HomeMy WebLinkAboutMiscellaneous - 597 FOSTER STREET 4/30/2018 597 FOSTER STREET }
210/104.B-0050-0000.0
tORTH
TOWN OF NORTH ANDOVER cF�t,�o 6 gtio
�•� yf' � ,,..r, .6 U
O 1A
Building Department
1600 Osgood Street 4
Building 2- Suite 2-36 Building Dept �9S.3 CHOSE<�y
North Andover MA 01845
Tel: (978) 688-9545 Fax (978) 688-9542
/ COMPLAINT FOR INVESTIGATION
DATE: a/ �0 ,� TEL #: r '7� �- 1P
1*1 �fA0k6
/
NAME OF COMPLAINTANT:
ADDRESS.:: :.
COMPLAINT TYPE:
Electrical:
Plumbing:
Gas:
uilding:
Property Owner:
Address: -� s ���.
Other:
C'vNs � �, �„/ v�. Sly c✓ - eC s eye. 70 3a
/d e4//7 1-74'
.
-5-
Signed: '��
10
Complaint Form-Revised 6.2007
$ # 2 Date,/ �(>.....
f pORTH
° t"`° '°_•"° TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
,SgACMUSEt
This certifies that ... ��. ............. ...1.r�i.J......................................23s
has permission to perform ......10. ..........1``: zt... ................................ .
wiring in the building of..r.. UJB........r............... G1�S„7
at.... �l ......., ......................... .-........... North Andover,Mass.
//l�
Fee.. ''�..... Lic.No... vl
....
< . ..........
E�ePLC: x
Check
Commonwealth of Massachusetts official use only
aNo. �
Department of Fire Services Permit
BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked
[Rev. 1/07]
leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT RV INK OR TYPE ALL INFORA44TION) Date:
City or Town of: - To the Inspector of Wires:
By this application the undersi ed gives not' e o his or her intention o perform the electrical work described below.
Location(Street&Number)
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunctiop Xvith a building permi Yes No El BLDG PERMIT#
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the followin table maybe waived by the Inspector of Wires.
r No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total,
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above r-1in ❑ o.o mergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No. of Switches No.of Gas Burners No.of Detection and
Initiating Devices
Tot
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertin Devices
No. of DishwashersSpace/Area Heating KW Local❑ Municipal EJ other
Connection
No. of Dryers Heating Appliances KW Security Systems:*
KW D
No.of Devices or E uivalent
No. of Water No.of No.of
Data Wiring:
1 Heaters Signs Ballasts No.of Dvices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I cert,under the pains and penalties of perjury,that the information o this application is true and complete.
FIRM N LIC.NO.:
Licensee: 9 Signature LIC.NO.:
(If applicable, enter "ex mpt"i thns num ne.)' —Bus.Tel.No.:
jqiq
Address: ! Alt.Tel.No.:
*Per M.G.L.c.147,s.57- security work requires Department of Public SafeTy" "
Licen LIC.NO.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent —
Signature Telephone No. PERMIT FEE.
ELECTRICAL PERMIT NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR-DOUG SMALL
1.ROUGH INSPECTION:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
2.FINAL INSPECTION:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
3.UNDER GROUND INSPECTION:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors'comments:
(Inspectors'Signature-no initials) Date
4.INSPECTION—SERVICE:
DATE CALLED NATIONAL GRID: NAME:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
5.INSPECTION-OTHER:
Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED.
F
The Commonwealth of Massachusetts
Department of Industrial.Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/d'ia
Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/Plumbers
Applicant Information Please Print Leglibl�
NaMc(B.usiness/Organization/Individual):
Address:
City/State/Zip: Phone#:
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. F1 Now 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.z 7. ❑Remodeling .
ship and have no employees These sub-contractors have 8. ❑Demolition
working for mein any capacity. workers'comp.insurance. g, ❑Building addition.
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL ME]Plumbing repairs or additions
myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs
insurance required.]i employees.[No workers'
comp.insurance required.] 13.n Other
?Any applicant that checks box 41 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.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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 WORD 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 DLA for insurance coverage verification.
I do hereby certify under the pains andpenaldes ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#:
FOther
only. Do not write in this area,to be completed by city or town official.
n: Permit/License#
hority(circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
son: Phone#:
.y
«TOWN OF NORTH ANDOVER NORT#1
BUILDING DEPARTMENT °�tTL`° '6;6"45
1600 Osgood Street, Suite 2-36, North Andover Ma 01845 0 ,�
NOTICE OF VIOLATION
ACHUs���y
Date:
Address:
Building ❑ Z6ning Bylaw ❑Stop Work Order ❑ Certificate of Inspections
l
Electrical Plumbing 1 ❑Gas
Violation observed: F A-2-6 LJ/ /V
Failure on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law
780CMR���4Annd ve�ing By law. Please contact the Building Department for further information at 978-688-9545
Inspector A � � � � � q
Home Owner V1
Contractor
Y
RT
TOWN OF NORTH ANDOVER o��"°o H
y O
3'C 6f.`��� r•4. 6
O
Building Department * ,�
1600 Osgood Street o
Building 2- Suite 2-36 Building Dept rE°'`���y
�
North Andover MA 01845 9CHU5
Tel: (978) 688-9545 Fax (978) 68-8-9542
COMPLAINT FOR INVESTIGATION
DATE: TEL #: `�
NAME OF COMPLAINTANT:
ADDRESS.::.-•
COMPLAINT TYPE:
Electrical:
Plumbing:
Gas:
Ifuildi g.
Property Owner:
Address:
Other:
r
U/IJS��� �-,`a�/ a.� SIeG✓ y Cv��°x. 77v 3a �'ef-.6i�L'� �����'�1
l
Signed:'
Complaint Form-Revised 6.2007
t
N° ;E , i 4 8 Date�fc;..:.� ....
NOR711
°f'"`° '•�"� TOWN OF NORTH ANDOVER
F p
PERMIT FOR WIRING
,SS^CHUS�
This certifies that ..1...�,r!..... �`..........................................................
has permission to perform..... .................... ...........
wiring in the building of-........... ............. ' .............. .......................
%t!�! .7� ..........................North Andover,Mass.
Fee ..N........ Lic.N04,&1 `l ...............................................................
ELECTRICAL INSPECTOR
G!l 12/16/97 10:12 25.00 PAID
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
atfice use
- uhf &nmimm t—�—n of gltl# ztts permit No. _
txcupencr A Fee c:~
- 3W peave bMzL
BOARD OF FIRE PREVeMON REGULATIONS W CUR 1290 _
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL YORK
All work to be perforMch
med in ac�rdance with the assausetts Electricai Code, SZ7 CMA 12-120 . .
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
QM or Town of NORTH ANDOVER To the Insp or of Wires:
The udersigned applies for a permit to pertottte elec=icai work described below.
Location (Street St Number) QSTe Ls�^
Owner or Tenant Sec aalS ire
Cwner's Address Q 0
Is thts permit in canju tion with/a cuilcir.5 Gerrit: `!es No r (Check Appropriate Box)
?ur-csa ct SuiiCirg Utility Authcrizatiro—n No.
l�D Amps 1ad1 aZ0 Vcits Cverr:ead '2 Uncgrno t_: No. of Meters
: Existing SarJice �-
New Service Amps _1 `/olts Cverctead r Undgmd Q No. of Meters
Numper of Feeders and Ampacity
Lccation and Nature of Proposed Electncal WcrK
Total
No. at ligl:tng Cutters
Na. Zi acs i No. cr ?anstormers KVA
v n-
3wtr-:r, '==: KVA
Na. at L:gnt:ng -xtures � ,r..c. _ _mac. _ Ganeratcrs
I No. at E:nergency Lignting
NO t Receatac a Cutlets
No. cr Cii saver, Units
.ur..ers j
No at Swtta't Cut!ets j No. cr ^-as aurners FIRE ALARMS No.of cones
.oral No. ct Cetection arta
No. at Ranges ; No. c: S,r Cznc. _rs Initiating Oevicas
ctal .stat I
Nc.ct,eat Nc. ct Sounaing Oevicas
No. of -iscosats ....=s ons C:J
No. a Salt COrttatnea
ScacejArea -ea'ng <'.Y Oa:ec::cniSounctng •�avtcss !
No. at �isnwasners '
I — Muntc:nai r--Other j
No. at Orvers
mea ng =evices K'N _coal _ Cannec::an
No. cr
Nc. Lbw :c:tage
ExIasm Nirrc
No. at water Heaters KW ' Signs, t
No. Hvcro Massage Tuaa ! No. at Motorsctai ^P
INSUPANCc CCC PAGE: Pursuant M :na ecu:rerrer.:s = aassac-._serS genera( Laws s:antral ecwvatent. YES A* NO
I nave a current Liaatiity Insurance Pouch :nc:x:reg -Zzr--:eteC Ccera::ens Coverage or -is ,ueYE= NO — t :cu nave cnecxec Yss -,tease inctcats :no type at coverage cv
.nave sutxmtttea vada proof of same :a :he C"ics.
clecxwng the aocrocnate tax. _
INSURANCE � BONO = _
OTHER ;Please Scec:'--r) (Exptratlon Oatet
'esamatea Value of E? Etre I Worx s iu FI.W
Worx to Start Ins:ec-cn Cata Roc:es:ec r�augn / J
Signea unser ate Penalties at perjury eG r_�
T,■ t1C. NOkz . 22
MRM NAME �` ; L1C. NO. JJ� 33
Licensee 0 S g-att re 3 _
_ 3us. :al. Na.
ACC:eSS
O pall, Q/ Q ,alt. :al. No.
CWNEa•S INSURANCE WAI Ea: I am aware .Zat a Lcersee Gres rot nava ;rte insuranes coverage or its suostantiw eQutvaleAgent
nt as er
cutrea ty Massaclusetis General laws• arta that ZV s:graiure an �>s :errrat acCticaticn '«atve3 this requtremenL Owner
(Please checx ons)
'etearcne No. P EMIT F S
($;gnattue at owner Cr ASentf =��''
PF.Ritrr No. APPLICATION FOR PERMIT TO SU1LD — NUKIn M►HOUVER, ♦+u%zb. - "
} b4sL,P X10® LOT NO. 2 RECORD OF OWNERSHIP DATE (BOOK PAGE
y� '4lONE ,SUB DIV. LOT NO. I
LOCATION PURPOSE OF BUILDING
OWNER'S NAME �Q�' -/ "may' • NO. OF STORIES / SiZ[ 4-u Pic P J
OWN[R'i ADDR[ii BASEMENT OR SLA• t
�af f®�`�.i-`J� S"�: /S� / Cep o`�e�0 `fj S
ARCHITECT'$ NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME — SPAN ��'
rte' --
DISTANCE TO NEAREST BUILDING DIMENSIONS OF BILLS
DISTANCE FROM STREET TO POSTS •+
DISTANCE FROM LOT LINES — SIDESf��� T•• � REAR GIRDER$
OO
ARCA of LOT FRONTAGE > HEIGHT OF FOUNDATION THICKNESS '
�GC�AC.,-�.�c�'� yj�'/`i f'
IS BUILDING NEW SIZE OF FOOTING x
IS BUILDING ADDITION / MA:ER:AL OFCHIMNEY
IS BUILDING ALTERATION
�O � If BUILDING ON SOLID OR FILLED LANG
WILL BUILDING CONFORM TO REOUIREM[NTS OF CODE IS BUILDING CONNECTED TO TOWN WATER —.Jr
BOARD OF APPEALS ACTION. IF ANY If BUILDING CONNECTED TO TOWN SEWER ��C-7� .
i
IS BUILDING CONNECTED TO NATURAL GAS LINE
3 PROPERTY INFORMATION
INSTRUCTIONS
LAND COST
SEE BOTH SIDES EST. BLDG. COST %t
LST. BLDG. COST►LR eQ. FT. j
PAGE 1 FILL OUT SECTIONS I - 3
EtT. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 R D BY
ATTACHED GARAGES MUST CONFORM TO STAT[ FIRE REGULATIONS
' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
j
DATE FILED�� �� 4 1 IMO 11t$PfCTOR
1 _
OrGi4TURIE OF OWNLW OR AUTHORIZED AGENT
Owners Tel
FEE r
Contrac� Te14�
!'EIIIMIT &RAN=D
�. Contra. Lic # 49 Z7
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3 31 i DEED,ANDIOA aSESSOR'S MAP,8�, G`
A�'nf ��
TION.A MORE-14W ATE REFRE5f ,
�y e, r~s s ,,t3 WILL R UlHE AN INET, It'> rIT 6 •. ;
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Scale, 46
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777
JO IN S. LAURETANI
SURVEYING OW
'
gMERICAN ¢
• I SURVEYOR' t z
" A PROFESSIONAL LAND SURE ,
CERTIFY THAT THE 77 Rumford Avsrn;e• Waltham,MA 0 154 (617) q'�"`
s R DO HEREBY � � H� bA ''
ABOVE
MORTGAGE INSPECTION
g .,EFOR a �•
eSrEr•� (
r °+. PLAN WAS PREPARED
.IN „
ep/.+
1MOrtg � lrrsp :
CONNECTION WITH A NEW MORTGAGE "' -'OOUNN REGIRY OF0
AND IS NOT INTENDED OR REPRE•
ORIGINAL RECORDED AT_��`• 0-4
L C erg.
SENTED TO BE A LAND OR PROPERTY THE LOCATION OF THE PAGE
LINE SURVEY. NO CORNERS WERE DWELLING SHOWN HEREON EITHER BOOK-�-8�--
BE USED FOR ES- WAS IN COMPLIANCE WITH THE LOCAL PLAN REFERENCE: ` • 1
SET' IT HEDGE OR EF DRAWN PER TOWN OF - ��F, " DATED
TABLISHING FENCE, APPLICABLE ZONING BYLAWS INn;,,t
BUILDING LINES.THC LAND AS SHOWN FECT WHEN CONSTRUCTED WITH RE- MAP _#
N CLIENT FUR
HEREON 1S BASED Q SPECT TO HORIZONTAL DIMENSlOtJAL ADDRESS:.-• ' ., Y ash t T,
c R
NISHEO INFORMATION AND MAY BE REQUIREMENTS ONLY),Q 15 EXEMPT _.-.. _ + •.x F
SUBJECT TO FURTHER OUT-SALES, FROM VIOLATION ENFORCEMENT AC• BORROWER:••- �'` - ----- e ,
M NTS AhID RIGHTSOF TION UNDER MASS•G.L.TITLE VI►,CHAP.
TAKINGS,EASE E r�
1, -,. n RESPONSIBILITY IS EX .AOA, SEC. 7, UNLESS OTHERWISE SUBJECT DWELLW' NAL F:ES IN F�� ElSUf� t1�M
., WAY. 1� CON.
TEP�DEDHEREINTOTHELANDOWNER NOTED OR SHOwN HEREON.
A COiJ•'AS SHOWN ON ' 2P D:•.
pCCUPANT. IT ) N4T ft,ITENDED FIRh{ATORY IPtSTRUMENT SURVEY INSURANCE Rr L#
' IS ADVISED WHEN STRUCTURES ARE COtAMUNITY ^CHECKED cll� I
TO Be RECORDED__ LESS FROM FET DR i
DAi'_" ----%�' ... SHOWN TO BE t' OR -L s
CLIENT r' r�
,� LYY PROPERTY OR REQUIRED ZOIJItJG BY i � /o`fo f8 J ' Gc�x
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Commonwealth of Massachusetts
City/Town of NORTH ANDOVER MAS C USf�'*51VED
R - System Pumping Record
Form 4 OCT 10 2006
T
IN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. The Sysieer�a�IF'Umpiag, c"oTrd must
be submitted to the local Board of Health or other approving authori��y�–
A. Facility Information
Important:
When filling out 1. System Location:
forms on the 1 j
computer,use J 91 S
only the tab key Address f,
to move your
cursor- not
use the return City/Town State Zip Code
key. 2 System Owner:
nc
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date q o- 2. Quantity Pumped: Gallons
0a c"
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe): —
4. Effluent Tee Filter present? ❑ Yes Er No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System,:,(
-- a C�n c.r —— — -- –
6. System Pumped By:
(gin _ - j-C S
Name nn Vehicl icense Number
Company —
7. Location where contents were disposed:
L
Si9 nature o auler Date
http://www.mass.gov/dep/water/approvaIs/t5forms.htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 30`0-�—
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
6-kt�� (example: left front of house)
bac� o� 6vs-c
� Z �
DATE OF PUMPING: 10 a"O-1QUANTITY PUMPED � S a-c) GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE YEMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: