HomeMy WebLinkAboutMiscellaneous - 94 ELM STREET 4/30/2018a
Date .. !. AA21
...... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ...L Iw. k—q . Ar . .... ...... . 1.
has permission for gas installation
e/�
in the build' sof .... ° ! � .................... .
at ....!`f..�.............. ...... orth doves, ass.
Fee. ,l�'.�. Lic. No..�?' !l�C1! .. .
GASINSPECTOR
Check # 1-4 0
8122
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
61�
Date Permit #
Building Location 94- UH q Owner's Name RA ME S IYi
IVnkTH Ati1DD11a MIA Type of Occupancy '4' F M/L`%
New ❑ Renovation ❑ Replacement ❑ Plans �ubmitted: Yes[] No ❑
Installing Company Name COLUMBIA �b,S qF MASSACHUSETTS Check one: Certificate #
Address 55 MARSTON STREET HCl Corporation 1862
LAWRENCE, MA 01841-2312- ❑ Partnership
Business Telephone 9 7 b - 691- 64-0 6 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked res, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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. -
Check one:
owner[] Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all
pertinv-4 provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/
ByT e of License:
Plumber Signature of Licensed Plumber or Gas a3w J,
Title Gasfitter
Master License Number 374-5
City/Town Journeyman
APPFlO�VED-7517—ICE SE ONLY
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Installing Company Name COLUMBIA �b,S qF MASSACHUSETTS Check one: Certificate #
Address 55 MARSTON STREET HCl Corporation 1862
LAWRENCE, MA 01841-2312- ❑ Partnership
Business Telephone 9 7 b - 691- 64-0 6 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked res, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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. -
Check one:
owner[] Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all
pertinv-4 provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/
ByT e of License:
Plumber Signature of Licensed Plumber or Gas a3w J,
Title Gasfitter
Master License Number 374-5
City/Town Journeyman
APPFlO�VED-7517—ICE SE ONLY
Location-,9/-
No.
/
No. 2,7
Date 12 -/f -Q z
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
s'••°' E<�'
^GNUS
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
e-�
TOTAL
Check # /hl�
16067
Z?�Building Inspecto
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
7777�-
BUILDING PERMIT NUMBER: 2c;) DATE ISSUED:�'-
SIGNATURE: /'JL4&�
Building Commissioner/IR2134qor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
9y �g� elm `S�.
5 �
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
ReqWred Provided
1
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone ❑
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Records
Name (Print) Address for Service : -
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
James hr�PC�er�C
�65�7G
Licensed Construction Supervisor:
License Number
3,5a j
A ddr r
�/ �!
Eapi tion ate
(Oa✓
nature Telephone
3.2 Registered Home ITgEQvement Contractor -R
�Y
Not Applicable ❑
�I [° r) C6
7 7 7
Company Name
Registration Number
Sa rh 2
Address
E ration bate
Si ture Telephone
OU
rn
M
z
O
91
v
rn
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buiWing permit.
Signed affidavit Attached Yes ....... Pf No ....... ❑
SECTION 5 Desch tion of Proposed Work check anapplicable)
New Construction ❑
Existing Building ID/
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other Specify, + ' } /
Brief Description of Proposed Work:
o� �o s% 'n JeCAn
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost (Dollar) to be
Completed bV perirdt applicant
UFFICIAIL
(a) Building Permit Fee
Multiplier
USEytiNLY. ' ':
......::............::
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, (e v as 01 Lr/Authorized Agent of s ject property
Hereby autho to act on
My behal tatters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I> as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD
SPAN
DfWNSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
I " i
Proposal Page No. of Pages
J & J ROOFING
apewanzing In An I ypes of
�® Roofing - Ventilation - Carpentry
(508) 683-2968
PRO OSAL SUBMITTED TO
PHONE
DATE
STREET
JOB NAME
CITY, STATE and ZIP COtTff
Aar' j Sys
JOB LQGATION
X r
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
Xa..K'..........__........_...........................................r%...........'/._�%.f...G............_X_C..:S./.. `�..............'°"..........G.......................C._..........
i................ Grace- _ .._....a0d G ........A.A'et -----------Afee- PQ ` '.:....._ .3 ........�.---------- -----.._..:
e..........._�..�.._:.::.:f ....................... ..................................... ........................................................... ............... ........................_:................._.........._._._..............................._.............................................
App-A , ._ .....................:..a.:...er..'.......a.ch/- O `5.. r ....... "..........................
4)m. ......... ...>�t ► ®.U..�I .._...._� ..'..t..%%'1C'.. �r�.........:d lr _:...:::
so L
.e..�.�......:_..e.n. __.......��, �..e...._�r ��.� r, .........o.un-�. �-.-.c:.._. e ..h....:�rn�r� :::..... ........
.n ..2�.1....t off .._rl. _......e......._v.e..i ......._a s ......._ r�_ -.�. .......r..... _�, .:.67.........rcld,..... _..:
.t
c........ ..._ a..........�.ec i s Q ;. 'c ,........ :............._:...._.....:..:....
Slue.......: rn...?._ .....r- v...C.......n�11 Q ...... c..o........................................................
_e..%Y,s�...........C...........tr�l?..........1..........-l.t,r±.L:.....'1.........t�_..�C�................................ ............ .._:......... _.... ................_
.......................................................... .......... ......_........_.......................................................... ............. .......................................................................... ..............................................::............:...:...................... _......-
We prupUf hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
O
%,�
�00
V i x 1 f C)cd ski (X � � i� � dollars ($ Ci . )
Payment tob Wd follows:
le / , 19
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Amptancr of 'proposal— The above prices, specifications
and conditions are satisf2ctory and are hereby accepted. You are authorized
to do the work as specified. Payment will be made as outlined above.
Signature
e: This proposal may be //��
withdrawn by us if not accepted within V days.
Date of Acceptance: Signature
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§}; ✓f26 �O�J7?/ITEl192UlCQUfL CZ��a"�1CQ'J1U-C'lZfl4P.�1�
BOARD OF BUILDING REGULATIONS
License:,,GONSTRUCTION SUPERVISOR",
Mumtier CS , 065870
I Birthdate. 12/1711974';
Expires 12!17/2002 E: Tn. 6
r,
} �-- Restricted To 00
is f'
JAMES P FREDERICK
352 ISLAND POND RD'
DERRY .NH iO3O38: y� ` ' ;Administrator '
... �y;� � •/ � ,U/ 09YLIYCO�I2f!/ M ✓//CQ.dOQCItLCQp,�,
Board of Building Regulations and Standards .'.
HOME IMPROVEMENT CQNTRACTOR
..
RsratanI'26777
4T Expiration =077y#9/2002
�1
` r Y iy�e :Individual
JAMES P. FREDERICK-,,' 7" wr
JAMESr FREDERICK,
352 1SLAND POND
DERRY NH 0303$..
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name '--cam Please Print
Name: �1 amc S Eer�er.JCV
Location: /_ /I'l') (�T✓��7
City /t/. • A r) G� Vee, Phone #
0 I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
�
City: A, ✓✓V /v. // 0.30 3 S- Phone * 46.3 E1�f,10S�
Z-
Company name:
Address
City: Phone #:
73 /J 3 3 yah 701,.2, -
Company
,.2, -
Insurance Co. Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00
and/or one years' imprisonment_as vkell as_civil penalties jnlheinrm.ofa_STOP.W. _ORK ORDERmd_a fine_of.(.$1-00M)-a day.Kjainstme. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
V
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date o2 % G
Print namey(%�l'�'1PS / ,��cd� C/C Phone# 460:rog
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
Check if immediate response is required .0 Licensing Board
E] Selectman's Office
Contact person: Phone #: E] Health Department
Ei Other
n
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
le 00C�
(Location of Facili
N
a
Signature of Permit Applicant
ra 9 o a
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
f NORTk
a «� r"I. °°"° Zoning Bylaw Denial
^, Town Of North Andover Building Department
27 Charles St. North Andover, MA. 01845
SSACHUSEt phone -978,1688-9545 Rik 978-68'8-9542
11
Remedy for the above is checked below.
Variance
rkin Variance
..-Street:.�......
Item # Special Permits; Plannin "Board = Item #
V anance
.
Set
Se
Access other than.Fronta e S eciw Permit
Ma
/Lot: .�
Lot
Lo
Common Drivewa S ecial Per
He
Con re ate Housin S ecial Permit
Va
Continuing Care Retirement Special Permit
i:
A Z? Y4
S
Lar a Estate°Condo S ecial Permit
RequestA 'S (�®..�
01
Date:
Ror, A�QeQ f cufu-a
11e0CQ NOQ.N 1ztN t5k m.Pf 9 tC 5+ l A0P_ Po 1,
Planned Residential Special Permit
1 1-
to - c�
S
Watershed Special Permit
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following;.Zoning Bylaw -reasons:
Zoning
Item
Notes
Item
Notes
A
Lot Area
-
F
Frontage
1
Lot area Insufficient
1
Frontage Insufficient
2
Lot Area Preexisting;"
SV
2
Frontage Complies
3
Lot Area Complies
3
Preexisting,frontaga
y e- 5
4
Insufficient Information
4
Insufficient Information
B
Use
5
No access over Frontage
1
Allowed
G
Contiguous Building Area
2
Not Allowed
1
Insufficient Area
3
Use Preexisting,
2
Complies
4
Special Permit Required
Li e 5
3
Preexisting CBA
S
5
InsufficientInformation4
Insufficient Information
C
Setback
-H--Building Height
1
All setbacks comply
1
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient .
"
3
Preexisting Height
4
Right Side Insufficient
4
Insufficient Information
5
Rear Insufficient
I
Building Coverage
6
Preexisting setbacks)
y e S
1
Coverage exceeds maximum
7
Insufficient Information
2
Coverage Complies
D
Watershed
3
Coverage Preexisting
Ile S
1
Not in Watershed
y z,S
4
Insufficient Information
2
In Watershed
j
Sign
iA
3
Lot prior to 14/24/94/v
1
Sign not allowed
4
Zone to be Determined
2
Sign Complies
5
Insufficient Information
3
Insufficient Information
E
Historic District
K
Parking
1
In District review required'4
1
More Parking Required
2
Not in district -
`t e -S
2
Parking Complies
3
Insufficient Information
3
Insufficient Information
4
Pre-existing Parkins
Remedy for the above is checked below.
Variance
rkin Variance
Item # Special Permits; Plannin "Board = Item #
V anance
Site Plan Review Special Permit
Set
Se
Access other than.Fronta e S eciw Permit
Pa
Frontage Exception Lot special Permit!
Lot
Lo
Common Drivewa S ecial Per
He
Con re ate Housin S ecial Permit
Va
Continuing Care Retirement Special Permit
S
Inde endent iElderl : Housin . S ecial Permit
S
Lar a Estate°Condo S ecial Permit
Ea
Planned Develo ment District S pecial Permit
g
Planned Residential Special Permit
S
R -ti DensitySpecial Permit Q.�
S
Watershed Special Permit
Area Variance_
i ht Variance
Nance for Si n
pecial Permits Zoning Board
ecial Permit.Non-ConformingUse ZBA
rth Removal Special Permit ZBA
ecial Permit Use not Listed but Similar
ecial Permit for Si n
ecial Permit Preexisting nonconforming
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by theapplicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to.the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
Building Department. The attached -document titled "Plan Review Narrative" shall be attached hereto and incorporated herein
by reference. The building department will retain all plans and documentation for the above file. You must file a new building
permit application form and begin the permitting process.. Y_
)GJ�eci Se L40 !ti¢
a r ea
J-•} r7k J to
Wlictio�
Building DeApplication Received Apenied
Denial Sent: If Faxed Phone Number/Date:
:ate
view Narrative
-folnarrative ' ' • _
. g is provided to further explatnthe reasons for denial for the application/"
perms for the property indicated on the reverse side.
Referred To:
M
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pal" zn Q l loti� l is
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REAL ESTATE ie _
SCHRUENDER DIVISION 73 Chickering Road (Rt. 125/133), North Andover, MA 01845 (978) 665-5000 Fax: (978) 68,15-5900
January 16, 200i
Buiiding inspection
Town of North Andover
North Andover, MA u 1845
VIA FACSIMILE: 688 6642
TO -Wi-iOM iT MiGHT CONCERN:
Please be advised that 94-96 Elm Stye, t is not in the Historical
District_ It therefore does not need approval iom the Olde Center
Historical District Commission.
Any questions please tali me at 978 6-5 5000_
Sincerei r.,
George I Schnender, Jr.
Chairmf n
North A ldover Historical District Commission
CC Gladys & Raymond Mesiti
