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HomeMy WebLinkAboutMiscellaneous - 93 MAIN STREET 4/30/2018Xv W Date.2--�l .......... . .. . ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that Jep–,-�o a .............................................................................. ........................................... has permission to perform .............. ............. ....... . ...... ...... . .... ....... . . ....... n 0 C-- ............................................................................... ,�viring in the buildi g of ....... %--. �--. ...... .......... .... . Andover, Mass. 4 Fee.AZ5 . Lic. No ........................... ....... ....... -.— .................. .. ..... EL CAL INSPECTOR Check4t S L44L F- 8 I Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 11411 Occupancy and Fee Checked [Rev- 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 IW,qRC,�, Z /1 -7 (PLEME PRVVT 1N NK OR TYPE,4LL RWORkU TIOA9 Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or hei; intention to perforp&c�qte�cLtrical work despri4ed belo^ Location (Street & Owner or Tenant Owner's Address Is this permit in'conjunction with a building permit? Yes H' No [I (Check Appropriate 13ox) Purpose of BuildingCntnm9rjA. ( / 'JC4�-V 1��h �: I _ Utility Authorization No. Existing Servlce2g�; Amps tli� 1240 Volts Overhead E��Undgrd E] New Service Amps Volts Overhead [] Undgrd [:1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters 5 - No. of Meters Completion ofthe followitiz table mav be waived bv the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires (,0 Swimming Pool Above Ej In- grnd. grnd. No. of Emergenqy L!gliting No. of Receptacle Outlets 2 No. of Oil Burners FIRE AL No. 6f Zones No. of Switches No. of Gas Burners Tft-oflWe-ction and Initiating Devices No. of Ranges (aA S7 No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I.N!yAb ............ I ns I ............. . .......... I KW I ....................... No. of Self -Contained 3 Detection/Ahrting Devices L No. of Dishwashers Space/Area Heating KW unicippi E] other Local El"Nonnection No. of Dryers (CrA y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER:,* Ay-,V-� im L-+ Mc-Q%?-+h�f 3- 249 -13 J;�L F��AIM" L4 Attach adaltional detail if desired, or as required by the Inspector of 97res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3 1 2 1 - / 3 Inspections to be requested in accordance with NEC 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 operation7' coverage or its substantial equivalent. The undersigned certifies that such cov^e is in force, and has exhibited proof of same to the permit issuing office. CBECK ONE: INSURANCE ff] BOND[:] OTBE I certify, it n der th e p a in s an dp en alties ofp erjury, th a in qlafiqn on fi; is a lication s e and complete. in -i "I L 1��' , LIC. NO.: 90 M P\ Cr FIRMNAME:P-r gZt��:, LL Licensee: LjLP,14,r Signature LIC. NO.. (1fapplicable, enter 'exempt" in the licenfe uumber line Bus'. Tel. No.* Address: 53 /AC'0%70-,-tv( L)I+r Alt. Tel. No.: *Per M.G.L c. 147, 1. 57-6 1, 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 (che one) D owner E] owner's agent. Owner/Agent i Signature Telephone No._ PERMIT FEE:$ 7575-6 /0 4- 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L 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 by the Inspector of Wires abandoned and invalid if he 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. El 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 furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. • Rule 8 — Permit/Date Closed: ***Note: Reapply for new permit 0 • Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass EN Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: PARTL4,L ROUGH INSPECTION: Pass [N Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: ROUGH INSPIF5;TION: Pass M Z Failed Re- Inspection Required 0 Inspectors Comm_Mts: JA r ��, Inspectors Signature: v U Date: FINAL INSPECTION: Pass M ' 'IV Failed Re- Inspection Required 0 Inspectors CommeVs: 4 Inspectors Signature. Date: DEBWEINHOLD ...TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com The Commonwealth ofMassachusetts Department of Industrial Accldi�ts Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/ContractorsAElectricians/Plumbers Applicant Information Please Print Legibly (Iqq C Name (Business/Organization/Individual): 1�JULAI(Ay'-_ D T 9AQ Address: 53 City/State/Zip:DPAUN(�e_ 03'TIL7 Phone#: (00�? a-3�_ Are you an employer? Check the appropriate box: Type of project (required): 1. El I am a employer with 4. El I am a general contractor and 1 .6. 0 !��ngruction ployees (full and/or part-time).* �Iaimp have hired the sub -contractors 7. ffRemodeling 2. 1� a sole proprietor or partner listed on the attached sheet. I ship and'have no employees These sub -contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. F1 We are a corporation and its 10. 0 Electrical repairs or additions E] required.] 3. 1 am a homeowner doing all work officers have exercised their right of exemption per MGL 11. F1 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.E] Roof repairs insurance required.] t employees. [No workers' 13.0 . other comp. insurance required.] !Any applicant that checks box #1 must also fill out the section below showing their wbrkers' compensation policy information. T 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 thename of the sub -contractors and their workers' comp. policy information. Iam an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site iqformation. Ihsurance Company Name:. Policy # or Self -ins. Lie. #: Expiration Date; Job Site Address: , City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Idohereby~un erthepain a 0enaldes ofperjury that the information provided above is true and correct . q , _s j� Phone#: 601��? 9 -35 - Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense # 3 —c-),/ -13 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone 9: / f Information and Instruction's 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 hire express or implied, oral or written." An employer! is defiried as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint 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 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 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ 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 Industrial Accidents for 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 Department 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-insured companies should enter their self-insurance license numb..er 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. Pleas ' e be sure to fill in the permitilicense 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 burn 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 BostQn, MA 02111 TO, # 617-7274900 ext 406 or 1-877.TMASSAFE Revised 5-26-05 Fax # 617-727-7749 1 m e - This certifies that ....... S ............... has permission to perform. . ........... plumbing in the buildings of. .......................... at ...... . . .......... , North Andover, Mass. .................... ... Fee. Lic. No. Mt ... PLUMBING INSPECTOR Check P TYPE OR PRINT CLEARLY 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ O_ { MA DATE[ T{ PERMIT#. JOBSITE ADDRESSWNER'S NAME OWNERADDRESS ..S91rJE TEL +� 1FAX OCCUPANCY TYPE COMMERCIAL F EDUCATIONAL © RESIDENTIAL) NEW: Q RENOVATION: FIXTURES 7 FLOOR- BSM 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 /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY _ ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER FI REPLACEMENT: FI PLANS SUBMITTED: YES Q NOF y INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 041 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND 0 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. SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this ap and that all plumbing work and installations performed under the permit issued for this application Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _ !Grl_R�. ni .., � . L� { LICENSE # CHECK ONE ONLY: OWNER Q AGENT 0 the be of my knowledge age rovisiory� the MP xj JP © CORPORATION 0I # { PARTNERSHIP 0# LLC [jft COMPANY NAMErlJ j �? S j.¢i/�' �� �y ADDRESS '2 -0660 �_ZJ CITY 1 STATE ZIP 0 087 it TEL X3..._ 3 FAX ` EMAIL _ s CELL •S�. t��� COOP? O z o U W a z w ?;+fie• , �� tii: • - N � •.�yy. r t • �" t. ' O F] z o � w con W o CL Z u LU O a w W aLU w 3 co a 00 a W � a U J a IL a - X w, H LL r W H z° 0 H U W a z . 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnliennt Name (Business/Organization/Individual): Address: S_ .0 aa,� City/State/Zip: /,Ia2t)a40.vr d 1i Z&A0;' phone#: Ga3.. 6�934/1, Are you an employer? Check the appropriate box: 1. [ I am a employer with —L 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp, insurance workers' comp. insurance. 5. ❑ We aie a corporation and its required.] 3. ❑ 1 am a homeowner doing officers have exercised their 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.❑ Electrical repairs or additions I l.Q� Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site Information. t Insurance Company Name: ?olicy # or Self -ins. Lic. #: Expiration Date:_ lob Site Address: !3/%'%'s�ly .si City/State/Zip:__ ,(Jp attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 )f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do here("r fp under the paju�a, ties of perjury that the information provided above is true and correct. ell uiiictat use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: N r •'i 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 hire, 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 apard66tswZl who resides4hereiri, of 4he occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwellmOouse or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be'an`2inployer." MGL chapter 152, §25C(6) also state9 this `every sta�te dr4ocal licensing agen'C�9 all withhold the lss6n& br ` 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-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 employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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 Department 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-insured 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 but iii the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the;3,.ermit/1 cense number which will be used as a reference number. In•addition; an �pplieant`. that must submit i ultlple 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 burn 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. e + ' 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 0 i COMMONWEALTH OF MASSACHUSETTS; PLUMBERS AND GASFITTERS 1 LICENSED AS A MASTER PLUMBER _ ISSUES THE ABOVE LICENSE TO: RICHARD R MIGNAULT .' 5 FARRWOOD ROAD WINDHAM NH 03087-1835 I I { 99748 05/01/14 187577 i A �11u, Sd4/A0g'ssew'MMM :i!sIA uol1eWIo;ul 8ulsua3ll Sdd Joj •asua:)!! slyl }o uolle:)onaa io} asne:) si apo Sulppng alelS silasny?esseW ayl}o uoil!pa luaian:) a ssassod olajn!!ej .i f - i i 4 •33uds p3soiaua 30 Qu166)1333 atgna 000`S£ uti1 ssai utuluoa u3l dnoig 3sn ,�uu3o s$aippng - pa13ia1sa.luD PERMIT FOR GAS INSTALLATION T —his certifies that *11as permission for gas installation. �d— .......... in the buildings of .... Z.0 .............................. at....... ..... North Andover, Mass. Fee .10 .... Lic. No. ?N41". . . /k* GASINSPECTOR Check 8630 ev 4 I — QN— 1 w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I A)p /9,UDeqc 2 _ MA DATE 3�aa ' /3 PERMIT # - JOBSITE ADDRESS Si OWNER'S NAME !%_ ji�i 2?./�►� GOWNER ADDRESS L S4tne TEOFAX ---� TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL_I EDUCATIONAL RESIDENTIAL® CLEARLY NEWT -1 RENOVATION: 911 REPLACEMENT: O PLANS SUBMITTED: YES Q NO Q APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER . __.. z --� z—J COOK STOVE I ;`Dl.. II ,I �- _ .,_-�.,�,�-1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE . I��. L — -- - --- -.._ _.._I �— INFRARED HEATER LABORATORY COCKS I MAKEUPAIR UNITl-. _ -- OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER + INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO (�_I IF,,YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ® BOND 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 0-11 AGENT �I SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes y knowledge and that all plumbing work and installations performed under the permit issued for this application will be inmp i ce with all Sion Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 17, PLUMBER-GASFITTER NAME�Gs1,y'� M 16,4/4 y `T LICENSE #F 9 � SIGAT&E MP 50 MGF 1 JP JGF LPG] CORPORATION D# = PARTNERSHIP ©#= LLC [J# ; COMPANY NAME: _��.SiRi�^ _,� ADDRESS CITY LOP�!?10 STATE ZIP ]TEL FAX E:�� CELL 3 �SGd- /._.... EMAIL /?'J AOJ _... 1. n a z 0 H U W a W a z� o y� W H W OF ow. z U w ft W � � 55 co wco O LU > a za w w Cdr w co o a a a �y J F °- a a Cl) w x w F- U- H z fv z o u F U W a CQ7 C7 - ,'\ The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations qu 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -/G yq i?o *W !G —)-a r/ LT Address:_ City/State/Zip: 1A1tD,414,-,v2 Aly/ 61349Phone#: 603— Are d3— Are you an employer? Check the appropriate box: 1. [KJ am a employer with _� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship andhave 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. [J Remodeling 8. [❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.q Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. At Homeowners who submit this affidavit indicating they ace 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 their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. AJ r !21 Policy # or Self -ins. Lie. #: Expiration Date: Y- / / — /3 Job Site Address: 9'3 City/State/Zip: �j%G ,�u✓r=i? /�'� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Y do 1,ereb rti del) the pained pence of pe; jury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town offccial. 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 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 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 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 be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withholdthe 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-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 employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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 Department 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-insured 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 permittlicense 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 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. 021 It TO, # 617-727-4900 oxt 406 or 1-8777MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass,govfdia ."COMMONWEALTH PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER .ISSUES THE ABOVE LICENSE TO: I. RICHARD'R MIGNAULT 5 FARRWOOD ROAD WINDHAM NH 03087-1835 9748 05/01/14 187577 rgym �A Sd(J/A0!)'SS2A'MNlM :I!SIAUOIIELUJOIUISUISUO:)'ISdGJOI -i35Ua:)jj sl4l 10 U011e:)OAaJ -Lol asne:) si apo:) suippe ams sliasnq?essen ay; ;o uoil!pa juaiin:) e ssassod of ajnl!ej -oouds posoloug JO (£U-1166) 103J Oiqno 000'gE uuql ss31 ullnu03 q3TXdnoj23snAuc3os2tuppnff- pap!jisajun qA Date/. . TOWN OF NORTH ANDOV ER 0 PERMIT FOR P��UMBING ,A US This certifies that ... 'A'7 -n - ......................... has permission to perform ..... A�'.ti t4. ................ plumbing in the buildings of . . J.c.y.e. ..................... at ...... . ........ T., North Andover, Mass. Fee.p? Lic. No.. . ...... PLUMBING INSPECTOR Check # 7555 =a I & MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ! yOO?I1 / 0VDOV r4AA Date 10 Receipt# Permit# % J� Building Location flR9J s Owner's Name '`"ilii-�r�/ �%©yG� Map: Lot: Zone: Type of Occupancy O/i N✓ 9(� ��'/� %G� New ❑ Renovation Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name ,fM.%, K �` le'o rz> Addressi�j^ . ©2�[ 9� i�M,P9 my EstimateValueof Work: Business Telephone / —%%$r^ 3 6 T Nameof Licensed PlumberorGas Fitter FG a,S Checkone: I" Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ff No ❑ If you have checked ygs, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ 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. Checkone: Signature of Owner or Owner's Agent Owner El Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above ap I' t' are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the per is or this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Cod nd C e 42 General Laws. By Signature of LicenhcoKumber Title City /Town APPROVED OFFICE USE ONLY Type of License: Master 9 Journeyman QF License Number O p� Revised 05/17/00 v r c 3 m z O z N m n O m v D m N O z O T m m LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 —352-2858 pager 978-502-5921 October 22, 2007 Dr. John Rizza 7 First Street North Andover MA. 01845 RE: 7 First Street, North Andover MA. 01845 Dear Dr. Rizza As you requested I visited the above site October 22, 2007 to review the LVL Beams and structural details as used in the renovation to the above property as shown on plans certified by me September 10, 2007 consisting of 3 sheets dated September 6, 2007. I have reviewed the installation of the LVL beams and other structural details as shown on the drawing and can certify that the structural alterations are acceptable and meet the loading conditions required by the Massachusetts State Building Code. Should you have any questions please do not hesitate to call. Yours truly, 61--, //,3 Lawl-ence H. Ogden, P.E. Structural 27765 w7 A Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... f.. 6 ...... /-w C- has permission to perform ................. i�).e- ��4 wiring in the building of ........... ....................................... at ......... 7 .... ...... !;�z7 .......................... -... , North Andover, Mass. Fee).�� Lic. No.&;.i;�3 ......... . 6"Z�� .. �. 464. ...... ELEC-rRICAL INSPECMi Check,, 6 6 A lx� SL'\ Commonwealth of Massachusetts Official Use Only `/.�, Department of Fire Services Permit No. 7 73t,-' BOAR Occupancy and Fee Checked T D OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leavr h1��L1 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 W INK OR TYPE ALL INFORMATION) Date:J� 7 City or Town of: NORTH 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) `% F, izsr Owner or Tenant 10 Telephone No. Owner's Address — Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service 6_00 _ Amps lao / Qyb Volts Overhead Q� Und rd g ❑ No. of Meters New Service rd Amps / Volts Overhead ❑ Und g ❑ No, of Meters A Number of Feeders and mpacity Location and Nature of Proposed Electrical Work: PA ej of Recessed Luminaires No, of Luminaire Outlets No. of Luminaires of Receptacle Outlets a <_ No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Above ❑ In� grnd. gr No. of Oil Burners /f INo. of Gas Burners No. of Air Cond. Total Tons Totals: ---......__.. .... t............. .......t.r Space/Area Heating KW Heating Appliances KW vin table may be waived by the Inspector of Wires, 0.0 Total Transformers KVA Generators KVA o, o Emergency Lighting ❑ Batte Units FIRE ALARMS No. of Zones o. of etection an Initiating Devices S/'w No. of Alerting Devices 01V a vP11,C lietection/Alertin Devices Local [:]Municipal [I Other No. of water ' No. of No. of -u• of yevices or Equivalent HeatersData Wiring: signs Ballasts . No. of Devices or Equivalent 4 No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTHER: No, of Devices or Equivalent -- � )2e�� M M � C w � Attach additional detail if desired, or as require3 by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties o � p ofperjury, that the information on this application is true and complete. FIRM NAME: elf, 6 'C LIC. NO.: /4 rag ff'3 Licensee:_ lL%�1�� weL Ar10 ,-i Signature 41 (If applicable, enter"exempt " in the number line.) LIC. NO.: 16-217,3?y Address: �,y�'� f Bus. Tel. No.: P - 0- &1 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt. L cl. No. a ^ D 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: $ W- o-7 P f - I'\ -09 pvl�? w • J� i f ii •• The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 C-1 www.nmss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Business/Organization/Individu 1�,�•,y tT E c ,Lv �� Address: City/State/Zip: +L JO APhone #:__ } Q 3/ 3 an employer? Check the appropriate A2ra woikerc' T box: i.m a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. [] I am.a.so)e proprietor or partner- have hired the sub -contractors listed on the attached sheet t ship and have no employees These subcontractors have working for me .in any capacity, workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MOL myself. [No•workers' comp. c, 1.52, § 1(4),' and we have no insurance required.].t employees. [No workers' comp. insurance required.] *Any applicant that checks ho>` ff I must also fill out the section below showin their bo Type of project (requires: 6. ❑ New construction 7. Remodeling 8. Q Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other i olL Homeowners who submit this affidavit indicating they am doing all work and then hire outside 'contractors mu submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheat showing the name of the sub -contractors and their workers, comp. policy infamutdon. 1 aman employer that is providurg:workers' compensation information. insurance for my einplayees: Below is the policy and job site Insurance Company Name: ' [ AO -Ti \ 7r,S 0 eoh41- Policy # or Self -ins. Lie. #:�{F1 _� � Expiration Date: Job Site Address: 7 ) VsT- cS/� ei City/state/zip--,e%�� 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 andpenaLdes ofperjury. that the information provided above is true and correct QK'Cial ase 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 #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. w ` Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, 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 that, 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 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.ot compliancewith 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 #heir certificate(s) ate(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 Industrial Accidents for 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, notthe Department 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-insured 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 fiiium 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 WaslAngton Street Boston, MA 02111 Tel. # 617-7274900 Ext 406 or 1-877-M:ASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia aim August 29, 2007 Scott Sirota SMS Four Realty Trust P.O. Box 937 Byfield, MA 01922 RE: 17-19 FIRST STREET - NORTH ANDOVER, MA REAR DECK (DEI Project No. D 1826) Dear Scott: Per your request we visited the referenced site to view the concerns voiced by the prospective owner with regard to the existing two story deck. See attached SK -1 for items we recommended to be implemented. On Tuesday, August 28, 2007 we revisited the site to view the completed work. All of the items recommended have been satisfactorily completed except for the bolting at the ends of the double 2" x 10" below the upper deck. We had recommended that 3/4" through bolts be used versus lag bolts. Subsequent to our visit, per photos furnished by you, these fasteners have been changed to meet our requirement. If there are any further questions feel fee to call. Very truly, DAIGLE ENGINEERS INC. C -0A - Robert K. Daigle, P.E. (ext. 115) Principal/ President rdaigle@daigleengineers.com encl.: DEI Sketch SK -1 (08/21/07) RKD / cim Daigle Engineers, Inc. 1 East River Place Methuen, MA 01844-3818 978 682 1748 978 682 6421 fax www.daigleengineers.com KENNETH DAIGLE STRUCTURAL No. 28E53 ?GPSTE� Over 25 Years in Business - Est. 1979 DEI ♦ 8/29/07 ♦ DI826R082807.doc ♦ Page 1 of 1 ITEM - 4 AT LOWER DECK, STIFFEN RAIL POST BY ADDING 4"x4" STRONG BACK ON OUT SIDE. REAR OF RESIDENCE 1 \ I I I ITEM -2 `--�- ITEM -3 1 INSTALL P.T. (2) 2"x 10" TIGHT TO I AT UPPER DECK ONLY, SECURE BOTTOM OF JOISTS AT UPPER DECK. LEDGER w/ 2'0 x5" GALV. LAGS SUPPORT EACH END OF BEAM AT POSTS 1 w/ 4- 4'0 GALV. THRU BOLTS (2 IN BEAM I PREDRILLED INTO EXISTING 1 STUDS, ONE IN BETWEEN 1 AND 2 IN NEW 4"x 4" x 24" SCAB BELOW EACH EXISTING ANCHOR. BEAM. TOE NAIL BEAM TO BOTTOM OF (NET SPACING APPROX. I G" EACH JOIST. I O.C.) LOWER DECK 1 UPPER DECK ILL I ITEM - I INSTALL 12"0 CONCRETE SONOTUBE BELOW THIS SUPPORT. EXTEND 48" BELOW GRADE. PROVIDE SIMP50N GALV. POST BASE ANCHORED TO PIER. ITEM - 5 PROVIDE INFILL BALLISTERS ON INSIDE OF UPPER STAIR TO OAA__ MEET CODE. 'V A DECK PLAN APPROX. SCALE: 1/4" = 1'-0" ITEM -G ADD P.T. 2"x8" BELOW STAIR HEADER. LAG TO FACE OF SOUTH POST AND SUPPORT ON P.T. SCAB AT NORTH POST. USE 2- 2'0 x 5" LAGS ALL WORK SHALL MEET THE REQUIREMENTS OF THE MASSACHUSETTS STATE BUILDING CODE. PROJECT: REPAIR/ REINFORCING OF REAR DECKS AT STAMP: - r07 DRAWN BY: DATE: RKD 8.2 I.07 17- 19 FI RST STREET ,'J�A IF 6FA 4 DESIGNED BY: REVISION DATE 1: NORTH ANDOVER MA ROBER� RAD p KENNETH 40 4 CHECKED BY: REVISION DATE 2: DAIGLE R.KD Daigle Engineers, Inc. STRUCTURAL DEI JOB NO.: 5KETCH NO.: I East River Place NO 28583 D 1826 Methuen, MA 0 1,544-3515 5K- I 978 G82 1748 � CLIENT NO.: SKETCH SEQUENCE: www.dalgleenglneers.com 975 682 642 I (fax) SIG SMS I 1 OF I ,J IN ITEM - 4 AT LOWER DECK, STIFFEN RAIL POST BY ADDING 4"x4" STRONG BACK ON OUT SIDE. REAR OF RESIDENCE -------------}---n---;-- I I � ITEM -2 ITEM -3 INSTALL P.T. (2) 2"x 10" TIGHT TO I AT UPPER DECK ONLY, SECURE I BOTTOM OF JOISTS AT UPPER DECK. LEDGER w/ 2'QS x5" GALV. LAGS SUPPORT EACH END OF BEAM AT POSTS w/ 4- 4"Q3 GALV. THRU BOLTS (2 IN BEAM PREDRILLED INTO EXISTING STUDS, ONE IN BETWEEN I AND 2 IN NEW 4"x 4" x 24" SCAB BELOW EACH EXISTING ANCHOR. BEAM. TOE NAIL BEAM TO BOTTOM OF (NET SPACING APPROX. I G" EACH JOIST. I O.C.) LOWER DECK UPPER DECK I I ITEM - I INSTALL 12"0 CONCRETE 50NOTUBE BELOW THIS SUPPORT. EXTEND 48" BELOW GRADE. PROVIDE SIMPSON GALV. POST BASE ANCHORED TO PIER. ITEM - 5 PROVIDE INFILL BALLISTERS ON INSIDE OF UPPER STAIR TO ww __ MEET CODE. "V A DECK PLAN APPROX. SCALE: ITEM -G ADD P.T. 2"x8" BELOW STAIR HEADER. LAG TO FACE OF SOUTH POST AND SUPPORT ON P.T. SCAB AT NORTH POST. USE 2- 2'0 x 5" LAGS ALL WORK SHALL MEET THE REQUIREMENTS OF THE MASSACHUSETTS STATE BUILDING CODE. mujrw: REPAIR/ REINFORCING OF REAR DECKS AT STAMP: — 07 DRAWN BY: DATE: RKD 8.2 I .07 17- 19 FI RST STREET iJA I; 84 4 DESIGNED BY: REVISION DATE 1: NORTH ANDOVER MA ROBERTP RKD p KENNETH 'A.a CHECKED BY: REVISION DATE 2: 41 DAIGLE 40 RKD .Daigle Engineers, Inc. STRUCTURAL DEI JOB NO.: SKETCH NO.: • • I East n, M Place 28 8 D 1826 S K— 1 Methuen, MAOI 844-3818 978 682 1748 CIJENi NO.: SKETCH SEQUENCE: www.dalgleenglneer5M51 s.com 978 682 642 I (fax) SIG 1 OF I Location aa No. Date 1&0 0 Th TOWN OF NORTH ANDOVER Certificate of Occupancy $ Buiiding/Frame Permit Fee $ Foundation Permi Fee $ CHU Other Permit Fe $ Sewer Connection Fle $ 2 Water Connection Fee $ -� TOTAL $ Building Inspector 8555 Div. Public PER11IT NO. � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. q r PAGE 1 MAP K40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. ti LOCATION �,�/ PURPOSE OF BUILDING DWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DIMENSIONS OF SILLS POSTS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET 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 APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 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 FEE Z PERMIT GRANTE 19� rvll �y 8s'�5 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 'A Q , vo EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. b CONTR.LIC.# /��? H.I.C. # 1 Q� /I -Xo (� v BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ 14 1/2 1/1 FIN. ATTIC AREA _ N_O B M HEAD ROOM FIRE PLACES MODERN KITCHEN _ 4 WALLS ( 9 FLOORS CLAPBOARDS B _ 1 22 J 3 _ _ I DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW D COMtACN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD A TOILET RM. 12 FIX.) FLAT 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 UNIT HEATERS GAS 7 NO. OF ROOMS OIL 8'M'T 2nd _ t.f 13rdI ELECTRIC 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. W W s•. w aasa Cj u 0 F -4o U z OC me u R. W. O r� 04 a w w W W W s•. w aasa o w° u 0 F -4o U z OC me u R. W. o w r� is w a w w W O w2 cn co w" a p U w u: —co w z w w cq z cn Q o cn mc W to m C ' Q L Ea fm c m d N L O ' c N C CD cm C A' 'C N m N 2 4 2 W O E Q L O O v ii O y O � a� cm I C C a o� CO2 O O 'F m m Z O � ♦r 3 O CO CDcaQ L cc O Q a- cm< CO) C 'c O cc v J .O .CL O CD C z O CL :.3 CO) O C CL C ca � (A J Z G W CL z z O w a > a LU wU) z > U J Z J LL. z U - LU O z \ Z � w Q w rL U) c o me c � O i C H _O C mc W to m C ' Q L Ea fm c .CD = o z C EE ' o m cm Co. c ca l0 m m L ` c C3�p Cos cm m //�� •O �!.�C m O 'O N O N E m omo y m m ::c AZ o :moa Q .y O R '5 Z F' :coo HCL m C _ m:3 � O aoH W yr N m r„ •MD O C ~ � N G.Z C.3 V N v m c m c N2 a' m' 0:8 = •O = O i N �. 4- d 4- m m d N L O ' c N C CD cm C A' 'C N m N 2 4 2 W O E Q L O O v ii O y O � a� cm I C C a o� CO2 O O 'F m m Z O � ♦r 3 O CO CDcaQ L cc O Q a- cm< CO) C 'c O cc v J .O .CL O CD C z O CL :.3 CO) O C CL C ca � (A J Z G W CL z z O w a > a LU wU) z > U J Z J LL. z U - LU O z \ Z � w Q w rL U) The Commonwealth of Massachusetts Department of Industrial Accidents AV= 111an ins 600 Washington Street Boston, .31ds& 02111 Workers' Compensation Insurance Affidavit I am a homeowner performing all work myself. ❑ I gal a sole proprietor and have no one worms in any capacity 0/I am an employer providing workers' compensan n for my empiovees working on this job. cornslany-na e: addre r .... . 1 do herebv certifvlunder tpains pe a * of penury rhe the information provided above is true and correct Print name official use only do not write in this area to be completed by city w tows official city or town: permivliceax X t"Building Department C3Licensiug Board C3 check if immediate response is required C3Selectmen's Office ❑Hnith Department contact person: pboue 0; MOther (nvoed 1/95 PIA) r c� ¢ • �lNoK rH '9 ti Q-� BUILDING PERMIT 3? 4� ::,• ,` '• °� 11��1TOWN OF NORTH ANDOVER ° o I Y _ APPLICATION FOR PLAN EXAMINATION h Permit NO: & Y r �°' 7 Date Received n0 + Date Issued: t S` °j �cNus IMPORTANT: Applicant must complete all items on this nagre TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential �OP I t*61W-1 �• ' f i �.'& Y'J��#u'�.h. �� .✓ .$? 'y tai. � A O ,Ai L1 lSfRI V Histonc,Distrct � e o a� �711k TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ATwo or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septio❑i oodplam illVetlan� �;�#eriaed',DistrIM iot %D 976o D(L�a lNA�- Q iT 'TD GfN�r�N .Q G,�,?;0'A),'*VJ of F2Aih;AVq a -iD1V J5 t9 wA&s: Crsj AL't.- �FGe��z s Identification Please Type or Print Clearly) OWNER: Name: &z Zhfi 121.-22A Phone: 978 -L9.5 -S O0 A ARCHITECT/ENGINEER IV 1VG Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ I ov b CO QNME6$ '4WJqk" Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun d � Permit No#: Date Issued: BUILDING PERMIT .,. ► TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received EMORTANT:.Aypplicant must complete all items on this page 1 � 7�...�ki�y tik.s '� r r � .c, �, �, filT�'`.. � r, i`i � �' � t*'1.r �iYfi 3� _ 2�s •` � i j'uii' i i �. i .E .*�4 �j� ; z, y...A�,�- ....��--._� C TO— rin R"� .Tf,.•".7.-`�''�-..... ..� -, •ter" .�':{y~.I. IVIAP?�I?ARCEL:.._,_.�:__ ZO(VING`DISTRICT� ��"�`�HlstonciDlstrict�, ` ,�� ',ye:ss 7io ' �? 'rs•E•vs.•-r: `G"':'.$�""'�"�.-....��'c^- •tee„ .r ':. ��" j. r,. , ,r.•...;.' ` 1.�t®.,, z� - { �r1^•• .r+'��-% rf";_ .__ ,,. = ��. r � � .;.T .L;. _. •�.� .._.... �. �:.. _ `_ _ _ Machine. Shop,,Vlllage _� yes _ no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other tic. d. Sep Vi/ell Flood"p lain 0 Wetlands ' r§ .: Water"shed D►st�ict D.ater/Sewer.•_{ Vll DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly - OWNER: Name: Phone: ArIrIrP�� Contacfgr Name: �.:. Rhone:. . �:Address� �.....,. _ �--�� � �5" _ :" 4 •NL.v..y.Y,J -- .µ F•' 4!`f.' .:•'^�•._ ,.. .- Y r •-2"tir� • -_ t- , .." .. • ... __. ' Y'K ..... .,a ;.,1....... nv:n...�,..._...;. � � . Supervisors' Construction, License: :- �. _ :�.; _ �..: Exp:.' Date ` r • rte' - r Ho e,l rove D .m rnp menu License .�` xp to ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. I.___ ,Total Project Cost: $ FEE: $ Check No.: Receipt No,; DOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fun • • L• r S_ignatia�e_of AgeritLOwner Signature of contractor -_ Plans Submitted ix r—. Plans Waived 11 Certified Plot Plan ❑ Stamped Plans ❑ 13- OF SEWERAGE DISPOSAL Public Sewer Jr 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Sianature COMMENTS, P HEALTH COMMENTS Reviewed on Signature Zoning Beard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT'- Temp Dumpster on site yes Located at 124 Main Street ILre Department signatureldate COMMENTS Locatea srs4 usgooa Street no 1 f J -imension 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine No Doc.Building Permit Revised 2014 _. fes' F: Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I' .` I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ 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 ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy o CContract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 sl Doc: Building Permit Revised 2014 Location Ir 14 No.. 6 if i - 2 -of 7 Check # Date /;I- /Y -- S. -TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $19-0 Foundation Permit Fee Other Permit Fee TOTAL $ Building inspector ri C: to rt x H Uju 2 LL O Q O m aa) u .+_' Y \ O O LL aa)m 0 >' N U O_ N Ln pO vai Z Z O .2 "a O LL t j O T v C E ..= U N O LL u �n Z Z mccH a t W O LL O H en Z J V J W t mo O CC u N — C LL W 0. H Z Q t to O d' — C LL Z W Q W Q W LL 7 m z Y {% a+ N N Y E N —: , AW: : 4- y . V N J m FM O W a.Z C!) W co 0 �O Z F- U co a z w0 C- U G c W J �l N v O z Y E O z 0- 0 I 01— (D m O �, d 0 0 O CL FL 0- 0 O v_ J �CL O �z O CL U c CL