HomeMy WebLinkAboutMiscellaneous - 81 MEADOWOOD ROAD 4/30/201810553
Date..5.4::Zntl�......
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ....... ....... C) . .............................
.. ........ .... ...
has permission to perform ..... (..e—p CP . ...... .............
Slue., r"
plumbing in the buildings of........., ........................ .......................................
at ............. �3 � M-rolsollllo�,
............................................. ......ed.:.......... North Andover, Mass.
Fee..Y.).'� ..... Lic. No. !�.rl - t!.(> -r ..................................................................
PLUMBING INSPECTOR
Check #
\4
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
I
CITY Q �� p� Vl V Q ar' MA DATE - 14 —7'j7 PERMIT #—t-=-d5j
A�
JOBSITE ADDRESS �( an c,Jow �� OWNER'S NAME( a rua tt � N-ck 5 kQ
P
OWNER ADDRESS y a"d�1 FAX
RA -
TYPE OR
OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL [�
PRINT
CLEARLY
�/
NEW: F-1 RENOVATION: [� REPLACEMENT: u PLANS SUBMITTED: YES [] N0E�—
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR 1 AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY r `-
ROOF DRAIN
SHOWER STALL"s
SERVICE 1 MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESE] NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY E OTHER TYPE OF INDEMNITY [-] BOND M
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT Q
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp'ernce with al anent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Kevin Downer � LICENSE # 30417 SIGNATURE
MPI] JP El CORPORATION ❑#PARTNERSHIP FJ#[ LLC[❑#C�
COMPANY NAME I Kevin Downer ADDRESS 6 South Stowell
CITY Worcester STATEF—M—A-1 ZIP 101604 �� TEL 508-425-0359
FAX I CELL �� EMAIL
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
Z j Office of Investigations
I Congress Street, Suite 100
o` Boston, MA 02H4-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Marne (Business/OrganizatiottMdividual):
Kevin Downer
Address:6 S Stowell Street
City/State/Zip: Worcester MA 01604
Phone #: 508-425-0359
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
Type of project (required):
employees (full and/or part-time).*
have hired the sub -contractors
6. ❑ New construction
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
g, ❑ DemoIition
working for me in any capacity,
employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance
required.]
comp. insurance.*
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work
officers have exercised their
I LM Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
I2.0 Roof repairs
insurance required.] t
C. 152, §1(4), and we have no
employees. [No workers'
13.0 Other
comp. insurance required.]
*Any applicant that checks box # 1 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.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Travelers Insurance
Policy # or Self -ins. Lic. #:680-006E156972
Expiration Date: 5/8/2015
Job Site Address: All .Jobs City/State/Zip: All of MA
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 WORK 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 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.
Phone #: 508-425-0359
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 S. Plumbing Inspector
6. Other
Contact Person: Phone #:
n`.
�yur..r
DRIVER'S
LICENSE
OMMONWEALTH OF MASSACHUSETTS
.l
...
�,
9, 2ND
NONE
4u Nlj%2=R
5802771 1 5
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0440-2018
3 DOB
04-30-1977
le t4i 15
SEX ii1 '.'J 11GT .546
D , ONE
U
WORCESTER MA 01604-5369
30417._, 05/01/16 214133
KEVIN W
•;9r..,
6 SOUTH STOWELL ST
WORCESTER, INA 01604.5309
OMMONWEALTH OF MASSACHUSETTS
.l
P UMBERPR GASF ITTERS
ISSUES THE FOLLOWING LICENSE
LICENSED AS A' JOURNEYMAN PLUMBER
KEVIN W DOWNER
6 S ST® JELL ST
U
WORCESTER MA 01604-5369
30417._, 05/01/16 214133
N2 3 13M 1
DateZ. ..... :-2 .... q1......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..?e ...................................................
-has permission to........................................ 0,4? ------
. ......... .. ....... .................
wiring in the building of ...... ..............................................
at .... b ...... ..... I NorthAndover, Mass.
Fee -.;6 .... . ..... Lie. No.?hl"4�
.............. ... .....................
ELECTRICAL INSPECTOR
Check # eq—
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
T1E09Mt10NWF4LTH0FMASS40R E 7S Office Use only
DLPARTMFI 0FPUBLICS4FM Permit No.
BOARDOFMEPREVEMONRWUlAT10NSS27CMR12-110 _ --�-- —
\91-0
Occupancy & Fees Checked
;0
4
APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WORK p
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ;
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street �
Owner or Tenant
Owner's Address
Is this permit in conjuncho with a building permit:
Purpose of Building
Existing Service c? -CD Amps?- ® 1/01ts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
Yes [Z[ No M (Check Appropriate Box)
Utility Authorization No.
Overhead Underground [D No. of Meters
Overhead Underground [:3 No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
and
ound
No., of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipala
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER -
Iru=xeC mW Laws
IhawaamettLijyiru==PblicymduifirgCanpi* CmerdWcritsskshnfile*ivalat YES ® NO a
Ihawst# madNWpoofofsanebthe0@re YES M NO r Ifjwha%ediedWYFS,pleaseirdicatethet WcfwmaWbydmkirgthe
NRRA CE M BOND � MHR M (AmSp *) 2s Q (L I (`f -t I -2
E*ra ion Date
&hEkdValueafEkcfiica1Wcik$
WcrkiDSiart ^ hspecfi nD*RgxsW Rough [ AJ i L LFeral
T'7 f1y1=r:�T�Ir�/lii.�
LicaiseNa _� 7�b �� G�
LiarseNo
BIsimTd.Na�G
_
Alt. Tel.
OWNER'S PWRANCEWANER;IamawarethattheLicaz9ec�nott eteirstr=wmaWorisstslaldaoWhala>tasmgzedbyMassadxsmCanal Laws
an dAffysa�mcn hspemitappkaimHmiAsftm*M nat.
(Please check one) Owner M Agent
Telephone No. PERMIT FEE I i_
Location��r-o�
No. PO , Date
N°R'" TOWN OF NORTH ANDOVER
3? o' , • ,Molt
p Certificate of Occupancy $ • v
* BuildinglFram erriti3 Fee $
ss�CNuse Foundation PermiNd'v$ _
Other Permit Fee
Sewer CA.Mion, Fee
Water c6hnec hFee , $
11
TOTAL xg $
[// Y Buildinb InspecG
y/YJr�
��
6103 Div. Public Works
Location ' �� x4a/ w'aj R,� 1d Z�14
No: Date S 'fid �.
e
e
.# 567
TOWN OF KRTH ANDOVER
Certificate of Octup c'
Building/Frame Permit Fee?�$ =E
Foundation P it Fee $
Other Permij Fe $
Sewer Connection 60
.-0753
Water Connection Fee g�
TOTAL $ ,2p a d.,) c1
gild'.g Inspector
6 415
DiuiPul6lic Works
Location k oZt�_A 119 - "'C' 1 �tkc�bowcao>
,No. 1 P"2i
Date 7 193
r r
kORT)l
TOWN OF NORTH ANDOVER
r`o: -51LI�3
p
Certificate of Occupancy $
} 0o"
*
Building/Frame Permit Fee $AV
Foundation Permit, eeM $
Other Permit Fee $
Sewer Connection Fee $ &3
.. , -Water Connection Fee $ s ' S
rUN
�k�*i
w3 6178
$
Building Inspector
Div. Public Works
Location 1,. • �* -
No.
I . r
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation PermitFee$
Other Permit Fee $
Sewer Connection Fee $
MUM' r1 "7
n 71
W nnectlon Fee $
TOTAL $
Building Inspector
Div. Public Works
i
e=a,
PER111T'NO.` APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. pj( #w/ 3 S ✓' PAGE 1
In
3 SIGNATURE OF
MAP K-4U.I
ZONE
LOT NO. .J /
SUB DIV. LOST -NO.
2 RECORD OF OWNERSHIP DATE
BOOK 'PAGE
LOCATION p
PURPOSE OF BUILDING S; oaf
llftf
OWNER'S NAME , q
NO. OF STORIES J SIZE
� z/?
Ze
OWNER'S ADDRESS ,
SEMENT OR
ARCHITECT'S NAMElf"
`
�U•
SIZE OF FLOOR TIMBERS IST X/)2ND �fX �® 3RD
/ •IC'
BUILDER'S NAME
�oma5
Gcn
i
SPAN /
/4/-
DISTANCE TO NEAREST BUILDING
/
DIMENSIONS OF SILLS 4/
Tj
DISTANCE FROM STREET �/1
/
" POSTS
DISTANCE FROM LOT LINES - SIDES
/" /
REAR
" GIRDERS !`
AREA OF LOT y1�
!f
Z
FRONTAGE
HEIGHT OF FOUNDATION ®/
THICKNESS
IS BUILDING NEW Cy
C•�^,>
SIZE OF FOOTING /1CIJ/
X J/
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION o
IS BUILDING ON OLID R FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS
6NE LO
INSTRUCTIONS
SEE BOTH SIDES 1�IlfFE o v
PAGE 1 FILL OUT SECTIONS 1 - 3 LMFDA DA " " d e,
PAGE 2 FILL OUT SECTIONS i - 12 DUE FRAME PERMIT $l? dj �
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
19 a
251993
D 17
3 PROPERTY INFORMATION
LAND COST
E81. BLDG. COST
EST. BLDG. COST PER SQ. -S Al -11
EBT. BLDG. COST PER ROOM Ll )61)06)
SEPTIC PERMIT NO. 1/�lJ
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
�".�►`�
BOARD OF SELECTMEN
�UILDI G INSPECTOR
` `"' ...
t
Y
_ BUILDING RECORD
1 OCCUPANCY 12 '
SINGLE FAMILY
I STORIES
MULTI. FAMILY -
OFFICES
APARTMENTS
_
CONSTRUCTION
2 FOUNDATION
I
!'d"II�
8 INTERIOR FINISH
CONCRETE
PINE
3
1
2 I3
CONCRETE BL K.
BRICK OR STONE
HARDW D
PLASTER
_ DRY WAIL
UNFIN.
PIERS
3 BASEMENT;.
AREA FULL FIN. B'M'TAREA _
'/, 1/1 1/1
IN, ATTIC AREA
N_O B M T
FIRE PLACES--
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I ,9 '.. FLOORS
CLAPBOARDS
1
2
�_
3
_
_
DROP SIDING
WOOD SHINGLES
CONCRETE
\EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
-
_
HARDW'D
COMMCN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY 1
BRICK ON FRAME
_
_
' ATTIC STRS. 8 FLOOR I_
CONC. OR CINDER BLK.
WIRING
STONE ON`MASONRY.%
STONE ON"FRAME
SUPERIOR I- I POOR _
ADEQUATE ONE
5 ROOF
GABLE HIP
10 PLUMBING
BATH 13 FIX.)
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
_
TAR 8 GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
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
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd
ELECTRIC
13rd
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS: WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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FORM U - LOT RZiMB FORK
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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: _ ��CC [.c.100C1 �IE4-/IL4 COC.42 Phone 97, 5 - /V-c?d
LOCATION: Assessor's Map Number Parcel
Subdivision l�-i�PcrBI.J Lot (8) 02%
Street Peadowo6c] 7cl. St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
G-1 ' Date Approved 2
Conservation Administrator Date Rejected
Comments
17 s.111111"Fro,
Town Planner -
I
Comments
Health Agent
Comments
Public Works.- sewer/water connections
driveway permit
Fire Department
Received by Building Inspector
to S' }
l -DING DEPARTiif,c;�NT .
Date Approved5712.6::
Date Rejected
Date pro d
Date Re ed
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 182 Date AuGusT 24, 199'
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 81 MEADOWOOD ROAD (Lot #21) Type D
MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/1 CAR GARAGE IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
�M°RTM 1
CERTIFICATE ISSUED TO Meadowood Realty Crop.
•` 733 Turnpike St.
p ADDRESS North Andover.
,Js "O Building Inspector
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