HomeMy WebLinkAboutMiscellaneous - 83 WILLOW RIDGE ROAD 4/30/2018 (2)C
Commonwealth of Massachusetts ! Ofiiciai t;ct)nl� —
('�
c, Department of Fire Services Permit No.
i -
y% BOARD OF FIRE PREVENTION REGULATIONS
[Rev. OccuI Ocy and Fee Checked //p
pann] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
.\II .pork to he Iled'nrmrd in accordance \\ith the \l;usachu , is Electrical l•oLlc (\Ila ). >,' (\1R I2.1)(1
WLE. LS'E PRLN T IA' l;\'K OR TYPE, ILL LN'FORJ , I TIOX) Date:
City or Town of: �/ ✓a►vl r � TO 1170 hMjs (!Auer uJ IVilT.s:
13y this dpplicatiun the undersigned gives notice ofhis ur her intcntion to perti,rm the electrical work described below.
Location (Street & Number) I3 (,,iji / 9,J je p
Owner or Tenant wi,'CVI�.e f LC�CG is Telephone No. 09)7,75jgS/
Owner's Address a3 w, 1110",J d tip
Is this permit in conjunction with a building permit? Yes [-�K No ❑ (Check Appropriate Box)
Purpose of Building �gt�C 5,H oroo., 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 0AM 14 &et-, S✓g 1419,,p
Location and Nature of Proposed Electrical Work: 6P roWt� �o
r",,,,,,.)„r, „ „r,a,. r,.u.... ... r., ... _1.
No. of Recessed Luminaires 41
. 1111. 1.1...11. .., ..n. /....„n.. n;
No. of Ceil.-Susp. (Paddle) Fans
".... n(up'IV IPLNI LU Oy arc hopt w- Ur r,rr,
No. o Tidal
Transformers KVA
No. of Luminaire Outlets 4%
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In-
❑
o. o mergency Lighting
,Bat
urnd. end.
Units_
No. of Receptacle Outlets 13
No. of Oil Burners
-tory
11FIREALARMS No. of Zones
No. of Switches 7
No. of Gas Burners
'No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Tons)
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Number
Tons
KW
:No. of Sel -Contained
Totals:
Detection/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ tilulllclpal ❑Other
��z. Connection
No, of Dryers
Heating Appliances KW
s, .
Security Systems:
No. of Water �
No. of No. of
No. of Devices or Equivalent
Heaters KV1”,
Signs Ballasts
Data Wiring:
_
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total UIP
telecommunications Wiring: -- -
No. of Devices or Eq uivalent
"I HLK:
0: .Ilhrch,r,l,.lirn:ncl',Irnril i/,lesiva. ora rr1/rnrc,.l AY rirr lr,.j;ccn;r.. II',r,
Estimated Value of Electrical Work:( \\ hen required by municipal policy.)
\bork to Inspections to be requested in accordance with .\IEC Rule 10, and upon completion.
INSLRANCE COVERAGE: L,mess waived by the.o\vncr. no permit for the pertornrulcc of clectric,d work may issue unlcS:.
the licensee provicles proof of linhility insurance• includin" "coniplcted operation•' ciwerah�e or its substantial cquivalertl. HIL,
tatdcrsi .nccl certitic!. that such co�cra!,e i:, in liber, ;111,.1 has (:%hihitcd proof of �;aplc to the permit
c IlFcK ONF-': INS( R.\\CI [t]� 130"\,D ❑ t>riiriz ❑ (speedy:)
l ;rrfi/b. (under the rrtiitc ;rnrl prrlulJira ;�J'per%reef, ,'J►uI Jfte %»J n."no err ol, .'11is ;1plVicathm r:, /rfle uJ!d
F1IINI N,kNIE: t%� US 1tiI 4Ge' LIC. NO.:
Licensee: f/es .tom/ IQLt 7-� •i,�nature r -
i 67 - r_ I C.:'v 0.:
1!'11'1'1%/;1i1--- 101Cr,/Lt "r rrr;l;r' :rr lhl' 1,1 r,; , (.;(11th, r,iu --
;lddress: y[�NJ6 )(p Bus. Tel. Flo.: _
;Vt. Tel. Vo.: __
'Security Systc Contractor IJCCt1SC reelUir(A for this \40rl(, if applicable, enter the license number herr: _
OYYtiER'S IN. 'RANCE WA 'ER: I and avv:ue that the Licensee dr,l!; nal huvu the liability insurance covcra,.e nk:rnl,Illy-
tequired by lav . y my :;i 'MItur below, I hereby w,Ylve tllls rrquirumcnt. I ,un the (check one) ❑ owner ❑ owner', :Y17ent.
Owner/Agent �-- j �j l �
.)i�;Ylat1JY"t; �/'� T:_l..i3lt:;r;c.`i•t.�`7%!'i`l/Ga"3%/7 P�'�.0/�T F'F',F'• �'�/�J,
MA
zf
e
Location 83 tk t' l ow PtcN z- C u .
No. P3 9 Date
MORT►I TOWN OF NORTH ANDOVER
• � s
• ; , Certificate of Occupancy $
�� ;''• Eta' Building/Frame Permit Fee $ L
ncNus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 33 CJ _..--
Check # ! 0/c/3
18632
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
JU.
BUILDING PERMU NUMBER: •`7 DATE ISSUED: /V/13 11—
&
SIGNATURE: 1—
SIGNATURE:
Building Commissionerff for of Buildings Date
SECTION I- SITE INFORMATION
1.1 property Address: 1.2 Assessors Map and Parcel Number:
133 i!�14oct/ /z/d.oic- Xj /0`7LDA20 r �8
Map Number Parcel Number
1.3 Zoning Information: r 1.4 Property Dimensions:
1Z/ C, C-rs6 ('_
Zoning District Proposed Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required I Provided Reqwred I Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Food Zone information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
il:�f.Ulli:
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
District: Yes (•1,0
2.1 Owner of Record
Miah4e-/ Lacca-ec
Name (Print) ' Address for Service:
12.2 Owner of Record:
1
Print
Si agnature Telephone
Address for Service:
�saav a
3.1 Licensed Construction Supervisor:
Not Applicable ❑
C1) r 1'r 7-.a Jt: y2 M 67
q SQ CD
�,,�,,r�
4t n` 0,) Lf 7
Licensed Construction Supervisor:
License Number
S' O t tp r.k �rtur Wr3 �tc�cc� q.
Address
ins/o G
C—a
YS' es'
Expiration Cate
Signature
Telephone
p
3.2 Registered Home Improvement Contractor
Not Applicable ❑
1*11 '#106 to ((j n) 7 r"vLTi0,' '
% �`1 (•� r Y y
Company Name
Registration Number
7/1 & /a L,
Address
i- ��U
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2
Workers Compensation Insurance affidavit must be completed and submitted
in the denial of the issuance of the builAng permit.
Sianed affidavit Attached Yes ....... V No ....... o
application. Failure to provide this affidavit will result
SECTION 5 Descri tion of Proposed Work check an applicable)
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) 0 Alterations(s) 0 1 Addition f
Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify
Brief Description of Proposed Work:
L )t % 2r�5,'o h /0 I'S14 6C U/ 1'r- 4 '9 3
st 4 So -1 /Z ev r' O I= F t; X,'s 1-,& /Z. rc
I CF.0 TMN 6 - FAMMATFII rnNCTUTTrTMV rneTc
Item Estimated Cost (Dollar) to be
Completed bpermit applicant
OFFICIAL USE ONLY
•:'
1. Building —
3 c eo
(a) Building Permit Fee
Multiplier
2 Electrical
o c
(b) Estimated Total Cost of
Construction
3 3 l 000
3 Plumbing
Building Permit fee (a) x (b)
2 a
J
4 Mechanical HVAC --
5 Fire Protection i c
6 Total 1+2+3+4+5 t
G.T /�TtA1T A
Check Number
OWNERS AGENT /OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1 C h oa l z—L-" C C eSc as Owner/Authorized Agent of subject property
Hereby authorize C A �- (s i /�y <Cdo to act on
My behalf, in all a rel ve to rk authorized by this building permit application.
/`l zoo�-
Si iature r Date
SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION
'' 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
of
NO. OF STORIES SIZE 1 y x y o
BASEMENT OR SLAB [ ,q r3
SIZE OF FLOOR TIMBERS 1' yc 10 2 ND 3
SPAN 19' FC e r
DIMENSIONS OF SELLS bout
DM ENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION S 1`e e i THICKNESS
SIZE OF FOOTING / a s X
MATERIAL OF CHIMNEY
1S BUILDING ON SOLID OR FELLED LAND So L --
IS BUILDING CONNECTED TO NATURAL GAS LINE Al,
J
!1
r
�� a
(Z,e—,.. 47 rz✓` r --
FORM U - LOT RELEASE FORM rw ct�Wt ad .
*7 - . 644
'. 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 rn I C 6 c--1 L enc e5 c- PHONE
97i? 72-,5;Y9!5;7
LOCATION: Assessor's Map Number 10-70 PARCEL
SUBDIVISION LOT (S)
STREET �/� a`'/ Pa` d5 e- P -d ST. NUMBER
OFFICIAL USE ONLY
• i� (I ILS .11jIIMF=/►i1. ' 1 ;� : i 11 -
TOWN PLANNER
COMMENTS
COMMENTS
r -eCC�e
PURL ORKS- S�EA.A E O
DRIVEWAY PERMIT_
FIRE DEPARTMENT-
DUMPSTER PERMIT
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED r
DATE REJECTED
z% DS — � ! r �a�t7
dw-11�1491,6, -I d—
IS '
RECEIVED BY BUILDING INSPECTOR DATE
FORM U - Revised 6.08 JMC
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
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A. .
The debris will be disposed of in:
�✓ A !�' 1 .
leo tgoL M4S-s '
(Location of Facility)
Lk --e L�Y)
Signature of Permit Applicant
Fire Department Sign off-. /leo v S R
Dumpster Permit
Date
...c a,vn$r1&U" Vu88n ui inassacnitselts
Department of Industrial Accidents
Ogee of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le»ibly
Name (Business/Orpnization/Individual): /,�I R So U 1 6.1 . _ , e,
Address: /�_ C, C a C 6 L o n y 0 r,,
City/State/Zip: Q),9 he F,,r,Z
M,9. oleTo
Phone #:
Are you an employer? Check the appropriate boa:
1. ❑ I am a employer with .3
4. ❑ I am a general contractor and I
employee's (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
C. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. [Building addition
10. E3 Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
�,., um mcaon oelow snowing their workers' compensationa
policy inforn at
on: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers' comp, policy information.
I am an employer that is providing workers' compensation insurance for my employees.
information. Below is the policy and job site
Insurance Company Name: I r 9 v t t e it,s -F , r
Policy # or Self -ins. Lic. #: W C - U /3 g �- p X L 3 9 /] Expiration
Date:_
Job Site Address: q3 fZ City/State/Zip:_� PT ti
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-yearimprisonment, 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¢4r the pains and�alties of perjury that the information provided above is true and correct
/7/ ,-%_
0
Phone #:
Oficial use only. Do not write in this area, to be completed by city or town official,
City or Town: PermWLicense #
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 #•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employerson in theservice of an then under any coto provide workers' compensation for ntractir toof hire
Pursuant to this statute, an employee is defined as` .. every p
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 m a Joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of all individual, partnership
association or other legal entity, employing employees. However the
or the
nt of the
owner of a dwelling house having not more than three maintenan enconswctiond who eorthrepair7work on suchadw ling house
dwelling house of another who employs p
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 "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
until acceptable evidence of compliance with the insurance
enter into any contract for the performance of public work
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 CLLC�oorrLimited��a oD insurances IfLan)with no employees LLC or LLP does have �� �e
members or partners, are not required to arty
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance co and
being requesteddate the vnot the Depit. The artment of shouldavit
be returned to the city or town that the application for the permit or licensei
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-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
to
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo
tm
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 an will beused as a reference need only submit one affidavit indicating �'�t
er. In addition, an applicant
that must submit multiple permittlicense app Y givenyear,
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
to 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 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 fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05 www.mass.gov/dia
M� C
MIRASOLO CONSTRUCTION
FULLY LICENSED AND INSURED
15 OLD COLONY DRIVE
WAKE -FIELD, MA 01880
(781) 245-5585
L—
job Sheet
Date
Home Phone
Work Phone
I
.� ✓�ie �a�rvrreoazeaeaCCit a���aac/zuQeC�d ,�
Board of Building Regulations and Standard's
m HOME IMPROVEMENT CONTRACTOR
Registratioio: 106849
9XPiiat10ir -712812006
Typo; DOA
MIRASOLO CONSTRUCTION.3NC,
Christopher Mirasplo ..,
15 Old Colony Drive,
Wakefield, MA 01880 Administrator
w
z
a .it
t
job Sheet
Date
Home Phone
Work Phone
I
.� ✓�ie �a�rvrreoazeaeaCCit a���aac/zuQeC�d ,�
Board of Building Regulations and Standard's
m HOME IMPROVEMENT CONTRACTOR
Registratioio: 106849
9XPiiat10ir -712812006
Typo; DOA
MIRASOLO CONSTRUCTION.3NC,
Christopher Mirasplo ..,
15 Old Colony Drive,
Wakefield, MA 01880 Administrator
w
MIRASOLO CONSTRUCTION
This Estimate is for:
Leccese, Michael
83 Willow Ridge Rd
North Andover, MA 01845
Estimate
DATE ESTIMATE NO.
3/17/2004 04-72
FULLY LICENSED AND INSURED
15 OLD COLONY DRIVE • WAKEFIELD, MA 01880 • (781) 245-5585
Telephone ::1
978-725-4951 or 978-686-4420
I DESCRIPTION I TOTAL I
Project: Build a 14'x 41'6" combination sunroom and garage.
Work Consists of. .
1. Build walls sunroom floor and roof according to plans.
2. Roof will have ice and watershield, then shingled to match house.
3. Windows will be: 5- TW 2846 Andersen, 1 - 6' wide Anderson Frenchwood Gliding door,
1 - steel door unit and 1 - 9'x7 steel garage door with opener.
Windows and sliding door to have grills and screens.
4. Siding to be primed cedar clapboard to match existing.
5. Homeowner to obtain building permit.
6. Contractor will remove debris pertaining to this job.
7. Interior work includes strapping ceilings and build wall between sunroom and garage.
TOTAL
SIGNATURE
19,000.00
$19,000.00
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G. J. sRUNO ASSOCIATES
1% IV
Ab ASSOCIATES
RESIDENTIAL
SIGNERS
28 BERKELEY ROAD
I Otj
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'DENTJAL DESIGNERS
N N
28 BERKEL
EY ROAD
ANDOVER MA o1845
. . . . . . . ...
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G. J. BRUNO ASSOCIATES
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RESIDENT IAL DESIGNERS
28 BERKELEY ROAD
N. ANDOVER MA 01845
PIM