO �.___ m 2003 QUARTERLY REAL ESTATE
THE COMMONWEALTH OF MASSACHUSETTS BILL NUMBER 2584 RE
TOWN OF NORTH ANDOVER•, I TOWN OF NORTH ANDOVER Loc: 535 CHICKERING ROAD
P: 0 BOX 124. OFFICE OF THE COLLECTOR OF TAXES Id: 071.0 0033 0000.0
NO. ANDOVER; 'MA 01845 Your Preliminary Tax for the Fiscal Year 2003 Deed/Legal : 87 105
M-F 8:30-4:3o'11-1 TO 7:30PM beginning July 01 2002 and ending June 30 2003 Land Area: 1.52 (ac)
TAX 688-9550/ASSR 688=9566 on the property described is as follows:
First Amount Interest Second Amount Interest <: RECRPT;YQl1C#1Ei1
.:.:....
1-TAX 2.461.86 0.00 2-TAX 2.461.86 0 ;. :T4TAk TAX:::&. P ASSkIS :.>: :::::
CP 64.36 0.00 CP 64.37 0.00 `:Ai3G f;: Oa2.A1OftNT'.>' :::: <:> ; 2526.22::;::
x'23;:
NOIt 2R�2>AMOl1NT>�>< «' >�2<526 i. ...
.................1.........................................................i.................
PR
_..........L.L.. .:::::::......::..:..::::x..:5.26...,........
E REALTY TR
SSEX
UST
ii +y>;< s2' 22 <> sss5tx�'i'.``�`'`
TAX.S::PAI� ra052..44;;;
LOUIS P MINK I
UCC JR TR
21
3 SUTTON STREET
NORTHANDOVER A 0 ER MA 01845
............ .
112002:>:;'>::':> :;;:: 52.::.:2.:::.:.
s
J�ie �ranrma,:weul!/c o�;ltt'��,scrc/tuaella ,
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 027367
Birthdate: 07/15/1949
Expires:07/15/2003 Tr.no: 11826
Restricted To: 00
LOUIS P MINICUCCI JR
231 SUTTON ST#1A .�.
+ N ANDOVER, MA 01845 Administrator
NoK ' H
Town of AndoverE
o
� - 40p •Arts.
o�A�o�„,11 A dover, Mass.,
�d RATED
7S H E
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS
CERTIFIES 1 4ty �Jt V BUILDING INSPECTOR
CES THAT........... ................................................... .............................. ................................................. Foundation
has permission to erect... .........00�I.��,....., buildings on .406 .3,0�.....CA.044��t„!1 i�,.....Ad! Rough
to be occupied as....I...*a 10 O Chimney
w � ...............III IV
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 B -Laws relating to the Inspec ion, Alteration and Construction of
Buildings in the Town of North Andover. / nor 4Y0 0=0 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS THS Final
UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR
.............................. Rough
/0........................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required t0 Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
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.