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Home My WebLink AboutMiscellaneous - 64 BUCKINGHAM ROAD 4/30/2018 l64 BUCKINGHAM ROAD � - 210/020.0-0054-0000.0 2012 Massachusetts Electrical Code Amendments 527 CAM 12.00§Rule 8: 111 accordance with the provisions of M.G.L.c.143,§.3L,the permit application form to provide notice of installation of wiring shall be uniforin throughout the Commonwealth,and applications shallbe filed- i on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.CTI c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction.activity,and may be.deemed-bythe,Inspector_of_Wires abandoned.and-invalid,ifhe--. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the-permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act fiuthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development ofreal property.With limited exceptions,the Act automatically extends,for four years beyond its otherwis a applicable expiration date,any permit or approval that was m effect or existence during the qualifying period beginning on August 15,2008.and extending1hrough August I5,2012. rule 8—PermitJDate Closed y, * Dote:Reapply for new permit�Y Permit Extension A ct—Permit/Date Closed: S--12-1 y' ' Date.....j.:.2.02....... AORT" o0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING . Y^ This certifies that .......:- --..' ` has permission to perform ...... ................................... wiringin the building of. .............................................................................. at.... : . ...... ...:...s.::............�1... ..-. :r.:..... . North Andover,Mass. Fee. ........... Lic.No�'t# ,,�............r'o, ELEcMCALIv . 93 ? (fomrrwnwsalg o / Official Use Only Y cc'' Permit No. � 2cc7�eparfmant of ire Serviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev, 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W0 X All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12,0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: A&lcyy To the Inspector of�Wire By this application the undersigned gives notice of his or her intention to perform the;�w described below. Location (Street & Number) 6 y Owneror Tenant -r-AA, rl Telephone No, Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building %1.IGcC- 14151,1 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: rI7*tZR, 97� Completion of rhe ollowin table ma be waived by the Ins ecior of Wires. No.of Recessed Luminaires C(-7 No.of Ceu.-Susp, (Paddle) Fans No ° otal Transformers KVA No.of Lumlhaire Outlets No. of Hot Tubs Generators KVA No, of Luminaire) Swimming Pool Above ❑ n- ❑ o.ol Emergency Lighting rnd, grnd. Battery Units No. of Receptacle Outlets /L9 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No,of Gas Burners No-.-of elect on an Total Initiating Devices No, of Ranges No. of Air Cond. Tons No.of Alerting Devices No,of Waste Disposers eat um u,rn er ........................ono,o e - ontaine Totals .....••......•.•..••". Detection/Alerting Devices . No, of Dishwashers Space/Area Heating KW Local❑ un c pa ❑ Other Cyonnection No. of Dryers Heating Appliances KW echo of Dete stems:* or Equivalent c) o. o ea KW o, o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Ec uivalrnt No. Hydromassage Bathtubs No. of Motors Total HP a ecornmunicauunsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspeciur of It,resJ k Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: 2—q.-09 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 c�ov,er is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 440 C,4L (!,>Q 7)q40'141 47 LIC. NO.: IY?63:4 Licensee: A44 1-11,D . 144415 4 W', Signature LIC, NO,: } , (If applicable, enter "exempt"in the license number line.) Bus, Tel, No.:977-6S z -e.,Z6 , _Address: S-7 Birq oQr s•7- AIae7,, ^g DIrYS- Alt.Tel. No.: )2f-3_1T--573Z/ *Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: 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, 1 hereby waive this requirement. I am the(check one ❑ owner [Iowner's agent. Owner/Agent Signature Telephone No, PERMIT FEE: S V-v _ ;1 '� r �l _ � )_ F I ��_\'� � , -�L�� ' �2./ t -} I Y 1 �� ♦/ •! ., Date...... `Z- .... ; f NORT#f :° `" °� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING t r ,sgACHUSE� r. This certifies that ......................................�U G GSC%�. ............................ has permission to perform .......... '3 wiring in the building of.......... ............................................ 4: /q. C ,w at.:.............�.....�......�.��...................�,North Andover,Mass. Fee-57 ........ Lic.No.../�„ (l .'.3',q............A.,z' .. t........ 1?LECTRICAL INSPECTOR Check �! �`c5 C 8577 C'ommonwealg o f Maelathc em Official Use Only cc�� 57, . leparlment o f Sire Services Permit No. � BOARD OF FIRE PREVENTION Occupancy and Fee Checked REGULATIONS (Rev. I/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 (PLEASE PR.INT IN INK OR TYPE� ALL INFORMATION) Date: C9 --a-- o 9 City or Town of: ^Ao u e - To the Inspector of Wires. By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) &-4 1�(,t,1<11 'A �tjCj 01 Owner or Tenant am Q rl C®y) o Telephone No, o Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building ,/Uei,, . y—u t C L Utility Authorization No.-to/ 8 Y oil Existing Service 00 Amps /Pb / e;L6C9Volts Overhead ®' Undgrd ❑ No. of Meters r ° New Service a_Q�L Amps I)LO /cPYOVolts Overhead Undgrd ❑ No. of Meters l Number of Feeders and Ampacity 2 0,00-Arh /3 Location and Nature of Proposed Electrical Work: Aa --c, r( A)ew ay0 A/pi a l� crseTUi`C 'L Com letion of the followinjZ table may be waived by the lns ecror of Wires. No.of Recessed Luminaires No, of Ceil.-Susp,(Paddle) Fans o.of Total Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No,of Luminaire) Swimming Pool Above ❑ In- o. ol Emergency Lighting rnd. grnd. 11 Ba"ery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Vetection an Initlatinp, Devices Total No.of Ranges No. of Air Cond, Tons No. of Alerting Devices No, of Waste Disposers eat Pump ,..,u.m....er........ons......... W No. of Self-Contained Totals: I Detectlon/Alertinp Devices •.�� No. of Dishwashers Space/Area Heating KW Local❑ Connectionicii ❑ Other No. of Dryers Heating Appliances KWecurtty ystems:* No,of Devices or E uivalent No. of Mier KW o. o o. of Data Wiring: HeatersBallasts Signs No. of Devices r t o F.c ut'v•alent No. Hydromassage Bathtubs No. of Motors Total HP a ecornmunicauuns \Firing: No.of Devices or Equivalent OTHER: Attach additional derail if desired, or as required bt•the lnspeciur of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2' OND ❑ OTHER ❑ (Specify:) /certify, under rhe pains and penalties of perjury, that the information on this application is true and complete, FIRM NAME: 04010 E,-6-CTre1C,4L. Cav7)q,4C7-,1L1 LIC, NO,: /y 1 3:4 Licensee: ,4¢4//D 1444G4s, Signature LIC. NO.: (if applicable, enter "exempt"in the license number line.) Bus.Tel. No,:q7>t-68 z -626 Address: S"1 /�EGrHoytt?' S7- Alae ,gc�pdt/t'>Q i�►4 O1S Alt.Tel. No.:9Y-371-S31` 'Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S" License: Lie. 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, S a i "�` ��J � o� � `� �� . Date./.�`7 .`?. "�°T:1tia TOWN OF NORTH ANDOV " R 3r ; 0 s PERMIT FOR PLUM G SSACHUS�This certifies that a [ �i e t. . . . . . . . . . . . . . . . . . . . 4„ has permission to perform . . . .N. /. .. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of .G. .,1 " . t. . . . . . . at . . . . �f . .E. . . North,Andover, Mass. Fee. . ( r. . . . . . . . 3 . . . . .Lic. No.!. .z.`. . . . . . . . . . . .ii . . �. . . . � . PLUMBING INSP- ,70R e Check# [� 799 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FMWG (Type or print) NORTH ANDOVER, MASSACHUSETTS date �c C� CT Building Locations C61 Permit# Owner's Name Amount$ TO New D Renovation ® ReplacementD Plans Submitted � a w C4 zi W F w a� c oZ o z V F z z x a W F wz F w z w x z d w F F w c� w z 'o � m,4 z 0 z w o 0 SU B -BASEM ENT 3 a VO C > G' y F O BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . F L 0 0 R 4TH . FLOOR 5TH . FLOOR { 6TH . FLOOR 7TH . FLOOR 8TH .' FLOOR (Print or type)_ Name J e f Check one: Certificate Installing Company 16L11 r5�> 0 Corp. Address G (f . S:,4 Al 49A Q AJ /V01 0 Partner. us ness Telepnone Firm/Co. _ Name of Licensed Plumber or Gas Fitter C INSURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Check one: If you have checked es please indicate the a cove Yes 0 No[ $'p rage by checking the appropriate box. Liability insurance policy Other type of indemnity 0 Bond . 13 Owner's Insurance Waiver: [..am aware that the licensee does note the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 13 Agent 13 t hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will a in compliance with all pertinent provisions of the MF tits State G od d C jwp 42 of the General Laws. By nature of Licensed Plumber Or Gas Fitter Title umber S City/Town, Gas Fitter icense um er Master _ APPROVED(OFFICE USE ONLY) Journeyman _ - 5 Date.?)-? . . 9 "°RTN TOWN OF NORTH ANDOVER oe .° .,ao 3a ''` °c PERMIT FOR PLUMBING . 40 SACHUS 7V t w This certifies that has permission to perform . . . PA.C. !. . . . . . . . ` plumbing in the buildings of . . . <! . . . .. . . . . . . . . ... . . . . at . . .ta. . . � �,`:5:`.H" . . . . . . . . . . . . ..North Andover,Mass. �vt }} Fee.?./.'." .Lic. No.2.-)r2.`?.? . . . . U�-"�`�. ... . . . . . '. { PLUMBING INSPECTOR Check # 57cl L 1 .. 7980 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location64 �j °A/Gt S' Date O �_��_;; RAM Owners Name � ��}�/3 c;ill f� Permit#' Amount _?yl— Type of Occupancy New 0 Renovation ® Replacement Plans Submitted Yes No FIXTURES rA 04 rA �a rz a x w w a arA rf = d U Z A v' a a w H o G � 1 05 rA A 4 rA w A A pq SLBEM NEELOCIR a 8��11'II�1T M EIOOR 3M FLOCR 4M RaR 5M�OCIi 6M Rfm 7MH19CR 8M Rim (Print or type) / /I / Check one: Certificate Installing Company NameA.9,,4 ,K /U�n d�. �� Ut a, j� Corp. Address r C`Ke x Partner. Business Telephone �'—�,O p r e Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond 11 a Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 13 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and' tall i g p g at ons perform under Permit Issued for this application will be in compliance with all pertinent provisions of the M ac setts State Plumb' g C andpt of the General Laws. By: re o kens um Title Type of Plumbing License , City/Town License Numoer Master a Journeyman PROVED(OFFICE USE ONLY a Date. � �.�. .. .. .... x -T 40RT#1 TOWN OF NORTH AN VER • PERMIT .FOR GAS INSTALLATION ACHusES�y This certifies that ,/!'E,/ ' . +: . . . . . : . ��°� .�a . . . . . . . . . . . . . . . l has permission,for gas installation . . . . . . . . . . . . . . . . . . . . . . . . y in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . at . . �,E. !f: .g. `iy. . . . . : . . . . , North Andover, Mass. Fee. "'"" . Lic. No..Z' . . . _.,. :. GAS INSPECTOR Check# S Z- 6696 6696 MASSACHUSETTS UNIFORM APPUCATON FOR PERMrr TO DO GAS FTITING (Type or print) DateA—/0 q NORTH ANDOVER,MASSACHUSETTS Building Locations �-I CV C ,Jll 6s 4A A Permit# Amount$ 3 0 i Owner's Name New Renovation Replacement Plans Submitted U m H w o o w H w d w d Cw7 F z Z F W 04 0 C4m 0Fq w Z w O w O 04 O ;,To a A C7 a OU a SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR ' 6TH . FLOOR t 7TH . FLOOR Y 8TH . FLOOR (Print or typ�e�n n� /� / / Che k one: Certificate Installing Company Name �..J C K e✓'1�i i CO c�/�3 S /y(4/C �, �(u�.l�lY/ Corp. Address C C7 rr C e71 (A) Partner. usmess I a ep one cDc _ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M) No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work m llations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the M sac setts State Ga;s oded Ch r n th, General Laws. By: Signature of Licensed-P]umber Or Gas Fitter Title ® Plumber c City/Town Gas Fitter License Numner 0I Master APPROVED(OFFICE USE ONLY) ® Journeyman G 1^v Location No. ` Date /0Aq 3 y� TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ F Foundation Permit Fee $ / JACNUS * � ermit Fee $ l,r, ---- Sewer Connection Fee $ _ OCT 3 19WWater Connection Fee $ TOTAL cdecie- Building Inspector i Div. Public Works PE&'%trr No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE- 1 [ MAP d40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ' ZONE ` I SUB DIV. LOT NO. I - LOCATIPURPOSE OF BUILDING �.�t✓ 6u e q OWNER#NAMEr NO. OF STORIES SIZ �:f OWNER'S ADDRESS f y �� BASEMENT OR SLAB ARCHITECT'S NAME V SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APP:JLS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST c SEE BOTH SIDES ae EST. BLDG. COST —1300, PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BEJ/F}.EDAAND APPROVED BY BUILDING INSPECTOR DATE FIL %�,y f 1 BOARD OF HEALTH SIGNATURE OF OWNER OR AU HORIZED AGENTr FEE PLANNING BOARD PERMIT GRANTED 19 g1 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYS�oulEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA 1/1 1/1 1/1 FIN. ATTIC AREA _ N_O BM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDV✓'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H•T'G L]NIT HEATERS 7 NO. OF ROOMS GASOI L B'M'T 12nd I_ ELECTRIC 1st 3rd NO HEATING r. N NORTH own` 6 OL over Of No. 431 DRIVE.WAY ENTRY PERM! �--� -- - - er, Mass., 1 C H ME WICK MOPAINNINL Aw p)� ?� SS BOARD OF HEALTH PER T T THIS CERTIFIES THAT..... .. .. ... ....... .. .t....... BUILDING INSPECTOR has permission to .............. ........ buil ings o • Rough Chimney to be occupied as...........144r. ' ... 9 -or woe "' Final provided that the person accepting this per all in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONST N STARTS Service *deA Final • ... ... . . . . .. ..... ... .......... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requir d to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by S�o�pre' Building Inspector BUILDING PERMIT NORTH OFttLeo �6Ati 76 0 TOWN OF NORTH ANDOVER ►0 4 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �gSSAc►+u5�`��y Date Issued: IMPORTANT: Applicant must complete all items on this page Zr �.i r +'i A x'Tb ,r i- ''.a _�#, w �r 'S LOCATrION (� � Rev 5 ° sFv> e s anfi "„y ♦ ,3pt t }s r4 yy11$ate ;' Ta as PROPERTY OWNER ` �_Asni MAP NO �PARCEL�,�ZONING DISTRICT'"` .� �. Histone District , �� Shop,Villa:ge yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ane family Addition Two or more family . Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other r Septic; �Wrell ri loo t' Ullatershetl District * ,y ,�,: ,u �, ^•c a m. _ r .d-o!^fit.�+'"^"gay ,a�1 t°: c+ 'y.:r�x �-,::3 .. ..- ,,*, -- �. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: 5/�•- 1,� ��, Phone: Address: a�;2. y:.� F 4 .S,,.y-w<,�yi z, �+R'�rF. a^rfi-�` -�� R+ '� � �":. F �^ r�*° t F-.r _C.,i+, "7 y,.+. 3a 4C0NT=RACTOR,rName ,tc7/cPhone C��r as .w :, ry ~; y, 1 .�..a�, a . 4-ate- .4 Address -. z+ �+«8�-.++*t .-12- � '9t-�'..w aw'.+,xF !T S-Z "a`�`- zCr ' �. ; - xkx c. +^ Y1"i° Supervisors Construction ,License 3 rs 7� z- , ,ii.Exp Hamelripro�ementr:License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO ASED ON$125.00 PER S.F. Total Project Cost: ' `� 0G 0 FEE: 1V Check No.: �-� j Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r L c``` Si nature of contractor Si r'nature of A ent/Owner� Location i Date A d� i No. TOWN OF NORTH ANDOVER ti w F 9 ' Certificate of Occupancy $ ---�— • + -- �►�"°•,-.�•�'�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F a I Check # I �-Y Building Inspector I - Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on'Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning hoard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments `Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street `FIREZEPARTMENT ,Temp Durn ster ongsite es p ,* < -no -, r L.ocatetl at 124 Main St eetVp Y � r , : � '�`v�-.«,';j t+'Y -.�, �'-#�+F �'tr� k.,t,`3.F.�' a mss-„ .-.l s f P,, i +a S },,.• Fire Department signature/date . jr m kr 5 a`" '1" -�,� a ,. .p. � .�� ,t � � ��F.. ''+ .;x.,•, ��...�- � .' RAS;�-* s.e ✓ * a "_.� " COMMENTS 4 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract a Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑. Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified .Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers,Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 G i I G ^^� _ bwl [ f S nicrowave under [ cabinet elevated countertop CM behind sty � �t for .seating i E AORTH TO" of `. sAndover . 0 No. oi� '� dower, Mass. x2 /, O� COC IC E"'.C. y� •IL7- ORATED Cl �5 '9S E BOARD OF.HEALTH Food/Kitchen PERMIT T D Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT......... 4. ..Q/!J. � �� ...... ................ .................................... .......................... Foundation 00 has permission to erec g ..... . ................................ Rough to be occupied as.... .. . N �........... ....�!!I'.�......*........ ...... ......... ... ...............:..... Chimney 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. PLUMBING INSPECTOR VIOLATION of the Zoning-or Building Regulations Voids this Permit. Rough Final &40 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTR.0 T Rough ............ . .. ...........................................................:....................... Service BUILDING INSPECTOR Final b 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. The Commonwealth of Massachusetts De artment o -f P 1-ndustrial Accidents e tG' ;' * Office of J1ZveV&jzti0nS x t � 600 Washin ton Street "' Boston, MA 02111 t w1V1•C'.112LlSS.s Ol��i'.iia Workers' Compensation Insurance.Aff-Idavit: An iicant Information guilders/Contractors/Electricians/Piumbers Pjease Prinf LeaibiFJ Name (Business/Organization/Individual): �" �O/V !-C j cr Address: ,? < City/state/zip: /rr eti/r'",'/L( ,l9 Phone Are Are you an employer?Check the appropriate box: l.❑ I am a employer with 4. ❑ I am a general con7sheet F7. pe of project(required): employees(full and/or part-time).* have hired the sub New construction 2. I am a so}e proprietor or partner- List d on the attac �modeling ship and have no employees These sub-contractors have 8. Demo}ition working forme in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑ Building addirion re uired q ] Officers have exercised.their 10-0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I.❑ Plumbing repairs or additions myself. [No.workers' comp. c. 152, §1,(4) and we have no insurancerequired.] 12: e uranc„ t Roof r i em ]o e� ❑ pairs P Y _s. [No.workers comp. insurance required-] 1.3•E] Other e q d. *Any eownapplicant thatwho checks box#1.must also fill out the section below showing th-ir workers'compensation policy information. 'Homeowners who submii.Uiis agidavit indicating ii;e, ere i oiu:•_, :r„ 7✓onttactors that ehccl this bo must attached an additional sheet showingr th`n hi cuwide eaniraciors rnusi submit a new atnuavit indic^rng s ch. tete name.ofthe sub-ccnzr=tors and their workers`coft infanna.{ton. information f am an etTlayer that is providing workers'compensation insurance,for m3' omP•Policy employees. Below is the policy and'ob site Insurance Company Name: Policy#or Self.ins. Lic:#: Expiration Date.- Job ate:.lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy deciamtion pac Failure to secure coverage e(showin;the policy number and expiration date), 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 in e to 5250.00 a day against the violator. Be advised that a cop}'of this statement may be forwarded to the Office of Investigations of.the DIA for insurance coverage verification. I do hereby certify under the pains qnd penalties of'perjurp that the informadOn provided above is true and correct Si--nature: Dates• _0 Phone#: - Official use onip. Da not write in this area, to be completed by cite or town afcial City or Town: Permit/License# Issuiag Authority(circle one) I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector " 6.Other P S. Piumbinp Inspector 'Contact Person: Phone#: Infor=mation and Instructions Massachusetts General Laws chapter 152 requires all empioyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined.as every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as"an individual,partnership; association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and includi-n-the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing-employees. However the owner of a dwelling house having not more than.three ap artments and who resides therein, or the occupant of the dwelling house of another who-employs persons to do maintenance,construction or repair work on such dw-eiling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"ever,,state o r local licensing agency shall withhold the issuance or renewal of a license or permititooperate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of eompiiance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or.partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have_, empiovees, a policy is required_ Be advised.that this afncla.vit may be submitted to tine Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the.affidavit. The,affidavit shouid be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have.any questions regrzrciinw the�iam, or ifyou are required to obtain a workers' compensation policy,please call the Department at the nta_-nber:Iisted below. Self insured coMmanies should enter th-eir self-insurance license number on the appropriate line. City or Town Officials Please be sure that the'afndavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the p-ermitliicense number which will be used as a reference number. In addition,an applicant that must submit multiple_perrrrit/license applications in any given year,need only submit one affidavit irdicafin'currmitt poiicy information(if necessary)and under".lob Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for filture permits or licenses. A new affidavit must be filled out each year, RThew a home owner or citizen is obtaining a Iic-ens� or permit not related to any business or commercial venture (i.e. a.dog license or permit to burnleaves etc.)said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fay; number: The Commonwealth of Massachusetts Department of L-ndustrial Accidents. Office of Lavestigations 600 Washington Street Boston; IIIA (12111 Tel 4 617-727-4900= 406 Qr 1-9.-77-MASSAF'E Revised 5-26=05 Fax 4 617-727-77449 V'WA'.mass.govldia Board of Biaiid ngRe Iat - eons"aid Standards g .. Gorstruc4ior►Supennsor License -�°� License CS .52307 a Birthdate '7/15x9949 ' Expirattoet 7/151200) 7'r# 1 x'490 Restrtctto i G t MICHAEL 'P DIODATI I '�z�t.Al€�'RENGE Iv1A 01543 Corrttyts�aoner, ` - ��16Z90�i7mto9't.6llel�ufc:-o�✓!/LIrJdO�ttl6P.�t4 � �: - ' � �f Board of Building Regulations and Standards Lis Brise or registration Valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date._If found return to:: $ ons an n oard of Building R lah d Standards Registration 147741 4 0 e Ashburton Place Rin 1301 X:ptratton: g/4/2009 Tr# 265429 nston,lVla.0108 Type: 9ndividuaf MIKE DIODATI MIKE DIODATI 22 THOMAS RD �d •S� -'�°"'` LAWRENCE (1AA 01:843 Administrator Not valid without signature. ' Diodati Construction 22 Thomas Road Lawrence,Mass.01843-3227 Fully Insured and Licensed General Contractor Design and Build Foundation to Finish Phone 978 682-7628 Fax 978 685-6997 E-mail VISA AND MASTERCARD ACCEPTED 2/4/2009 Mr.and Mrs.Sam lacona 40 Meadowview Rd. North Andover,01845 Re:Kitchen and bath remodel at 64 Buckingham Rd. North Andover,Ma.01845 Mike Diodati of Diodati Construction agrees to perform the following work at the above mention site. Kitchen The existing kitchen is to be stripped of all wall and flooring materials.All walls will be made ready for new electric and plumbing(supplied by others).Once complete all exterior walls will insulated to and new sheetrock applied to all walls.All new sheetrock will be seamed,taped and made ready for painting (painting supplied by others).Upon completion the customer supplied kitchen cabinets and moldings will be installed and made ready for countertop installation(by others). All plumbing and electrical work will be provided by licensed tradesman under separate permits.At the same time an new 200amp electrical service will be provided by David Electric of North Andover and new heating system will be provided by MRAK plumbing of Sandown N.H.Each contractor will be responsible of their own permits and inspections In addition to the above mentioned work new hardwood floors to match existing will be install along with new interior kitchen doors and window new window trim. Bath The existing 0 floor bathroom is to be stripped of all walls,flooring and ceiling materials. All walls will the be insulated for both sound and thermal protection.Once all new plumbing and electrical work has been completed and approved new sheetrock will be installed and made ready for painting(painting by others).Any areas to be tiled will be covered with 1/2 inch cement board to replace sheetock.Once P 1 completed new plumbing fixtures will be installed. All demolition material will be placed into an onsite dump trailer and transported to LLS recycling in Salem.N.H. Upon completion the area will broom swept clean and free of any debris. Estimated start date 2/6/09 Estimated completion date 4/6/09 I Diodati Construction 22 Thomas Road Lawrence,Mass.01843-3227 Fully Insured and Licensed General Contractor Design and Build Foundation to Finish Phone 978 682-7628 Fax 978 685-6997 E-mail rn ikediodati2comcast.net VISA AND MASTERCARD ACCEPTED 2/4/2009 Mr.and Mrs. Sam Iacona 40 Meadowview Rd. North Andover,01845 Re:Kitchen and bath remodel at 64 Buckingham Rd. North Andover,Ma.01845 Terms of payment are as follows: $ 0 at signing of contract $5,000.00 upon completion of all demolition and debris disposal $ 10,000.00 upon completion of all approved carpentry,electrical and plumbing rough $ 15,000.00 upon completion cabinet and countertop installation $ 15,000.00 upon job completion and customer satisfaction Cost Associated with the above mention project. Electrical $ 9,100.00 Plumbing and heating $ 16,150.00 Cabinets and countertop $ 10,000.00 General labor and materials $ 10,000.00 Total $ 45,250.00 Owner ,f Contractor ��`v 1 The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute with the contract,the contractor may submit such dispute it a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the customer shall be required to submit to such arbitration as provided in MGL 142A Owner Contractor