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HomeMy WebLinkAboutMiscellaneous - 790 FOREST STREET 4/30/2018 (2)Date ...... �. .. �-�.....�7........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... i'�`'(� . .. has permission to performSU .......ZOLOS. ..... wiring in th e buildin of........... .. ..... , � ..................... at ..........1......1. Q...... .--�.. ............ ........ , North Andover, Mass. Fee5."' ............. Lic. No. 2 G I.0.................................................................................... ELECTRICAL INSPECTOR Check #— r v 0 A �rl\ Commonwealth of Massachusetts Official Use Only mom Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (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 PRINT IN INK OR TYPt ALL INFORMATION) Date: [.() a3 -15 City or Town of. NO�tTH ANDOVER 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) /')qo �,✓BSt eJ�. Owner or Tenant Phu, ' (ye f r,(tio Telephone No. 1(12-3;0-S� � Owner's Address Ct c5-� S4 - Is this permit in conjunction with a building permit? Yes ❑ No W1 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service rOU Amps k}o / 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:�Sll Sv n atiG\ ptdtt� 'a. ` 1 Completion of the following table may be waived by the InsDector of Wires. Z11- 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 ❑In- 1:1 rnd. rnd. o. o Emergency ig mg Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump I Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water K`,1, No. of No. of Data Wiring: Heaters Si ns Ballasts No. of Devices 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: `'� , C (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 certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: /a cy F\cr r�C `S,r.0 . , LIC. NO.: C R Licensee:` t 'r \c- Signature (i1,,,�� W LIC. NO.: (Ifapplicable, enter "exempt" in the licenk number line.) U Bus. Tel. No.• ` o - Address: _ ` ��,�� �ve . (SracQFc� Q- CAS31� Alt. Tel. No.: -3ZG— *Per M.G.L c. 147, s. 5t-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 norm4ent. required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE. $ � The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, K4 02114-2017 www mass.gov/dia s�• Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Legibly Name (Business/Organization/Individual): 1L Address: �Lr iiLa-tt� C City/State/Zip: 15rJUTA A , 003C Phone #: V& -M-7769, Are you an employer? Check the appropriate box: Type of project (Tecjuired): 1.❑ I am a employer with employees (full and/or part-time).* 7• [] New construction 2. ❑ I am a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity. [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 9. 0 Demolition 10 ❑ Building addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. " 12. [] Plumbing repairs or additions 5. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. ❑ - 13. [� Roof repairs These sub -contractors have employees and have workers' comp. insurance.t 6. �&We are a corporation and its officers have exercised their right of exemption per MGL c. 14. El Other 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fall out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such 1Contractors that check this box must at an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-contracfors have employees, ttiey must provide their workers' comp. policy number. -tam an employer that is piovidiizg workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins, Lic. #: �L �6� (�( �-5,► Expiration Date: Job Site Address:UE�, MA. 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy 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 and penalties of perjury that the information provided above is true and correct. Signature: 171y� �d✓ti Date: Phone #: CAI t'' sckk 12>U 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 #: /Z- Ste=`/ q Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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 of lire, 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 including 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 apartments 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 dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate 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 compliance 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 -contractors) 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 employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Iizdustrial Accidents foi- confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Deparhnent of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-in'sur6d companies should'enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job 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 future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia >-,Lrtty Mu r 1 'e INSURANCE March 10, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Re: Property Address: 790 Forest St, North Andover, Ma 01845 Policy Number: H3S21835055970 Underwriting Company: LM General Insurance Company Claim Number: 031438946-0001 Date of Loss: 2/11/2015 Attn: Town/City Official Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 �► 40R':��o TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SA US This certifies that ................ has permission to perform .... ........................ G' plumbing in the buildings of .. ...' 7"!? ! :.� .................. . at .. "i ..... �`......`. ................ . North Andover, Mass. Fee. �.`'..' .. Lic. No...i.... ? .. ...... % .. ........ '/ .......... UPLUMBING INSPECTOR Check # 4979 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) / n ass. Date A) 01 Permit # x g 17 �0 �Q��S �-�7�� Owner;s'Name (2 L' /'r i P r� Buildin Location ' \ '-f-y'pe of Occupancy Residential New ❑ Renovation ❑ Replacement Pians Submitted: Yes ❑ No ❑ 1-. FIXTURES installing company Name _Heritage Htg. &Plg. Co. Inca Address is -pleasant Street Stoneham, Ma 02180' Business Teleph'oh "I y. 781� 38_7776_ Name of License3ii Pl mib:Ge r. Gordon Switzer Check one: IX Corporation ❑ Partnership CSI Firm/Co. Certificate 714 1iNSt1RANCE C0VERA•C*E: I have $.'', burnt t liability+ jnibtance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. :Yes Ifyou have cheTcked, es, please Indicate the type coverage by checking the appropriate box. A Ilability Ilisurahce policy -In Other type of Indemnity ❑ Bond ❑ I OWNER'S (NSUJ ANCE. WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 bfAhe Mass.'General Laws, and that my signature on this permit application waives this requirement. Check one: owner ❑ Agent ❑ i.SignaT re of t7wner or e�wner's Agent t I heteby.certify that all ol•the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that ail plumbing work and installations perfatmed under the permit issued for this application, wil! be in compliance with all pertinent litovisions.of the :Massachusetts Stale Plumbing ode and Chapter 142 0l the General Laws. By Signano A ture o I cons tum er Title i i, Type of License: Master [X Journeyman ❑ City/Town 8322_ AP46VEbT0� IF'1"License N Sn '� " . umber Z n rt W N ` tn Z Y i- �. O W n i a s N0 a V Z Z H z o Z w a �► 01 ¢ rr w aCL �� a Z- z id to 2:a 0 h >- w v. z a to a tt `i e J V Z O t ¢ d W N < w p a— Z o¢ a CC H d W r- r U r 1x- H W O r N o d N T ,n 3 Y h Z o a O 00 r a a a Y a Y X a w W a LL O o a Q Q x a a a SUB—BSMT. BASEMENT, IST FLOOR 2NDFLoon SRDFLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR — . I I 1±1 L -- installing company Name _Heritage Htg. &Plg. Co. Inca Address is -pleasant Street Stoneham, Ma 02180' Business Teleph'oh "I y. 781� 38_7776_ Name of License3ii Pl mib:Ge r. Gordon Switzer Check one: IX Corporation ❑ Partnership CSI Firm/Co. Certificate 714 1iNSt1RANCE C0VERA•C*E: I have $.'', burnt t liability+ jnibtance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. :Yes Ifyou have cheTcked, es, please Indicate the type coverage by checking the appropriate box. A Ilability Ilisurahce policy -In Other type of Indemnity ❑ Bond ❑ I OWNER'S (NSUJ ANCE. WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 bfAhe Mass.'General Laws, and that my signature on this permit application waives this requirement. Check one: owner ❑ Agent ❑ i.SignaT re of t7wner or e�wner's Agent t I heteby.certify that all ol•the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that ail plumbing work and installations perfatmed under the permit issued for this application, wil! be in compliance with all pertinent litovisions.of the :Massachusetts Stale Plumbing ode and Chapter 142 0l the General Laws. By Signano A ture o I cons tum er Title i i, Type of License: Master [X Journeyman ❑ City/Town 8322_ AP46VEbT0� IF'1"License N Sn '� " . umber 0 ►- V W a N Z G7 Z 01 J a t r ', o �} �� . y a N z y N W ,a r j• , � . r �: r m J J 01 z a � � W C N r O O �% W �" h U �"' Z Q O � o � p � W "� Z O N '� � z a � v �- a 3 u' o °° a o z w a � a o � W � � m d c a v '� H m _ ', w i W a � V � , �'; S I . i � ,.. N _ W V 1 ir' �, .. ... I i r. � �1. y y ;� � .. O ' � '� �' t � U '�� � � r � 7 bW. � �., Y R ��, ., � r 1' . � ;', . , Q i �•� � R �s, t i r 1 # �; iii i�:) � � ++ 1. r �, 1r r ! f r, � ,� E } .. � . � 0 ►- V W a N Z G7 Z 01 J a t Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 9SSgcHus�` Sandra Starr Telephone (978) 688-9540 Health Director Fax (978) 688-9542 January 3, 2002 Paul Guerrieo 790 Forest Street North Andover, MA 01845 Re: Application for a 3 -Season Room Dear Mr. Guerrieo: Your application for a 3 -season room at 790 Forest Street has been reviewed by the Health Department. The application was denied on December 21, 2001 for the following reason: The submittal did not have adequate information for the Health Department to render a decision based on current Title V Regulations and The North Andover Minimum Requirements for The Subsurface Disposal of Sanitary Sewage Revised June 1997. The Health Department requested a certified scaled plot plan depicting the location of the septic system, dwelling and the proposed construction. The plan was to include scaled distances from any component of the system to any proposed work. The Health Department met with your contractor, Michael Windsor, and explained the required information necessary to complete the submittal and the required setbacks needed to obtain approval. A certified plot plan dated 12/23/01 REV 12/27/01 was submitted by the homeowner to the Health Department and reviewed for compliance with Title V Regulations and The North Andover Minimum Requirements for The Subsurface Disposal of Sanitary Sewage Revised June 1997. At the time of submittal, it was determined that the proposed construction did not meet the setbacks from the septic system as mandated by the Title V Regulations and The North Andover Minimum Requirements for The Subsurface Disposal of Sanitary Sewage Revised June 1997. Pleas re -submit a revised plan relocating any proposed construction within 10' from the subsurface disposal system. Upon submittal of a certified plot plan meeting the required setbacks, the Health Department will issue necessary approval for a building permit. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincere 1 l.S V B ' n J. LaGrasse, Health Inspector Cc: Sandra Starr, Health Director Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Liberty Mutual® INSURANCE May 29, 2013 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Re: Property Address: 790 Forest St, North Andover, Ma 01845 Policy Number: H3S21835055970 Underwriting Company: LM General Insurance Company Claim Number: 026916919-0001 Date of Loss: 5/15/2013 Attn: Town/City Official Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect a lien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Location ,No. 3�/� Date � - /�- Mme,, TOWN OF NORTH ANDOVER �o Certificate of Occupancy $ Building/Frame Permit Fee $ Check # Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S` Building Inspector,/) ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1.1�Property Address: APPLICATION TO CONSTRUCT REPAIR, RENOVAT5 OR DEM�sOLISH A ONE OR TWO FAMILY DWELLING v •a..:^ar R � BUILDING PERMIT NUMBER: �` Lr DATE ISSUED: AW SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1�Property Address: 1.2 Assessors Map and Parcel Number: �C ,z< / Map 94mber Parcel Number 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 RegWred Provided 1.7 Water Supply M.G.L.C.40. 54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private ❑ Zone . Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service VO St ature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable ❑ L// Licensed Construction Supeisor: Q License Number ATdress r 7 /e5 //G ! 75' y Expiration D to Signature Telephone 00 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone /z- - 7-01 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 building permit. Signed affidavit Attached Yes .......❑ No....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Q Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: mac/ 0 u , �^ r/ v / {{ !/ el i� / � y' C 6 [�9J / K r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant FICI�I. E}FONLSL' x 34 > r .. J. 1. Building ,z (a) Building Permit Fee Multiplier 2 Electrical � ��d (b) Estimated Total Cost of Construction 3 Plumbing p v Building Permit fee (a) X (b) tJ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOR ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf all•ma rs relay e to vwrk authorize this building pennit application. Signature of Owner Date 10 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3Ku SPAN DRvIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORMI�g(r�� 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 APPLICANT t LOCATION: Assessor's Map Number /O ,sic SUBDIVISION STREET % �6 � �. Q PHONE K7j 3 �6 PARCEL LOT (S) ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** /CONSERVATION RECOMMENDATI NS O TOWN AGENTS: A MINI TRATOR DATEAPPROVED DATE REJECTED COM TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS INSPECTOR -HEALTH --41t t -, �-, J V( 1N5N1--GTOR-HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 1(,NJ S .bT: �- P� PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIV1. ED BY BUILDING INSPECTO Revised 9\97 im DATE r Q Q) (o On -1;,)�z (Y3 IC G%/�%�4�t,nonw�l� at� lf�aaac�use�a ' -n BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR , Number' CS 034094 Birthdate: 06/07/1948 Expires: 06/07/2002 Tr. no: 27419 I �L Restricted To: 00 MICHAEL WINDSOR PO BOX 2148 !� HA 4ILTON, MA 01982 Administrator r1 �T 3 3d'•i I 32•aT� . )T I I I I I �Gt I I I I 5 790 Forest Street VO.Andover,MA r l og.-37 TO TME ( LJ tj Ion'-Pu � MORTGAGE LO ED IN ION PLAN Arm ITS mLE a1SURERS. ) I � d , 1 CERTIFY VAT 1 HAVE ExAMNED THE PREMISES AND THE BUILDINGS SHOvm DO ( ) I MASSACHIUSxJETTSV tom` CONFORM TO ZONING LAWS AND AMENDMENTS. I.0.(FRONT, SIDE. R REAR YARD SETBACK ONLY OF NO?.TH >�7j e� MIRN CONSTRUCTED, OR ARE EXEMPT FROM MOLA710H ENFORCflAENT ACTION UNDER MASS. G.L. 71RE VII. CIAPTER 40A. SECTION 7. UNLESS OTHERINSE NOTED. I FURTHER CERTIFY THAT THIS PROPERTY IS I 10-rLOCATED IN THE ESTABLISHED FLCCD DEED HAZARD AREA. COMMUNITY PANEL NO.: I.Cj(j0W- ,, tS5DAiE: x' 15- 63 BOOK 12�s V"fNAnOH OF THE RECORDS IS MADE ONLY SUBSEQUENT TO TME RECORDED DATE OF 111E 313 LATEST DEED AND DOES NOT INCLUDE VERIFYING 111E ACCURACY OF THE D® DESCRIPTION PACE PREVIOUS TO I7S DATE OF RECORD. CERT. N0. NNc0 r l og.-37 TO TME ( LJ tj Ion'-Pu � MORTGAGE LO ED IN ION PLAN Arm ITS mLE a1SURERS. ) I � d , 1 CERTIFY VAT 1 HAVE ExAMNED THE PREMISES AND THE BUILDINGS SHOvm DO ( ) I MASSACHIUSxJETTSV tom` CONFORM TO ZONING LAWS AND AMENDMENTS. I.0.(FRONT, SIDE. R REAR YARD SETBACK ONLY OF NO?.TH >�7j e� MIRN CONSTRUCTED, OR ARE EXEMPT FROM MOLA710H ENFORCflAENT ACTION UNDER MASS. G.L. 71RE VII. CIAPTER 40A. SECTION 7. UNLESS OTHERINSE NOTED. I FURTHER CERTIFY THAT THIS PROPERTY IS I 10-rLOCATED IN THE ESTABLISHED FLCCD DEED HAZARD AREA. COMMUNITY PANEL NO.: I.Cj(j0W- ,, tS5DAiE: x' 15- 63 BOOK 12�s V"fNAnOH OF THE RECORDS IS MADE ONLY SUBSEQUENT TO TME RECORDED DATE OF 111E 313 LATEST DEED AND DOES NOT INCLUDE VERIFYING 111E ACCURACY OF THE D® DESCRIPTION PACE PREVIOUS TO I7S DATE OF RECORD. CERT. N0. Name: Location: City Phone I am a homeowner performing all work myself. E] I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. City: z v ''_1�cz (j l� S— Phone # `� '7 8` Y 3 / y r" c Policy #_ S C e 2 e7 h;17? z Company name: Address City: Phone* Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fined ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains Official use only do not write in this area to be completed by city or town official' E] Building Dept ❑Check if immediate response is required Building Dept [] Licensing Board p Selectman's Office Contact person: Phone #. n Health Department 0 Other FORM WORKMAN'S COMPENSATION Paul GuerrWo 790 Forest St. North Andover, MA M & M CONSTRUCTION CO. 75 Oxford Ave. Bradford, MA 01835 BUILD A NEW 3 -SEASON ROOM Room will be built using the existing porch in the back of the house. Room size will be 10'x17'9". Walls will be 2"x4", 16" o.c. with'/2 plywood on the outside. Siding will be masonite, matching the existing siding on the house. Room will have a cathedral ceiling. Roof will be supported with a 6"x12" composite -beam, that will be covered with pine. Roof plywood will be 5/8" CDX ply. Roof shingles will match house shingles as close as possible. Rafters will be 2"x10" s, 16 o.c. with an 8' overhang. Install ridge vents and soffit vents for venting roof. Left wall will have an Anderson CW245 window and a wood 2-8x68 door, and a wood 2-8x6-6 door, a 9 light over 2 panel. Right wall will have 1 Anderson C345 window. Back wall will have 2-C345 windows with a right and left triangular window. All windows will have 1 "x4" common pine for casings. INSULATION: Floor= 6" faced, walls= 3 %2" high density faced. Ceiling will be strapped with 1"x3" wood strapping. Walls will have %2" blueboard with a. smooth finish. Roof will have %z" blueboard with a textured finish. Electric will be done to code. Light fixture will be bought by homeowner and installed by contractor. Build a 4'x4' pressure -treated deck off the backdoor, with a set of stairs going down to the ground. Decking on steps and porch will be trex. Rails will be 2"x4"pt. With ballister 6" o.c. Risers will be 1 "x8" pine. Window inside will be cased with 2 1/2" colonial casing. Door will be cased the 2 1/2"colonial casing. Finish flooring done by homeowner. REMODEL KITCHEN Remove all plaster on walls and ceiling. Remove all kitchen cabinets, break up tile floor and remove. Remove ceiling joist over kitchen. Build new knee walls up to the roof to make the kitchen a cathedral ceiling. Install 2"x4" s under the rafters to make rafters thick enough to install proper insulation. Strap the ceiling withl"x3"strapping. Insulate wall and ceiling with fiberglass insulation. Install electric by code. Install all kitchen appliances. Walls and ceiling will have %2" blueboard. Ceiling will be textured. Install a velux skylight that opens in the ceiling. Homeowner to supply kitchen cabinets, counters, sink, faucets, light fixtures, tile for back splash and finish flooring. Install a new CR235 window to replace the existing one. Install new finish trim inside kitchen. Install new kitchen cabinets and counter by plan. Install tile backsplash. Install new 1/4" plywood on kitchen floor. CONTRACTOR WILL SUPPLY one thirty yard dumpster for rubbish removal Remove 9' of end wall between kitchen and diningroom. Support ceiling with a beam. COST OF JOB: $46,400.00 (forty-six thousand, four hundred dollars). $12,000. to start; $12,000. half -way through room; $12,000. When room is done; $6,000. Half -way through kitchen; balance due on day of completion. CONTRACTOR NOT RESPONSIBLE FOR painting, staining, and cost of permits. Contractor will pull the permit. IV A(Michaael4n�dsor) Date: 2 G Dater 2— (Paul (Paul Guerrero) 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: of Facility) Signature of 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 Q 1 ui z " a� o ico a° a � a a o c U w a a a o rs; w a � W W '["0 o aG c9� iw a n a°' cd w H w a w w ca z cn 0 o cn ui z .a MM 0 0 O NN� �V SII I CA CD .y 2 O O co V _cc CL CA O L-3 CLy O O C _cc fl. y -7 3� �o co Cl Q O C' OL cm4 C 0" C ccC 9 do O O Z Q CLy C 0 U) ccw w ocw U) 'oma : G N c 32 G3 ,CCU cc, ;= O L : O 0 t Ea a mCF �r O m v m :oIN y c U:E go o o r �-w' m 3 co cm �/ : O N v ` V: y cc C 0 `Em ?;mo a d8 i EDO V M EL. C � m `✓: C3 Z co o nC cm H O 0 C _ o �� aID ~ H r ca ea = r 0 w •N Mo W W�E dt C v.0 v y0 Z `� c3 0 cm CO)Q ) = to= m 0� ON)= O = .-aim 5 .a MM 0 0 O NN� �V SII I CA CD .y 2 O O co V _cc CL CA O L-3 CLy O O C _cc fl. y -7 3� �o co Cl Q O C' OL cm4 C 0" C ccC 9 do O O Z Q CLy C 0 U) ccw w ocw U) / -2e-) "I:;I, Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that....'0 ............ has permission to perform .................. plumbing in the buildings of ........... at. . ........... North Andover, Mass. Fee ?O L i c. No.......... .... _!- ; ; PLUMBING INSPECTOR Check # 5128 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 3 � Date /—d - Uy Building Location 790 iD ti NGS (owners Name ?G of (9- u e jAele 0 Permit # k:6-1,) Amount Type of Occunancv New Renovation Replacement Plans Su�Ke@Yes ❑ No ❑ FIXTURES (Print or type)/ r Check one: Certificate Installing Company Name 0 n CL L r GH G! b� rl Corp. Address � � �� 11140C11 Partner. Business Telephone y B_ 722 9 9 SS- © Firm/Co. rj b G Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box: Liability insurance policy El Other type of indemnity 0 Bond ❑ Insurance Waiver: I, undersed, have been made aware that the licensee of this application does not have any one of the above ��4three insurance ignature Owner Agent El 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 installationspwormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Spfe'pfumbipg Code' -an hWWr 142 of the General Laws. y: City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License 9f'D 6 icense Number Master ID Journeyman 3 B , Date ... .. . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... .; r rf�.� � :........ f�. '` �.`./1....... ............. Sas permission to perform .......N............1.� n! ........................ Pfiring in the building of .....1.!.P.c:...lt....................................................... J _ ... , North Ando er, s at .... ........�, �^.........c-J ' s. ..... Slr........ a �7 �. Fee � . 5:..... Lic. N(�?, .!x'05. ......... ..�y..rr� ? .............. OLECTRICAL. ApEcrOR Check # Official Use Only Permit No.— -,s 5� VoMt-4 4 PO" .S4ff 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 CMR 12:00 (Please Print in ink or type all information) Date 41,6S, To the Inspec or of Wir : Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & rJ� Owner or Tenant /�y cu e /1 / Owner's Address %C/!7 ' in n o' Is this permit in conjunction with a building permit Yes 3- No ❑ (Check Appropriate Box) 7 Purpose of Building /-/-71,W/ �Utility Authorization No. Existing Service / Zo Amps Z 5/0 Voits Overhead ❑' Undgmd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work s 7-C 11�e / v m�d� / 72140AI > n7a OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I 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 = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Ele trical orkE Work to Start 2 G O L Inspection Date Resquested Z V2 Rough / Final Signed under the enattie of pe q'ury: FIRM NAME ��� d nDs✓ b /Prn%`), I -0e LIC. NO. 9 f15 G s Lkensee77fo,,g,¢,:g, P Signature L� ��r/.� O LIC. Bus. Tel No. i��✓'+� / '! �0 Address %�/ ST f.3t�; /� ani AZ ✓yl i� Alt rel. No. 7 — --.2 7.3 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) 0l 5 �Jl (Signature of Owner or Agent) Telephone No. PERMIT IF EE Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA / Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Snitch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total j No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained t No. of Dishwashers /Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating 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 I 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 = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Ele trical orkE Work to Start 2 G O L Inspection Date Resquested Z V2 Rough / Final Signed under the enattie of pe q'ury: FIRM NAME ��� d nDs✓ b /Prn%`), I -0e LIC. NO. 9 f15 G s Lkensee77fo,,g,¢,:g, P Signature L� ��r/.� O LIC. Bus. Tel No. i��✓'+� / '! �0 Address %�/ ST f.3t�; /� ani AZ ✓yl i� Alt rel. No. 7 — --.2 7.3 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) 0l 5 �Jl (Signature of Owner or Agent) Telephone No. PERMIT IF EE